One of the most controversial maneuvers performed during childbirth is what is known as the Kristeller maneuver , which is one in which pressure is exerted on the mother’s abdomen (the fundus of the uterus) to get the baby to come out, or as minimum reaches the coronation, that is, the head pops out.
It owes its name to a gynecologist named Samuel Kristeller who began to put it into practice in 1867, and although it has been discouraged for years due to lack of scientific evidence on its effectiveness, many mothers continue to say that during childbirth they were pressured from above so that the baby come out.
The reality is that the prevalence of this maneuver is unknown, because its use is not reflected in the clinical course of women in labor, but it is still being used today. We will talk about what the risks of this maneuver are and what scientific studies say about it .
Risks of the Kristeller maneuver
The Kristeller maneuver involves some risks, basically because a baby that has not yet come out is being forced from the outside.
What does it consist of specifically? Pressure is exerted on the fundus of the uterus for 5 to 8 seconds, synchronously with uterine contraction, with a pause of 0.5 to 3 minutes, in order to facilitate final advancement and expulsion of the fetal head.
Among the risks, some very serious risks have been described such as placental abruption, uterine rupture, tears in the mother’s perineum, fracture of the baby’s clavicle and injuries to the brachial plexus, that is to say, really serious things.
What the scientific evidence says
One of the studies that the Ministry of Health and Social Policy took into account when it drafted its Clinical Practice Guide on Attention to Normal Delivery is the one carried out in 2009 in Istanbul, whose level of scientific evidence is I ( which means that the results are very reliable).
In this study, carried out with 197 pregnant women between 37 and 42 weeks of gestation, an attempt was made to determine the effect of the Kristeller maneuver in shortening the time of the second phase of labor .
Data were observed on the time the mothers needed to give birth when the maneuver was carried out and when it was not carried out, blood samples were taken from the umbilical cord to assess fetal distress, it was noted to what extent the delivery was instrumental, which it was maternal morbidity and mortality, whether there were neonatal trauma, whether the babies had to be admitted to the neonatal intensive care unit, and the infant mortality.
The results showed that there were no significant differences in the duration of the second phase of labor and that, although there were variations in the arterial cord blood tests, the data were within normal values, and there was no newborn with a Apgar test less than seven in none of the groups.
The Kristeller maneuver is discouraged
Given this scientific evidence, which shows that babies took the same time to come out regardless of pressure or not, the study authors decided to discourage its use, in the same way that it is discouraged in current normal delivery protocols .
The Ministry of Health’s Clinical Practice Guide on Normal Delivery Care recommends not doing it , as we see on page 61:
“The Kristeller maneuver is ineffective in reducing the duration of the second stage of work.”
Regarding the inflatable belt mentioned in the summary of the evidence, it refers to a study, in which an inflatable belt capable of accurately measuring the pressure exerted and the angle of the direction of the maneuver was used. Something that in everyday practice, when the arm is pressed on the pregnant woman’s belly, it is not controlled with this precision.
For its part, the WHO also advises against it as its effectiveness has not been proven. The body explains in its recommendations for a positive birth experience:
“In many countries it is common to apply pressure to the uterine fundus during the second phase of labor. This is done in order to speed it up. Sometimes it is done just before giving birth and sometimes from the beginning. This is apart from cause maternal discomfort, there is a suspicion that it could be harmful to the uterus, perineum and fetus , but unfortunately there are no studies in this regard. The general impression is that it is used too often, and its effectiveness has not been proven . “
The Spanish Society of Gynecology and Obstetrics (SEGO), however, differs in its recommendations and maintains that it cannot be used to lower the baby’s head through the birth canal before fitting, but it is allowed in the second phase of delivery, when the head is already embedded:
“The pressure on the uterine fundus can be used only with the intention of helping the detachment of the head, but in no case to facilitate the descent of the presentation.”
How to avoid it
As an alternative to pressure exerted externally, it is recommended and suggested that every effort be made to take advantage of the law of gravity: if a woman lies down, the baby does not fall outwards, but falls towards the mother’s spine, towards his back, and the way to the outside becomes more difficult, depending above all on the strength of the mother when pushing.
This is a terrible temptation for the people around them, who try to help the mother from outside, usually through the Kristeller maneuver.
If low doses of epidurals are used (the so-called walking epidural) and the mother is allowed freedom of movement, it is possible to stay in an upright position, making use of the only force that does not depend on the mother or the professionals and that helps an outrage: the gravitational force that Newton described back in 1687, a few years ago.
Hence the importance of developing a Birth Plan where the mother’s wishes are recorded when giving birth.
The Kristeller maneuver on video
An image is worth a thousand words and a video is worth a thousand times more than an image, so we bring you some videos so you can see what Kristeller’s maneuver is.
In the first, the maneuver is (terribly) obvious. The girl exerts considerable pressure, as much as the weight of her body allows:
In this video that follows, the maneuver is much more subtle. No sharp blows are made, but the woman who carries it out lets the weight of her arm fall on the fundus of the uterus, pressing down and out:
To finish, in this third video we observe a man dropping his weight on the woman’s abdomen (from minute 1:30):
The curious thing about the matter is that in the three videos the delivery is presented as normal, natural or without complications, that is, as if it were one more maneuver than many necessary for a baby to be born.
As we have said, it is a maneuver that carries many risks and for this reason it should be carried out only when it is considered appropriate, after weighing the pros and cons and after informing the woman of what is going to be done and why , but not how. a little help so that the baby comes out a little earlier or to help the woman lying down to take out that baby that, due to going against gravity, has more problems coming out.
Photos | iStockphoto
In Babies and more | Kristeller’s maneuver, an aid to be born (but with risks), Isasaweis’s birth experience
