Impacted Fetal Head at Cesarean Birth: A Clinical Nursing Review

Fetal head impaction (IFH) occurs when the presenting part becomes wedged in the maternal pelvis during a cesarean section, requiring additional maneuvers to complete birth. As cesarean rates have risen, so has IFH, estimated to occur in 1.5% of all births annually in the United States. Maternal complications include uterine extension, hemorrhage, bladder injury, and intensive care unit admission. Neonatal complications include low cord pH, skull fracture, intracranial hemorrhage, hypoxic-ischemic encephalopathy, and death. These outcomes are not inevitable. Management technique, clinician education, and interdisciplinary institutional preparation are modifiable factors with direct bearing on outcomes when IFH is encountered.Despite its frequency and consequence, the topic of IFH and the role of the nurse are absent from nursing education, professional standards, and scope-of-practice guidance. A search of CINAHL, PubMed, Ovid, and EBSCO identified no peer-reviewed nursing literature addressing IFH or its intraoperative management. Labor and delivery nurses commonly report first encountering manual vaginal disimpaction when urgently asked to perform it during an emergency, without education, competence validation, or institutional policy. Improving outcomes requires institutional infrastructure built before any individual emergency, and professional nursing organizations must clarify where manual vaginal disimpaction falls within nursing scope of practice.