- All relevant infection control methods to be utilised.
- Consider the need for a back up crew.
- Prepare equipment required:
- Adult and infant BVM
- Baby mucus extractor
- Placenta bucket
- Small combine
- Space blanket
- Sterile gauze pad
- Sterile scissors
- Umbilical clamps
- Reassure mother, remove constrictive clothing and place an incontinence sheet below pelvis.
A systematic approach should be adopted;
- Position the woman flat on her back and position her thighs up onto her abdomen.
- During the next contraction, apply gentle downward traction for 30 seconds.
- If no resolution, move onto Rubin manoeuvre without waiting for contractions.
Rubin I manoeuvre (suprapubic compression)
- Continue mild downward traction of the foetal head.
- An assistant adopts a 'hand over hand position', CPR style.
- Place both hands suprapubically over the posterior aspect of the fetal shoulder, and apply continuous pressure in a downward lateral motion. Doing so will encourage the impacted shoulder to roll towards the baby’s chest.
- Coach the mother to push with the contraction at the same time as the assistant attempts manipulation of the baby’s shoulder.
- If no resolution after 30 seconds, commence Rockin Rubin manoeuvre.
Rubin II manoeuvre (compression / relaxation)
- Maintain downward traction while the assistant applies pressure to the impacted shoulder in a rocking motion.
- If delivery is unsuccessful after 30 seconds place the mother in the Reverse McRoberts position, by rotating her onto all fours.
Reverse McRoberts Position (roll onto all fours)
- Attempt delivery of the non-impacted shoulder (which is now the uppermost shoulder).
- Transport Priority 1 to nearest obstetric unit repeating all manoeuvres en route.