During normal vaginal delivery, the accepted method for delivering the baby's shoulder is:
Gentle traction upward on baby's head to deliver the posterior shoulder, then traction downward to deliver the anterior shoulder.
+Gentle traction upward to deliver the posterior shoulder, deliver the posterior arm, then traction downward to deliver the anterior shoulder.
+Hook an index finger in baby's anterior axilla to deliver the anterior shoulder and arm, then gentle traction to deliver the posterior shoulder.
+Gentle traction on baby's neck downward to deliver the anterior shoulder, then traction upward to deliver the posterior shoulder.
+Gentle traction on baby's head downward to deliver the anterior shoulder, then traction upward to deliver the posterior shoulder.
With one hand on the baby's head and while instructing the mother not to push, the covered second hand lifts the chin up posterior to the maternal anus (modified Ritgen maneuver). After delivering the head, palpating the neck for the umbilical cord, and suctioning the airway, both hands are applied to the baby's head and downward traction is applied to deliver the anterior shoulder from beneath the pubic symphysis. Flexing the hips or applying suprapubic pressure may aid in disimpacting the anterior shoulder at this point. After the anterior shoulder appears, gentle upward traction is used to deliver the posterior shoulder (remember: head up-down-up.) Brachial plexus palsies or rectal lacerations may occur if too much force is used.