Shoulder dystocia: A qualitative exploration of what works

Objectiveto explore expert practitioners' methods of managing shoulder dystocia.Design and settinga qualitative interpretive study enabled a descriptive, hermeneutic analysis of data collected. Data were collected via tape recorded interviews, transcribed and analysed to explore themes and meanings.Participantsfive clinicians (four midwives and one obstetrician) who have significant experience in the management of shoulder dystocia and work in high risk maternity practice.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.Implications for practicethe 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.