Skip to content

Training for managing impacted fetal head at caesarean birth: Multi-method evaluation of a pilot

Published in:
BMJ Open Quality

van der Scheer JW, Cornthwaite K, Hewitt P, et al Training for managing impacted fetal head at caesarean birth: multimethod evaluation of a pilot BMJ Open Quality 2023;12:e002340. doi: 10.1136/bmjoq-2023-002340


Why it matters

Impacted fetal head, where the baby becomes lodged in the maternal pelvis, is a challenging complication that can occur during caesarean births. It can cause serious harm to the person in labour and the baby. Though impacted fetal head can affect as many as 1 in 10 unplanned caesarean births (1.5% of all births) in the UK, surveys reveal lack of confidence among UK maternity professionals in using the right techniques for managing this emergency – partly because of a lack of high-quality training.

One problem is that current training has mostly been provided only for obstetricians, even though a multi-professional team involving midwives, anaesthetists and other professionals is needed to manage the emergency. Available training is also limited by lack of use of tools like birth simulators that let professionals rehearse all the techniques that might be needed to manage an impacted fetal head safely. And more opportunities are needed to practice communication with those in labour and their birth partners and to develop crucial other “non-technical” skills for managing obstetric emergencies.

Survey data shows a strong appetite among maternity professionals for high quality, multi-professional training. To address this need, a multiprofessional training package for managing impacted fetal head at caesarean birth was developed as part of the Avoiding Brain Injury in Childbirth (ABC) programme commissioned by the UK’s Department of Health and Social Care.  The content and methods of the training package were informed by literature review, surveys with UK maternity professionals, and input from parents and birth partners with experience of UK maternity care.

This package needed to be evaluated to assess whether it was likely to improve the knowledge and skills of maternity professionals involved in managing impacted fetal head.

Our approach

We tested the training package with 57 maternity professionals (obstetricians, midwives, anaesthetists, and others) from five maternity units. Training took place over three hours and involved a package of methods, including:

  • a lecture
  • an animated video
  • workshops with a novel birth simulator offering hands-on training
  • practice with new algorithms for clinical management
  • simulations where teams got to practice managing an impacted fetal head as though the emergency was happening in real life

What we found

Over 95% of the maternity professionals who took part agreed that the training was relevant and would be helpful, both for their own clinical practice and for improving outcomes of babies and parents affected by an impacted fetal head. Some professionals felt the training helped fill an important gap, while others said that it formalised and extended their existing knowledge.

The training package increased professionals’ confidence in the technical skills they would need to manage impacted fetal head. The animated video and hands-on practice using the birth simulator helped to show some of the aspects that are hidden from view in real life. Midwives and anaesthetists said they now better understood how challenging it could be for obstetricians to reach below the baby’s head to help deliver an impacted fetal head.

After the training, the professionals felt a lot more confident in the teamworking needed to safely manage an impacted fetal head. Training together, and working with the management algorithms, helped them to better understand and coordinate the different roles of team members during the emergency. The professionals valued the training’s emphasis, principles, and practical tips for communicating with those in labour and their birth partners.

Representatives from Maternity Voices Partnerships acted as “simulated patients” or observed the simulations. They recommended that future training should further clarify that one professional remains responsible for all communication with the woman in labour and birth partner during the emergency, and that potentially distressing silences should be reduced.

The training package is now ready for further testing and evaluation, including piloting to determine how best to scale and implement the training at local and regional levels in the UK.

Other contributing authors to this article:

  • Akbar Ansari
  • Alessandra Giusti
  • Alison Powell
  • Annabelle Olsson
  • Bothaina Attal
  • Evleen Price
  • Giulia Maistrello
  • Imogen A.F. Brown
  • Janet Willars
  • Jenni Burt
  • Joann Leeding
  • Lisa Hinton
  • Matthew Woodward
  • Natalie Richards
  • Nick Fahy
  • Oscar Lyons
  • Wendy Randall

With thanks to the authorship group members:

Alexandra Emms, Bethan Everson, Christopher W. Sadler, Clare F. Redfearn, Daniel Wolstenholme, Eftychia Sousi, Emma Crookes, Fida M Ali, Helen Gardner, Kerry A. Noble, Laura Cowell, Louise Lea, Muhammad Nauman Mehr, Nicky Lyon, Philippa Storer, Rhiannon S. Wong, Samiramis Saba, Sandra Igwe, Susanna Stanford and Zenab Barry

The work has been completed by a collaboration between the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and THIS Institute (The Healthcare Improvement Studies Institute), as part of the Avoiding Brain Injury in Childbirth programme funded by the Department of Health and Social Care.

Sign up to receive the latest news, reports and articles from THIS Institute.