Kristeller maneuver: why this practice is not recommended during childbirth

One of the most controversial maneuvers performed during childbirth is what is known as Kristeller maneuver, which is the one in which pressure is exerted on the mother's abdomen (the bottom of the uterus) to get the baby out, or at least reach the coronation, that is, that the head appears.

It owes its name to a gynecologist named Samuel Kristeller who began putting it into practice in 1867, and although it has been discouraged for years Because there is no scientific evidence about its effectiveness, many mothers continue to tell them that during the birth they were pressed from above so that the baby could leave.

The reality is that the prevalence of this maneuver is unknown, because its use is not reflected in the clinical course of the parturients, but today it is still being carried out. We will talk what are the risks of this maneuver and what do the scientific studies say about it.

Risks of the Kristeller maneuver

The Kristeller maneuver It entails some risks, basically because it is forcing the exit of a baby that is not yet out, from the outside.

What is it specifically? Pressure is placed on the bottom 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 the final advance and expulsion of the fetal head.

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Among the risks some have been described very serious such as placental abruption, uterine rupture, tears in the mother's perineum, fracture of the baby's clavicle and brachial plexus injuries, that is, really serious things.

What does the scientific evidence say

One of the studies that the Ministry of Health and Social Policy took into account when drafting its Clinical Practice Guide on Normal Delivery Care is the one that was carried out in 2009 in Istanbul, whose level of scientific evidence is I ( which means the results are very reliable).

In this study conducted with 197 pregnant women between 37 and 42 weeks of gestation, attempts were made to determine what was the effect of Kristeller's maneuver in shortening the time of the second phase of labor.

Data on the time that mothers needed to give birth when the maneuver was performed and when it was not carried out were observed, blood samples were taken from the umbilical cord to assess fetal suffering, it was noted to what extent the delivery was instrumental, which it was maternal morbidity and mortality, if there were neonatal trauma, if the babies had to be admitted to the neonatal intensive care unit and the mortality of the babies.

The results showed that there were no significant differences in the duration of the second phase of labor and that, although variations were seen in arterial blood cord analysis, the data were within normal values, with no newborn with an Apgar test less than seven in any of the groups.

Scientific evidence indicates that its effectiveness is not proven, but its possible side effects are.

Kristeller's maneuver is discouraged.

Given this scientific evidence, which shows that babies took the same time to leave whether pressure is applied or not, the study authors decided to discourage its use, in the same way that it is not recommended in the current normal delivery protocols.

The Clinical Practice Guide on Normal Delivery Care of the Ministry of Health recommend not to do it, as we see on page 61:

"The Kristeller maneuver it is ineffective in reducing the duration of the second stage of work ".

With respect to the inflatable belt mentioned in the summary of the evidence, it refers to a study, in which an inflatable belt was used that was able to measure exactly the pressure exerted and the angle of the direction of the maneuver. Something that in everyday practice, when the pregnant woman's belly is pressed with her arm, is not controlled with this precision.

For its part, WHO also advises against it Not being proven effective. The agency explains in its recommendations for a positive birth experience:

"In many countries the practice of applying pressure to the uterine fundus during the second phase of labor is common. This is done in order to speed it up. Sometimes it is done just before giving birth and sometimes from the beginning. carry 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, its effectiveness not being proven.“

The Spanish Society of Gynecology and Obstetrics (SEGO), however, differs in its recommendations and maintains that it cannot be used for the baby's head to go down the birth canal before fitting, but it is allowed in the second phase of the childbirth, when the head is already fitted:

"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."

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How to avoid it

As an alternative to the 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 outside, but falls towards the mother's spine, towards his back, and the road to the outside becomes more difficult, depending above all on the strength of the mother at the time of bidding.

This is a terrible temptation for the surrounding people, who try to help the mother from the outside, usually through the Kristeller maneuver.

If low doses of epidural are used (the so-called epidural walking) and the mother is allowed freedom of movement, it is possible to remain in an upright position, using the only force that does not depend on the mother or the professionals and that helps a barbarity: the Gravitational force Newton described there by 1687, a few years ago.

Hence the importance of developing a Birth Plan where the mother's wishes at the time of giving birth are recorded.

The Kristeller maneuver on video

A picture is worth a thousand words and a thousand times better a video than a picture, so we bring you some videos so you can see what the Kristeller maneuver is.

In the first, the maneuver is (terribly) obvious. The girl exerts considerable pressure, as much as the weight of her body allows her to:

In this video that follows the maneuver is much more subtle. No dry blows are made, but the lady who performs it drops the weight of her arm on the bottom of the uterus, pressing down and out:

Finally, in this third video we observe a man dropping his weight on the woman's abdomen (from minute 1:30):

The curious thing is that in all three videos, the delivery is presented as normal, natural or uncomplicated, that is, as if it were a maneuver more than 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 done only when deemed appropriate, after weighing the pros and cons and after inform the woman of what she is going to do and why, but not as a little help for the baby to get out a little earlier or to help the woman lying down to take out that baby who, because of going against gravity, has more trouble getting out.

Photos | iStockphoto
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