Step 1. The top of the uterus (fundus) is felt (palpated) to establish which end
of the fetus (fetal pole) is in the upper part of the uterus. If either the head
or breech (buttocks) of the fetus are in the fundus then the fetus is in
vertical lie. Otherwise the fetus is most likely in transverse lie.
Step 2. Firm pressure is applied to the sides of the abdomen to establish the
location of the spine and extremities (small parts).
Step 3. Using the thumb and fingers of one hand the lower abdomen is grasped
just above the pubic symphysis to establish if the presenting part is
engaged. If not engaged a movable body part will be felt. The presenting part is
the part of the fetus that is felt to be in closest proximity to the birth
Step 4. Facing the maternal feet the tips of the fingers of each hand are
used to apply deep pressure in the direction of the axis of the pelvic outlet.
If the head presents, one hand is arrested sooner than the other by a rounded
body (the cephalic prominence) while the other hand descends deeply into the
pelvis. If the cephalic prominence is on the same side as the small parts, then
the fetus is in vertex presentation. If the cephalic prominence is on the same
side as the back , then the head is extended and the fetus is in face