title: Two-step delivery may avoid shoulder dystocia: head-to-body delivery interval is less important than we think.
abstract: A belief that prolonged head-to-body delivery interval endangers the newborn underpins the common obstetrical practice of delivering the baby's trunk immediately after the head is born. Without intervention, however, birth typically occurs in two steps: once the fetal head is delivered there is usually a pause, and the rest of the infant is born with the next contraction. Allowing a two-step delivery does not increase the risk of fetal harm, and may lower the incidence of shoulder dystocia. A two-step approach to delivery should be considered physiologically normal. This has implications for the definition of shoulder dystocia.
authors.affiliation: Department of Obstetrics, Stanton Territorial Hospital, Yellowknife NT; School of Population and Public Health, University of British Columbia, Vancouver BC.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kotaska
authors.affiliation: Division of Midwifery, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver BC.
authors.forename: Kim
authors.initials: K
authors.lastname: Campbell
mesh_terms: D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D004420:Dystocia / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012782:Shoulder
keywords: head-to-body interval; hypoxic ischemic encephalopathy; shoulder dystocia; two-step delivery