Gently bring down a loose loop of cord (approximately 15cm).
If the shoulders do not spontaneously deliver place a single layer towel over the hips and buttocks and grasp the pelvic girdle with thumbs on the sacrum and index and mid fingers on the hips.
Once the tip of the scapula comes into view gently rotate the posterior shoulder anteriorly into the oblique by rotating the baby through 180°. The sacrum is kept anterior at all times.
With the next contraction and maternal effort apply gentle downward traction to deliver the shoulder.
Gently rotate through 180° in the opposite direction to bring the anterior shoulder into the other oblique plane.
Deliver the anterior shoulder by using gentle downward traction. Keep the sacrum anterior.
If an arm is extended and obstructs progress slide two fingers along the anterior arm and apply gentle pressure in the cubical fossa. Flex the arm and swept across the chest and out of the vagina. Rotate the baby to original position with back facing
Place forearm under the baby for support.
Commence delivery of the head with the next contraction. Maintain foetal head in a flexed position to allow passage.
Perform Mauriceau Smellie Veit manoeuvre: place index and middle fingers on the foetal maxillary prominences, raise upwards