During labor and delivery, any number of emergencies can occur. One type is shoulder dystocia, which is dangerous for both baby and mother. This occurs when the baby's shoulders get stuck in the birth canal. If the doctor does not respond properly, it may increase the risk of injury. HELPERR is a mnemonic used by obstetricians who encounter this type of complication.
HELPERR: A Tool Used by Obstetricians to Address Shoulder Dystocia
HELPERR comprises maneuvers that assist doctors with delivering the baby:
- H – Help: When standard medical care doesn't get the shoulder unstuck, the doctor should enlist help. While attempting other maneuvers, it's important to gather a team. This could include labor nurses, a pediatrician, a neonatologist and others.
- E – Evaluate for Episiotomy: The obstetrician should evaluate the usefulness of performing an episiotomy. In general, this in itself won't help the shoulder become unstuck. It may only allow more room for the doctor's hand when trying other maneuvers, according to a 2004 article in the journal American Family Physician.
- L – Legs: The McRobert's maneuver is a technique that can help relieve shoulder dystocia. It involves hyperflexing the mother's legs against her abdomen. There is sometimes more successful when combined with the next maneuver.
- P – Pressure: Suprapubic pressure involves placing a hand on the mother's abdomen over the baby’s shoulder. Pressure helps to manipulate the impacted shoulder.
- E – Enter: The obstetrician inserts his/her fingers to perform rotational maneuvers. This may include the Rubin II maneuver and/or the Woods corkscrew maneuver.
- R – Remove: The obstetrician removes the baby's posterior arm. The doctor flexes the elbow and delivers the forearm in a sweeping motion over the chest.
- R – Roll: This involves rolling the mother onto her hands and knees. This change in position sometimes reduces shoulder dystocia.
When these attempts don't work, there are other measures the doctor may take. Doctors who fail to follow an acceptable standard of care in responding to this complication may be negligent and liable for any injuries that result. Consult Jason R. Schultz if an Atlanta doctor may be liable for injuries. Call 404-474-0804.
