A baby is born in a hospital with an epidural....he come out with a nuchal hand as well as a nuchal cord.

A typical monitoring strip. The top jagged line (in the blue tinted area) is the fetal heart tones. Notice that they are variable between 120 beats per minute and 150 beats per minute. (normal heart rate is 120-160 bpm). the bottom line with 'hills' is the contraction monitor. Each hill is a uterine contraction. Each red vertical line represents one minute. So this mom is having strong contractions every three contractions (with some "piggy back" contractions, as represented by the two VERY close 'hills' on the right side)

The head is fully crowned and begins to emerge. The white "thing" on the baby's head (by the doctor's index finger) is an internal fetal monitor that is screwed into the baby's scalp to monitor the baby's heartrate internally.

The head begins to slip out.

The head is out, and already the baby opens his eyes to look around. Fluid spills out around the baby's head, and a hand appears right by his ear. (you can see his fingers anteriorly, by the doctor's left hand)

The doctor suctions the baby's mouth before the baby is born.

Mom reaches down as the baby is about to slip out. The baby's right arm crosses his body, and his right hand is born with the head.

As the baby slips into the world, he takes his first breath and greets his mom with a cry. The umbilical cord is looped around his neck like a necktie.