Shoulder dystocia

(progress in stepwise fashion until delivery progresses)

1. Recognize by failure of delivery to progress past neck, “turtle sign” when head retracts back to perineum after pushing
2. McRoberts maneuver: Knee-chest position
3. Suprapubic pressure by assistant
4. Anterior shoulder sweep: rotate the anterior shoulder towards the baby’s face by pushing on scapula to unlock anterior shoulder from pubic bone
5. Rotate the posterior shoulder to anterior position using a similar shoulder sweep and then deliver that shoulder
6. Deliver posterior arm by passing the arm along the baby’s chest
7. Episiotomy or fracture the clavicles as a last resort