Does the HELPERR Mnemonic Really Help?

On Behalf of | Oct 21, 2020 | Medical Malpractice

Shoulder Dystocia, or SD, is one of the most common labor and delivery emergencies in Kentucky. If the baby is too large to move down the mother’s narrow birth canal and becomes lodged in it, the umbilical cord keeps moving down. The cord could cut off oxygen supply to the baby’s brain and cause Cerebral Palsy in less than five minutes.

Clearly, the clock is ticking in these situations. When the pressure is on, like many of us, doctors fall back on what they know. In many cases, that’s the outdated HELPERR mnemonic device. Reliance on this principle often causes more harm than it prevents.

Doctors must adhere to a very high standard of care in these situations. Therefore, it is easier for a Lexington personal injury attorney to establish negligence, or a lack of care. Despite what they might claim, physicians are legally responsible for everyone in the delivery room, including nurses and patient care techs. So, the same standard of care applies to everyone. Damages in a medical malpractice claim usually include compensatory damages, for things like medical bills, and substantial punitive damages.

Call for Help

It seems obvious that, faced with an emergency situation, medical professionals would naturally call for help. But in many cases, this first reaction runs contrary to their professional instincts.

Nurses often do not summon help because, in many hospitals, asking for help is a sign of weakness. Nurses and other non-doctors are expected to handle such emergencies on their own, even if they clearly lack the tools and training to do so.

Doctors often do not summon help because of professional arrogance. In many cases, confidence and an “I’ve got this” mentality are admirable qualities in a doctor. But in this situation, these attitudes could have lifelong effects for both mother and baby.

Perform an Episiotomy

This second step shows just how outdated the HELPERR mnemonic is. An episiotomy is an incision on the mother’s perineum (area between the anus and genitals) which is designed to widen the birth canal. Once upon a time, doctors performed episiotomies whether the mothers needed them or not. But professional organizations now frown on this procedure. An episiotomy often causes uncontrollable maternal bleeding, both in the L&D room and during recovery.

Other mechanical birth aids are equally as dangerous. Forceps are a good example. These surgical tools resemble large salad tongs. The doctor pinches the baby’s head, arm, or other exposed area, and tries to pull it out of the mother. Tiny newborns are so delicate that this additional force sometimes causes unspeakable injuries to the child.

Adjust the Mother’s Legs

This step refers to the McRoberts Maneuver. Two or more people take the mother’s legs out of the stirrups and elevate them above her head, with her knees at roughly a 90-degree angle. This change alters gravity effects and often naturally pushes the baby down the birth canal. “Often” is the key word here. The McRoberts Maneuver is successful about 80 percent of the time.

That statistic begs the question of why the McRoberts Maneuver is not further up the list. Since it is often successful and always non-invasive, it should probably be tried earlier. And, since the failure rate is rather high, doctors should have plenty of time to go to Plan B.

Apply Suprapubic Pressure

By this time the five minute clock has probably ticked down to about three minutes. So, these last three interventions are increasingly desperate.

Suprapubic pressure is essentially abdominal CPR. The doctor pushes on the mother’s abdomen in an attempt to force the baby down the birth canal.

Although not technically invasive, suprapubic pressure is quite dangerous to the baby. As mentioned, any pressure could cause a serious injury. So, this random pressure could almost literally crush a baby’s head.

Furthermore, this step is very time-consuming. If the McRoberts Maneuver failed, the mother still has her knees elevated. The doctor must put the mother back in her original position before even attempting suprapubic pressure. As a result, more precious seconds tick away.

Perform Entrance Maneuvers

Entrance maneuvers are an invasive form of suprapubic pressure. The doctor reaches into the mother and twists the baby, hoping to change the baby’s position. If all other similar attempts have failed, this one will probably not succeed. But at this point, it is essentially too late to try anything else.

Remove a Posterior Limb

The final act of desperation involves removing the baby’s arm or leg to reduce its body mass. The thinking is that it is better to go through life with one arm or leg than to go through life shackled by Cerebral Palsy.

Refer the Mother

Arguably, this last step should be the first one. Referring the mother to a birth specialist at the first sign of trouble is by far the best way to prevent birth injuries.

The HELPERR mnemonic usually causes more birth injuries than it prevents. For a free consultation with an experienced personal injury lawyer in Lexington, contact the Goode Law Office, PLLC. We do not charge upfront legal fees in negligence cases.