What is the first step in managing shoulder dystocia during delivery?

Managing shoulder dystocia effectively starts with the McRoberts maneuver, which involves flexing the maternal hips toward the abdomen. This maneuver alters the pelvic angle, increasing the space in the birth canal and facilitating the release of the impacted shoulder. It is a non-invasive technique that can often resolve the situation without additional interventions, making it a primary step in emergency protocols for shoulder dystocia.

Other interventions, such as calling for additional medical staff, may be necessary later if the situation does not improve, but immediate action to alleviate the dystocia is crucial. Performing an episiotomy is generally not recommended as a first step in shoulder dystocia management because it does not directly address the problem and can introduce additional complications. Similarly, applying fundal pressure may worsen the situation by increasing the shoulder's impaction rather than relieving it.

Therefore, initiating the McRoberts maneuver as the first response is the most evidence-based approach to manage shoulder dystocia, prioritizing both the safety of the mother and child during delivery.