Case Study: Implementing tiered “Management of Impacted Fetal Head (IFH) at Caesarean Birth” training across south London
Background
Until the end of 2026/27, the ABC Programme will focus on embedding IFH training into routine practice across south London maternity services through continued faculty development, quality assurance and support for local guideline implementation.
Trusts will be supported through site visits, bespoke coaching, peer learning and network sessions to strengthen local training delivery, embed best practice and develop governance processes to monitor incidence, outcomes, staff experience and service user experience.
Challenge
Although stillbirth and neonatal mortality rates have improved, rates of birth-related brain injury remain high, with 4.2 babies per 1,000 live births affected each year.
The 2021-22 Health and Social Care Select Committee report reviewing the safety of maternity services in England highlighted ongoing variation in maternity outcomes, workforce pressures, and the need for effective multidisciplinary training to improve safety. This has been echoed by subsequent reports, including Lord Darzi’s Independent Investigation of the NHS in England and Baroness Amos’ National Maternity and Neonatal Investigation, which concluded in June 2026.
A significant contributor is impacted fetal head (IFH), which affects up to 1 in 10 unplanned caesarean births and can increase the risk of hypoxia and brain injury. The Avoiding Brain Injury in Childbirth (ABC) programme aims to address these challenges and reduce avoidable brain injuries by 50% by 2030.
Baseline and pre-training surveys across south London, conducted by the HIN, identified significant gaps in preparedness to manage impacted fetal head (IFH). These include:
- 72% of staff either had no clear policy to follow or were unsure whether local IFH guidance existed.
- 31% of staff had received formal training in managing IFH (of which the majority are obstetric colleagues).
- Staff also reported low confidence in performing technical manoeuvres and discussing associated risks with parents, highlighting the need for consistent guidance, multidisciplinary training, and support to improve safety and outcomes during emergency caesarean births.
What we did
The programme used a cascade train-the-trainer model to support sustainable local delivery. Tier 2 (T2) events were attended by multidisciplinary maternity staff, including practice development midwives, clinical midwives, obstetric registrars, obstetric consultants and anaesthetists.
Before training began, monthly virtual drop-in sessions were established to raise awareness, share programme plans and support engagement. Baseline scoping also occurred before the training began, assessing the existing IFH training, staff confidence, equipment, guidance and clinical practice across the participating trusts. A south London target of 10 faculty members participating per maternity unit was established.
To support sustainable training delivery within their maternity units, participants received education on:
- IFH recognition and management.
- Communication and documentation.
- Practical skills training in the three disimpaction techniques: abdominal cephalic disimpaction, reverse breech extraction and vaginal disimpaction.
- Simulation-based workshops.
- Facilitation skills.
- Local implementation planning.
The monthly virtual drop-ins continued throughout the training and trust implementation phases, providing ongoing programme updates, peer learning opportunities, and a forum for sharing learning across the network.
Impact
Between January and August 2026, eight tier 2 (T2) Train-the-Trainer events resulted in 112 clinicians being trained as IFH faculty.
Before the training, baseline surveys showed considerable variation in confidence across all professional groups:
- Midwives reported lower confidence in recognising IFH emergencies and supporting management during obstetric emergencies.
- Obstetricians reported lowest confidence in counselling women about the risks of IFH, understanding multidisciplinary team (MDT) roles in IFH management, documenting IFH events, and conducting post-event staff debriefs.
- Anaesthetists reported variable confidence in recognising IFH and understanding their role within the multidisciplinary response.
Post-training responses showed improved clinician confidence and knowledge across all assessed domains.
- Across staff groups, confidence shifted from predominantly “somewhat confident” to “confident” and “extremely confident” in IFH recognition, escalation, management, documentation and team leadership.
As a result, all 10 south London maternity units have either commenced or are planning local IFH training for their clinical workforce to embed the ABC approach to managing IFH and to support compliance with the Maternity Incentive Scheme (MIS) Year 8 requirements by November 2026.
“Excellent session, very informative and informal, [with the] ability to ask questions and exchange ideas.”
“Very informative and interesting day, loved the simulations and chances to practice for when we facilitate our own sessions.”
“The simulation was absolutely brilliant and felt very true to life. I can see this being implemented with great success at my Trust.”
“Excellent session, so well prepped and professional. Very confidence building and sensible approach. Probably the best training session I’ve had in the NHS?!”
Feedback from participants of the tiered training across south London
Next steps
Until the end of 2026/27, the ABC Programme will focus on embedding IFH training into routine practice across south London maternity services through continued faculty development, quality assurance and support for local guideline implementation.
Trusts will be supported through site visits, bespoke coaching, peer learning and network sessions to strengthen local training delivery, embed best practice and develop governance processes to monitor incidence, outcomes, staff experience and service user experience.
We thank all maternity clinicians across south east and south west London who participated in the IFH programme as trainers and trainees. Your commitment, engagement, and valuable feedback have been vital in the successful implementation and ongoing sustainability of this work.
Get in touch
Please contact the team to learn more about ABC implementation in south London.
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