What should be done if the McRoberts maneuver and suprapubic pressure fail?

When the McRoberts maneuver and suprapubic pressure do not resolve a shoulder dystocia situation, it is essential to proceed with additional maneuvers to effectively manage the impacted shoulder and facilitate delivery. The Woods screw maneuver and the reverse McRoberts maneuver are specifically designed to navigate this complication by changing the position of the fetus or attempting to dislodge the impacted shoulder.

The Woods screw maneuver involves rotating the fetal shoulder in a corkscrew motion to help free it from the maternal pelvis. The reverse McRoberts maneuver alters the maternal position further to create more space in the pelvis, which may help in disengaging the shoulder. These maneuvers are recognized practices that increase the probability of a successful delivery without needing to escalate to more invasive procedures immediately.

In contrast, immediate preparation for an emergency cesarean section may not be warranted at this stage. This option could unnecessarily prolong the situation and potentially harm the mother and baby while all other effective methods are not fully utilized. Waiting for a natural delivery without intervention or administering medications to relax the uterus would not address the critical issue of shoulder impaction and would likely have negative outcomes for both the mother and the infant.