Delivery of Shoulders

■ Most frequently, the shoulders appear at the vulva just after external rotation and are born spontaneously (see Figures 6-9 and 6-10).

FIGURE 6-9. Delivery of anterior shoulder.

(Reproduced, with permission, from DeCherney AH, Pernoll ML. Current Obstetric & Gynecologic Diagnosis & Treatment. Nor-walk, CT: Appleton & Lange, 1994:212.)

FIGURE 6-9. Delivery of anterior shoulder.

(Reproduced, with permission, from DeCherney AH, Pernoll ML. Current Obstetric & Gynecologic Diagnosis & Treatment. Nor-walk, CT: Appleton & Lange, 1994:212.)

Occasionally, the shoulders must be extracted:

■ The sides of the head are grasped with both hands and gentle downward traction is applied until the anterior shoulder descends from under the pubic arch.

■ Next, gentle upward traction is applied to deliver the posterior shoulder.

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