The steps to treating a<unk>  are outlined by the mnemonic ALARMER: * Ask for help. This involves asking for the help of an obstetrician, anesthesia, and for pediatrics for subsequent resuscitation of the infant that may be needed if the methods below fail; * L hyperflexion and abduction at the hips (McRoberts maneuver); * Anterior<unk>  disimpaction (suprapubic pressure); * Rotation of the<unk>  (Rubin maneuver); * M delivery of posterior arm; * Episiotomy; * Roll over on all fours. Typically the procedures are performed in the order listed and the sequence ends whenever a technique is successful. Intentional fracturing of the clavicle is another possibility at non-operative vaginal delivery prior to Zavanelli's maneuver or symphysiotomy, both of which are considered extraordinary treatment measures. Pushing on the fundus is not recommended. Simulation training of health care providers to prevent delays in delivery when a<unk>  presents is useful. Procedures A number of labor positions and maneuvers are sequentially performed in attempt to facilitate delivery. These include: * McRoberts maneuver; involves hyperflexing the mother's legs tightly to her abdomen. This widens the pelvis, and flattens the spine in the lower back (lumbar spine). If this maneuver does not succeed, an assistant applies pressure on the lower abdomen (suprapubic pressure), and the delivered head is also gently pulled. The technique is effective in about 42% of cases; * Suprapubic pressure (or Rubin I); * Rubin II or posterior pressure on the anterior<unk> , which would bring the baby into an oblique position with the head somewhat towards the vagina; File:ShoulderDystociaFig1.Step 1: Index and middle fingers insertion with the hand opposite the baby's face File:ShoulderDystociaFig2.Step 2: Baby's head slightly tilted downward with the free hand File:ShoulderDystociaFig3.Step 3: Two fingers are placed on the humerus like a splint File:ShoulderDystociaFig4.Step 4: Baby's hand appears under the maternal pubic symphysis, allowing the anterior arm to be delivered * Wood's screw maneuver which leads to turning the anterior<unk>  to the posterior and vice versa (somewhat the opposite of Rubin II maneuver); * Jacquemier's maneuver (also called Barnum's maneuver), or delivery of the posterior<unk>  first, in which the forearm and hand are identified in the birth canal, and gently pulled; * Gaskin maneuver involves moving the mother to an all fours position with the back arched, widening the pelvic outlet. More drastic maneuvers include: * Zavanelli's maneuver, which involves pushing the baby's head back in (internal cephalic replacement) followed by a cesarean section; * Intentional causing clavicular fractures, which reduces the diameter of the<unk> s that requires to pass through the birth canal; * Maternal symphysiotomy, which makes the opening of the birth canal laxer by breaking the connective tissue between the two pubes bones; * Abdominal rescue, described by O'Shaughnessy, where a hysterotomy facilitates vaginal delivery of the impacted<unk> .
Shoulder dystocia
Back labor
Asynclitic birth
Liber pantegni
Cervical dislocation
Shaken baby syndrome
Traumatic asphyxia
Neo-Hippocratism