Research shows that approximately one in four women give birth by caesarean section and around five in a hundred of these operations are performed towards the end of labour, when the cervix is fully dilated and the head has already entered the pelvis but is obstructed by the bony structures. It is estimated that 16 in 100 births are planned caesarean.
Caesarean sections at the second stage of labour
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.
One in 20 births happens towards the end of labour (second stage) and approximately 17 in 100 births are by emergency caesarean. 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 the risk of serious injury to the brain, but must also take great care to avoid injury to the mother’s uterus in the process.
Birth injuries
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 an impacted fetal head has occurred. In reality, this means that many junior obstetricians are dealing with this kind of emergency delivery for the first time with no prior training.
UK findings show how an impacted fetal head can cause difficulties for one in ten unplanned caesareans and sadly two in 100 babies affected by impacted fetal head die or are critically wounded.
There is currently no national guidance on the management of an impacted fetal head at caesarean section.
MIDAS study of Impacted Fetal Head at Caesarean
MIDAS study of Impacted Fetal Head at Caesarean commenced in March 2019. The objective was to determine the incidence and consequences of an impacted fetal head at the time of caesarean section at full dilation in the UK.
With a better understanding of the statistics and incidences, better research and training should follow.
However, there clearly needs to be more in-depth consideration of providing guidance on the management of fetal head at caesarean section to obstetricians and NHS Trusts in order that the incidences can potentially be reduced.
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Matthew Olner is a Partner in our Medical Negligence team, which is ranked in Tier One by the independently researched publication, The Legal 500, and Commended in The Times Best Law Firms 2023. Our team in Derby, Leicester or Nottingham is vastly experienced in providing legal representation at inquests.
If you would like to talk through all the funding options to ensure you get the help you need at such a difficult time, then please contact Matthew or another member of the team on 0800 024 1976 or contact us via our online form.
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