• 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
  • Oxygen
  • Placenta bucket
  • Small combine
  • Space blanket
  • Sterile gauze pad
  • Sterile scissors
  • Towel
  • Umbilical clamps
• Reassure mother, remove constrictive clothing and place an incontinence sheet below pelvis.

A systematic approach should be adopted;

McRoberts Manouvre

• 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.