On the Direction of Axillary Traction in Shoulder Dystocia Management

The article ‘Axillary traction: An effective method of resolving shoulder dystocia’ was published in the Australian and New Zealand Journal of Obstetrics and Gynaecology by Ansell et al. [1]. The authors are to be commended for their work in revitalising and formally describing this valuable technique, which provides a crucial option in the management of this obstetric emergency. Their findings successfully demonstrate its efficacy as a primary manoeuvre. Our team has been developing and implementing a technically similar approach that also utilises axillary traction. However, we wish to highlight a critical distinction in the proposed vector of traction that we believe offers a significant biomechanical advantage. While Ansell et al. instruct to ‘apply axillary traction to follow the curve of the sacrum’ (an inherently downward direction), our modified technique advocates for the application of steady traction in a superior and lateral direction (i.e., upwards and outwards towards the maternal abdomen) (Figure 1). We acknowledge the excellent outcomes reported by Ansell et al. using their technique. Nevertheless, we posit that a conscious emphasis on a superior-lateral traction vector could enhance the efficiency and effectiveness of the axillary traction manoeuvre. In our clinical experience, this modification has consistently resulted in the rapid and controlled resolution of shoulder dystocia. We thank Ansell and colleagues for their important contribution and would be interested to hear their perspective on this technical nuance. We suggest that future studies, perhaps utilising high-fidelity birth simulators, could objectively compare the force required and the time to resolution between these two traction vectors to further refine this vital procedure. This work was supported by Research Team Incubation Project of Minzu Hospital of Guangxi, Zhuang Autonomous Region (Grant MKFY202401). The authors declare no conflicts of interest. No data were used to support this study.