34 yo G4P3 at 39 6/7 weeks, pregnancy complicated by gestational diabetes, controlled with glyburide.  EFW 9 lbs.

Presents in active labor, progresses well to complete at 2230.

Pushes x 45 minutes:

Any special preparation you want before delivery? *

At delivery, head comes out to eyebrows and then perineum has to be  “milked” down the face

Turtle sign

What do you do?

A nice review of maneuvers:

Military website describing the maneuvers

And the maneuver they left out: Gaskin

So baby is delivered, cries spontaneously and is placed onto maternal abdomen.

What are next steps?

Placenta delivers spontaneously, followed by some clots, but then steady heavy bleeding.

Pitocin is already running.

What do you do?

*  (empty bladder, coaches/leg holders/nurse prepared, stool in place)