5 risks of the kristeller maneuver and its relationship with obstetric violence

Childbirth is a time of vulnerability for women and many have already suffered some form of obstetric violence, such as Kristeller’s maneuver. Gynecologist and obstetrician, Dr. Débora Maranhão (CRM 184349/SP), from Hospital Moriah, talked about the subject, explained what it is and mentioned the risks that the maneuver can bring to the woman and the baby. Check out!

What is the Kristeller maneuver

According to Dr. Débora, the Kristeller maneuver was a technique widely used by obstetricians to accelerate labor and reduce the expulsive period. “The maneuver was performed when the baby took a while to get down and get in the position to leave, or when the baby was not properly fitted with the mother’s pelvis”.

In addition, there were cases in which the woman had little contraction or was very tired and could no longer exert enough force to deliver the baby. Next, understand how the procedure was performed.

How is it done?

To perform the maneuver, the doctor explained that “the elbow and the arm are placed on the bottom of the mother’s uterus and pushed down with pressure to accelerate the baby’s exit during delivery”.

Although prohibited by the Ministry of Health and the World Health Organization (WHO), the technique is still performed in some hospitals in Brazil, mainly in the Unified Health System. This happens because many mothers do not have knowledge about the entire process that involves childbirth and the postpartum period, in addition, they do not know that the maneuver is related to obstetric violence. See more about this in the next topics!

Why is the Kristeller maneuver no longer recommended?

According to Dr. Débora, it was believed that the maneuver could help speed up the birthing process. However, “over time, it was found that she does not shorten labor, does not shorten the expulsive period, which is the final period of the baby’s delivery, and, at the same time, is very aggressive”.

In addition, the technique is no longer recommended, “it is one of the maneuvers that is closely related to obstetric violence”. The procedure can hurt the mother causing physical and psychological damage. “The obstetrician had to exert a lot of force and this also made everyone in the delivery room very anxious, it could cause placental abruption and even a worsening of the outcome”. In other words, the technique does not bring benefits to the mother or the baby, on the contrary, it is invasive.

What are the risks of the Kristeller maneuver?

The maneuver is no longer performed by many professionals who seek a humanized delivery, providing the mother with security and support in several aspects. Therefore, learn about the main risks of the technique cited by the obstetrician:

• Postpartum abdominal pain: Dr. Débora informed that the maneuver can cause postpartum abdominal pain “due to the great pressure and support of the arm and elbow on the belly, which may even leave bruises on the skin”.
• Increased perineal laceration: according to the doctor, the technique can cause second and third degree perineal lacerations because of the more abrupt exit of the fetal presentation through the vagina. In addition, “there is also a greater chance of pelvic floor dysfunction from increased intra-abdominal pressure on the pelvic muscles,” she added.
• Rupture of the liver or spleen: the obstetrician said that “if the maneuver is performed above the uterine fundus, there is also a risk of rupture of the liver or spleen, but these injuries are much more serious and rare, as it depends on a lot of force”.
• Psychological risks: “The Kristeller maneuver can cause psychological damage to the mother due to the stress of the whole situation and the aggressive movement of the team to perform the maneuver”, commented the specialist.
• Risk for the baby: for the baby, “there is a risk of brain hematoma and fractures, but it is not demonstrably greater than the cases that did not perform the maneuver”. However, the doctor said that “it is not possible to say, as several studies are inconclusive in the real immediate and long-term effects that the maneuver can cause in babies”.

Dr. Débora pointed out that “generally, the Kristeller maneuver is performed in cases where the evolution is not being good, so it can be a confounder in the perinatal results”. That is, “brain hematoma and fractures in the baby may be associated with greater fetal anoxia and low pH in the umbilical cord blood, that is, with a greater risk of sequelae due to fetal hypoxemia (low oxygen)”.

How to Avoid the Kristeller Maneuver

According to the obstetrician, it is possible, yes, to avoid the Kristeller maneuver, as there are other means, such as medication, to help in the expulsive period. “For example, oxytocin is a medication that increases uterine contraction and will help the uterus to exert more force on its own.” In addition, controlled traction can be performed, teaching the mother to pull and force during the expulsive period.”

The professional informed that other mechanisms can also be used to help the mother at the time of delivery. “The change in decubitus, that is, I change the patient’s position because, sometimes, that position is not good for her to exert force. So I put the mother on her feet or crouch so she can do better”.

In addition, the obstetrician cited other forms, such as “the tug of war that we pull the patient by the hands so she can push through the expulsive period of labor. In addition, “there is the possibility of putting the patient in a bathtub or taking her to the bath to relax her lap”, she added.

In cases where the expulsive period is already long, an instrumental delivery can be performed. In other words, “both the forceps and the vacuum extractor are used to abbreviate and alleviate the fetal suffering and the mother’s suffering, who is already totally exhausted. Mainly, when the cesarean delivery route is no longer indicated because the baby’s head is already too low”, he concluded.

Kristeller’s maneuver and obstetric violence

The Ministry of Health and the World Health Organization (WHO) have banned the Kristeller maneuver, as it qualifies as obstetric violence because it is an aggressive technique that can harm both mother and baby. Despite this, there is still no federal law that supports women. However, some Brazilian states, such as the Federal District, for example, have state laws with measures to protect and support women.

However, there are regulatory bodies, such as the World Health Organization (WHO), the National Directive for Assistance to Normal Childbirth and the Collegiate Board of the National Health Surveillance Agency (ANVISA) that created resolutions that regulate the behavior of health professionals and support victims nationwide.

At the time of delivery, it is important that there is a humanized scenario, after all, this is a moment of anxiety and tension for the mother. So, it is essential that health professionals provide emotional support, comfort and encouragement according to the woman’s needs. Enjoy and learn more about belly button pain in pregnancy – a nuisance that affects many women.