Despite modern advances in medicine, childbirth can still be dangerous for both mother and child. One particular risk is that of an impacted foetal head injury.
An impacted fetal head generally occurs in an emergency caesarean section attempted during the second stage of labour. In this second stage, the mother’s cervix has already opened to 10cm and is fully dilated. As this is immediately before the mother gives birth, the baby’s head has by this point descended down into the mother’s pelvis and it is far more difficult and dangerous to perform the C-section.
Even experienced obstetricians can have problems delivering the baby in these circumstances as they will need to act quickly to dislodge the impacted fetal head from the pelvis. Little or no room between the pelvis and the baby’s skull means that this is an extremely challenging situation
With a growing number of caesarean sections being carried out in the UK, which now accounts for 25% of births, and second stage C-sections accounting for 2% of births, fetal head impaction is a serious situation facing medical professionals.
Damage Caused by an Impacted Fetal Head
The most common cause of injury to a child with an impacted head is the pushing on the baby’s head in an attempt to dislodge it from the pelvis. This is most often done through a ‘push’ technique, where the attending medical professional attempts to place their hand between the mother’s pelvis and baby’s skull, while an assistant pushes up via the vagina. As a baby’s skull is very fragile this force can lead to serious injuries such as skull fractures, intracranial haemorrhage, and hypoxic brain injuries (resulting from depriving the child of oxygen). Oxygen deprivation may result in permanent brain damage, or even death.
Such an intrusive procedure can also be extremely traumatic to the mother. Maternal injuries can include serious birth tears, uterine tears, damage to the uterine artery, bladder injuries, bowel injuries, or haemorrhages, as well as difficulties with future pregnancies.
The significant risks associated with this complex birth procedure necessitates a very high standard of training. Unfortunately a large number of junior obstetricians are forced to deal with this emergency with no prior training, and a national survey found that 60% of obstetricians below consultant level had received no training at all.
Case Studies of impacted fetal head injury
Zhang v Homerton
In this case the court ruled in favour of the Claimant, and found that Homerton University Hospital had engaged in inappropriate, dangerous and negligent manoeuvres during the birthing process. The Defendant had attempted to dis-impact the fetal head from its lodged position by pushing up from below and this was deemed to be a negligent technique.
Following this negligent childbirth procedure, the baby tragically suffered a subgaleal haemorrhage (bleeding between the scalp and the skull in addition to a depressed fracture to its right parietal bone and then had an inter-cranial haemorrhage, resulting in permanent brain damage. Following the ruling in favour of the Claimant the hospital was required to pay substantial damages and associated costs.
Nixon Tonking died shortly after childbirth in 2014 due to injuries caused by an impacted fetal head. After his death there was an inquest into the incident, with a case overview being used to introduce new procedures in an attempt to reduce the likelihood of the same mistakes being repeated.
The injuries Nixon Tonkin received included skull fractures, subdural and subarachnoid haemorrhages, and brain swelling. These injuries were most likely caused by the attending midwife when she pushed up with two fingers via the vagina, to attempt to dis-impact Nixon’s head during the C-section. The baby died shortly after birth and the coroner’s inquest found that the actions of the midwife was the most likely reason for the baby being unable to breathe unassisted from birth.
Following the inquest, new measures were introduced by the NHS. The use of cupped hands or a fetal pillow, or alternative techniques such as a reverse breach extraction, have replaced the use of fingers when attempting to dis-impact a child’s head. Training has also been increased for these types of emergency and experienced consultants must now be present if they are anticipating an impacted head caesarean section.
Measures Being Taken to Improve Safety During Childbirth
High profile cases such as the two above have revealed the need for further research into impacted fetal heads injuries in order to prevent further injuries and deaths.
In March 2019, the MIDAS study of Impacted Fetal Head at Caesarean Section began a six-month surveillance study using the UK Obstetric Surveillance system. The goals of this study were to identify:
- how many second stage labour C-sections involving an impacted fetal head were being carried out in the UK;
- what circumstances led to these;
- any identifiable risks associated with these circumstances;
- what techniques were used to dis-impact the fetal head; and
- what trauma these techniques caused to both mother and child.
Further research will help medical professionals increase their understanding of this situation and the best techniques to use when managing an impacted fetal head. Currently there are no formal ‘best practice’ NHS guidelines for this complex and risky procedure, other than to avoid the use of fingers on the baby’s skull. This lack of clear guidance could potentially be a factor in further birth injuries and fatalities.
Compensation for negligence during childbirth
If you feel that the care you or your child received prior to, during or after birth was negligent, you may decide to bring a claim in order to secure justice and compensation for yours and your child’s injuries. Speak to one of our medical negligence solicitors who specialise in birth injuries.
Devonshires Claims support victims of medical negligence by providing:
- A free no-obligation case evaluation
- A no win no fee agreement
- A network of medical experts and specialist medical negligence barristers
- Over 20 years’ experience in securing justice and compensation