What is the role of maternal positioning in the management of shoulder dystocia?

The role of maternal positioning in the management of shoulder dystocia is primarily to create more space in the pelvis and facilitate shoulder rotation. When a shoulder dystocia occurs, the fetal shoulder becomes lodged behind the maternal pubic symphysis. By changing the mother's position, the pelvis can be altered in ways that may help free the impacted shoulder.

Positions such as the McRoberts maneuver, where the mother's knees are brought up toward her chest, or the use of all-fours position have been shown to provide the leverage needed to assist in the rotation and ultimately the delivery of the baby's shoulders. These positional changes can help to reduce the angle and improve the biomechanics involved in the delivery process, which is crucial during an event of shoulder dystocia.

Other options do not directly address the specific mechanical and spatial challenges presented by shoulder dystocia, focusing instead on aspects less directly related to the immediate management of the situation. For instance, while maternal anxiety and pain management are important considerations in labor overall, they do not significantly impact the physical maneuvers needed to resolve shoulder dystocia.