Written By: Romina Cani & Dr. Ummay Kulsoom

Many mothers are surprised to learn that the World Health Organization has clearly recommended against the use of fundal pressure, also known as the Kristeller maneuver. This is the technique where a provider applies strong external pressure using hands, fists and sometimes elbows, on a mother’s upper abdomen during the pushing stage in an attempt to “help” the baby descend. Some common indications cited by care providers are suspected fetal compromise, prolonged labor and poor maternal pushing efforts due to exhaustion. Though poorly reported due to fear of litigation, fundal pressure has been prevalent variably all around the world. In USA and UK, it is an unregulated and discouraged practice while Portugal has categorized it as a form of obstetric violence.

It’s important for families to understand why this intervention should be avoided, and how eliminating it can actually create a calmer, safer, and more positive birth experience for both mother and baby.

For many women, the pushing stage already comes with intense sensations. Adding unexpected pressure on the abdomen can increase anxiety, pain, and a feeling of being overpowered as fundal pressure is often applied without the mother’s consent. Birth requires a delicate hormonal balance, and fear or tension can interrupt this natural flow. Understanding this helps mothers feel more grounded and confident when advocating for respectful care.

Different bodies, babies, and labors progress at different rhythms, and research consistently shows that there is no proven benefit to applying manual force from above. A Cochrane systematic review (2017) and a large multicentric randomized trial (2013) in South Africa “The Gentle Assisted Pushing study (GAP)” concluded that fundal pressure was not linked with improvements in vaginal birth outcomes and it increased the frequency of cervical tears and led to postnatal discomfort. Other potential risks highlighted in many studies include pelvic floor injury,  anal sphincter injuries, uterine rupture and urinary retention apart from deleterious effects on the newborn. These findings reinforce the importance of individualized, evidence-based care rather than relying on outdated techniques.

Another key point for families to remember is that gravity and movement are far more effective — and much safer — aids during labor. Upright positions like kneeling, squatting, or leaning forward widen the pelvis naturally, encourage the baby to rotate in their own time, and help labor progress without unnecessary force. Many mothers find that simply changing positions, using breath work, or adjusting the environment (dim lighting, warm water, or supportive presence) creates more progress than any external pressure could.

So what can mothers do to support themselves during the pushing stage? Choosing positions that feel instinctively right, staying mobile, and having continuous emotional and physical support, all contribute to a smoother experience. It’s also deeply empowering for mothers to discuss their preferences with their care provider ahead of time, especially when it comes to avoiding interventions like fundal pressure.

Just as engaging in meaningful activities can soothe the mind during late pregnancy, making intentional choices during labor supports a mother’s sense of agency. By trusting the body’s natural wisdom and surrounding themselves with supportive care, mothers can look back on birth feeling respected and safe.

In today’s evidence based era, fundal pressure seems anachronistic. It was proposed as a last resort method when operative deliveries were non existent. Fundal pressure has been proved as not only ineffective but also harmful to both mother and baby.

Eliminating fundal pressure isn’t just about removing a harmful technique — it’s about honoring the mother’s body, her intuition, and the natural process of birth. We are all accountable for this and your experience and opinions matter. Speak up and allow other women around you to beware of taking the same path. Knowing when to say NO is an important aspect of an empowering and blissful birthing journey.