Emergencies Around Childbirth by Maureen Boyle

Author:Maureen Boyle
Language: eng
Format: epub
Publisher: CRC Press

See Box 8.3, which lists potential maternal adverse outcomes.

ISSUES AROUND MANAGEMENT OF SHOULDER DYSTOCIA

It is important to acknowledge that Hope et al.35 found that the midwife was the lead professional at 65% of births compromised by shoulder dystocia by the time the body was delivered. MacKenzie et al.36 concurs with this with their review of 514 shoulder dystocia cases, where 264 (51%) were managed by midwives alone. In addition, they emphasised effective management of shoulder dystocia relies on prompt recognition in order to minimise the delay in head-to-body birth interval and is aided by a clear understanding of the mechanism that is causing the dystocia. Staff training in the management of shoulder dystocia has been shown to reduce the incidence of adverse outcomes such as brachial plexus injury.37,38 Buerkle et al.39 conducted a randomised controlled trial with midwives to compare the skills of performing a shoulder dystocia algorithm after hands-on training compared with a demonstration and found that the assessment of technical skills was significantly higher after the hands-on training. However, limitations to the study concluded that performance may be different in real-life situations and training success may only be in part transferable to actual emergencies.

In the United Kingdom, pioneering education in emergency training began in June 1996, with the first Advanced Life Support in Obstetrics (ALSO)40 course, which was a systematic, mnemonics-based programme in the management of obstetric emergencies.41 This gathered momentum, with the mnemonic of ‘HELPERR’ (as shown in Table 8.1) becoming central to shoulder dystocia guidelines in many obstetric units, and rapidly expanding courses for skills and drills training were being introduced to assist in the management of shoulder dystocia.

Table 8.1 The ALSO HELPERR mnemonic40

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