Gaskin Maneuver: A Safe Technique for Relieving Shoulder Dystocia
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is the Gaskin maneuver, often called the all fours method?
The Gaskin maneuver, often called the all fours method, is a technique used during vaginal delivery to resolve shoulder dystocia, when a baby's shoulder becomes wedged behind the mother's pelvic bone. [1] Moving the mother onto her hands and knees increases space in the pelvis to free the shoulder. [1] It is low-risk and often avoids more invasive procedures. [1]
What the research says
Most cases resolve quickly with the all-fours position alone. In a registry of 82 consecutive shoulder dystocia cases managed primarily with the all-fours maneuver, 68 women (83%) delivered without any additional maneuvers, the average time from diagnosis to delivery was 2.3 minutes, and there was no maternal or perinatal death. Morbidity occurred in only 4 deliveries, all with birth weights above 4,500 g (Bruner et al., J Reprod Med, 1998). [2]
Awareness among clinicians has been limited. In a survey of physicians in the Middle Tennessee region, the most commonly used methods for shoulder dystocia were episiotomy, the McRoberts maneuver, and suprapubic pressure, and only 8% reported knowing and using the all-fours maneuver, which is why the authors called for educational programs (Drummond et al., Tenn Med, 2000). [3]
Training providers matters. A systematic review reported that mastery of shoulder dystocia management skills through simulation training can reduce neonatal brachial plexus injury by 66% to 90%, although the link between simulation drills and fewer clinical injuries has been inconsistently replicated (Gurewitsch Allen, Simul Healthc, 2018). [4]
The Challenge of Shoulder Dystocia
During the final stages of labor, unexpected challenges can arise that require immediate and skillful intervention. The Gaskin maneuver stands as a vital tool for birth professionals, offering a physical solution to one of the most stressful complications of delivery.
Shoulder dystocia occurs in a small percentage of vaginal deliveries and represents a medical emergency that requires prompt action. It happens when the baby's head has been delivered, but the shoulders remain trapped inside the mother's body, usually behind the pubic bone. [1] This obstruction prevents the baby from moving further down the birth canal and can lead to serious complications if not resolved quickly. The Gaskin maneuver addresses this by using gravity and maternal positioning to create the necessary space for the baby to pass.
Delivery Phase | Standard Position | Gaskin Maneuver Position |
Maternal Stance | Lying on back (lithotomy) | Hands and knees (all-fours) |
Pelvic Impact | Standard pelvic opening | Widened pelvic diameter |
Gravity's Role | Neutral or resistive | Assists in dislodging the shoulder |
Provider Access | Frontal access | Access from multiple angles |
Step-by-Step Procedure
When a provider identifies shoulder dystocia, they may choose to implement the Gaskin maneuver as an initial step. The process begins with rolling the mother from her back onto her hands and knees. [1] In many cases, this simple change in position is enough to resolve the dystocia. [2] If the shoulder remains stuck, the mother may be asked to lift one leg into a "runner's lunge" position, which further expands the pelvic bones. [1] If these postural changes are insufficient, the provider may then use manual techniques to rotate the baby's shoulder. [1]
Safety and Clinical Benefits
One of the primary advantages of the Gaskin maneuver is its inherent safety. [1] [2] Unlike some other emergency delivery techniques, it does not involve applying external pressure to the mother's abdomen, which can sometimes worsen the impaction. Because it relies on natural movement and gravity, it is considered a low-risk intervention. Furthermore, successfully using the Gaskin maneuver can prevent the need for more invasive procedures, such as an emergency C-section or a symphysiotomy. [1]
The Legacy of Ina May Gaskin
Named after the renowned midwife Ina May Gaskin, who introduced the technique to modern obstetric practice, the maneuver reflects a commitment to physiological birth. It honors the body's natural ability to adapt during labor while providing a structured clinical response to a dangerous situation. It is taught to doctors and midwives as one of the options available in emergency obstetric care.
Conclusion
The Gaskin maneuver is an example of a simple intervention in maternal healthcare. By using maternal positioning to overcome the physical hurdle of shoulder dystocia, it provides a safe and often effective path forward for families in the midst of a delivery emergency. While no one hopes for complications during birth, knowing that such techniques exist can provide peace of mind to those approaching their delivery date.
For more information on preparing for a safe delivery and understanding various childbirth techniques, explore our library of maternal health resources.
Talk to your provider: Ask your obstetrician or midwife during prenatal visits which shoulder dystocia maneuvers their team is trained to use.
Frequently Asked Questions
Is the Gaskin maneuver painful for the mother?
The maneuver itself is not inherently painful, though moving into the all-fours position while in active labor can be physically demanding and uncomfortable.
Can the Gaskin maneuver be used with an epidural?
The Gaskin maneuver is more challenging to perform with an epidural due to reduced leg mobility, but with the assistance of the healthcare team, a mother can still be moved into the necessary positions.
Who was the Gaskin maneuver named after?
The Gaskin maneuver was named after Ina May Gaskin, a prominent American midwife who popularized the "all fours" technique after observing its success in traditional birth settings.
What happens if the Gaskin maneuver doesn't work?
If the maneuver is unsuccessful, healthcare providers will immediately move on to other techniques, such as manual rotation of the baby or, in rare cases, surgical interventions. [1]
How quickly must shoulder dystocia be resolved?
Shoulder dystocia is a time-sensitive emergency because the baby's chest is compressed, preventing normal breathing; providers typically aim to resolve it within a few minutes.
Does the Gaskin maneuver require special equipment?
No special equipment is needed, making it a highly accessible technique that can be performed in any delivery setting, including at home or in a hospital.
Can I request the Gaskin maneuver in my birth plan?
Yes, you can discuss your preference for physiological positions and emergency maneuvers like the Gaskin technique with your provider during prenatal visits.
Is the Gaskin maneuver common in hospitals?
Many hospitals still prioritize the back-lying position, and the all-fours maneuver is one of several emergency options that providers may be taught to use for shoulder dystocia. Ask your provider which maneuvers their team is trained in.
Are there any risks to the baby during the maneuver?
The maneuver itself is very safe for the baby; the primary risks are associated with the underlying shoulder dystocia, not the technique used to resolve it.
How does the "runner's lunge" help?
The lunge position creates an asymmetrical opening in the pelvis, which provides the maximum possible space for the baby's shoulders to navigate the pelvic bones.
Content reviewed and produced following the Rinnit editorial framework. Last updated: October 8, 2026.
Related Reading
McRoberts Maneuver: How It Frees a Stuck Shoulder During Birth, Steps, Success Rates, and Risks describes the first-line maneuver used to free a stuck shoulder.
Brachial Plexus Injury: Symptoms, Causes, and Treatment explains nerve injury that can follow a difficult birth.
Understanding Vaginal Delivery covers the stages of vaginal birth and recovery.
Understanding the Three Stages of Labor explains what happens in each stage of labor.
References
Cleveland Clinic. Gaskin Maneuver. Cleveland Clinic Health Library. Medically reviewed; last updated February 1, 2024. https://my.clevelandclinic.org/health/treatments/gaskin-maneuver
Bruner JP, Drummond SB, Meenan AL, Gaskin IM. All-fours maneuver for reducing shoulder dystocia during labor. J Reprod Med. 1998;43(5):439-443. PMID: 9610468. PubMed: pubmed.ncbi.nlm.nih.gov/9610468
Drummond SB, Bruner JP, Reed GW. Management of shoulder dystocia. Tenn Med. 2000;93(9):331-333. PMID: 10998970. PubMed: pubmed.ncbi.nlm.nih.gov/10998970
Gurewitsch Allen ED. Simulation of shoulder dystocia for skill acquisition and competency assessment: a systematic review and gap analysis. Simul Healthc. 2018;13(4):268-283. PMID: 29381590. DOI: 10.1097/SIH.0000000000000292
Medical disclaimer
This article provides general information and is not a substitute for professional medical advice. Always consult a qualified healthcare provider about your birth plan and any delivery concerns.
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