Fundal Pressure – Update

I have written about fundal pressure preventing measures and related stories in my previous posts. When they pulled down our old labor ward, my designer (meaning handmade) posters saying 'Say No To Fundal Pressure' and with a sketch of a fellow giving fundal pressure to a distressed patient went down. I believed the message had gone home and the evil had been rooted out. Yesterday I was giving a lecture on controlling bleeding. It was for the postgraduate freshers. When I got around to using pressure for hemostasis, i explained how it works when there are vaginal lacerations that cannot be sutured. One example of such a situation was after giving fundal pressure to aid childbirth, I said. And then I had an idea. These freshers did not know me so well. I could speak without fear of my true feelings being recognized. So I asked them one by one about their work experience. “How long have you worked in the department? I asked. “Two months, excluding our allied postings” they said. “Have you got adequate work?” I asked. “How many fundal pressures have you got to do?” I asked the girl sitting at the end of the first row of chairs. “Two” she said brightly. “That's good” I said with a straight face. “What about you” I asked the guy sitting next to her. “Seven” he said proudly. “That is great” I said. I had a hard time keeping a straight face. “How many did you get” I asked the next person. It seemed she had none. And so did the next eight residents, including all three residents from my own unit. I was relieved they had not made fundal pressure at any time. But I was in the mood to carry on the charade a little longer. “That is not justice,” I said “we work in the antenatal clinic till five or five thirty P.M., and all our registered women seem to be delivering with them; at least those who require fundal pressure.” They kept quiet. I checked the units of the two who made fundal pressure and then of those who didn't. There were two girls from the same unit as the boy who had a proud seven to boast of. “How come you got seven and they did not get even one?” I asked him. “Do you shove them aside and take the case over whenever fundal pressure is required?” He just smiled broadly. “Or do you make the poor fellow give fundal pressure for you too because he is tall and strong?” I asked the two girls. They smiled unsure of where it all was going. I asked the others and it appeared none of them had had the opportunity to make fundal pressure. At that point I was unable to hold back my true facial expressions. Two units out of six practicing fundal pressure was serious business. “I know I shouldn't have taken you for a ride” I said “but my strategy of catching the innocents worked, did it not? I got positive answers to a question that the senior residents always answer with a no. Can't you two understand that fundal pressure is a dangerous thing to do; that it leads to seniors taking over for managing lower genital tears, uterine ruptures, and sometime postmortems? Don't ever make fundal pressures. It is a crime against humanity.” I got the two to mark their names on the attendance sheet so that I could identify them later, got the next resident to confirm that they had marked their own names and not of someone else, and then let them go. I hope the transaction has taught them what they actually should have known on their own.