Video 4:

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Correct application of suprapubic pressure is from the same side of the mother as the anterior shoulder’s scapula is located. Forward pressure toward the mother’s opposite side applied firmly with a fist or heel of the hand behind the anterior shoulder directs the shoulder off midline to an oblique orientation within the pelvis. The locus of pressure is directly above the pubic bone, neither fundal nor directly on the pubic bone; pressure is directly laterally and not vertically as the latter may lead to clavicle or ipsilateral humeral fractures. Since it is an indirect maneuver, suprapubic pressure should be coordinated with performance of Rubin’s maneuver on the anterior shoulder while a second obstetric assist completes the delivery by applying traction to the head.