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Avoiding Brain Injury in Childbirth (ABC) collaboration

Improvement approaches and interventions


The Avoiding Brain Injury in Childbirth (ABC) programme aims to support maternity services to improve clinical practice of two significant contributors to avoidable brain injury in childbirth:

  • detection and response to suspected intrapartum fetal deterioration
  • management of the obstetric emergency of impacted fetal head at caesarean section

Sub-optimal monitoring and response to fetal heart rate changes have been repeatedly identified as one of the most common contributors to preventable harm. When there are concerns about a baby’s wellbeing during labour, maternity staff need the right tools and support to be able to provide the highest quality of care. Just as important is communicating effectively with women and their birth partners and making sure they are listened to and involved in decisions about their care.

When impacted fetal head at caesarean section occurs, it is an obstetric emergency. These births are technically challenging, with significant risks to the person in labour and the baby. Managing impacted fetal head safely as a whole-team emergency requires clear management algorithms and effective multi-professional working. Until the development of the ABC approach, there was no national guideline or consensus on how best to manage these births, nor any evidence-based training. This has led to a lack of confidence among maternity care professionals, variable practice and risks of harmful care in some circumstances.

ABC is a unique collaboration between the Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, and THIS Institute.


The ABC programme has developed a nationally standardised approach for the detection and response to fetal deterioration during labour. Using maternity staff, women and birth partners came together to co-design ABC by sharing their ideas, views, experience and expertise and giving feedback as tools and systems are developed. We used a wide range of methods to generate this feedback, including surveys, interviews, in-situ simulation and workshops. This work has established a new approach for improved identification, escalation and action on fetal deterioration.

For impacted fetal head, the ABC programme has co-designed and user-tested evidence-based management algorithms, innovative educational tools and multi-professional training to support good practice in managing this emergency. The aim is that implementation of these tools and multi-professional training for the whole maternity theatre team will facilitate a prompt and effective response to prevent injuries, as has been the case with other obstetric emergencies such as shoulder dystocia.

For both clinical situations, women and birth partners co-designed good practice ABC principles for communication during labour. Building on these principles, ABC has produced practical, bespoke tools and communications resources, including actionable prompts for ensuring respectful, collaborative relationships with women and birth partners.

Successfully using the ABC approach depends on supportive culture, systems and behaviour. The ABC safety culture toolkits support good practice in relation to aspects of culture relevant to each clinical situation.

Funding and ethics

This study is funded by the Health Foundation’s grant to The Healthcare Improvement Studies Institute (THIS Institute) and the Department of Health and Social Care. It is independently led by THIS Institute.

The study was reviewed by the University of Cambridge Psychology Research Ethics Committee.

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