Shoulder dystocia: when to use suprapubic or fundal pressure.

"The delivery of the head with or without forceps may have been quite easy, but more commonly there has been a little difficulty in completing the extension of the head. The hairy scalp slides out with reluctance. When the forehead has appeared it is necessary to press back the perineum to deliver the face ... time passes. The child's head becomes suffused. It endeavors unsuccessfully to breathe. Abdominal efforts by the mother or by her attendants produce no advance; gentle head traction is equally unavailing. Usually equanimity forsakes the attendants. They push, they pull. Alarm increases. Eventually by greater strength of muscle or by some infernal juggle, the difficulty appears to be overcome, and the shoulders and trunk of a goodly child are delivered. The pallor of its body contrasts with the plum-colored cyanosis of the face, and the small quantity of freshly expelled meconium about the buttocks. It dawns upon the attendants that their anxiety was not ill-founded, the baby lies limp and voiceless, and too often remains so despite all efforts at resuscitation".