8.6  Shoulder presentation

Shoulder presentation is rare at full term, but may occur when the fetus lies transversely across the uterus (Figure 8.7), if it stopped part-way through spontaneous inversion from breech to vertex, or it may lie transversely from early pregnancy. If the baby lies facing upwards, its back may be the presenting part; if facing downwards its hand may emerge through the cervix. A baby in the transverse position cannot be born through the vagina and the labour will be obstructed. Refer babies in shoulder presentation urgently.

Do not attempt to turn a sideways lying baby. Unless a trained physician or midwife can turn the baby ‘head down’, it must be delivered by caesarean surgery.

Figure 8.7  Transverse lie (shoulder presentation). This baby cannot descend through the birth canal.