Obstetrical solutions for stuck shoulders evolved without the advantage of listening to midwives. Thankfully, midwives have traditional strategies of their own for shoulder dystocia.

Squatting and Standing: Moving into a squat may shift the pubic bone and roll the shoulder out from under the pubic bone. The widening of the ischial spines will increase room in the transverse. In this vertical position, uterine contractions may be stronger and more efficient. Moving the mother to a standing position can work as well. The pelvis may be more mobile when a mother stands with knees slightly bent. A strong helper can hold her under the arms to stabilize and support her. Standing allows a hand in, if needed, more than does squatting.

Gaskin Maneuver: Simply flip the mother over onto her hands and knees. The motion can cause an inner rotation of the shoulders. Remember, to move the baby, move the mother. Notice if the head now restitutes and look for a lengthening neck. If yes, pushing will now bring the baby.

"Running Start": What if the baby still doesn't come out? With mother on her hands and knees, she quickly lifts a knee and sets the foot down flat. At the same time, since verbal instructions are difficult for the mother to process at this time, the midwife or assistant grasps whichever leg is handy and moves it up to the new position with the foot flat on the bed. The mother now has one knee down and one knee up, a bit like a runner waiting for the signal to begin. This move rotates the symphysis pubis joint and rolls the shoulder off and into the open pelvis. The symphysis shrugs off the shoulder, like the lumberjack rolling off the log. The pelvis widens on the side that the knee is raised, so the midwife may want to raise the knee on the side where she suspects the baby's back is. Often the mother's right leg is the one to lift. But in a flurry, just grab a leg and lift it. Immediately, the posterior shoulder should slide out and with it, the entire child.

Praying Hands Rotation: If the baby is still stuck, the next step can be done quickly also. The midwife slips the fingers of both hands inside. With flat palms, one hand braces the baby's back and the other hand braces the chest, like a prayer around the baby. Thumbs are not required and can stay out of the mother. The baby is rotated so that the posterior shoulder moves toward the chest. The baby is essentially spiraled out.

Lift the Sacrum: If the posterior arm can't move, it may be that the baby is too large to rotate easily in the praying hands rotation. The midwife uses her dominant hand to attend the posterior shoulder. She uses the back of that hand like a wedge between baby and sacrum and lifts the sacrum up with her knuckles while her fingers sweep the posterior arm to baby's chest (and into the oblique diameter). Opening the sacrum enlarges the pelvic outlet diameter.

Bring the Posterior Arm Out from the Hands and Knees Position: Whenever success at bringing the baby's shoulder into the oblique fails to bring the baby, the midwife should go after the posterior arm and bring it out. For the mother already on her hands and knees for the birth, it is easy for the midwife to slip the four fingers of her hand inside along the mother's thigh. She will want her hand along the baby's back, not the chest. She should then sweep the fingers upward toward the tailbone. This act alone may move the posterior arm into the oblique.

— Gail Tully, excerpted from "Shoulder Dystocia: The Basics," Midwifery Today Issue 66

[ozmidwifery] Shoulder Dystocia from Midwifery Today

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