A 28-year-old G1 P0 female presents in active labor after an uncomplicated pregnancy. She progressed adequately in labor, getting an epidural at 6cm dilatation. After delivery of the fetal head, the head partially withdraws back into the birth canal (turtle head) and this was immediately noted. A modified McRoberts’ maneuver was done with suprapubic pressure without success. This was followed by a Woods’ corkscrew maneuver. Ultimately, delivery of the posterior arm was successful with delivery of the shoulders and trunk of the infant. The infant was noted to have brachial plexus palsy which was ultimately found to be permanent. Because it was a very difficult delivery, the physician wrote a quick note and went to the nursery to check on the baby. Unfortunately, the documentation by the physician did not include the procedures that were done and in what order, and did not mention which shoulder was anterior.
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