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“Turtle sign” indicates shoulder dystocia, an obstetric emergency where the anterior shoulder is impacted behind the pubic symphysis. The first-line maneuver is McRoberts: hyperflex the mother’s hips onto the abdomen to straighten the lumbosacral angle, which often frees the shoulder. Apply firm suprapubic pressure directed posteriorly and laterally to dislodge the anterior shoulder—never fundal pressure, which worsens impaction and risks uterine rupture. Episiotomy does not relieve bony impaction and is not a prehospital maneuver. Pulling on the head risks brachial plexus injury (Erb palsy). Additional steps, if needed and trained, include delivery of the posterior arm or rotational maneuvers (Rubin/Woods). Paramedic obstetric objectives stress calling for additional help, timing/documentation, avoiding excessive traction, and preparing for neonatal resuscitation due to potential hypoxia. After resolution, assess mother for hemorrhage and newborn for compromise. Prompt, sequential application of evidence-based maneuvers improves outcomes for both patients.