Gaskin Maneuver

Overview

The Gaskin maneuver is a simple change of position used during childbirth when a baby's shoulder gets stuck after the head has come out. This problem is called shoulder dystocia (say: shoul-der dye-STOH-sha) — it means the baby's shoulder is caught behind a bone in the parent's pelvis. In the Gaskin maneuver, the birthing parent turns onto their hands and knees. This changes the shape and angle of the pelvis, which can make room and free the stuck shoulder so the baby can be born. It is named after Ina May Gaskin, a well-known midwife who described it.

Shoulder dystocia happens in fewer than 2 in 100 vaginal births. The hands-and-knees position is one of the standard first steps used to deal with it, so most midwives and doctors are trained and ready to act quickly.

It can happen in any birth, including a first birth. It is a little more likely if the baby is larger than average, if the parent has diabetes in pregnancy, if a previous birth had the same problem, or if the birth needs help from forceps or a ventouse (a suction cup). Many cases happen in births with none of these things.

Symptoms

Common symptoms

• The baby's head has come out, but the rest of the body does not follow within the usual few seconds.
• The baby's head may seem to pull back slightly against the perineum (the area between the vagina and the back passage). This is sometimes called the 'turtle sign'.
• You may feel strong pressure and a need to push, but the baby does not move forward.
• Your midwife or doctor may suddenly call for extra help and ask you to change position. This is part of a planned, practiced response.

Symptoms in children

• Most newborns are completely well after this happens.
• Some babies are born with one arm that looks weak or does not move as much as the other — this is usually a stretched nerve and most recover fully.
• Some babies have a broken collarbone or bruising, which heals with time.
• Your baby will be checked carefully straight after birth for breathing, movement in both arms, and colour.

Symptoms in older adults

• The Gaskin maneuver is only used during childbirth, so it does not apply to health problems later in life.
• Birthing parents in their late 30s and 40s may have a higher chance of diabetes in pregnancy and larger babies, which are linked to shoulder dystocia, so it is worth discussing your risk with your midwife.

Causes

Main causes

• After the head is born, the baby's front shoulder catches behind the pubic bone (the front part of the pelvis) instead of slipping through.
• Sometimes the baby's position, or the shape and size of the pelvis, means the shoulder cannot pass easily.
• Often there is no clear cause, and it cannot be predicted in advance.

Risk factors

• A baby that is larger than average.
• Diabetes in pregnancy (gestational diabetes), especially if blood sugar levels have been high.
• Shoulder dystocia in an earlier birth.
• Being overweight at the start of pregnancy, or gaining a lot of weight during pregnancy.
• Labour that is started off (induced) or speeded up, or a birth helped with forceps or a ventouse.
• A long pushing stage, or going well past your due date.

When to see a doctor

See a doctor urgently if:

• Your baby's arm seems weak or still does not move normally after a few days.
• Heavy bleeding, fever, or pain that is getting worse after birth.
• You feel very low, anxious, or unable to cope in the weeks after the birth.

Book a routine appointment if:

• You had shoulder dystocia in a previous birth and want to talk about planning another pregnancy.
• You have diabetes in pregnancy or a scan suggests a larger baby — ask your team what this means for your birth.
• You would like time to talk through what happened during your birth with a midwife or doctor.

Diagnosis

There is no test that can tell for certain whether shoulder dystocia will happen. It is recognised at the moment of birth by your midwife or doctor, based on what they see and feel — the head is out, but the body does not follow. After the birth, the team checks both you and your baby carefully.

Tests that may be done

• Ultrasound scans to estimate the baby's size (helpful for planning, but not accurate enough to predict shoulder dystocia).
• Blood sugar tests in pregnancy to check for gestational diabetes.
• After birth, a careful physical check of your baby's arms, collarbones, movement, and breathing.
• If an arm seems weak, a referral to a specialist baby or nerve team for further checks.

What to expect at your appointment

During the birth, your care team will act quickly and calmly. They will ask you to change position, call for extra help, and explain what they are doing. You may see several staff arrive at once and hear clear instructions. Afterwards, someone will talk you through what happened and arrange checks for you and your baby.

Treatment

Treatment means freeing the baby's shoulder quickly and safely. The Gaskin maneuver — turning onto hands and knees — is one of the first things teams try. Other steps can be used on their own or together. The aim is to make more room in the pelvis so the baby can be born.

Self-care at home

• Follow your midwife's or doctor's instructions — they will guide you through each movement step by step.
• Turn onto your hands and knees when asked. You may be helped to move, and pillows can be placed under you for comfort.
• Breathe steadily and try not to panic. Your team has practiced this and will stay with you.
• Ask your birth partner to stay close, hold your hand, and speak calmly to you.
• After the birth, rest as much as you can, ask for help with feeding and moving around, and keep your postnatal appointments.

Medical treatments

Care teams follow a set of practiced steps, sometimes called a shoulder dystocia drill. These include calling for extra help, asking you to change position (such as hands and knees or lying on your side), a position where your knees are brought up towards your chest, pressure applied above your pubic bone by a trained person, and if needed, internal movements to turn the baby's shoulders. A small cut to widen the opening (an episiotomy) may be used in some cases. Your team will explain what they are doing as they go, and will discuss pain relief and other options with you.

When is surgery considered?

Surgery is not used to solve shoulder dystocia at the time, because once the head is out the baby needs to be born vaginally. A caesarean (C-section) may be planned for a future birth if you have had shoulder dystocia before and your team thinks the risk is high. Surgery may also be needed afterwards to repair a severe tear.

Living with this condition

Most parents recover well in the weeks after birth, though you may feel sore, tired, and emotional. Your baby will be checked for any arm weakness or injury, and most problems settle with time and physiotherapy. Keep your postnatal checks and any follow-up appointments.

Lifestyle tips

• Build rest into each day and accept offers of practical help in the first weeks.
• Do pelvic floor exercises once your midwife or physiotherapist says it is okay.
• Keep moving gently — short walks can help your circulation and your mood.
• Attend your postnatal checks, your baby's checks, and any physiotherapy appointments.
• Write down questions before appointments so you remember what you want to ask.

Diet and exercise

Eat regular balanced meals and drink enough water, especially if you are breastfeeding. Gentle activity such as walking helps recovery and mood. If you had diabetes in pregnancy, you will usually be offered a follow-up blood sugar test and advice about healthy eating and activity.

Mental health and emotional wellbeing

Some parents feel shaken or frightened after a difficult birth. It is common to replay it in your mind, feel tearful, or feel anxious about a future birth. These feelings are valid and treatable. Talk to your midwife, health visitor, or doctor — a birth debrief, counselling, or peer support can really help. If you ever have thoughts of harming yourself or your baby, contact your local emergency number or a crisis support line straight away.

Prevention

Shoulder dystocia cannot always be prevented, and it often happens with no warning signs. Some things can lower risk or help you feel prepared: keeping blood sugar well controlled in pregnancy, talking with your team about your risk if you have had it before, and planning to give birth where staff are trained to manage it.

Vaccines

There is no vaccine for this. Your midwife will talk with you about the routine vaccines offered in pregnancy, which protect you and your baby.

Screening programmes

You may be offered blood sugar testing for gestational diabetes if you have risk factors, and growth scans may be suggested. These help your team plan your care, but they cannot predict shoulder dystocia for certain.

Complications

If left untreated

• For the baby: a stretched nerve in the arm (called a brachial plexus injury), which usually improves over weeks to months; a broken collarbone; and, rarely, a shortage of oxygen.
• For the parent: heavier bleeding, deeper tears, and a higher chance of needing help with future births.
• Emotional effects such as distress, flashbacks, or anxiety about birth.

Long-term outlook

Most cases are resolved quickly, and most babies are born healthy. Most arm nerve injuries heal within a few months, sometimes with physiotherapy. If you plan another birth, your team will talk with you about the safest options and support you in making choices that feel right for you.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.