Impacted fetal head

If your baby’s head was allowed to become stuck in the birth canal during labour or was impacted within their mother’s pelvis during a difficult birth by caesarean section, their brain injury may have been caused by a birth complication called impacted fetal head (IFH).

When a baby is injured after IFH, your birth experience and the baby’s injuries may be assumed to be the natural outcome to an unexpected and unavoidable complication.  In many cases, however, the risk of impaction should have been recognised and minimised by careful management of the labour, and serious injury avoided by delivery of the stuck baby by an experienced obstetrician with support from a trained team of maternity clinicians.

On this page, you will find the answers to many of the questions that families have after experiencing a stuck or impacted fetal head (IFH) birth injury: what it is, how it happens and when you should seek help.

Our birth injury solicitors have helped countless families of injured children to understand how their injury occurred and to claim the compensation and support that they need for their child. We can help you answer these questions with advice from trusted, independent medical experts, and secure the compensation and practical support that your baby deserves. If you would like to find out more about your baby’s IFH birth injury, and what that means for your baby and family, or you have been contacted by MNSI or NHS Resolution, contact us to talk, free and confidentially, to one of our experienced birth injury solicitors.

If your baby’s injury was caused by their shoulder becoming stuck during their birth, read more about claims relating to shoulder dystocia and Erb’s palsy.

What causes a baby to get stuck with impacted fetal head (IFH)?

During labour, the baby’s head slowly moves down into the mother’s pelvis. This is a natural stage in the birth process and positions the baby for delivery through the birth canal. For some babies, during their journey towards vaginal birth their head gets stuck, becoming deeply wedged or impacted within the pelvis. When this happens, labour is obstructed by the impacted fetal head (IFH), risking severe injury to both mother and baby.

IFH is most commonly identified during unplanned caesarean section births in the second (or pushing) stage of labour, when the mother’s cervix is fully dilated but the baby cannot be delivered. In some cases, a baby can also become stuck with impacted fetal head (IFH) in the earlier first stage of labour.

Maternal obesity, unusual positioning of the baby or issues with the size or shape of the baby’s head all increase the risks of the baby’s head becoming stuck or impacted during labour. A common medical response to slow progress in labour is to give the mother IV Syntocinon to strengthen her contractions, but this can also cause the baby’s head to become more deeply impacted into the mother’s pelvis.

Can birth injury from impacted fetal head (IFH) be caused by medical negligence?

Impacted fetal head (IFH) is an obstetric emergency. Midwives and doctors must take appropriate action to minimise the risk of IFH when there is slow progress in labour. They must be able to recognise signs that labour is obstructed by IFH and must escalate their concerns to a senior obstetrician if IFH is suspected.

Safe delivery of a stuck baby with impacted fetal head requires quick and skilful handling by an experienced, senior obstetrician (childbirth doctor) supported by a maternity team who have been trained to handle IFH emergencies. During a caesarean section, the obstetrician must carefully and quickly free the baby’s head from where it is wedged within the maternal pelvis but has very little space to put their hand between the baby’s deeply impacted head and the maternal pubic symphysis. Delays in disimpacting the head and delivering the baby can result in hypoxic (HIE) injury to the baby’s brain, whilst excessive force can cause traumatic brain injury.  The obstetrician must also avoid causing tearing injuries to the mother’s uterus which will be stretched and thinned from the prolonged labour and highly vulnerable to injury if there have been previous unsuccessful attempts to deliver the stuck baby by ventouse suction or forceps.

Medical negligence claims for compensation for impacted fetal head (IFH) birth injury are becoming more common, and often arise from the following maternity care mistakes:

• failing to follow maternity care guidelines;
• failing to recognise the risk of obstructed labour or impacted fetal head (IFH);
• failing to recognise and act on signs of IFH or obstructed labour;
• incorrect use of Syntocinon during labour;
• leaving an inexperienced or resident doctor to manage IFH;
• failing to escalate suspected IFH to a senior obstetrician;
• negligent use of emergency manoeuvres or technique;
• excessive force or multiple attempts at forceps or ventouse delivery;
• delays in performing a caesarean section;
• delayed delivery of the baby;
• maternity team training and teamwork failures.

What are the risk factors for impacted fetal head (IFH) birth injury?

It can be difficult to predict accurately which babies will become stuck with impacted fetal head (IFH).

UK research studies suggest that IFH affects approximately 1.5% of all births, increasing to 10% (1 in 10) of all unplanned caesarean births, and one third (1 in 3) of caesareans which take place during the second stage of labour when the mother’s cervix is fully dilated. The risk of IFH is doubled where the caesarean section takes place after previous unsuccessful attempts have been made to deliver the baby using forceps or ventouse suction.

The risk of birth injury from IFH is increased in pregnancies where:

• the mother is overweight (maternal obesity);
• the baby is in an unusual position during labour;
• the baby has a big head;
• the baby’s head shape is changed by caput (swelling) and moulding (bone movement) in labour;
• labour is prolonged or slow to progress;
• maternal contractions are augmented with the uterine stimulant, Syntocinon;
• attempts to deliver the baby by forceps or ventouse suction have failed.

Can impacted fetal head (IFH) negligence cause brain injury to a baby?

Medical negligence and poor clinical management of a labour that is at risk of being obstructed by impacted fetal head (IFH) can result in severe brain injury to the stuck baby.

We recently secured a liability judgment in a claim for a child who suffered skull fractures, subgaleal and intracranial haemorrhages (brain bleeding) during multiple attempts by obstetric doctors to rotate and free their impacted fetal head using forceps and ventouse suction. The child has ongoing neurodevelopmental disability and ADHD.

Delays in delivery of a distressed baby caused by negligent failure to recognise and respond to signs that labour is obstructed by IFH can also result in cerebral palsy disability from hypoxic ischaemic encephalopathy (HIE) birth injury.

Can I claim compensation for my baby’s impacted fetal head (IFH) birth injuries?

If your baby suffered birth injury and disability as a result of negligent maternity care involving obstructed labour from an impacted fetal head, they may be entitled to compensation. You can claim compensation for their injury and also for the financial loss and lifelong costs of meeting their additional needs arising from their disability.

Depending on the child’s injury, disability and family circumstances, their compensation may include sums for:

• their pain, suffering and disability;
• costs of care and case management;
• home adaptations or increased costs of accommodation;
• therapies and private medical costs;
• specialist aids, equipment and assistive technology;
• adapted vehicles, wheelchairs and additional transport costs;
• support with special educational needs (SEN);
• financial losses, including loss of earnings;
• Court of Protection deputyship costs.

We tailor each child’s claim to ensure that it reflects their own needs, circumstances and disability. You can talk to one of our specialist birth injury solicitors, free and confidentially, to find out how we can help you claim the compensation that your child deserves, by contacting us.

If you have been contacted by NHS Resolution or MNSI after the birth of your baby, we strongly recommend that you contact us for free, confidential advice straight away. Birth injury claims must be handled by claimant specialist solicitors to protect your child’s full entitlement to compensation.