McRoberts Maneuver for Shoulder Dystocia
The McRoberts maneuver is the first-line intervention for shoulder dystocia, involving hyperflexion of the mother's legs tightly to her abdomen to rotate the maternal pelvis and free the impacted anterior fetal shoulder from behind the pubic symphysis, allowing delivery of the shoulders and body. 1, 2
What the Maneuver Accomplishes
When the phrase "delivered shoulders and body with McRoberts" appears in documentation, it means the baby's anterior shoulder was successfully freed from behind the mother's pubic bone using this positioning technique, allowing the remainder of the delivery to proceed. 1
The maneuver works by:
- Rotating the maternal pelvis to flatten the sacral promontory 1
- Lowering the fetal head in the umbilical-coccygeal axis 1
- Increasing the functional diameter of the pelvic outlet to dislodge the impacted shoulder 3
Success Rates and Clinical Context
The McRoberts maneuver alone successfully resolves shoulder dystocia in 42% of cases when used as the sole intervention. 3 In clinical practice, success rates may be even higher (88.2%) when combined with routine suprapubic pressure. 4
Cases requiring only McRoberts are associated with:
- Lower mean birth weights 3
- Shorter active phase of labor 3
- Shorter second stage of labor 3
- Decreased maternal and neonatal morbidity compared to cases requiring additional maneuvers 3
Proper Technique
The patient must be positioned supine to ensure optimal effectiveness of the McRoberts maneuver. 1 The American College of Obstetricians and Gynecologists recommends applying suprapubic pressure simultaneously with McRoberts positioning to help dislodge the anterior shoulder. 1, 2
Critical pitfall: Pressure must be applied correctly (using more than 1-2 fingers) to avoid further deflexion of the fetal head, which could compound impaction behind the pubic symphysis. 1
When McRoberts Fails
If McRoberts with suprapubic pressure is unsuccessful, the American College of Obstetricians and Gynecologists recommends proceeding sequentially to: 1
- Rubin maneuver
- Wood's screw maneuver
- Delivery of the posterior arm
The specific maneuver chosen matters less than the duration of dystocia—neonatal injury rates reflect severity rather than maneuver choice. 2, 5