McRoberts Maneuver

The McRoberts maneuver is a technique used during vaginal delivery if your baby’s shoulders become stuck in your pelvis (shoulder dystocia). When this happens, your baby can’t fully descend through the birth canal. This maneuver is often the first step your healthcare team will try to help create more space for delivery.

During the maneuver, your delivery team flexes your thighs tightly toward your abdomen. This movement rotates your pelvis and widens the space at your tailbone (sacrum). This can free your baby’s shoulder. It usually takes two providers and support from the delivery team to complete the maneuver.

What happens during the McRoberts maneuver?

It starts with checking your pelvis and the baby’s position to confirm shoulder dystocia. Your obstetrician will diagnose shoulder dystocia if:

• They delivered your baby’s head, but the rest of their body is still inside the birth canal
• It’s been at least one minute since the baby’s head emerged without the rest of their body

During the McRoberts maneuver, your delivery team will flex your thighs tightly towards your abdomen while also shifting your hips outward, creating a V position. This position helps move your pubic symphysis up by about 2 centimeters. It also helps widen your pelvic outlet.

This position allows your baby’s shoulder to rotate from back to front and slip out from under your pelvis. It’s most effective when done during a contraction or when combined with suprapubic pressure. This is when your providers put gentle pressure above your pubic bone to dislodge your baby’s shoulder.

What are the potential benefits and risks?

The advantages of a successful McRoberts maneuver are:

• A vaginal delivery can continue
• You avoid complications of shoulder dystocia, like neck or spine injuries, broken bones and lack of oxygen
• Lower chance of needing a C-section or episiotomy

Possible risks of the McRoberts maneuver are:

• Separation of your pelvis
• Neuropathy in your lower limbs

How effective is the McRoberts maneuver?

The McRoberts maneuver works about 42% of the time on its own, but success increases to 95% when combined with suprapubic pressure or delivering the posterior arm first. Your baby can continue being born through your vagina if these maneuvers are successful.

What are the alternatives to the McRoberts maneuver for shoulder dystocia?

The McRoberts maneuver is usually the first treatment for shoulder dystocia. Your provider will usually use suprapubic pressure, too. Other things they may do are:

• Deliver the posterior (arm closest to your vagina) arm first
• Rotate your baby’s shoulder by applying pressure to the front of the posterior shoulder
• Rotate your baby’s shoulder like a corkscrew by applying pressure behind the anterior (top) shoulder
• Move you to your hands and knees to widen your pelvis (Gaskin maneuver)

Your provider may recommend an episiotomy to make room to complete these maneuvers.