Management of an impacted fetal head during emergency caesarean section

Approximately one in four women give birth by caesarean section and about five in a hundred of these operations are done near the end of labour when the neck of the womb is fully open and the head has already entered the pelvis but is stuck on the bony structures These operations are often complicated If the baby's head is deeply wedged in the woman's pelvis it can be difficult to lift it up, so delivery of the baby's head at caesarean can occur As a result tears to the womb and vagina can cause bleeding There can also be problems for the baby, such as broken bones and brain damage from lack of oxygen Occasionally babies may die from this There are a number of ways to make such births easier: an assistant can push the head up with their hand from the vagina, or a specially designed balloon in the vagina can achieve the same effect Sometimes the surgeon delivers the baby's feet or arms first Doctors can also use medicines that cause the womb to relax to allow more room to manoeuvre We do not know which of these methods is best for the mother and the baby The NHS would like to conduct research in this area Before they do so they want to find out from doctors and midwives, how common the problem is, what techniques are currently in use and which ones should be tested in future research projects We also need to determine how acceptable research in this area is We will survey doctors who perform caesarean births, and midwives to find out which techniques they use, how they learned about them, and what training needs they have We will also perform a national survey of parents and conduct face to face discussions with groups of women who have experienced this type of Caesarean birth to hear their views We will perform a survey of hospitals throughout the UK to find out what poor outcomes and difficulties occurred in late labour Caesarean births, what manoeuvres were attempted and what the outcomes were for women and their babies The end goal is to design a clinical study into one or more techniques to deliver a head that is stuck in the pelvis at Caesarean birth We will ask women and experienced doctors at focus groups whether they would be willing to be involved in such a study, and what they feel the challenges would be