Which maneuver is generally attempted first when dealing with shoulder dystocia?

The McRoberts maneuver is generally the first technique attempted when managing shoulder dystocia because it effectively alters the maternal pelvic anatomy to create more space for the fetal shoulders to pass through. This maneuver involves the mother bringing her knees up towards her chest, which can increase the angle of the pelvic inlet and potentially relieve the shoulder obstruction.

This position helps in flattening the lumbar spine and rotating the pelvis, enabling the impacted shoulder to move past the pubic symphysis more easily. Given that shoulder dystocia can be a critical situation requiring immediate action, starting with a simple yet effective maneuver like McRoberts can dramatically improve the chances of resolving the issue without further complications.

Other maneuvers, such as the Zavanelli maneuver, which involves pushing the fetus back into the uterus and performing a cesarean section, are usually considered only after simpler attempts have failed. The Fundal pressure technique is not advisable as it can worsen the situation, and the Suprapubic pressure technique, while helpful, is often used in conjunction with the McRoberts maneuver rather than as a primary step.