6 November 2023
Across the UK there have been increasing rates of caesarean sections with approximately 34% of all pregnancies turning to delivery by caesarean section, with statistics showing 15% of these were elective caesarean and 19% being emergency or unplanned caesarean.
The priority with delivery, whether vaginal or caesarean, is the safety of mum and baby but with caesareans, and particularly emergency caesareans, there are challenges that can place both the baby and the mother at risk. On such challenge is when there is an ‘Impacted Fetal Head’ and statistics show that this can complicate approximately 1 in 10 unplanned caesarean births. This article will explain about what this means and how it can affect mum and baby.
What is it?
Putting it in non-medical jargon, an Impacted Fetal Head is where labour has been prolonged and the baby’s head has become stuck deep in the mother’s pelvis, making it more challenging to deliver the baby. This can lead to an unplanned caesarean birth (or other manoeuvres) to assist with the obstetricians getting the baby out of the mother. It is vital to get the baby out of the pelvis and deliver the head as soon as possible, so as to reduce the risk of the baby becoming distressed and potentially starved of oxygen.
Management of Impacted Fetal Head
When an Impacted Fetal Head occurs, there are various different approaches that can be used by the midwives and obstetricians to help with the delivery of the baby. These can include:
- Manual rotation (the baby being moved/turned by the doctor using their hands)
- Caesarean methods including an assistant pushing the head up from the vagina, delivering the baby feet first, and/or giving the mother a medicine to relax the womb.
There is no “best way” to manage births where there is an Impacted Fetal Head and it is really up to the treating doctor to consider the best approach at the time of delivery but prompt action is required.
What are the risks?
These births are significantly more challenging, and they put risk on both the mother and baby if not dealt with promptly. There can be serious consequences if labour is not able to progress as quickly as would be expected (prolonged labour).
Some of the risks to babies when there is an Impacted Fetal Head include:
- Damage to the head and face
- Nerve damage
- Perinatal brain injury due to starvation of oxygen, and
- In some rare cases, death.
Some of the risks to mothers include:
- Tearing in the womb,
- Serious bleeding
- Longer hospital stays as a result of caesarean section.
- Post-partum haemorrhage (although this is a risk following any labour),
- Urinary tract injury and
- Infection which could be as severe as sepsis.
What is perinatal brain injury?
A perinatal brain injury can be caused as a result of a lack of oxygen and causes the brain to become starved of oxygen. Such oxygen starvation can lead to the brain not working how it should and can cause all sorts of impairments to the baby and its development.
Perinatal brain injury may lead to long-term neurodevelopmental challenges, including cognitive, neurological, motor and sensory impairments. The most severe forms of perinatal brain injury can lead to cerebral palsy. Cerebral Palsy can range in how it is presented through the child and this will be dependent on the brain injury, i.e. which parts of the brain have been affected and the extent they are damaged. Cerebral Palsy can show in the following symptoms:
- Delays in reaching development milestones – for example, not sitting by 8 months or not walking by 18 months
- Seeming too stiff or too floppy
- Weak arms or legs
- Fidgety, jerky or clumsy movements
- Random, uncontrolled movements
- Walking on tiptoes
- A range of other problems – such as swallowing problems, speaking problems, vision problems and learning disabilities
The severity of a brain injury can vary significantly, and some individuals have limited problems while others can be severely disabled.
The NHS Resolution Early Notification Scheme identified Impacted Fetal Head as a contributory factor in nearly 10% of potentially the most expensive maternity claims from 2018 to the present date, due to the significance that a brain injury can have on a child.
In the event you or a loved one has experienced a labour where you believe there may have been an Impacted Fetal Head and you / your baby has suffered injuries as a result, you may be able to bring a claim for clinical negligence. Such a claim cannot change what has happened, but it can get you crucial answers as to what happened, as well as seeking to obtain compensation which can assist with rehabilitation.
Our team here at Williamsons have a wealth of knowledge in clinical negligence, and if you feel you have any concerns in relation to the treatment received, please feel free to contact us at Williamsons on 01482 323697 to discuss your concerns further.