McRoberts Maneuver

What is the McRoberts maneuver?

The McRoberts maneuver is used during childbirth when one or both of your baby's shoulders are stuck in your pelvis during a vaginal delivery. When your baby's shoulders are stuck behind your pelvis, it prevents them from fully descending the birth canal and coming out of your vagina.

The McRoberts maneuver involves an obstetrician or other healthcare provider flexing your thighs toward your abdomen. The maneuver helps to rotate your pelvis and open your sacrum to release the baby's shoulder.

When is the McRoberts maneuver used?

The McRoberts maneuver is a technique used when a baby has shoulder dystocia during vaginal delivery. It's one of the first methods a healthcare provider will use to correct shoulder dystocia before continuing with delivery. It usually requires two healthcare providers and various healthcare personnel in the labor and delivery room.

What is shoulder dystocia?

Shoulder dystocia occurs when your baby's shoulders become lodged behind the pubic symphysis or the area where the pubic bones connect in the pelvis. During typical vaginal childbirth, your baby passes through the public symphysis. However, in the case of shoulder dystocia, one or both of your baby's shoulders get stuck. This prevents your baby from descending through and coming out of your vagina. Shoulder dystocia can cause serious problems, but in most cases, babies are born safely.

Who is at risk for shoulder dystocia?

You may be at higher risk for shoulder dystocia if you:

• Have a small pelvis.
• Are expecting a large baby (fetal macrosomia).
• Have previously given birth to a large baby.
• Have gained too much weight during pregnancy.
• Have a breech baby.

How effective is the McRoberts maneuver?

The McRoberts maneuver is effective about 42% of the time when performed alone. However, when coupled with suprapubic pressure (applying pressure to the area above the pubic bone), its effectiveness increases to 90%.

What happens during the McRoberts maneuver?

The first step in the McRoberts maneuver is to assess the pelvis and positioning of the baby to confirm shoulder dystocia. Your obstetrician will diagnose shoulder dystocia if:

• You delivered your baby's head, but the rest of their body is still in your vagina.
• It's been at least one minute since the baby's head emerged without the rest of their body.

During the McRoberts maneuver, a healthcare provider will flex your thighs tightly towards your abdomen while simultaneously shifting your hips away from your body (hip abduction). This position helps move the pubic symphysis by up to about 2 centimeters. It also helps to flatten and widen the sacrum.

The baby's shoulder can shift from back to front and then out from under your pelvis. It can be even more effective when performed during a contraction or while another healthcare provider applies suprapubic pressure.

How is suprapubic pressure applied?

Suprapubic pressure is when a healthcare provider uses their palm or fist to press down on your abdomen just above your public bone. The pressure is applied downward assist to dislodge the impacted shoulder. It's done with the McRoberts maneuver to increase the effectiveness of dislodging the baby's shoulders.

What are the advantages of the McRoberts maneuver?

The advantages of a successful McRoberts maneuver are:

• A vaginal delivery can continue.
• You avoid complications of shoulder dystocia like broken bones, nerve damage or asphyxia.
• Reduced risk of needing a c-section.
• Reduced risk of needing an episiotomy.

The McRoberts maneuver is often the first line of treatment for shoulder dystocia. It's a simple, straightforward approach to treating shoulder dystocia.

What are the complications of the McRoberts maneuver?

When performed correctly, there aren't many complications to the McRoberts maneuver. Under current guidelines, your baby's head should never be pulled, and their neck should be kept straight. Pulling or stretching the baby's head can cause a neck or spine injury. In rare cases, the birthing person's pelvis can separate or neuropathy can occur in the lower limbs.

What happens after the McRoberts maneuver?

After a successful McRoberts maneuver, your baby will be born through your vagina. When performed correctly and with pressure applied at the pubic bone, successful vaginal delivery is highly likely.

A note from Cleveland Clinic

The McRoberts maneuver is a procedure commonly used when a baby has shoulder dystocia during childbirth. Shoulder dystocia is when your baby's shoulders are stuck in your pelvis. A healthcare provider performs the McRoberts maneuver to shift your pelvis and dislodge your baby's shoulders. It may be slightly uncomfortable, but it's highly effective in correcting shoulder dystocia. This maneuver usually leads to successful vaginal delivery and a healthy baby.