Shoulder dystocia: A qualitative exploration of what works
Midwifery Volume 28, Issue 4 , Pages e521-e528
The authors sought to explore expert practitioners’ methods of managing shoulder dystocia through a qualitative interpretive study which enabled a descriptive, hermeneutic analysis of data collected. Data were collected via tape recorded interviews, transcribed and analysed to explore themes and meanings.
Participants five clinicians (four midwives and one obstetrician) who have significant experience in the management of shoulder dystocia and work in high risk maternity practice were interviewed by the authors.
Key findings
• the management of shoulder dystocia has been influenced by HELPERR, so that practitioners are led to believe they should follow the sequence of the mnemonic,
• in the reality of experience, some manoeuvres of HELPERR are difficult, if not impossible, to perform,
• in moments of trying ‘anything’ practitioners have discovered the manoeuvre of axillary traction, and
• axillary traction is a simpler and more effective manoeuvre to perform in any circumstance, than the sequence of manoeuvres suggested in HELPERR.
Axillary traction was identified by the participants as being a ‘way that works’ when managing shoulder dystocia that does not respond to McRoberts manoeuvre and suprapubic pressure. Once shoulder dystocia occurs it is important to focus on moving the baby rather than pulling on the baby. If McRoberts and suprapubic pressure manoeuvres are unsuccessful however, the authors suggest that practitioners could consider the use of axillary traction to move the foetal shoulders as follows by applying axillary traction to follow the curve of the sacrum which should result in the anterior foetal shoulder will pivoting around the symphysis pubis and the posterior shoulder will be delivered first.
The practitioners in the study found that axillary traction had been the manoeuvre they found most successful and they did not need to resort to anything else. If it is not successful at the first attempt, however, then it would be appropriate to move the woman into the all – fours position and attempt axillary traction again. it is suggested that three simple steps of McRoberts – Suprapubic Pressure – Axillary Traction could simplify the way in which shoulder dystocia is managed.
According to the authors the results of this study demonstrate that the actions to be taken in the event of shoulder dystocia should be further examined and possibly reviewed. The three simple steps of McRoberts Manoeuvre – Suprapubic Pressure – Axillary Traction could revolutionise the way in which shoulder dystocia is managed. This study however is based on the opinions and experiences of only five practitioners, asking the same questions to more practitioners, including those from different countries, could be helpful.