Normal Delivery of the Shoulders: Active or Expectant Attitude?

Little emphasis has been placed on the delivery of the shoulders in the normal situation. An active approach whereby the shoulder is pulled down immediately following the birth of the head may lead to some unexpected trauma of the shoulder girdle. On the other hand awaiting spontaneous delivery of the shoulders may lead to a significant prolongation of the birth process and possibly fetal distress. We have studied these 2 methods of delivery in 100 pregnancies and have compared neonatal apgar scores and cord blood acid base parameters. The mean time from delivery of the head to expulsion of the body was 18 s (range, 4 to 40 s) in the active group, and 50 s (range, 9 to 150 s), in the expectant group. This difference was statistically significant (P < 0.0001). The mean 1 and 5 min apgar scores as well as the mean cord artery and vein blood parameters of acid base status were similar in the 2 groups. The results demonstrate that prolongation of the expulsion process in order to achieve spontaneous delivery ...