The acceptability to women of techniques for managing an impacted fetal head at caesarean section and of randomised trials evaluating those techniques: a qualitative study

Gabriella Romano,Kate Walker,Eleanor Mitchell,Natalie Wakefield,Rachel Plachcinski,Susan Ayers

doi:10.1186/s12884-021-03577-z

Gabriella Romano, Kate Walker + Show 4 more

Open Access

https://doi.org/10.1186/s12884-021-03577-z

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Abstract

BackgroundThis study aimed to explore women’s views on the acceptability of different techniques for managing an impacted fetal head at caesarean; and the feasibility and acceptability of conducting a trial in this area.MethodsQualitative semi-structured interviews with a systematic sample of women who experienced second stage emergency caesarean section at a tertiary National Health Service (NHS) hospital in England, UK. Thematic analysis was used to extract women’s views.ResultsWomen varied in their perceptions of the acceptability of different techniques for managing impacted fetal head. Trust in medical expertise and prioritising the safety of the baby were important contextual factors. Greater consensus was found around informed choice in trials where subthemes considered the timing of invitation, reduced capacity to give consent in emergency situations, and the importance of birth outcomes and having good rapport with healthcare professionals who invite women into trials. Finally, women reflected on the importance of supportive antenatal and postpartum education for impacted fetal head.ConclusionsThis research provides information on the acceptability of techniques and any trial to evaluate these techniques. Findings illustrate the importance of context and quality of care to both acceptability and approaching women to take part in a future trial.

Highlights

This study aimed to explore women’s views on the acceptability of different techniques for managing an impacted fetal head at caesarean; and the feasibility and acceptability of conducting a trial in this area
Emergency caesarean section (CS) accounts for 16% of all births in the UK [1] of which at least 5% are done at full dilatation in the second stage of labour, that is 4830 births per annum [2]
Emergency CS performed in the second stage of labour has greater perinatal and maternal morbidity than those performed in the first stage [3]

Summary

Introduction

This study aimed to explore women’s views on the acceptability of different techniques for managing an impacted fetal head at caesarean; and the feasibility and acceptability of conducting a trial in this area. Emergency caesarean section (CS) accounts for 16% of all births in the UK [1] of which at least 5% are done at full dilatation in the second stage of labour, that is 4830 births per annum [2]. Second stage CS may be complicated by the fetal head being deeply impacted in the maternal pelvis which occurs in 1.5% of all emergency CS [3, 4]. The challenge for the clinical team is to disengage the head by hand due to minimal space between the bony maternal pelvis and the deeply impacted fetal head. There is no consensus on best practice and research is needed to inform the methods used by clinical teams during these critical incidents and determine which is the most effective

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