Impacted fetal head (IFH) birth injury claims

The baby’s head naturally descends into the mother’s pelvis during labour to position the baby for delivery through the birth canal. However, in some cases the unborn baby’s head can become wedged or impacted within the mother’s pelvis, obstructing vaginal delivery. This dangerous condition is known as impacted fetal head (IFH). IFH is an obstetric emergency.

Impacted fetal head is often associated with caesarean section in the second stage of labour after the mother’s cervix is fully dilated, but IFH can also occur earlier in the labour. The risk of IFH in labour is also thought to be increased by poor positioning of the baby, maternal obesity or the size or moulding in labour of the baby’s head. In addition, use of the uterine stimulant, Syntocinon, to stimulate contractions in a prolonged labour can also cause the baby’s head to become more deeply impacted into the mother’s pelvis.

IFH can be difficult to predict, so maternity staff must take appropriate action to minimise the risk of IFH when there is slow progress in labour, and must escalate their concerns to a senior obstetrician if IFH is suspected.

Safe delivery of a baby with IFH requires skilled handling by an experienced, senior obstetrician, supported by a properly trained maternity team. Severe injury can be caused to the mother and to the baby during caesarean section as the obstetrician attempts to free the baby’s fragile head from where it is wedged within the maternal pelvis, with little space to put their hand between the fetal head and the maternal pubic symphysis. The obstetric surgeon must also work quickly to deliver the baby to avoid risk of hypoxic injury to the baby’s brain, whilst avoiding a tearing injury to the mother’s uterus which will be stretched and thinned from a prolonged labour. The risk of injury to the mother’s uterus is further increased when second stage caesarean section follows an unsuccessful attempt at an assisted (forceps or ventouse) vaginal delivery.

UK research studies suggest that impacted fetal head or IFH may occur in up to 10% (1 in 10) of all unplanned caesarean births (1.5% of all births). IFH occurs in approximately one third (1 in 3) of caesarean births 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 follows previous unsuccessful attempts to deliver the baby using forceps or ventouse suction.

It is estimated that 2% (1 in 50) of babies who are affected by IFH suffer either serious injury or death.

In recent years, organisations such as NHS Resolution and the Royal College of Obstetricians and Gynaecologists (RCOG) have expressed concern about the rising number of birth injuries and medical negligence claims related to IFH. Reporting on its Early Notification scheme, the NHS’s defence organisation, NHS Resolution, called for raised awareness of the risks associated with IFH after finding a dramatic increase in the number of babies born with HIE brain injury after being found to have impacted fetal head during their caesarean birth.

Following a review in 2023 by RCOG, the Department of Health and Social Care (DHSC) announced in October 2024 that the Avoiding Brain Injury in Childbirth (ABC) pilot programme is trialling new training in the management of IFH obstetric emergencies for maternity staff at selected NHS maternity units in England, with the aim of reducing avoidable brain injuries in childbirth.

Impacted fetal head (IFH) is an obstetric emergency which requires prompt recognition and fast action from the maternity team, led by an experienced, senior obstetrician.

IFH birth injury claims often involve one or more of the following maternity mistakes:

• failing to follow maternity care guidelines;
• failing to recognise the risk of obstructed labour or IFH;
• failing to recognise and act on signs of obstructed labour or IFH;
• excessive use of oxytocin/Syntocinon during labour;
• leaving an inexperienced or junior doctor to manage IFH;
• failing to escalate suspected IFH to a senior obstetrician;
• incorrect choice or application of emergency manoeuvres or technique;
• excessive force or multiple attempts at forceps or ventouse delivery;
• delays in performing a caesarean section;
• maternity team training and teamwork failures.

Impacted fetal head (IFH) is a dangerous complication of labour which is not always easy to predict. Injury from IFH is thought to be more likely where:

• the mother is overweight (maternal obesity);
• the unborn baby (fetus) is not in the correct position during labour;
• the fetus has a large head;
• the baby’s head shape is changed by caput (swelling) and moulding (bone movement);
• labour is prolonged or fails to progress;
• labour is augmented with oxytocin/Syntocinon;
• delivery by forceps or ventouse has been attempted unsuccessfully.

Negligent maternity care which fails to recognise and correctly manage delivery of a baby affected by impacted fetal head (IFH) can lead to devastating injuries for both the mother and the baby.

Impacted fetal head or IFH can cause one or more of the following severe injuries to the baby:

• skull fractures;
• subgaleal and intracranial haemorrhage (brain bleeds);
• HIE brain injury (hypoxic ischaemic encephalopathy);
• death.

In addition, impacted fetal head or IFH in labour can cause maternal injuries, including:

• uterine tears;
• damage to the uterine artery;
• haemorrhage;
• injury to the bladder and ureters;
• bowel injuries;
• difficulties with future pregnancies;
• psychological injury;
• maternal death.

Compensation claims for HIE birth injury, including those caused by negligent management of impacted fetal head or IFH, are among the highest settlements that we achieve for our clients. This is because the compensation reflects not only the injury, but the lifelong cost of meeting the additional needs that arise from the child’s disability.

Following HIE birth injury, our clients’ settlements often include compensation for:

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

Visit our specialist cerebral palsy website for more information about compensation for children with HIE brain injury and cerebral palsy.

The amount of compensation that can be claimed for a mother’s injuries in an IFH birth trauma claim depends on the nature, extent and impact of the injury that she suffered. Claims for mothers with severe birth injuries may include compensation for the following injuries, needs or losses and expenses:

• pain, suffering and disability;
• medical or surgical costs;
• therapies and counselling;
• specialist equipment and aids;
• care, support and domestic assistance;
• necessary home adaptations;
• loss of earnings;
• other expenses arising from their injury, such as transport costs.

Where the mother dies as a result of negligent maternity care, depending on her family circumstances, her bereaved dependent family may be entitled to claim compensation for:

• her pain and suffering prior to her death;
• funeral costs;
• a statutory bereavement payment;
• the financial loss to her dependents from losing her income;
• the costs of replacing her ‘services’, such as childcare, housework etc.