Avoiding brain injury in childbirth: supporting safer management of impacted fetal head

Summary

Impacted Fetal Head (IFH) is a high‑risk childbirth emergency associated with serious harm to babies and distress for families and staff. Delivered as part of the national NHS England Avoiding Brain Injury in Childbirth (ABC) programme, we supported training of maternity teams across Kent and Medway, Surrey and Sussex to improve the safe management of this event.

Challenge

IFH occurs when a baby’s head becomes deeply lodged in the pelvis during labour, making caesarean birth complex and time‑critical. It is recognised nationally as a significant contributor to avoidable brain injury in childbirth. Evidence suggests IFH may complicate around one in ten unplanned caesarean births, with around two in every 100 babies affected.[i]

Events can be highly traumatic for families and for staff involved, contributing to stress and psychological impact. Historically, variation in training, confidence and local approaches has led to inconsistency in how IFH is managed. National reviews and guidance highlight the need for standardised training, stronger multidisciplinary working and better preparedness for these emergencies.

Approach

Our Patient Safety Collaborative (PSC) team coordinated regional delivery and implementation of the ABC programme, cascading learnings from a two-day course delivered by the national PSC faculty.

In January 2026, we delivered a regional train‑the‑trainer event – a model that trains a small group who then go on to educate others. It brought together 24 obstetric consultants and senior midwives from every maternity Trust in Kent and Medway, Surrey and Sussex. This mix of attendees reflected our multidisciplinary approach of bringing together different professional perspectives to improve safety and outcomes.

The training scenarios were designed to be inclusive, using diverse manikins and addressing disparities in outcomes for marginalised communities.

To help teams embed the training, we created a central resource hub, a twice‑monthly Community of Practice and programme‑led site visits. The team also supported Trusts with monitoring, including training uptake by staff role and audit measures related to IFH management.

Impact

IFH training delegate said: “I was unfamiliar with the management of IFH as a midwife and had never had to do this in clinical practice. I was nervous about this, but I now feel really well informed and able to support other midwives following today.”

As the programme is in early implementation, impact is currently demonstrated through engagement, early feedback and system‑wide adoption rather than clinical outcomes.

Across Kent and Medway, Surrey and Sussex:

• 100 per cent of maternity Trusts are engaged in the programme (nine Trusts, across 13 sites)
• 24 senior clinicians have completed regional train the trainer education and are cascading training locally
• We have created shared regional learning and improvement infrastructure.

Early qualitative feedback from participants suggests improved confidence and understanding in managing . As training scales, the intended outcomes include improved emergency management, reduced risk of severe neonatal brain injury, improved maternal outcomes in complex caesarean births and stronger multidisciplinary communication.

While full economic evaluation is ongoing, the programme has strong potential to deliver significant system-wide value:

• Prevention of avoidable harm: Reducing severe brain injury has substantial long-term cost implications for the NHS, including litigation costs associated with maternity claims
• Reduction in litigation: Obstetric claims represent some of the highest value claims within NHS Resolution, with IFH recognised as a contributing factor in some cases
• Workforce wellbeing benefits: Improved training and preparedness can reduce the psychological impact of traumatic clinical events, support staff retention and reducing sickness absence
• Efficiency gains: More effective management of emergencies can reduce complications, length of stay, and need for intensive neonatal care

If implemented at scale nationally, the programme has the potential to deliver both financial savings and improved workforce sustainability.

Spread and scalability

Nanette Money, ABC Programme Lead, Health Innovation KSS said: “By bringing every Trust together under a shared ABC training model, we are strengthening confidence, consistency and teamwork in high-risk situations. Ultimately, this is about reducing the risk of serious birth injury and ensuring safer outcomes for women and babies.”

The programme uses a structured spread approach, including a train‑the‑trainer cascade, a Community of Practice, site‑based implementation support and alignment with existing training programmes such as Practical Obstetric Multi‑Professional Training.

Early learning suggests the model is scalable and transferable where there is strong clinical leadership, multidisciplinary engagement, ongoing training and alignment with local governance and education structures.

Find out more

Find out more about the Avoiding Brain Injury in Childbirth on our Maternity and neonatal safety page or visit the Royal College of Obstetricians and Gynaecologists ABC programme.

[i] Impacted fetal head: A retrospective cohort study of emergency caesarean section – PubMed