Figure 8:

A: A common misstep in beginning internal rotational maneuvers is the clinician inserting her dominant hand, regardless of fetal position. Note the clinician is using her right hand to deliver the posterior (left) arm in this simulated delivery. B: Instead, in a shoulder dystocia where the head in left occiput anterior position and the fetus’ back is on the maternal left, the clinician preparing to deliver the posterior arm or perform a corkscrew maneuver is advised to begin with the left hand as pictured (regardless of hand dominance). Although initially awkward, once the posterior shoulder is rotated in clockwise fashion (adducting the shoulder toward the fetal chest) and the clinician’s arm reaches the 7 o’clock position, she has the full range of motion of the left arm to complete either the sweep of the posterior arm across the chest or the full 180-degree clockwise rotation to the anterior position in front of the pubic bone.