ManoeuvresFree in the app
Shoulder dystocia manoeuvres
HELPERR — move on quickly; go to internal manoeuvres early.
Source: RCOG GTG 42 (3rd ed. 2026) · NHS GGCCall for help, note the time, stop pushing. NO fundal pressure. NO lateral or jerky traction on the head.
Manoeuvre
| McRoberts | Lay flat; two assistants hyperflex her thighs onto abdomen — flattens lumbosacral angle. |
|---|---|
| Suprapubic (Rubin I) | From fetal back side: push behind anterior shoulder toward fetal chest — continuous, then rocking. |
| Rubin II | Fingers behind anterior shoulder push it toward the chest into the oblique. |
| Woods screw | Keep Rubin II; other hand on front of posterior shoulder — rotate toward the back (up to 180°). |
| Reverse Woods | Fingers behind posterior shoulder; rotate the opposite way. |
| Posterior arm | Hand along sacrum, press antecubital fossa to flex elbow, grasp wrist, sweep arm across chest and face. Never pull the upper arm. |
| Posterior axillary sling | Soft catheter looped under posterior axilla for traction or rotation. |
| All-fours (Gaskin) | Roll onto hands and knees; deliver the now-upper posterior shoulder first. |
| Last resort | Cleidotomy, Zavanelli (replace head + CS, with terbutaline), symphysiotomy. |
Episiotomy only for access — it does not release the bony impaction. Document times, manoeuvres, staff, anterior shoulder, cord gases.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.