A shoulder dystocia mnemonic for homebirth.

There are other shoulder dystocia mnemonics to be found on the internet, in obstetric textbooks and in assorted hospital protocols. Clearly there is mileage in the same mnemonic being used throughout hospital-based practice within the UK to avoid any confusion and streamline clinical practice, and the HELPERR mnemonic seems to have assumed this role admirably. However, for the midwife working at home it does not appear to be appropriate because: * it is not in the most useful order; * it does not allow for several other; manoeuvres that midwives have found helpful; * it is not always user-friendly and memorable. It is hoped that this article will prompt debate and discussion around the appropriate management of this rare emergency at home; and that midwives, should they choose, will be able to employ MAGIC R. PSAZZ as their mnemonic of choice in the homebirth setting. However, it is important to end by emphasising that no mnemonic or protocol should ever be more important than the clinical judgement of the clinician, which remains paramount throughout. The precise order of manoeuvres and actions will vary according to the situation and the midwife's communication with the woman, and her analytical and decision-making abilities remain crucial.