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Ways to Deliver When the Baby's Shoulder is Entrapped
Cesarean Section: Also called a c-section, this may be done in an emergency, but also is done if the doctor suspects that the shoulders are too large for the birthing canal. The moth has the option of receiving spinal anesthesia or an epidural, or general anesthesia may be used. A surgeon than makes a cut above the pubic bone, going all the way through to the uterus. The baby is delivered through this cut, rather than down the birthing canal.
Emergency C-Section: Emergency cesarean sections (c-sections) are those done after vaginal birth has already started, but there is an indication that there might be a problem. In this case, these may or may not be time to numb the mother before the doctor makes a surgical incision through the abdomen and uterus above the pubic bone to deliver the baby.
Episiotomy: This method can be used in the McRobert's position or otherwise. An assistant holds the baby's head (if necessary), and the doctor cuts or extends the episotomy to increase the room for the baby.
McRoberts Maneuver: The mother is moved from her position to the very edge of the bed. Two assistants are used to hold the woman's thighs in a hyperflexed position onto the abdomen. Another assistant elevated the baby's cut (if necessary), and the episiotomy is cut or extended. The baby is then gently forced downward for delivery.
Posterior Arm Sweep Maneuver: With one hand, the doctor delivering the baby finds the posterior arm and elbow. The arm is gently extended and delivery is attempted in a rotate position with the arm raised.
Suprapubic Pressure: Also known as the Ruben's Method, the doctor delivering the baby gently applies downward pressure while an assistant applies suprapubic pressure to the trapped shoulder. A rocking motion may be used if continuous pressure doesn't work. The shoulder is rotated toward the chest to deliver the baby.
Symphysiotomy: Formerly known as a sigualtian section, this operation is done instead of a c-section. A surgeon divides the ligaments found in the symphysis to increase the diameter of the uterus.
Woods/Rubens Maneuver: The Wood's Meneuver is a continuation of the suprapubic pressure method. As the accoucheur uses one hand to push on the shoulder as with above, he or she uses the second hand to help with the rotation while protecting the head.
Zavanelli Maneuver: The baby's head is gently pushed back into the vagina and delivered immediately by emergency C-section instead. Typically, this is a method used only after others have failed.
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