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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Shoulder dystocia

Obstetrics and gynaecology · UK scope · Sources checked 7 Sept 2026 · Clinical review pending

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The head is born but the shoulders are stuck

Failure of the shoulders to deliver with routine axial traction is an obstetric emergency that requires coordinated mechanical release.

Action: State shoulder dystocia, call help, stop pushing and oxytocin, start McRoberts positioning with suprapubic pressure, and move promptly to internal manoeuvres if unsuccessful. Never use fundal pressure.

Synopsis

Recognise impacted shoulders after birth of the head, apply current release manoeuvres without harmful traction, and organise maternal and newborn assessment afterwards.

  • Most cases cannot be predicted reliably from antenatal risk factors.
  • Call senior obstetric, anaesthetic, midwifery and neonatal help immediately.
  • Discourage maternal pushing and stop any oxytocin infusion.
  • Start with McRoberts positioning and directed suprapubic pressure.
  • Use only routine axial traction when assessing release.
  • The August 2026 RCOG guideline advises moving straight on after an unsuccessful manoeuvre, without waiting thirty seconds.
  • Episiotomy provides access for internal manoeuvres; it does not release the bony obstruction.
  • Examine both mother and newborn for complications after birth.

Key red flags

Retraction of the head against the perineum, failure of restitution or failure of shoulder descent should trigger immediate recognition.

Persistent impaction after an attempted manoeuvre requires progression to another manoeuvre, not stronger traction.

An unwell newborn after release needs immediate skilled assessment and resuscitation while maternal bleeding is assessed.

Investigation priorities

01
Immediate clinical assessment of shoulder impactionFirst step

Establish the emergency without delaying effective release manoeuvres.

Management branches

Initial releaseMobilise and use external manoeuvres

Routine axial traction does not achieve delivery of the shoulders.

  1. Announce shoulder dystocia, call the emergency team and ask someone to record the time and sequence of actions.
  2. Explain briefly to the woman, discourage pushing, stop oxytocin, flatten the bed and ensure useful access around her.
  3. Perform McRoberts by bringing the thighs towards the abdomen; assistants support the legs and position the pelvis effectively.
  4. Apply suprapubic pressure from the side of the fetal back to adduct and rotate the anterior shoulder; reassess with routine axial traction.
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Sources and review status4 sources · checked 7 Sept 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 7 Sept 2026; clinical approval remains outstanding.

  • RCOG Shoulder Dystocia: third edition, August 2026
  • RCOG Green-top 42: current guideline and version history
  • RCOG: shoulder dystocia information and recovery
  • RCUK 2025: newborn resuscitation and transition

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom