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Nachrichten, Termine, Experten
Nachrichten, Termine, Experten
Bonn, July 25, 2025 – Despite unclear evidence and contrary to national and international guidelines, the practice of fundal pressure continues to be used in many maternity clinics. A new qualitative study conducted as part of the MAM-Care research project at the University Hospital Bonn (UKB) – in cooperation with the University of Bonn and the University Hospital Cologne – is the first to systematically investigate how women subjectively experience this controversial obstetric procedure.
Fundal pressure involves medical staff applying targeted pressure to the upper part of the uterus to speed up the birth process. The S3 guideline “Vaginal birth at term” recommends that this intervention should not be used if possible, or only under strict indications and with the consent of the woman giving birth. However, current data shows that fundal pressure is widely used. In a MAM Care survey, 81% of the doctors and 38% of the midwives surveyed said they performed the procedure themselves. 21% of the women surveyed reported that pressure was applied to their abdomen during childbirth.
What women experience in this context – and why it varies so much
The study analyzed 12 cases of fundal pressure experienced within the last 12 months. The evaluation using the grounded theory methodology shows that whether the measure was perceived as positive, neutral, or negative depended heavily on how understandable the situation was for the women—and how well they were able to cope with it. These two factors— comprehensibility and manageability—were in turn significantly influenced by the behavior and communication of the obstetric staff.
“The participants said they either felt well supported or completely overwhelmed, depending on how they were spoken to,” explains Mi-Ran Okumu, lead author of the study and sociologist at the Research Center for Health Communication at UKB, who also conducts research at the University of Bonn. “The subjective experience is not a coincidence, but the result of communication and care design.”
Prof. Nadine Scholten, head of the Research Center for Health Communication and Health Services Research at UKB and professor of psychosomatic and psycho-oncological health services research at the University of Bonn, adds: "Our results show that it is not only the measure itself that is crucial, but above all the communication surrounding it. When women understand why something is happening and feel that their ability to act is taken seriously, even a critical intervention can be experienced as supportive."
Three classifications of experiences: positive, neutral, negative
The twelve cases were divided into three groups: Six women described their experience with fundal pressure as positive, three as neutral, and three as negative. In all groups, there were situations where it was hard to understand what was going on—often because of brief or missing explanations during the intense parts of labor. The higher the perceived level of manageability, the more positive the situation was seen.
The study does not take a general position on fundal pressure as a measure, but it does make clear that when it is used, it must be explained in an understandable way and carried out with consent. The conditions recommended in the S3 guideline, such as consent and the right of veto, should be consistently implemented.
Funding: The MAM-Care research project is funded by the German Federal Ministry of Education and Research (BMBF).
Prof. Nadine Scholten
Research Center for Health Communication and Health Services Research
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn
Chair of Psychosomatic and Psycho-Oncological Health Services Research,
University of Bonn
Email: Nadine.Scholten@ukbonn.de
Mi-Ran Okumu et al.: Making sense of fundal pressure: A qualitative study on women’s experiences of a non-evidence-based yet commonly practiced intervention; Archives of Gynecology and Obstetrics; DOI: https://doi.org/10.1007/s00404-025-08130-3
(from left) Mi-Ran Okumu and Prof. Nadine Scholten examined the fundal pressure during childbirth.
Source: Rolf Müller
Copyright: University Hospital Bonn (UKB)
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(from left) Mi-Ran Okumu and Prof. Nadine Scholten examined the fundal pressure during childbirth.
Source: Rolf Müller
Copyright: University Hospital Bonn (UKB)
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