Fetal manipulation for management of shoulder dystocia

Many authors assert that there is essentially nothing that can be done to better manage shoulder dystocia. They will point to injuries that have been proven to occur spontaneously and to a stable or even rising injury rate over the last decade and claim: 1 that the risk of injury cannot be reduced 2 that no manoeuvre has been proven superior to another or guaranteed to work in all circumstances 3 that the choice and sequence of specific shoulder dystocia manoeuvres beyond McRoberts' should be left to the discretion of the birth attendant 4 that the predominant concern during shoulder dystocia is its expedient resolution, by whatever means necessary, to avoid central nervous system damage or even death.