A.T lives in a rural village in sub-Saharan Africa. Her pregnancy had been largely uncomplicated, though her access to antenatal care was limited due to the distance to the nearest clinic. She had attended only two antenatal visits, where her blood pressure and foetal growth were recorded as normal. She delivered her first child at home without complications two years prior.

She went into labour at home and was brought to the local health centre by her family after several hours of contractions. The health centre is small and staffed by a nurse-midwife and a community health worker. On arrival, A.T was fully dilated, and after a short period of pushing, the baby’s head delivered. However, the baby’s shoulders became stuck, and the midwife immediately recognised this as shoulder dystocia when the baby’s head retracted towards Amina’s perineum.

The midwife, aware of the limited resources, quickly called for assistance from the community health worker. They immediately performed the McRoberts manoeuvre by positioning A.T’s legs up and out to widen the pelvis. When the shoulders still did not deliver, the midwife applied suprapubic pressure while instructing Amina to stop pushing briefly. Despite these efforts, the baby remained stuck, so the midwife performed the Woods’ screw manoeuvre, managing to rotate the baby’s posterior shoulder. This successfully freed the anterior shoulder, and the baby was delivered after several tense moments.

The baby, a 4.1 kg (9 lb) male, was born approximately two minutes after the diagnosis of shoulder dystocia. The baby was initially limp and did not cry. The midwife quickly administered basic resuscitation with a hand-held bag-valve mask, which resulted in the baby crying and breathing normally within a minute. The baby had visible bruising on the shoulders but no immediate signs of fractures or nerve injury.
A.T suffered a third-degree perineal tear due to the difficult delivery. The midwife performed the necessary suturing with the limited supplies available, and A.T was closely monitored for any signs of infection or haemorrhage.

A.T and her baby were observed for 48 hours in the health centre. Given the rural setting, the midwife provided education on signs of potential complications and encouraged Amina to return for follow-up care in one week. Due to the history of shoulder dystocia, the midwife advised Amina to seek early antenatal care in future pregnancies and referred her to the nearest hospital for further counselling and management of any subsequent pregnancies.