Birth Injuries – Impacted Head Caesarean Section Claims

Research shows that approximately one in four women give birth by caesarean section and about five in a hundred of these operations are done near the end of labour when the neck of the womb is fully open and the head has already entered the pelvis, but is stuck on the bony structures.

Caesarean sections occurring in the second stage of labour can be complicated by the impaction of the fetal head, which can lead to injury to both mother and baby. The second stage of labour starts when the cervix has opened to 10cm and is fully dilated.

It is estimated that around 5% of all caesarean sections are carried out under emergency circumstances in the second stage of labour. Delivery by emergency caesarean section in the second stage of labour has a far greater risk of complications.

If the delivery by caesarean section happens after the cervix is fully dilated, this is a much more complex procedure for the doctors.

If the baby’s head is deeply wedged (impacted) in the woman’s pelvis it can be difficult to lift it up to allow delivery of the baby’s head at caesarean to occur. This can result in tears to the womb and vagina, and can cause bleeding for the mother.

It can also cause serious problems for the baby, such as broken bones and brain damage from a lack of oxygen. The surgeon needs to act quickly to deliver the baby and avoid risk of serious injury to the brain, but must also take great care to avoid injury to the mother’s uterus in the process.

Commonly suffered injuries to the baby include:

• Skull fracture
• Intracranial haemorrhage
• Hypoxic (oxygen deprivation) brain injury
• Death

Common injuries to the mother include:

• Uterine tears
• Damage to the uterine artery
• Haemorrhage
• Bladder and bowel injuries

Increase in impacted head caesarean section negligence claims

Negligently managed caesarean sections in the second stage of labour can lead to compensation claims for the injuries suffered, and these claims are on the rise.

Research has shown that over 60% of training grade obstetricians have had no training for handling the delivery of a baby where impacted fetal head has occurred. In reality, this means that many junior obsetricians are dealing with this kind of emergency delivery for the first time with no prior training.

There is currently no national guidance on the management of impacted fetal head at caesarean section.

MIDAS study of Impacted Fetal Head at Caesarean

Research is underway and in March 2019, a MIDAS study of Impacted Fetal Head at Caesarean commenced. The objective was to determine the incidence and consequences of impacted fetal head at the time of caesarean section at full dilation in the UK.

With better understanding of the statistics and incidences, better research and training can perhaps follow.

However, there clearly needs to be more in-depth consideration of providing guidance on management of fetal head at caesarean section to obstetricians and NHS Trusts in order that the incidences can potentially be reduced.

It will be very interesting to see how this area of obstetrics develops and, importantly, how the training and guidance to allow doctors to provide consistent and high level care in these circumstances will improve.