推？不推？子宮底施壓於自然產第二產程運用之省思

To Push or Not to Push? Reflections on the Uterine Fundal Pressure Application in the Second Stage of Labor

在自然產的第二產程執行子宮底施壓是運用「推」的方式，在面對產婦脊椎，角度為30至45度往骨盆的縱向方向，以手臂／手肘或手掌直接放置在生產婦女的子宮底的位置，以溫柔、有力和穩定的人工施壓方式來協助分娩。子宮底施壓可能造成的潛在風險有：子宮破裂、產後尿滯留、會陰嚴重撕裂傷與疼痛、肋骨斷裂、產後性交不適與潛在新生兒窘迫或損傷的情況。因此建議臨床上施行這項措施必須小心謹慎，且執行者應是具有相關專業訓練與經驗的醫護人員。

Women who undergo vaginal birth apply uterine fundal pressure during the second stage of labor. Uterine fundal pressure is done manually with the practitioner's forearms, elbows, or palms pressed on the uterine fundus at a 30° to 45° angle to the maternal spine in the direction of the pelvis. The pressure is applied in the longitudinal direction. Gentle, firm, and steady pressure is recommended. The various side effects of applying uterine fundal pressure include: uterine rupture, postpartum urinary retention, severe perineal trauma and pain, rib fracture, postpartum dyspareunia, and potential neonatal distress or trauma. Therefore, caution is recommended in the application of uterine fundal pressure. Thus, only well-trained and experienced medical staff or nurses should be allowed to practice this intervention.