Updated: April 2022
To get this blog going I decided to write about a slight obsession of mine: The fear of, and routine ‘management’ of nuchal cords at birth (umbilical cord around the neck). I have written and presented about this topic and have bored the pants off many a person who has made the mistake of mentioning the subject. So, despite telling my colleagues that I had put away my ‘nuchal cord’ soap box I am bringing it out to launch this blog. The content of this post is based on part of a literature review I carried out for my PhD thesis. If you are interested in finding out more you can read the literature review in my thesis. I have also written a couple of journal articles on the topic: nuchal cords: think before you check and nuchal cords: sharing the evidence with parents; and had my work cited in guidelines and textbooks.
Why and how babies end up wearing their cord around their neck
The presence of a nuchal cord is a very common occurrence during birth. Up to 30% of babies are born with their umbilical cord around their neck (Mercer et al. 2010). How and when it ends up there will be different for individual babies. Interestingly, it is more common with male babies (Martin et al. 2005) – perhaps because they are more likely to have longer cords (Rogers et al. 2003). It also becomes more common with increasing gestation – I suppose there is more time to get wrapped the cord. If a nuchal cord does not occur in pregnancy it can occur during labour. As the baby moves through the pelvis they rotate and can wind the cord around their neck. See this post to see how rotation works.
A versatile scapegoat
The nuchal cord has become the perfect scapegoat because it lays blame with the mother/baby rather than the care provider/system. This has resulted in fear about nuchal cords becoming embedded within our culture. Whenever I read a story about an unexpected birth outside of hospital it often involves a nuchal cord. The story being about how lucky the baby was to survive the dangers of a nuchal cord away from the experts who can manage such a complication. In addition, I have heard too many birth stories where complications were unfairly blamed on the presence of a nuchal cord.
Before I tackle some of the myths—some quick anatomy and physiology: The cord is covered in Wharton’s jelly and coiled like a telephone wire. This protects the 3 blood vessels from the kind of stretch and compression involved in being attached to a mobile baby. The umbilical cord is also long enough (average 55cm) to be comfortably wrapped around the neck with plenty of left over length. Essentially, the umbilical cord is ‘designed’ to be worn around the neck (and body) without causing a problem.
Pregnancy
Research has found that a nuchal cord is not associated with morbidity or mortality for the baby during pregnancy (Carey & Rayburn 2000; Aksoy 2003; Clapp III et al. 2003; Gonzalez-Quintero et al. 2004). Unfortunately, some babies die before labour begins, and there is often no known reason, which can add to the devastation for the family. When these babies are born they are often found to have the cord around their neck (like a 3rd of all babies). Although I can understand the need to find a reason and to pick the obvious, I don’t think this is helpful in the longer term. Parents need honest answers about the loss of their baby, even if the answer is ‘we don’t know’.
Labour
There is no evidence that a nuchal cord during labour causes short-term or long-term mortality or morbidity (Masad et al. 2019; Tagliaferri et al. 2019). There is no indication to undergo a c-section if a nuchal cord is identified antenatally. The baby is not ‘held up’ by the cord because the whole package – fundus (top of the uterus), placenta and cord are all moving down together (see diagram). The uterus ‘shrinks’ down (contracts) moving the baby downwards, along with their attached placenta and cord. In fact, the space between the baby’s neck and the placenta is shorter at the end of labour because the baby is more scrunched up. However, when a c-section is performed for ‘fetal distress’ or ‘lack of progress’ during labour, the presence of a nuchal cord is often used as the reason… “your baby was stressed because the cord was around his neck” or “…the cord was stopping her from moving down”. The cord is unlikely to have had anything to do with any stress or lack of progress. Most likely, other interventions carried out during labour led to the end scenario (in particular, the use of syntocinon).
Birth (the last bit of labour)
The nuchal cord remains around the baby’s neck as his head moves out of the uterus and through the vagina. Usually the cord remains loose as there is lots of ‘give’ in it, and it requires less length than at the end of pregnancy (see diagram). A loose nuchal cord does not cause any problems. Blood continues to flow through the vessels just as it did during pregnancy and labour.
Very occasionally, a cord becomes stretched and tight during this last bit of labour – as the head is born. Either there is not enough ‘give’, or the cord is trapped against the pelvis by the baby’s body. This may happen with a shorter than average cord that is wrapped around the neck a number of times. However, the baby is not ‘strangled’ because he/she is not breathing oxygen – oxygen is provided by the cord, not their airway. Whilst the cord is stretched and compressed the blood vessels transfer less blood (but still some). This may result in short-term hypoxia (reduced oxygen supply) which resolves once the cord is loosened after birth and full blood flow resumes. These babies may arrive a little compromised but quickly recover – if the cord is left alone. Unfortunately, the way in which the situation is managed (see below) can create further problems. The resulting need for resuscitation is then blamed on the nuchal cord rather than what was done to it by the care provider.
Risks associated with clamping and cutting a tight nuchal cord
Once the cord is clamped, blood flow between the baby and placenta ceases, reducing the baby’s blood volume and oxygen supply. This makes resuscitation more necessary and difficult once the baby is born. Any delay in the birth of the baby (eg. shoulder dystocia) will further increase the risk of hypoxia. While waiting to be born, the baby now has NO blood supply rather than a limited one that can be re-established after birth. There have been successful malpractice actions against obstetricians in the US who cut nuchal cords prior to shoulder dystocia (Iffy et al. 2001).
One study (Sadan et al. 2007) found that neither cutting nor leaving a nuchal cord adversely affected the outcome for babies. However, they did not look at tight nuchal cords, and the cords were cut after the baby’s shoulder had birthed. The damaging effects of cutting a nuchal cord are becoming commonly understood in medicine and midwifery. A policy of keeping a nuchal cord intact has been found to improve outcomes for babies (Parr et al. 2014).
For a baby with a tight nuchal cord the worst thing you can do is clamp and cut!
Risks associated with pulling and looping a loose nuchal cord
A far more common practice is pulling and looping a loose nuchal cord. Most care providers do this and I was taught to do this when I trained. However, handling the cord stimulates the umbilical arteries to vasoconstrict, reducing blood flow. Loosening the cord will usually involve some traction which can risk tearing the cord and subsequent bleeding (from the baby), or partial detachment of the placenta. As a student midwife, I snapped a cord while looping it over the baby’s head. Luckily, my mentor clamped the ends quickly, but not before I got blood sprayed in my eyes! I later discovered that babies can be born with the cord around their neck. They either birth through the loop, or they come out with it still wrapped.
Checking for a nuchal cord
So, if you are not going to cut or loop a nuchal cord what’s the point in digging about to see if it is there? Checking for a cord interferes with the physiological process of birth. It also reinforces the notion that this is a birth complication that endangers the baby, rather than a common situation. Telling the woman to stop pushing and putting your fingers into her vagina can be disempowering and painful. There are also consent issues – how many care providers gain consent before this procedure?
Suggestions
- Talk to parents before birth about the possibility and normalcy of a nuchal cord (a third of all babies have a nuchal cord at birth)
- During birth DO NOTHING.
- IF the cord is preventing the baby descending once the head is born (extremely rare) use the ‘somersault technique’ see photos in this article by Mercer et al. (2010) or this movie.
- Once the baby is born, unwrap the cord (the mother/family can do this).
- If the baby is compromised at birth encourage the parents to talk to their baby and touch him whilst the placental circulation re-establishes the normal blood volume and oxygen for the baby. If the baby requires resuscitation, do it with the cord intact.
The baby in the photo at the top of this post was born at home into water. His cord was tightly around his neck twice. The midwife is unwinding the cord whilst bringing him to the surface and into his mother’s arms. He took around 30 seconds to start breathing whilst his placental circulation re-established his blood volume and oxygenated him. His father gently blew on his face and he took his first gasp – resuscitated by his placenta and his father.
Here is an amazing film of a baby with a multiple nuchal cord beautifully managed by his mother:
You can also watch a mother unwrap a nuchal cord during a water birth here.
Cut and paste of comments on previous blog site:
Carolyn Hastie
Lovely post Rachel and great start to your blog!
Would be good to add a ‘follow’ button, so those of us who want to can follow your work. You can also add an email subscription link.
Saturday, July 24, 2010 – 04:36 PM
Amy Holmes
thanks for the info rachel. I guess its a mind set ‘dont touch’ and once you get that mind set , it is easy to continue. The hard thing is educating midwives who are supporting you in a birth about keeping you hands off, and allowing the placenta to support the new babe
Saturday, July 24, 2010 – 06:06 PM
Pernille Powell
Ahhh, Rachel, you know I love you!!! What an absolutely fantastic distraction from your pHd. This blog simply has my name on it. It might help so I wont bother you several times a week with all my birth thoughts 🙂
You’re a gem
Pernille
Saturday, July 24, 2010 – 08:42 PM
Anna Robins
This is fantastic Rachel. Loving your procrastination ideas. Nuchal cord might be old news for you but there are so many doctors and midwives out there who still check for them and loop them over. Interesting your story of the snapped cord – this is a real fear of mine, when I have been instructed to loop the cord, it just doesn’t feel right!! Thankyou for sharing your experiences, this will arm me with reasons not to practice ‘checking and looping’. Look forward to more blogs.
Sunday, July 25, 2010 – 08:36 AM
Anonymous
What a great way to start a truely interesting blog. Congratulations Rachel. Lovely. Plus gorgeous photos. Always a bonus!
Sunday, July 25, 2010 – 01:46 PM
Rachel
Thanks everyone for stopping by and commenting. I will try and post something each week. You can subscribe the RSS on the front page of the blog and choose email notification if you prefer.
Pernille – you can still email me questions. I’m always happy to discuss birth stuff x
Sunday, July 25, 2010 – 05:39 PM
Dear Rachel!
Nice sharings from your side! Here in Pakistan most of the doctors suggest C-sec in case of nuchal cord prolem diagnosed during scan and they give logic that you should not take risk and be on safe side in such cases. Please comment..
Hi Rizwan
My comment is that the doctors are not following evidence-based practice, and the risks associated with a c-section for mother and baby are higher than any risk associated with a nuchal cord (normal and present in a 3rd of births). The practice also that goes against the hippocratic oath of ‘do no harm’. There are many ethical and legal concerns regarding this practice. It is very sad that so many woman are not getting honest information and are undergoing unnecessary operations. Perhaps someone needs to lead the change… there is more than enough research evidence to support it.
This site is amazing and the whole textbook is here – I loe the description and effort put in to describing birth above. – if you read this site abosrb the answers it may guide you asyou step in to the ground bogs and messy swamps of obstetric p ractice in a hospital setting.
Oh for clincila practice for neophytes to be conducted by home birth midwives who are able to pass on wisdom and experience as women have always done as mothers grandmothers and women with women. I get a lot of flack for this idea – and I am not sure what is bbehind the opposition from home birth midwives not freelancing and beginning a University for home birth outside of the parameters of fear driven practice.
Dear Rachel!
I am very pleased to see your comments. Really you are doing great job by sharing such useful information. May Allah(God) give you reward of this. Here are some of my confusions regarding this topic to which I am stuck with. Hope you will understand these and try to answer in the best possible way
What we people can do in such cases is ” to consult different doctors from the best reputed hospitals” to get right information. Like one name I should qoute Agha Khan hospital in pakistan is one of the leading name. We have contacted one experienced midwife as well overthere. She commented that its our daily job and I have seen thousand cases of nuchal cord and almost all of these undergo C-section.
I am convinced with your thinking and research but point which is confusing me a lot is the comments of doctors and others who are experienced in this field.
Please write why it is so. Please see the profile of Agha Khan Hospital in Pakistan before answering to my question. Hope you will understand what I am trying to make you feel.Means what best we can do is to consult different doctors/midwives to get multi opinion just to see if some partcular doc is giving us with wrong info. What else we can do apart from this.
Dear Rizwan
Much of medical and obstetric practice is culturally based. Not evidence based. There are a lot of opinions on many topics. In this post I have laid out my interpretation of the available research evidence and my own experiences (over a decade of not checking for nuchal cords). I cannot explain why other practitioners continue to subject women to unnecessary interventions. Perhaps you could has them to provide research evidence to support their opinions (as I have done). My guess is that fear of a nuchal cord is embedded in the culture and education of these professionals and they have not been able to experience an alternative way of approaching this normal situation. All we can do is share information… we can’t make people change 🙂
One more thing I want to know. How many loops of the cord normally are considered safe for normal delivery (means without C-sec). What I extracted from your sharings that it makes no difference how many loops are there. But logicall if there are more loops, those will definetly reduce over all length of cord. I have read from one of the posts here that a baby with 5 loops around the neck delivered normal. Please explain a bit more. Thanks
The number of loops is not important. You can have a long cord and lots of loops… or a short cord and one loop = same. The uterus/placenta/cord move down with the baby during labour. So as long as the cord is long enough to get the baby’s head out (i.e. the length of the vagina – which is not long when stretched into a baby’s head shape) then the rest of the baby can come out. It is extremely rare – but possible – that the cord is too short to allow descent of the baby. Then you would get a lack of progress and eventual fetal distress… often these babies get into a breech position before labour.
Really there is no reason to perform an operation ‘just in case’ due to a nuchal cord. They very rarely cause a problem. Why not wait and do a c-section if/when a problem occurs? If you really want to avoid complications relating to cords then don’t rupture the membranes as this to avoid cord compression – a much greater risk than a nuchal cord (http://midwifethinking.com/2010/08/20/in-defence-of-the-amniotic-sac/). Incidentally when the cord is around the neck it is often protected from compression 🙂
Thanks for linking to my blog. Good for you for getting started on your blog.
Gloria Lemay, Vancouver BC
Thanks Gloria
I’ve also linked to your fantastic audio in my ‘pushing’ post.
Rachel, thank you for visiting my blog. I have so much to learn, still (probably obvious in my post 🙂 , which was just written because I was annoyed at all the fear about nuchal cords), but it is good to see your research confirm what I already instinctively knew: that we can trust birth to work right nearly all the time, nuchal cords or not. I am really looking forward to reading the .pdf and saving it for my midwifery studies.
Manhattandoula – our instincts are almost always right ; )
My second daughter was a homebirth in water with a nuchal cord. She performed the “sommersault maneuver” you describe all by herself. The midwife told me to stop pushing so she could get the cord over the neck – it was tight enough that the first attempt to slip it over was unsuccessful; however, I couldn’t keep the contractions from coming. My daughter shot out, sommersaulted through the loop of the cord, and we brought her up to the surface. It was surprising, but perfect!
What a coincidence! My daughter, also born at home in water, did the same thing. I didn’t even realise that there was an issue with the cord, until my midwife told me after the birth, “She somersaulted out, that’s why you tore.”
My name is Tina Henry and I am a registered midwife. I have been asked to give a water birth presentation to our MoreOB group on water birth. They have also asked if I could show them a video of a baby self-somersaulting out due to a nuchal chord. I don’t suppose you have a video of your daughter’s birth and might be willing to share it with a few skeptics? I have witnessed it many times myself but can not seem to locate a video!
My brother’s cord was cut by a physician prior to a shoulder dystocia. He has developmental delays and learning disabilities resulting from it. My mom told me they had to cut the cord because it was too tight for him to be born, then he got stuck. He was born blue and had to be resuscitated.
I am sorry to read this Danielle. I wonder how many other children have ongoing problems that have been blamed on a nuchal cord rather than the management of it.
A dear friend of mine resulted in 40% hearing loss (which permanently affects his speech) from his cut nuchal cord, and he has voiced his speculation that his slow uptake on motor skills e.g. tying shoe laces and buttons as a young boy are related to it as well. He was cut off from oxygen for some time during birth because of this cut. This makes me so, so sad.
I feel a great urgency to find a midwife/nurse/physician who will be prepared to leave me and my child alone when I go through labour. My physician cousin thinks I’m a fool and also pushes the necessity of an epidural (her opinion) on me every time I mention my desire for natural birth.
I greatly fear a hospital birth for the lack of consent, courtesy and control it poses. At our most vulnerable and most independent moment – labour – we are asked to kindly shut up, lie back, and do as we are told. How did I never see, before getting married, that this gender inequality would touch me profoundly in pregnancy and birth?
I’m not sure where you are located but if you hire an independent midwife they should work for you rather than the institution. Doulas can also help you assert your wishes in a hospital setting.
Awesome, Thank so much for sharing this. Very important info, even for midwives 🙂
This is great. I don’t know how many times that the first thing a parent will say about a home birth to me is “we never could have done that our son had a cord around his neck!” and….. I hope that you continue to help bring light on this scare tactic.
Thanks Tracy
When people tell me that they had to have a c-section/forceps/intervention because the cord was around their baby’s neck I sometimes answer: ‘Really? My daughter was born at home with no problems BECAUSE the cord was around her neck’. Either way the cord is not related to the outcome but it is used as a ‘because’ for intervention, so why not for a good outcome?
I had the c-section for this reason… BUT he was 2 weeks late, I was not dilating, after 18 hours in labor, he was in distress. So yeah, sometimes it does matter. I would have preferred not to do it (adhesions and subsequent chronic pain), but just sayin.
You had a c-section for fetal distress. Why do you think the nuchal cord caused the fetal distress? Were you being induced? Syntocinon (pitocin) is the leading cause of fetal distress in labour http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/. A 3rd of the babies being exposed to syntocinon during labour will also have a nuchal cord. Why is the cord blamed despite what is known about syntocinon and fetal distress (hence CTG monitoring of fetal heart rate during induction)? This is why I wrote the post – the nuchal cord is a scape-goat rather than a cause.
love this, sharing it on facebook. what about a baby that gets tightly wound up inside and this prevents it from descending? a friend had a home birth planned but at her last ob app the baby was literally all tied up and the placenta was at the top so would possibly have caused an abruption. her midwife didnt want to risk it and recommended a section. also i know from spiritual midwifery and ina mays guide that she used to loop the cord, do they still do that on the farm?
Hi Bonnie
Hmmm I’m not saying the obs lied but:
– The placenta is usually at the top.
– I have never heard of a placenta abrupting due to this situation.
– If the cord really was that tangled the baby would have unwound during labour (they are clever like that) or the labour wouldn’t have progressed = transfer and c-section.
– Obs come up with some odd ‘reasons’ not to homebirth.
It would have been interesting to see the outcome if she had believed in her ability to birth and not relied on an ‘expert’ in surgical solutions.
As for Ina May – I’m not sure what they do on the farm now. As midwives our practice should be constantly evolving in response to knowledge.
Years ago, my doula trainer attended an attempted VBAC with CNMs in attendance. After a straightforward (and med-free) dilation phase, mom pushed and pushed and pushed with absolutely no descent by baby, with normal heart tones, even when they resorted to purple pushing. Mom decided on a repeat cesarean, and when the OB got inside, they were all amazed. This little acrobat had twisted itself in the cord so tightly and so intricately, there was no way it would have been birthed vaginally. It was around the neck, chest, waist, arms and legs, and under and around and through and back again! Baby was engaged, but high enough that even after several hours of pushing, the skull wasn’t molded at all, baby was so tightly wrapped. As far as I know, in her 30 years of doula and birth work, that’s the only time anything like that has occurred.
My last baby was a homebirth, waterbirth and the midwife got there shortly after the birth. The cord was around the neck and our baby did the manuever you mentioned naturally on his own. Then we unwrapped the cord and it wasn’t cut for at least 20 minutes. He’s a robust toddler now. 🙂
IMHO This could use an explanation for how the uterus/fundus/placenta follows the baby out and therefore means even a short cord is long enough.
Also a discussion of the risks of a long but non-wrapped cord.
And perhaps something on wharton’s jelly / cords coiling.
Thanks mystic eye
I stuck to the risks / management of nuchal cord to avoid the post becoming too long. There is a little more about why a baby might become entangled in my journal article (all a bit referency and boring).
The fundus/placenta does follow baby out, but in extremely rare cases the cord is only long enough (or wound multiple times) to let the baby get his/her head out and requires the somersault technique for the body. The posters above have experienced their own baby’s using the ‘technique’.
Hmm hadn’t considered the risks of a long but non-wrapped cord. Clever babies winding themselves up to prevent cord prolapse : ) ?
The anatomy and physiology of the umbilical cord is an entire post in itself… maybe one day I’ll get round to it.
R x
I just discovered this blog and I’m LOVIN’ it! Your knowledge and experience will be a great resource.
In response to nuchal cords, here’s another extreme example of our culture’s misunderstanding of this normal occurence. When an acquaintance of mine was telling me about the birth of her daughter, she mentioned how it was scary b/c the cord was around baby’s neck, etc, even from the OB’s perspective. Then she went onto to say that she found out that when she was born, the same thing happened (and also to her siblings during their births) and quickly drew the conclusion that it must be genetic!! What?! I gently tried to dispel this, but I don’t think she believed me. 🙂
I have heard over and over again of “scary” birth stories where the cord was wrapped around the neck/body, etc. You are so right that it’s high time for this myth to be dispelled! I am grateful that you have such an extensive body of knowledge on this subject.
I love a good nuchal cord post. I commented on Gloria’s post about how it’s something I’m regularly debunking for people and here’s another read I can give them, so thanks!
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Hi – love your blog.
Just wanted to comment that my last babe had tight nuchal cord. Resulted in slow to breathe, low apgar, transfer to SCN etc mentioned above.
In my case I had a midwife assisted homebirth. No interventions of any kind. Short, easy labour. Baby born on land. Waters broke spontaneously quite late. Baby monitored by doppler intermittently with no sign of problem. Cord was not cut until the placenta was delivered. I am certain I felt the point when the cord tightened around his neck just as he started to crown. He tugged his head forward in an unusual way.
In my case cord clamping was not the issue but short/tight cord appeared to be. Anecdotal I know but I thought I would mention it!
Thanks Shann. Birth stories (anecdotes) are always welcome. Well done to your midwife for leaving your baby’s cord intact – he would have had a much harder time recovering without his placental circulation. This situation is rare and as you demonstrated a baby can be born with a tight nuchal cord without needing to cut it.
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Thanks so much for all your hard work. Also, thank you for making it available to us. My baby born with the cord around her neck just turned 30!! (and is perfectly normal). She was the second of my six and the only one with a nuchal cord. I distinctly felt her roll during labor, and told the midwife. ( This was back in Australia in a training hospital.) The midwife had recorded the baby facing down, then up, then down again on successive checks. The resident doctor was called in, and the midwife talked him through the birth, allowing him to unloop the cord after my daughter’s head and shoulders were born (I distinctly felt the double ‘pop’, ‘pop’). For me there was one stitch, and for her; a purple face, which took an hour to become the same color as the rest of her body. Always I have assumed she wrapped it around during the labor, but maybe she actually unwrapped one loop!!
3 out of my 5 birth centre & home births had cords around the neck. Most were loose and were born through the loop, except for one, where it was very tightly around the neck. She was born with bruising on her face and red spots on her eyes, and took a while to start breathing. The midwives think that she started off posterior presentation, but turned during birth, which caused the extra pressure. But all babies perfectly fine, cord cut long after birth, and no problems. People kind of gasp when I tell them about the cords around the necks, and ask if I had to transfer to hospital or something. I only recently learned that nuchal cords were considered to be a problem, so I would usually just dumbly looked at the questioner and said, “Transfer to hospital? Why? The birth was just fine…”
In 2300+ births in 32 years I have seen a nuchal cord cut 3 times. Twice when I was an apprentice and really had no say in the matter, though the second one seemed needed to me, the moment the cord was cut the baby fell out of the vagina (mom was squatting). The only time I have ever cut a cord before the birth of the baby was with a cord looped 5 times around the baby’s neck. The somersault maneuver didn’t move the baby even a millimeter. I clamped and cut the cord and unwound the 5 loops and the baby was born easily (was the mother’s 5th child). I did have to work a little bit to get him breathing, but he recovered well and was nursing within the hour.
I have only needed to use the somersault maneuver a couple of times, works like a charm.
What great stats to share! That sounds about right. I’m not into the 1000s but out of the 100s of births I’ve attended I’ve only used the summersault manoeuvre twice and never had to cut a cord… yet. The baby with the 5x cord must have been spinning inside his/her mama!
I found this anecdote very interesting. I have a good friend who had an emergency C-section due to a stuck baby with a cord wrapped 4 times around his neck. It was a first birth, and I don’t think the baby made it far enough down the birth canal that there were many options. That’s my understanding at least, and how the hospital made it seem. So after reading this article, my thought was, “well there have got to be SOME exceptions.” And this anecdote does seem to be the rare exception. This article does make me wonder, however, if there were other options in my friend’s case had she been with a midwife rather than a doctor at a hospital.
I loved this article, and thought it was incredibly important. The first time I had any idea that a nuchal cord was normal, and not necessarily dangerous, was when I read “Spiritual Midwifery” during my 3rd trimester. When I initially started reading about pregnancy and labor, I was suspicious of resources that didn’t seem “mainstream”, assuming that mainstream sources would give the most balanced information. But the more I learn, the more incredulous I am about how misleading mainstream sources are.
My DD2 was born at home in water with 2 tight nuchal cords, my midwife used the summersault maneuver as i pushed and unwrapped her so she could reach the surface. 🙂 everything was absolutely perfect!
My last (fifth) baby had a loose nuchal cord, followed by descending shoulders and stuck baby. Somersault technique was instantly successful, but my little one had bloodshot eyes from the pressure. Otherwise, he’s a normal, healthy 18-yr-old.
Hi!
Thanks for your blog 🙂
My son had a loose nuchal cord during birth (UC) and that didn’t stress me at all… I wish more people knew that, that would be less stress for mothers to be.
My friend kept the cord attached for days and kept the whole thing including placenta,wrapped in salt, and carried it around with the baby, so baby could get the full nourishment.
This is called a ‘lotus birth’. It is more of a spiritual practice as the baby does not get any nutrients from the placenta once it has ceased circulating. The idea is that the baby choses when to release their placenta rather than having it cut away. You can find out more here: http://www.lotusfertility.com/Lotus_Birth_Q/Lotus_Birth_QA.html
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I love this blog! I’m a childbirth educator in NYC and I reassure expecting couples about the dreaded cord around the neck all the time. I wanted to ask you to clarify something if I may. I’m little confused about whether the unraveling of a nuchal cord should be done as the head emerges or after the baby has been fully born. When do you do it? Another question: I am sometimes asked by students what they should do if they end up delivering before the EMTs/midwife arrives. Is there nuchal cord advise you’d give here? Also, what about breech babies and the nuchal cord, do some babies never go down due to a tangle of the cord or a “short” cord? (So many questions, sorry! I think there’s a lot of mythology around this cord, and it DOES frighten women.)
Unraveling the cord can happen after the baby is born. Much less invasive than pulling and fiddling when the head is born and interrupting the mother’s instincts. If it is loose the baby may birth through the loop and not need unraveling. I don’t check for cord because I don’t do anything with it, and I sometimes don’t actually see the baby coming out (dark room, waterbirth, in another room). I wait, and if the mother wants help unraveling her baby, I’ll give her a hand.
If the baby is born before the midwife arrives – just leave the cord and unravel once baby is out. I think it is important to address this issue with parents to avoid unnecessary panic if/when they see a nuchal cord. The article you can download from this post is about sharing information with parents re. nuchal cords.
I’ve never heard of a breech baby being held up by their cord. Not sure how this would work because the uterus (with placenta attached) moves down with the baby. However a nuchal cord provides a perfect scapegoat for all manner of birth outcomes – although is not associated with any.
Usualy when parents are aware of the facts re. nuchal cord they are no longer frightened. A 3rd of them will experience a nuchal cord during birth so they need to feel OK with it. It is our job as educators to try and erradicate fear with knowledge.
my wife delivered a baby boy few days back. pre delivery every test including ultrasound (color dropper) was fine. but during birth baby was in “Abnormal Presentation” facing up-words..nurse pushed down the baby forcefully to make normal delivery possible.
During baby had “cord around neck” and could not breath for 5 min, my baby was on ventilator for 5 days and could not survive..
plz let us know who is to blame, n what precautions we should take in future..??
I am very sorry you lost your son. I can understand your need to find answers but I cannot know what was happening during the birth. I hope the health professionals present take the time to debrief with you and explain what happened from their perspective. I am not sure which country this occurred in… I can share some information with you that may help you process what happened and ask some questions of those involved.
Facing upwards is not an abnormal presentation and fairly common – you can read more in this post: http://midwifethinking.com/2010/08/13/in-celebration-of-the-op-baby/
The cord around the baby’s neck was more than likely just incidental, and nothing to do with the outcome as one third of baby’s are born with the cord around their neck with no problems.
No force should be needed for a normal birth to take place. I am not sure if you mean force was applied on your wife’s abdomen or on the baby? Was the baby’s umbilical cord left intact so that he could be resuscitated by the placental circulation? http://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/
What were you told about the cause of death? There maybe no-one to blame. Some babies don’t make it. I hope you get your answers.
Thanks for the reply.
1. This took place in India.
2. The force was applied on my wife’s abdomen so that baby move downwards..is it recommended..??
3. the Dr. informed me that during birth cord was tightly around baby neck..(baby could not breath for 5 min and resume breathing after 5 min), however 4 days old color dropper ultrasound showed no cord around neck..is it possible..??
4. The child specialist said “oxygen could not be supplied to brain hence he developed swelling on head” and expired after 5 days on ventilator..:(
5. about umbilical cord left intact, no info was supplied..
with this info. are u able to determine root cause…??
Without being there or talking to the health professionals there I will not be able to determine the root cause.
1. I do not have much knowledge about maternity care in India
2. Fundal pressure is not recommended and can be dangerous. More info here: http://www.scienceandsensibility.org/?tag=fundal-pressure
3. The cord can become wrapped around the baby’s neck as they rotate through the pelvis in labour. This is why there is no point in doing an ultrasound to see if the cord is around the neck. It also doesn’t matter in terms of labour outcome. A tight cord will not stop the baby breathing. The baby doesn’t breath until after birth (usually within the first minute). Until the baby breathes they are receiving oxygen via the umbilical cord just like they do in the uterus. This is why it important not to cut the cord until the baby is breathing on their own.
4. A healthy baby can cope without oxygen for around 7 minutes. So, unless the baby was stuck for this long with his head out and body in – the significant lack of oxygen either occurred earlier in the labour or after the birth (eg. by cutting the umbilical cord before he was breathing). Babies can survive a sudden reduction in oxygen at the end of labour because this is fairly common.
I think you need to ask the Dr for more information about what happened and why.
Dear Rachel,
‘Maternity care’ in India is a misnomer if you look at it from the angle of the mother. Doctors have this ‘i am god, you are patient’ attitude. You are left to their mercy with no right to ask questions. Nurses too, feel intimidated when asked questions to understand a procedure/ protocol. The worst is that,most of them enter into these professions only for the money they see in it. Compassion and kindness can be received in tertiary hospitals alone and that too,is directly proportional to the money you pay for it. There is nil respect for human rights and dignity as far as the hospitalized laboring mother is concerned. It is like, “She’d better lie down quietly as told, She’d better push without fussing too loud, and what? consent for episiotomy? ha, ha, that’s my doctoral right. Who’s asking here ?”
Btw, natural birthing has reached our shores only recently. There are 3 centers now in India, catering to the rich and elite internet users. For the rest of the women in India….
Globally there are terrible human rights issues in maternity systems – and the people who work in them. It is awful.
hi amit.. m really sorry to know about ur loss… read ur post in d ddun page on fb.. i hv jst completed my mbbs n am an intern rite nw.. so i dnt hv much experience.. bt what i can make out of what u said above is that ur baby was in breech presentation.. which is fairly common.. n i guess what was done by puttin pressure on ur wifes abdomen is a procedure called external version which is done to convert the breech presentation into a vertex (head) presentation.. this is also a common procedure which has its risks.. the most common of which is strangulation by the nuchal cord.. which happened in ur case i guess.. i dont know whethr the doctor is to be blamed in dis case bcoz i am not sure whether they took the necessary precautions..
Hi Smriti
I think Amit’s wife was in labour when this happened so I don’t think the baby was breech. Fundal pressure is sometimes used to ‘speed up’ the birth or in the case of shoulder dystocia. However, it is not recommended. An external cephalic version (ECV) should take place with a highly skilled practitioner using ultrasound and with immediate access to c-section.
The cord cannot ‘strangle’ the baby as the baby is not breathing. The most common complication of (ECV) is fetal distress or placental abruption. Umbilical cords are usually long enough to allow movement, even when multiple. We need to stop blaming nuchal cords for ever poor outcome and increasing the fear for parents. Nuchal cords are normal.
Hello, very interesting article, which I am sure I have shared before on the internet.
I am wondering now about how this relates to a breech baby. What are your thoughts please?
No difference really. The baby+cord+placenta+fundus all move down together. In fact the cord can be shorter as it doesn’t have to go from the head up the body and into the uterus like it does when baby is head down. You can pictures of a breech with nuchal cord here: http://londonbirthpractice.co.uk/joomla/educational/breech/home-breech-birth-photo-series_2.html
Of ocurse, I’ve seen those pics before, have probably shared on Facebook on more than one occasion in the past…. So, a breech baby with a tight white cord after a fairly normal and uneventful labour would probably do worse after immediate cord cutting than leaving it? We really, REALLY need more breech birth training
Any baby does better when their cord is left alone – especially a compromised baby. And yes we really do need more breech birth training. It has become a lost art.
Homebirth with my son. 38 hours of labor, he was accynclitic with his hand by his chin AND the cord was looped around his neck/shoulders AND the cord was tearing away from the placenta. it was successful! in a hospital, i would have been sectioned after the first 12 hours of labor for sure and who knows what they would have done had they known the other issues! more people need to know this is OK. thanks for sharing
Congratulations to you and your nuchal/shoulder cord baby! 🙂
i dont think the fear is about baby being strangled of ‘air’ but of blood supply. if the cord gets to tight around the neck it slows blood flow to the brain does it not? have u ever seen kids play that game when you were younger where they put tight pressure on a persons arteries on the neck and theyblack out? baby still needs blood flow to the brain does it not? ..
i dont think the fear is about baby being strangled of ‘air’ but of blood supply. if the cord gets to tight around the neck it slows blood flow to the brain does it not? have u ever seen kids play that game when you were younger where they put tight pressure on a persons arteries on the neck and they black out? baby still needs blood flow to the brain does it not? .
Hi Shannon
I wrote the sentence about ‘air’ because I have heard a few birth stories involving the ‘baby had the cord around the neck and couldn’t breathe so they cut it’. I think some parents do think it is the lack of air that is the problem – at least some of the parents I talk to do. The cord would have to be very tight to compress the vessels in the baby’s neck. Compared to the neck the cord is soft and pliable. When the cord is pulled tight at the end of birth the vessels in the cord are compressed which causes the reduction in oxygen. The baby and uterus are stronger than the cord so if it really was tight enough to ‘strangle’ it would snap with a contraction – it is the weakest point.
thank you for clarifying. i to believe that there is to much fear around the cord/neck but was unsure about this one point. when would it be dangerous if at all? if it was wrapped tightly 3x or something?
Yes, if it is very tight and the vessels are compressed there is a decrease of blood flow and oxygen. If this is prolonged ie. for minutes this can result in a baby who needs resus. However, the most important thing is to leave the cord intact to assist with the resus. So in extremely rare cases it can be dangerous (I’ve never personally experienced this) but what is more dangerous is the cutting of the cord.
Basically the biggest danger related to a nuchal cord is the way it is managed.
I think it’s great to reduce unnecessary fear and never feel for a nuchal cord. However I do believe occasionally the cord can cause real problems – possibly not the right forum to go into these but Anne Frye discusses them. I have known some myself. A lit review is helpful but we do need to still respect the occasional rare unexpected outcome. IS
Hi Nicky – If you read the post it does acknowledge that a tight nuchal cord can result in hypoxia. I do respect the occasional rare unexpected outcome but really feel that we need present the situation of a nuchal cord as normal and reduce fear. If we focussed on all the rare complications that are associated with childbirth we would end up like OBs doing all kinds of interventions to avoid tiny risks. A literature review can help to place the fear into context but practitioners also need to be able to manage the rare situation where a nuchal cord can create problems.
The CNM who caught my baby clamped and cut the cord within seconds of birth even though we had agreed on delayed cord clamping. When I asked her about it she said that she had to cut the cord because it was wrapped very tight. I was a little peeved about it then, but after reading this I’m even more so. Thankfully, no problems (that I know of anyway) from the immediate cord clamping, but it’s one of the few dark spots on an otherwise beautiful birth.
I was wondering, would a tightly wrapped cord be more likely to present problems in labor if the amniotic sac is ruptured? During my labor they really wanted to break my water because I was progressing so slowly, but I was insistant that they leave it alone. I remember it seemed really important to me at the time. After I found out about the tight nuchal cord I thought it must have been my mama intuition telling me to leave the waters intact to ease the pressure on the cord.
Without the waters there can be pressure on cord whether it is wrapped around the baby or not – so your intuition was probably right.
My 3rd child, a son, was born at home (as was one of his sisters) this past January. He had a triple nuchal cord. He literally came shooting out and I caught him. The 3 fantastic midwives who attended the birth spun him every which way to untangle him and then put him down on my wife. It was a little scary while it was happening, but the midwives remained cool and calm and went about their business.
His APGARs were 8 and 9 and the cord was not clamped or cut until well after the placenta was delivered. His 4 year old sister cut the cord!
Thanks for a great article on dispelling this myth.
My son had a Nuchal cord x2 as well as a true knot. Does the presence of a true knot make any difference? I’m thinking no, but the doctor was adament that my son would likely have not survived had I tried to labor with him. I was desperately trying for a VBAC after twins but am certain the doctor simply did not want to allow me to VBAC.
It is such a shame you were mis-informed. A true knot is unusual but lots of babies have been born with them. Usually no one knows until after the birth. Certainly not an indication for c-section. You should complain.
I just want to give the anecdotal info that TWO of my home water-birthed babies have had true knots in their very long cords. One of them came 4 weeks early, was 20 inches long, and a mere 5# 4 oz. Between me and my wonderful midwife, we think she just *knew* to come early because of that knot causing her troubles in adding pudge. 😉 Out of my 6 babies, three have been born at home into the water. One had a short nuchal cord (he sumersaulted himself as soon as he was in the water, and still had one loop remaining), and then these two true knots. The other three, sadly, I have no idea about, since the doctor who delivered them apparently didn’t think highly enough of my intelligence to let me in on it.
See Michele’s comment re. Her birth with a knot in the cord.
Our daughter was born with cord twice around the neck and true knot. Apparently either one is not an issue but both can cause big issues. Doctors say that the only thing which could have prevented her (neonatal) death was a c-section. We wish WS had had one, but the cord situation was not known beforehand.
I am sorry for your loss.
A true knot can cause a problem if it tightens and this can happen in pregnancy or during labour. This is a different scenario to a nuchal cord.
My 3rd, and most recent, child was born at 35 weeks. His heart rate would drop during each contraction but thankfully I have a great OB who agreed to let me labor on my own and only do a c section if the baby was truly in danger. I progressed quickly and delivered my son after 1.5 hours of labor (3cm to delivery). I delivered my son myself as my husband left the room to get the nurse who had gone to get the doctor. The cord was wrapped around his neck and he still, even at 35 weeks, scored 10 on both of his APGARs. Thank you for sharing this wonderful information…hopefully more mothers will choose to educate themselves before birthing their children.
Just so you know, I’m pretty sure that most babies heart rate drops during contractions. It’s just whether they go up again in between that is the difference between normal and cause for concern. Congrats on your little one! 🙂
I was planning a homebirth and at 40 weeks, not in labour and not fully engaged with a foetal heart rate of over 190bpm I had a C/S. My independent midwife told me it was because my son’s cord was around his neck twice and was preventing him from engaging and causing his high heart rate.
I have always believed that the C/S was necessary because the cord was causing the high heart rate problem, but now I’m not sure after reading this article. Did I really need the C/S?
I can’t really comment without having been there. I have not heard of a situation where the cord caused a high heart rate. However I would be concerned about a rate consistently over 190.
Do you have any ideas on what would cause a heart rate that high given I was not in labour?
A significantly high HR can indicate a reduction in oxygen = heart beats faster to get oxygen around body. It usually happens when a baby has been stressed for a long time in labour (which you weren’t) and is usually preceded by hours of HR dips with contractions. Or with an abruption (placenta separates before birth). Or with a high maternal temperature and/or infection. Either way it is not a good sign and your mw did the right thing by referring you to an OBs. I’m not sure what the cause was in your case. How was your baby at birth?
My son is fine (I’m not, I have PTSD from the way I was treated). His agpars were 8 and 9. I always assumed that once the pull on the cord was released he was able to get the cord blood he needed and his heart rate came back to normal. We did get him a lotus birth in theatre so he got all of his cord blood which I think helped his Agpar scores.
I didn’t have an infection or a high temperature. I wasn’t dehydrated, and I never had any bleeding through the pregnancy. I was in good health – which the hospital destroyed by cutting me open.
I recently obtained my son’s medical records, whom had a tight double nuchal cord cut minutes before birth. The day before onset of labour I presented at the hospital with leaking amniotic fluid. They monitored me for half an hour before I went back home. Reviewing his medical record I see this his heartrate on this day was persistantly between 170-180bpm and in ’90s during tightenings. There was no mention of this to me at the time though – the tracing done the next day while I was in labour is missing from his records – the notes say they were sighted but not by whom and no figure/record/signature. I shouldn’t be surprised though since it turns out his record states “loose cord around neck, unlooped and clamped after birth” when they actually freaked out about a double looped, tight cord, tugged on it, pushed a whole hand inside the birth canal to pull on it, then clamped and cut it. Then freaked out even harder since his shoulders hadn’t rotated and I couldn’t just :”push him out!”. I am actually disgusted that the procedure that created a resuscitation situation and low Apgars by 5mins is ‘hidden’ and lied about in his records. How can researchers produce the type of evidence that will convince all in the birth industry to stop this routine, dangerous practice. And how can children like my son be tracked for outcomes beyond birth if the timing and circumstances of cord cutting is not included in formal birth records!!
Anyway, I just thought it was interesting how he most probably already had a tight cord late pregnancy that may have been causing a higher heart rate going in to labour.
Medical records often don’t reflect what happened. Practitioners know that records hold a lot of weight legally and document accordingly. The old ‘if it isn’t written it didn’t happen’ that is drummed into midwifery students to encourage good record keeping works both ways. I am sorry your birth story has been re-written.
My boy was born safely at home with a nuchal cord and a loose knot too. There were no issues at all. It was a calm birth. I love sharing these little details with people so they know what trained professional midwives can easily handle and whats safe in a homebirth. I’m usually amused by the dramatic OMG reactions I get from people who don’t understand natural birth. Thanks for this fascinating info! A doula friend, Shelby, posted it on Facebook and I’m going to share it too!
So am I understanding right, that a tight nuchal cord is basically no excuse for it being cut? Or is incredibly, incredibly rare, but yes, it can be needed?
I just about cried when I read this article. DS1’s cord was cut before he was out. He was in distress (and they ‘forgot’ to turn the syntocinon off, or get me up off the bed), they gave me an episiotomy. His head was out. They cut his cord, then he was born. He had lots of breathing issues, and then had lots of feeding issues. Apgar at 1 minute was 4 (he got a 1 for hr & 1 for respiritory).
Hi Misskalypso
Sorry about what happened with your son, happened at my son’s birth too.
Same apgar at 1 minute, he was a 6 by 5 mins.
The story is here:
http://giftedbirthsupport.com/2011/06/01/birth-story-nuchal-cord/
Never say never. However, if a cord was so tight it was holding a baby up it would probably tear during a contraction – the uterus and baby are stronger than the cord. I can’t think of any situation when cutting off a baby’s blood volume would be an answer (doesn’t mean one doesn’t exist). Your’s and giftedbirthsupport’s stories are all too common unfortunately… and unnecessary.
I did some research after my son was born, and found stats that while many babies are easily born with a nuchal cord, a nuchal cord x 3 only occurs in 2-3% of births and almost always results in complications during delivery. Did you find the same in your research? Wouldn’t the length of the cord factor heavily into how this affected delivery?
I had a planned home birth. My waters broke immediately and then I started a 30-hour labor at home. Eventually transferred to the hospital where I pushed for 4 hours with no progress. After 40 hours of labor, I gave in and had a C-section. Baby had nuchal cordx3 which was rationale given as to why he could not descend.
Have you had/heard of any experiences like this?
A multiple tight cord is rare (as you found in your research). In relation to vaginal birth the complications associated with this unusual situation are probably related to clamping the cord and interrupting the natural recovery. In situations like yours it is difficult to pinpoint ‘why’ since babies have been born vaginally with multiple nuchal cords – see egs in post. And lots of babies are born by c-section for ‘prolonged second stage’ without nuchal cords. There is no research to support one leads to the other but in theory a short, multiple, tight cord could prevent descent but the tension on the cord would probably create heart rate abnormalities… Just speculating as I really don’t know 🙂
It can as it happened to me. I was induced for post maturity at 40 + 13, second baby with no descent into the pelvis (first baby born vaginally in the OP position) which I know wasn’t too much of a concern as sometimes that does happen, at induction I had a Bishops Score of 1. After the gel was inserted I went onto the monitor which showed a trace with some slight dips present although the registrar wasn’t worried enough to cart me off to theatre there and then, trace was repeated an hour later which showed a sleep trace so I was allowed to get up, wonder about etc. Later that day another gel was inserted, again a Bishops Score of 1 but followed by a normal trace. All day no sign of impending labour so I was pretty much left alone with a plan to do a trace again later that evening and then try again the next morning if nothing was happening.
Early in the same evening I started getting some mild cramping and a listen in with a doppler didn’t reveal anything worrying. A couple of hours later and just before I was about to head off to bed I went onto the monitor as was planned but this time the trace showed some evidence of tightenings which weren’t at all painful but there was also decelerations during the tigtenings and a period of bradycardia so off down to the delivery suite I went with a plan to monitor for a while longer. From here it all started to get a bit hectic, the decelerations became late decels although the tightenings were still not painful and described as prostin pains, there were episodes of bradycardia and tachycardia (my pulse rate was about 100 during those times though) and still my daughters head remained high. A decision was made to rupture the membranes (which was pretty uncomfortable and painful with a high head) with thick, fresh meconium present in the amniotic fluid. The late decelrations continued so as at this point I was assessed to be only 4cm’s dilated, no fetal descent and not in active labour, I was prepped for theatre. When my daughter was born she had the cord tightly round her neck 4 times with an Apgar of 8, 9 and 10 so recovered very quickly and apart from being a little unsettled for about 24 hours was absolutely fine thank goodness.
I know my case is a rare one and that the vast majority of babies are born perfectly normally and well with cords round their necks but I thought I’d just tell my story as it relates to what you said in your reply above.
Thanks for sharing your story. I’m really interested is the pathophysiology here. If the baby is in the same position as it was in pregnancy ie. high – why would the pressure on the nuchal cord be any different with some light contractions? Contractions caused by prostins (especially for a woman who has already had a baby) can cause fetal distress (see my blog post on induction of labour). The pathophysiology of late decelerations is placental insufficiency (often due to lack of resting tone in the uterus in response to induction medication). Cord compressions = variable decelerations. I am not convinced that your baby’s cord was the cause of the fetal distress here. Unless I am missing something.
In relation to the ‘high’ head – this is normal before established labour for a woman who has previously given birth. You were not in labour – so probably nothing to do with the cord.
I wonder what you would have been told about the cause if the cord had not been around her neck? Your scenario is not uncommon during induction… it is one of the risks you would (should) have been warned about in order to gain consent for the procedure.
I’m not sure of the answer to your first question because as you say with light contractions there would have been very little pressure on the nuchal cord, I’m not even sure the obstetric team knew, all they told me they could find to cause the fetal distress was the cord round my daughters neck. ( I forgot to mention in my first post that it was described to me as a very long cord which was tightly wound though so I don’t know if this may have had a bearing on it.)
There was no mention of the state of the cord or the placenta at birth so I’ve no idea if being postmature had caused any placental insufficiancy and unfortunately my records back 19 years ago were not as comprehensive as they appear to be nowadays. However, at the first monitoring after the gel was inserted I had no contractions at all yet there were dips present on the trace so it is quite possible that something else was amiss before any uterine activity began later that day (and even when it did they were, short, irregular and not in any way painful as I said, they couldn’t even be felt by the midwife placing her hand on my belly, it was only because they were evident on the trace that anyone knew they were occurring), I really don’t know and as I was asleep during the C section I heard none of the conversation going on at the time. I do know though that my daughters head didn’t start to descend into the pelvis even after my membranes had been ruptured, she was 81b and half an ounce at birth so not a huge baby and I had already as I said given birth to a baby vaginally in the OP position.
I must be clear though that I wasn’t rushed to theatre for a crash delivery, it was probably about 10 minutes or so before I was taken into theatre but I guess there was really little choice in the mode of delivery given the state of play at the time.
You’ve really got me thinking now because all these years I’ve believed it was the nuchal cord that caused the problem as that was the information that I was given at the time.
Sorry I can’t give you any more information on what happened as this is all I really know.
It is very difficult to analyse what happened without being there. All I am suggesting is that based on the physiology of the umbilical cord and the scenario presented – I cannot understand how this would be about the cord. Have you seen the movie in the post with a long multiple cord… unwrapped after the birth. I think you are illustrating my point – that the nuchal cord is often used a scapegoat and the stories women are told and re-tell reinforce this.
My understanding is that you were given prostin – this is a drug with effects = why you would have been on the CTG monitor. Women can have a reaction to prostin. You may not necessarily experience ‘strong’ contractions. The resting tone of the uterus can be effected which alters the blood flow through the placenta. Not that your placenta was insufficient – more that it was unable to perfuse adequately with the effects of the prostin. In some cases doctors will not use prostin with women who have previously birthed and prefer ‘mechanical’ methods of induction to avoid this.
And after an ARM the baby may not automatically descent into the pelvis – it may require labour contractions… which you weren’t having.
I am a doula and recently at a hospital birth, the baby was coming quickly, the nurse wanted mom in bed on her back, mom crawled in on hands and knees… nurse tried hard to get mom to turn over, mom refused. I encouraged nurse that the baby would come out – baby was born before Dr arrived. Baby was 10 1/2 lbs, nuchal cord x4 + a true knot! I thought it was great, but the nurse was freaking out, (she didn’t check for a cord when only head was out, didn’t know at all till baby was completely out). She cut and clamped the cord immediately after birth so the baby could go to the warming bed for ‘resuscitation’. IMHO, I think the fact that the mom birthed on hands and knees, let the baby come as easily as he did, and with the Dr. not being there, IF mom had been on her back with the nurse trying to pull on the head to complete the delivery (standard around here), the 10.5 lb baby with the nuchal cord x4 there might have been birth complications… I’m glad I helped mom follow her instincts and go to hands and knees on the hospital bed.
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Hello.
I’m hoping that you could shed some light on whether or not a c-section was necessary for the birth of my daughter. Here are the facts:
-had a very healthy pregnancy
-the baby was still up high, never engaged but was head down
-was 2 weeks overdue, but was being monitored three times a week and everything looked fine
-After being 42 weeks pregnant, I was bullied into induction, although I was not confident at all about it
-I was given cytotec (did NOT want that) at the hospital. Four hours later, was given pitocin, and was on it with no epidural for 2 1/2 days. I only dilated to 3cm but baby never engaged, still head down, and every time I had a contraction, baby’s heartbeat went down drastically, but it did go back up ok.
Doctor on call broke my water without telling me and saw miconium, baby was in distress. I had to make a decision: c-section or keep waiting and hoping something would happen. I wanted to keep going, but I was scared into thinking she could die or have permanent brain damage. (My husband was very scared, and my close friend, who was there for support, also worked there as a nurse in the birth unit and knew something wasn’t right.)
I decided to proceed with the c-section. I was so scared, hated the medicine.
When they opened me up and tried to get her out, she was trapped up high under my ribs, and when they got her, she had the cord wrapped around both arms in a figure-8 harness and once around her neck. They had to give her a little help with breathing, but she ended up being ok. While I was still on the table, everyone said I made the right decision because there was no way she was coming out vaginally wrapped up like that and that’s why she wasn’t descending.
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K, so I just need to know if this was just a “fluke” like my friend called it. Will it happen again? Could I have done something differently, like fetal positioning? It has been two years, and I’d really like to try and have another baby. Please help.
Ashleigh – Your baby was entangled in her cord and it was more than just a simple nuchal cord. From what you have written it sounds like an extremely rare case of true cord entanglement. There is nothing you could have done to prevent it and your c-section was most likely necessary. It was a ‘fluke’ and is extremely unlikely to happen again.
Thank you for this post! I love your blog and have been gradually digging backwards through it to occupy myself during the insomnia of 39wks pregnancy.
Over the last week I am pretty sure my (cephalic) baby has spun at least 360degrees and this, combined with my mother-in-law’s tales of my husband being born with cord “wrapped around his neck” and a story on my birth board about a 3x wrap, had started to concern me.
I have a great rapport with my lovely, non interventionist, homebirth mw who spent some time on the Albany team and now feel really confident to discuss the issue fully with her next time I see her, incorporate our conclusions in my birth plan, and prep my birth partners for the possibility. Thanks again for giving me that confidence.
I am so pleased you are approaching birth with information rather than fear. I would love to know if your baby does have the cord around his/her neck – pop back and let us know (if you get time). My own daughter was born at home with the cord wrapped around her neck… she is very proud of this
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My youngest son was born 2 weeks early after a worrying third trimester with reduced fetal movement. We’d had monitoring four times and experienced one decel, but he managed to pass the other times so they put it down to temporary cord compression. After each monitoring I was unhappy, my baby didn’t behave the same way my others had (he was my 14th), And though he ‘passed’, I wasn’t confident he was alright.
Going into labor two weeks early was unheard of for me, my pregnancies had got progessively longer with my 13th going 10 days passed due. I labored all day and baby was more active than usual. We headed to the hospital when I felt birth was imminent. In hospital I remained active, walking and rocking and I spent a lot of time in the shower. As second stage began I climbed onto the bed, kneeling over the back to deliver the way I had with my last 8 babies. After some hard pushes the membranes ruptured and meconium was seen, my mw turned to push the emergency button and then turned back to see my son land on the bed. I was urgently told to lift my leg and turned to see her unwrapping little Eli from his cord. It had been wrapped around his neck not once or twice but four times! We then discovered a true knot in it.
He was fine, his apgars were 9 and 9 and he weighed in at 6lb 6oz. My smallest baby. My biggest had been 9lb 12oz so he seemed so tiny.
His story is proof that cutting a nuchal cord isn’t necessary, I guess his fast birth made it impossible anyway, but his story also is warning that drs and mws should always listen to a mothers concerns, especially one who has experienced pregnancy before. It is believed that Eli may have been swimming in mec for weeks before his birth, it took weeks to get it out of his skin, and I believe that his growth had also been restricted.
Interestingly my first son, a father now himself, also had the cord around his neck four times but he was born by emergency caesarian for fetal distress. We have since looked at my notes and it seems I was induced for pre eclampsia that didn’t exist and then caesered for fetal distress that didn’t exist! Fortunately I went on to have vbacs, 13 of them 🙂
You are so right – mother’s are the experts on their own body/baby. You knew you son was not ‘alright’.
I wonder if you have the record for the most VBACs by one woman! 😉
Thank you so much for this, I’m sharing it on Facebook.
I am curious about a true knot in a baby’s cord. Does it post a risk and how often are true knots present without risk to baby’s well-being.
Hi Lisa
A true knot does increase the risk of the baby running into problems associated with reduced/interrupted blood flow http://www.springerlink.com/content/d4h5527365437160/
However, most babies with knots are fine and the knot is not noticed until after the birth. Michele (see comment above) gave birth to a baby with a nuchal cord and true knot.
Now there is the questions of the truly short cord – and is there such a thing?. The only problem I have is that I palpated a first time mother recently whose baby was at 40 weeks it was breech – but I made no mention as her. I was acting as a counsellor friend and educator. I am her Lactation Consultant not her midwife and was leaving for 2 months that week. I alerted her obs via her midwife who was going to arrange to perform an external version. This meant going to one of our unpopular hospitals a long way from home with a probable operative outcome. The mother chose a Caesarean birth at the hospital she was comfortable with. Home birth was not on her agenda until now. Following the birth it was stated there was a short cord. An ultrasound was performed priorand confirming the breech. There was a special mention made that the experienced technician could not sight the cord. Was this a case of a short cord not allowing a head down presentation? I do not know the answer except that the breech could have been born vaginally..
Breech babies are often breech for a reason – and a very short cord could have been the reason. They can come out vaginally with a short cord in the breech position… if they get the opportunity.
I had never heard of a really short cord causing a problem until I talked to my midwife about her 4th birth- her baby was born in an extremely fast labor with a cord so short that she pulled the placenta off on her way out, resulting in some major bleeding. Baby was born unassisted within about 15 minutes- almost like she knew that she needed to do it quickly!
Almost anything is possible with birth, it seems, but there is just a lot more fear than is really warranted.
Two comments: I don’t know of any literature that suggests sort cords cause breech presentations. If you think about it logically the distance from umbilicus to breech is considerably less than the distance from umbilicus to vertex, ergo a short cord would actually encourage a cephalic presentation – unless the cord insertion is below the fetal umbilicus at presentation. That would be a scarily low lying placenta. Most breeches are probably random presentations, some are related to the shape of the uterus (breeches are more common in bicornuatae uteri for example).
Second: I’m personally uncomfortable with the patient autonomy issues raised by the the educator failing to inform the client but instead going to her midwife to inform her Ob. I wouldn’t recommend that as standard practice as it raises some ethical issues in addition to removing the decision making from the mother.
Nice blog – The amount of misinformation about umbilical cord issues in the Obstetrical community is rather stunning – even for a community where misinformation, or more accurately misapplication of information is rampant.
You are right (you have had me testing things out with my doll and placenta). Short cord would not encourage a breech position. Maybe I’m getting mixed up with anecdotal short nuchal cords 🙂
David Hayes A long reply which I hope spells out there is more to a midwife’s assessment skills of breech presentation than just the examination or knowing about the cord length. Emotional and physical health and happy baby outcomes involve much much more.
I appreciate your comments and you have replied with the answers that suit the reason I put my question. That is I am always prepared to learn something new. Unless there is an ultrasound the cord position is not always assessable and even then the technician could not see one at all.
As for the ethical issues – this woman was my friend’s daughter and I am not eligible currently to be her midwife although I am eligible due to International qualifications to be her Lactation Consultant. The daughter relied on me a lot for advice and support as did the mother (stressed and stress producing for reasons other than the birth – the history being known to me and shared with her known midwife by the woman.). The daughter had called in with a state of high anxiety produced by lack of sleep due to husband’s (reasons are not uncommon but long hours and first time pregnancy for both). I decided her need for sleep was a high priority There were some resolvable problems with communication etc – So far my advice has been reliable for her thus far as evidenced by her calls for many other different minor problems about breastfeeding and company. Our friendship has developed over years..
I assessed the situation as (1) I was sure this was a breech with narrow presenting part way in to pelvis with head under the ribs confirmed by comparative grip.and strong fetal heart high on the left side, at 40 weeks in a primigravida — The presenting head in the pelvis can usually be felt easily partly in the brim in a first pregnancy. The woman was tender to touch due to a previous over zealous palpation the week before.. It was not my place to confirm this breech. The breech had not been picked up by the hospital. This is called co-operation between health carers. The examination was the first time she had wanted the examination. I would say her instinct were at high volume – some women just know.
She is not my client. (2) I also knew that she was seeing the doctor and midwife in two days time. I alerted them to her state of anxiety. I knew that this news would be handled with the skill required. Knowing your midwife and your hospital is easy in rural communities. We also know those that are out of date and one we label the “butcher shop”.
Of course I was facing a dilemma but I made a judgment call because I knew that on top of her current anxiety she needed sleep more than she needed another problem. She rang to tell me shad had a good night’s sleep. I also made certain of apology to her the day when the breech was confirmed. I am an experienced examiner. My clinical practice covers over 30 years in the filed as well as teaching and re-teaching the art of palpation to hundreds at higher degree level combined with another 18 years of practice.. I observe more with my eyes and ears and combine this with knowledge. I do not put my hands on unless asked or necessary. I chose to graduate as a Masters in Bioethics 14 years ago because of the all too common ethical dilemmas up to date midwives and students face in the highly operative and chemical interventionist hospital arenas.
The fact that the doctor with whom she was well connected at the hospital was prepared to arrange with an experienced colleague at a hospital 1 and half hours away to perform an external cephalic version was good news. The woman therefore had choices. I was leaving the next day for overseas. The woman I consider to be strong and capable of making her own decisions with the ability to read and discover all sides to the choice.
The short cord was not the problem but was discovered after the event. The placenta is normally situated high in the uterus in primigravida and a short cord has been, although rare, responsible for early detachment of the placenta during birth with a resulting severe intrapartum maternal haemorrhage. In retrospect one could be relieved that this did not occur. A short cord usually results in the baby choosing a position facing the placenta. An experienced midwife would be alert to the possibility in a multiparous woman of the placenta being low lying This may result in the baby lying in the transverse and t may bring prolapsed cord. A low lying placenta may also be “praevia’ or coming first which has problems of maternal haemorrhage at the onset of labour. An experienced midwife would suspect these in a post Caesarian woman and would ensure a precautionary ultrasound was done.
This woman also had disproportion of size – very tall and very small feet. which may lead to reduced pelvimetry and disproportion which sometimes results in difficulty for the baby to enter the pelvis head down. This woman also researched breech looked at the options and chose to stay close to home with friends and relatives rather than go a long distance for the ECV. This outcome may have produced a surgical birth isolated from family and friends – not everyone has public transport or finds it economical to travel long petrol eating distances to visit hospitals. I am a believer in the woman leading her care and that is I believe the happy outcome in this instance. Had I not alerted the hospital I believe this breech may have been missed.
LOVE LOVE LOVE that you wrote an article about this. I’ve been singing this song for years (8) to anyone who cared to listen – was thinking of writing an article myself but it looks like you’ve pretty much covered almost every point.
One thing I find myself doing most often when the cord is tight-ish in an obstructive way (seldom) is slip my 10 fingers through the loops, sort of holding the single/double/triple cord necklace at the perineal level and let the baby squeeze through as s/he comes out. Cord always stretches, and still pulsates after birth, no probs.
In hundreds of births, I’ve never cut and clamped on the perineum, and would feel SUPER nervous doing so. I saw it done by provider once early in my training, and the baby didn’t make it.
In my book:
Nuchal cords = no big deal … cutting the cord before baby born & stable = watch out.
Thanks for writing this article, I’m spreading it around to, well everyone I know : )
Of my 8 births (all at home) I have had 2 babies with cord issues,
First- baby #4 had 2 complete figure eights, the cord went from umbilicus up around the neck-down around his waist twice. As his head was born my midwife told me “there is a cord stop pushing” I instantly knew not to stop pushing, I pushed his shoulders, then his hips and he finally released, the cord was never an issue as it was the longest cord we had ever heard of, we measured it and it was 44 inches. Placenta delivered and then cord was cut.
Second- baby #6 during labor baby was presenting with the side of his head above his ear. My midwife was able to reposition his head, I began pushing and started feeling an extreme pain in my abdomen just below my navel that was not normal. As his head was born my midwife discovered a nuchal cord (it was around his neck once and went up over his ear on one side) that was extremely tight, his head then pulled back and started turning purple, he had severe shoulder dystocia, my midwife cut the cord and was able to maneuver him out. Baby had an apgar of 3 but was resuscitated successfully. When the placenta came we first noticed the extremely short cord (we also measured this cord total length was 12.25 inches) and 1/3 of the placenta was clotted, we feel that as he descended the cord put traction on the placenta and it was peeling off, for some reason he had a very strong cord. We discovered some interesting things during the newborn exam, 1- the cord being above my baby’s ear had caused it to form incorrectly, 2- he had “noose marks” from the tension the cord placed on him around approx 2/3 of his neck, 3- his head had been tipped to his left side for so long he had developed Torticollis (from the cord being up over one ear).
I truly believe that most nuchal cords are a variation of normal, just as breech born babies are (I can speak from experience as baby #5 was born frank breech at home).
Thank you for advocating for all babies with nuchal cords!
To clarify my above post, these births were attended by different midwives. The midwife with #4 was trained that nuchal cords are always a problem and I could see the concern on her face as I continued pushing but I “knew” that all was fine and to keep pushing With baby #6 cutting the cord on the perineum was the first time in over 6 years since she had felt a need to do so, she had learned through her 15+ years as a midwife that cords are not usually a problem. Baby #6 has had no other problems other than the Torticollis and is now almost 5.
I learnt, somewhere, and it seems to make sense, that if a baby is conceived, at the optimum time, i.e mid cycle, it imbeds at the fundus (where the blood supply is best). Hanging off it’s cord, like a light bulb off a flex from the ceiling, it is IMPOSSIBLE to get entangled in the cord. Conversely if the placenta is on the side wall of the uterus all manner of shenanigans can take place. Good pre conceptual care, and natural family planning would help this objective……..
Great article – I’ve done two lotus births and left the cord till it fell off of its own accord. Great results. I happen to give birth to babies with extremely short cords. Not sure why. Midwife says it would have been impossible for the cord to wrap round the neck. It does make giving birth in water (my preferred way to reduce pain) a little funny as I have to stand up immediately and exit the water as I have no distance on the cord to lift baby up to me. My placenta has taken approx 30 – 45 mins to birth after the baby.
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i have attended 6 births on my own now and had both my babies at home. because mine were both posterior and rotated in labor, my son’s cord was around his neck twice and my daughter’s once… i simply unwrapped them after they came out. both were born without any problems and breathed immediately. of the births i have attended, only one was born without some sort of cord wrap. 2 were very tangled (around the body, under the shoulder, etc) and both were just fine and breathed very quickly after they were unwrapped (though it did take all three of us 🙂 ). the rest had simple neck wraps again with no problems. thank you so much for offering a place to share this information!!!
I have found this blog very interesting. I gave birth to my son in June last year. I was in the birthing pool for the first part where they monitored his heart rate every 15 minutes when I wasn’t contracting. I opted for an epidural in the end and was taken to the labour ward where they strapped a heart monitor to me to listen to the baby’s heart continuously. Very quickly they could see that at every contraction, his heart rate was dropping to almost nothing. I presume this had been happening for quite some time but that the periodic monitoring in the pool had failed to pick up on it. The mw pressed the alarm and the doctors rushed in. I was told the baby needed delivering straight away, which they did using forceps. It was all rather traumatic and he came out with the cord wrapped around his neck and body which I always thought was the reason his heart rate was dropping so dramatically. I am wondering if this is correct now, although I see Melanie had the same experience.
When cord is around the neck it is protected from compression therefore it is more likely that the cord was being compressed between baby and uterus or pelvis (especially if the waters were no longer protecting it). However if you baby’s head was moving into your vagina it is normal for the heart rate to dip with contractions due to head compression. This is normal and not a complication – although some practitioners panic.
I agree that nuchal cord is a very common occurrence, up to 70% of births. It is not always a cause of fetal distress, however significant cord compression resulting in fetal hypoxia is the most common cause of fetal distress and can be due to many causes including nuchal cord. I don’t agree with your labeling – scapegoat. If intervention is needed for fetal distress it should be done. Waiting longer or delayed cord clamping isnt always the answer and can result in a fetal demise.
This post was based on an extensive literature review of all the available research evidence on nuchal cords. A nuchal cord is very rarely the cause of cord compression especially in first stage. In fact the cord is more protected from compression physiologically when around then neck than when draped over a shoulder or back. However the nuchal cord gets the blame = scapegoat even when it was most likely pitocin to blame. If there is fetal distress present in labour intervention is indicated. Not sure where I have said otherwise. C-sections can save lives. However some interventions such as cutting cords actually cause complications. If a practitioner chooses to do this they are open to legal action because it is acknowledged that it is bad practice (5 US cases so far). I would urge you to reconsider cutting cords and to read my post on the importance of placental circulation during resus. Cutting cords can result in fetal demise.
I have read extensively throughout this article. My concern is I have yet to see where you are saying that cutting the cord is EVER indicated? Having witnessed a baby turtling with what resulted in a very short cord, the MD cut baby’s cord and baby recovered quickly with resus but had to be admitted to NICU for significant cranial bruising. A CT was performed to rule out any subchorionic bleeding possibly from lack of blood flow to the baby’s head. Is your recommendation in such an instance to wait an extra 4-6 mins to roll mom back to do a C/S INSTEAD of cutting the cord? I am honestly appalled if a C/S is preferred to being able to instantaneously revive baby especially since the baby had already visibly lost blood flow to the brain for who knows how long all in lieu of cutting said cord. Wouldn’t more deoxygenated time put baby in a more compromising position? As I said, I want like to know if you are truly saying to cut a cord is never indicated. I have not seen you say anywhere were it is or maybe. Oftentimes, the cord can actually cause an abruption – even partial and not always break. So what is to be done in that regard? Just pull on it anyway risking it tearing or abrupting the placenta instead of cutting it in a controlled fashion? Mind you, I am not speaking of routine cutting. I am really wondering if you are saying a C/S is to be used in lieu of ever cutting a cord.
There is always and exception to every rule and as a practitioner you should never say ‘never’.
However, turtling is a sign of should dystocia – not a tight nuchal cord (read the description in the post about how the whole baby/cord/placenta move down together). In this situation (a stuck baby), lack of blood flow to the head occurs because of the compression of the baby’s neck and chest which impedes blood flow return, trapping it in the head… not due to occlusion of the cord although that will happen too.
If the cord is truly holding the baby up – unlikely as a baby and uterus are stronger than a cord – the cord will snap under pressure or perhaps pull on the placenta but not much as the placenta is very low, just behind the baby = not much give. Placenta abruption due to short cord usually happens (and it is very rare) AFTER the baby’s body is born because then the cord needs to find additional length. If the cord snaps it is manageable and you are unlikely to get sued for this scenario because you did not cause it. Whereas you could (and people have) got sued for cutting a nuchal cord before birth. I assume the MD was unaware of this litigation risk?
In answer to your questions:
“Is your recommendation in such an instance to wait an extra 4-6 mins to roll mom back to do a C/S INSTEAD of cutting the cord? I am honestly appalled ” – no my recommendation for a tight nuchal cord is described in the post. A shoulder dystocia needs to managed as an emergency – no waiting – and no wasting time fiddling with a tight cord and risking cutting baby.
“Oftentimes, the cord can actually cause an abruption – even partial and not always break. So what is to be done in that regard? Just pull on it anyway risking it tearing or abrupting the placenta instead of cutting it in a controlled fashion?” – I think you should consider the environment you work in. The cord very rarely causes an abruption during physiological birth. If it is happening often you may want to consider if people are pulling on babies as they are born, and/or pulling on nuchal cords etc. i.e. causing this rare complication.
“I am really wondering if you are saying a C/S is to be used in lieu of ever cutting a cord.” – no C/S is unnecessary at this point and in this situation, and would be a dangerous response. My suggestions for this scenario are set out in post.
I cannot imagine a scenario when I would cut a nuchal cord. I would rather risk a very rare cord rupture or placental abruption than risk disrupting a baby’s vital blood supply when he/she is compromised (and litigation for doing so). I wonder how that baby would have faired if he had been fully perfused after birth rather than missing a third of his blood volume during recovery. Severe cranial bruising has nothing to do with a nuchal cord. It has to do with injury to the scalp. Was this an instrumental delivery?
My own son was born almost two years ago now. While I was induced for pre-e, I was luckily able to ahve a vaginal birth. What I do remember is that after they gave me pitocin the baby went into distress. They were ready to cut me open, had shaved me and everything, but I remember telling myself that I didn’t want a c/s and I just needed to open up and get the baby out. From the time they checked and prepped me to the time they were going to put me under (about 15 minutes and after they had given me the meds to stop the contractions) I went from a 6 and 75% effaced to 10cm and fully effaced with the baby engaged. I pushed without contractions and a vacuum assist. When our son was born the cord was wrapped around his neck twice and he was very blue. They cut the cord as soon as he was clear and it took a few minutes before we heard him cry. I have always believed it was the pitocin that caused his distress and cutting the cord so quickly that kept him from recovering as quickly as he could have. It’s beyond reassuring to read your post and the numbers and know that the feeling I had that I could have had a natural birth in spite of the wrapped cord was not just wishful thinking.
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Thanks for the last entry from Robyn Heud. Strong woman strong baby. This site is just wonderful. I can count the number of times I cut a cord on my hand once for three times around the neck. The second stage was slow in coming but the fetal heart beat did not waver except to be what I call a hard and slowing beat. I prefer to listen rather than read graphs which I was forced to do many times when teaching. Love the diagrams and the whole damn thing. What a great asset Facebook has become for educators like me. We just love to teach and share.
I need to elaborate on my previous comment. The fetal heart beat slows in second stage as part of the process sometimes novices panic about that, experienced people would not.
Great article!
Just met with a couple where the dad’s greatest concern was how we would deal with a nuchal cord. He had been told his entire life how he was very distressed at birth due to the cord being wrapped around his neck. He would have died if the doctor had not gone up inside and unwrapped the cord from around his neck which was preventing his birth. When I told him this was just impossible he was surprised but insisted the doctor had done something to save his life. These type of stories perpetuate the dangers of birth and the need for management.
Great article Rachel.
As a Doula I always wondered how I would deal with a nuchal cord in a BBA situation, but now I feel confident I would know what to do – or should I say what NOT to do! I was also surprised to read about the frequency of nuchal cords.
Luckily the midwives in our area adopt a very hands off approach, and will only loop a cord if it’s absolutely necessary. We also encourage our clients to think about delayed cord clamping.
Keep up the good work.
Caroline
Great article! I look forward to reading more!
I was born with the cord looped around my neck three times. I was also born sunny side up, although my Mom had tried many, many times to flip me (hands & knees, butt in the air rocking). The midwife stated that I was so snug in the cord that she couldn’t have flipped me. My midwife did cut the cord because it was around my neck so many times/so tightly. I (thankfully) suffered no ill-effects!
I delivered my daughter by midwives in October of 2009. She had the cord looped one time, and we managed to do delayed cord clamping. I don’t know for sure if they looped or not, but I will definitely show this to my midwives for the next one (due March 2012)!
This post was extremely helpful! I will admit I teach natural childbirth classes and didn’t realize I had the wrong information for my clients. I will be sharing this information with future clients. This topic comes up in a great deal of classes as well, and I know they will learn a lot from this blog.
Just thought I’d share this link with you. It has pictures of a baby who had a nuchal cord x4 at her midwife assisted homebirth! Absolutely amazing pics! http://birthwithoutfearblog.com/2011/10/10/cord-around-the-neck-isnt-an-emergency-birth-pi/comment-page-1/#comment-4368
Thank you! I’ve added a link to this at the bottom of the post. 🙂
I am 37 weeks and 5 days pregnant, and my baby who was head down at 35 weeks is now breech. I went in for an external version, but after ultrasound doctor said I am not a candidate due to nuchal cord. This is my 2nd pregnancy and had previous vaginal delivery. Doctor said my only option is a c section. Wondering if there are any resources/optons for me.
C-section is not your only option although it might be the only option your doctor supports and is prepared to be involved with (if you are private). Attempting a vaginal breech birth without the support of your care provider will be difficult and if you do this it might help to get yourself a doula or advocate to deal with hospital staff while you labour (I am assuming you are hospital birthing due to seeing a doctor). I think a previous comment relates to breech with a nuchal cord. Some resources for breech birth:
http://www.breechbirth.org.uk/index.html (UK) and http://www.breechbirth.org.uk/index.html are a good start with links and information. Good luck and let us know what happens.
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This is by far the most understandable and comprehensive article that I have come across on the normalcy of nuchal cords. Thank you for this!
Makes so much sense. I wear a woollen scarf and wrap it round my neck several times but I never worry about strangulation because it is stretchy. Well done mother nature.
Ad me to the list of “somersault births” My babe had a very tight nucal cord x3 times around. We have the most amzing pictures of him under the water, being born this way. My midwife said she had heard of it happening, but this was the first time she had seen it. He took about 30 secs to take his first breath… and cord was cut about 2.5 hours later. 🙂
Fantastic article, glad I stayed home and allowed nature to take it’s course.
My last son (20 yrs old, now) had a loose cord around his neck as he emerged…then got stuck. As the assistant ran to get a hemostat, the Midwife did the somersault maneuver. He flipped “heels over head”, the core went slack, and we waited for the pulsing to slow naturally. No problems, except for bloodshot eyes that lasted for a couple of weeks. He was one of my most peaceful babies (out of 5). Also, my 4th VBAC.
ooops…that should read, ‘cord’.
The link to the website for the baby born in the Caul with the Nuchal Cord isn’t available any more. Do you have another link?
Thanks for letting me know. I will try and sort a link out next week when I am less busy.
Oh goody! Thank you for this. Just what I needed to hear having spent a little time thinking about this. My first baby was a planned home water birth and went so swimmingly well (less than 3hrs start to finish with intact perineum) 🙂 Second baby due in 3 months and hoping for more of the same. I was anxious about nuchal cords just in case midwives weren’t around in time (and I recall a tiny moment of anxiety when first baby was being born and the chord was checked for) and hubby was left to manage. Once again it seems ‘back off and let mother nature do her thing’ is the best approach. Thank you, thank you for speaking such common sense and writing in a way that makes a potentially complicated subject matter appear so simple!
I am struggling here because I lost my daughter at 39w 5 days to a nuchal cord. It was a type A three times around her neck and once across her body. In my research I have learned that this is actually NOT rare. How much time have you spent talking to parents who have lost their children to nuchal cords? There are 5 alone in the support group I attend. Stillbirths account for 1 in every 150 births in the US which adds up to 30000 a year!
My birth plan was to have a natural birth laboring at home and then going to the hospital for the birth. I hired a doula that had participated in over 150 births. When I went into early labor and went to my OB they failed to see the cord around her neck on the ultra sound and sent me home. Over that weekend my daughter went hyperactive on me and I phoned my doula. She told me that it was fine and that the baby was just excited by the birth. When I went to my OB the next morning there was no heartbeat. I have met many parents of stillbirth that have similar stories. I understand that you are trying to dispel myths but it seems to me that you are actually contributing to them which I find reckless. I suggest you interview some parents of loss.
I am sorry for your loss. I do speak to parents who have lost babies.
A third of babies have the cord around their neck yet do not encounter complications. Complications are rare. Stillbirths occur for a number of reasons they are not all due to cord accidents. Cord accidents are rare. Often in an attempt to find the cause and give parents an answer a nuchal cord becomes the scapegoat when often it is just incidental not causal.
You were concerned about your baby and you were not ‘heard’ – this was more important ‘information’ than knowing or not knowing about a nuchal cord. Women should always take note of a change in normal behaviour for their baby – reduction of movement, change of movement – and care providers should respond.
I am not disregarding your experience, I am trying to dispel the huge amount of fear surrounding the very common situation of a nuchal cord. If every woman carrying a baby with a nuchal cord was fearful – one third of women would be stressing out unnecessarily.
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Reblogged this on Radiant Beginnings and commented:
What a GREAT Post !!!!
Thanks for linking to Edward’s birth story. I found it quite eye-opening reading this post because I’d never really noticed how differently the cord around the neck was handled in my two births. With my first (story: http://madanddave.wordpress.com/2012/04/24/lillians-birth-story-the-start-of-the-road-to-home-birth/) I was actually told to stop pushing after the head was out while the midwife unwrapped the cord which was twice around the baby’s neck. Whereas, with the second birth (homebirth) they didn’t unwrap it until after he was born.
Thanks for sharing your birth stories. It is so important for women to hear/read about other women’s birth experiences 🙂
Oh yes, thanks for linking to Gabriel’s birth story too. I really do love this post of yours 🙂
Thanks for sharing your story 🙂
…and thank YOU for providing a platform for students, midwives and mothers to reflect, learn and improve practice. I’m sure the other mother’s here will agree with me when I say the effort you put into writing and disseminating this information is so important and valued.
Gifted Birth, where’s the ‘like’ button? 😛
Thank YOU for your vital work in this area… the more voices out there the better for women and those who attend births. We must bump into each other some day since we are not that far from each other in distance (or birth philosophy) 🙂
I would love to meet and talk all things umbilical cords, hoping I can attend a birth conference one of these days and bump into you and Carolyn Hastie. That would be great!
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I’m wondering if I can get some reassurance from you. My story is slightly different because my baby died in utero at 31 weeks in 2010. VERY VERY tight triple nuchal cord and was lying transverse at the time of demise. During birth, I could not birth the body until the cord was cut because it was so incredibly tight. Baby was blue, almost black. No other causes of death were found, and several midwives and perinatologists have ruled this to be an umbilical cord accident. The cord was not abnormally long or short. I am now pregnant again and nearing 29 weeks. Baby went from vertex to breach in a matter of one week, and the cord is near the neck with some “bunching.” It could not be discerned whether the cord is across the front, but it is draped over both shoulders. I am trying to remain calm, but incredibly fearful that history will repeat itself. Peri and midwives are not pushing for anything…even extra monitoring is ulitmately up to me. I do logically understand all the facts about the cord – the baby’s ability to unwind itself and to survive birth with nuchal cords, but that was not my experience. We never even got that far. If you could provide me with any sort of peace of mind on this issue, I would appreicate it. I did have a successful birth in 2006.
I am so very sorry for your loss. It is unlikely I can provide any peace of mind for you… only holding your baby in your arms will do this. What happened to your baby was incredibly rare. Any other complication is more likely during this pregnancy than a reoccurrence of the previous complication… but that is logic not emotion, and as a mother who has lost a baby emotion is strongest. You need to do whatever makes you feel best during this pregnancy (monitoring, not monitoring, etc.) – follow your instinct and talk about your fears openly because they are valid and need to be acknowledged. I would love it if you could come back and tell us all how it went once you have this baby in your arms. Much love to you xx
Please– let us know how things went for you!
Hi, I just wanted to mention what happened to me. My daughter (fourth child, all previous births vaginal, two at home) was born by crash C-section, after prolonged rupture of membranes and failed induction at 40+13. After 5 hours on syntocinon (the pessary having failed to work), her stats became alarming and I was in theatre under general anaesthetic within 15 mn of the first blip.
My daughter was found to have the cord not around her neck but once around her body and 5 times around her thighs. The placenta was sited near the top of my uterus and essentially she was tied up near the top of the uterus and unable to reach the way out. The obstetrician could not even get near her head to get a foetal scalp monitor clipped on even though she was apparently presenting fairly optimally (ROA). The obstetrician said afterwards that she wished she’d had a camera to hand take a photo of the entanglement- she’d never seen anything quite that bad. She was never, ever, going to be able to come out through the usual way.
My daughter was fine in the end (despite being born with an infection) but spent a week in the neonatal unit on strong antibiotics. If I’d gone ahead with my home birth plans and refused to be in hospital she would not be here now. I just wanted to say that you can’t always manage these things at home or gently, and I am just very glad for us both that safe surgery and antibiotics exist!
“you can’t always manage these things at home or gently, and I am just very glad for us both that safe surgery and antibiotics exist!” Absolutely – necessary intervention saves lives. However your situation (a complex cord entanglement and induction) is not ‘these things’ – the post is about nuchal cords during an uncomplicated, physiological birth. I wonder if the infection was a result of frequent vaginal exams and attempts to put a scalp electrode on? It would have been great to have got a photo of your baby tangled up 🙂
To be honest, after 4 days of ruptured membranes it was always a possibility. And I did refuse any vaginal exam before the induction so the first time anyone put their hand up there was the Tuesday afternoon for the pessary. I kind of expected that to work- nobody knew what the problem was until the CS, and I expected to go into labour quickly after the pessary- it seemed a but churlish to hold off any longer permitting a vaginal exam. The only thing that might have helped would have been to have a doppler blood flow scan on the cord on the Monday. I could have had the CS then rather than waited 4 days until we were both infected…
No, the obstetrician didn’t attempt to put in a scalp electrode in until late on the Wed evening (she was born 3 hours later) as she became increasingly puzzled about why I wasn’t going into labour and slightly worried about the baby. Most likely the pessary or its insertion caused the infection.
Hindsight is a wonderful thing 🙂 you probably weren’t going into labour because your baby couldn’t get out vaginally… And you can’t really avoid vaginal examinations during induction.
We home freebirthed our third daughter almost 8 weeks ago, I birthed her on one knee and caught her myself, unwrapped her single loop nuchal cord myself before lifting her up to me chest. No dramas whatsoever, cut her cord at least half an hour possibly more after her birth, well after the placenta was birthed and all the baby’s blood had passed from placenta to her.
I should add, we had had ultrasounds prior to make sure she was well positioned (not transverse or anything) and we checked for true complications there with the cord as well… even without those scans though had we felt things were not progressing well or something was not right (and i believe i would have known) then we would have sought help from the hospy.
Congratulations 🙂
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I found this anecdote very interesting. So after reading this article, my thought was, “well there have got to be SOME exceptions.” And this anecdote does seem to be the rare exception. This article does make me wonder, however, if there were other options in my friend’s case had she been with a midwife rather than a doctor at a hospital.
Thank you so much for a comprehensive and informative website on labor, delivery & child birth. I am a nursing student in OB rotation and I found your website while I was searching for more information on nuchal cord. A mom I was caring for during my rotation gave birth to a beautiful baby with a nuchal cord and I wanted to learn more info (than what the textbook had to offer!). I will be sharing your website with my RN bound friends hoping to go into OB. I am hoping to pursue master’s in midwifery someday!! Thank you for sharing your wisdom with the rest of us!!
Hi there, Love your blog and sorry I didn’t realise it was you who spoke at HB Aust conference on the weekend until it ended! Happy to add another anecdote to the ‘healthy baby born with nuchal cord and no intervention’ list. My 4th baby, born at home after 2 hour labour, stayed with head born for 5 minutes and 3 attempts at restitution of shoulders before his body came. I asked my midwife for help as I didnt understand why he wasnt coming out! I said the cord was twice around the neck, she reassured me he would slip through it, but I kept telling her he couldn’t turn all the way to let his shoulders be born and he kept turning back. She asked me to move and said he had a nuchal arm with the cord wrapped around that too and asked if she could try and free his arm, apparently I said yes but she couldn’t move it, and she said the cord had plenty of slack in it so she didn’t think it was tight enough to prevent him from turning. She couldn’t figure out what was going on, neck not turtled indicating shoulder dystocia, and asked me if I wanted to try standing, I did and put my leg up on the side of the birth pool and after some elbowing inside me he slipped out. It was then we discovered his cord harness! It was not only around his neck twice and then his arm but criss crossed in an x over his torso. He was such a well wrapped gift that it was a job to keep him above the water of the (half full, not hot enough) birth pool without it appearing that his cord would snap at his umbi, it was pulling hard and I felt it and I was worried it wasn’t pulsing. My midwife reassured me it would start again, if it wasn’t now, once we got the pressure off it, and when she felt it it was pulsing perfectly. Our bub was lovely and purple but decidedly not interested in doing anything, including breathing or moving, but with a bit of help with the bag he was breathing at 2 minutes. There was never a time when his oxygen appeared to be compromised, he was well oxygenated and was breathing before cord stopped supporting him. Our conclusion was that the lovely wrapping he decided to be born with meant he needed a little extra time until the uterus and placenta came down low enough behind him to allow him to turn enough for his shoulders to be born. His reluctance to breath we put down to the very quick birth, which was shocking for me too, rather than nuchal cord.
Four of my five birth children have had a nuchal cord, and only one presented a “problem.”
My first son was born with the cord around his neck. During the very last part of his descent, it tightened up considerably, and he was born white and unconscious. His heartrate had been fine just a couple of pushes before, but when his head was born, the cord was very tight, too tight to stretch over his head. The midwife laid him on my chest– I was in the bathtub– and immediately went to work on him, leaving the cord intact. Everyone in the room was silently praying for this white, unconscious baby, but I just stroked his foot and cooed to him and told him how happy I was to see him. The midwife intubated him and gave him oxygen, etc., and he came around in a few minutes. I have often wondered what the outcome would have been if I had been in a hospital situation and they cut the cord and whisked him through the cool air, away from me, and away from my heartbeat and presence and voice. The cord was not pulsing much, but it did give him a little oxygen while he was revived. He had no further problems after that.
A few years later I gave birth to another boy, posterior (rotated to OP as he descended) and he had the cord around his neck twice and with a “true knot” as my midwife called it. The cord was long and loose and presented no problems, although the knot looked scary!
Hope my story is encouraging to someone. 🙂
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Can you please send the link again for your article in the first paragraphe. The above dropbox link isn’t working and I’d really like to read it.
Thank you
I’ve fixed the link… try again 🙂
It works now, thank you!
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I have a question. I am a home birth midwife and I do not have a problem changing how I do things so that I can have evidence-based practice. I’m just a little confused here because how would we know that there was a tight cord if the article advocates for not reaching in to check for the cord at all? Are you saying here that we should just let the baby be born with the cord still on?
Hi Lin
Thanks for your question.
Yes, I am suggesting not checking for a nuchal cord or doing anything with a nuchal cord. Loose or tight the baby will come out (in 99+% times). Theoretically you would know that a cord is very tight and very short and actually preventing a birth by either seeing no descent with contractions/pushing and/or the cord tearing. A cord is not strong enough to prevent a baby being born… at worst it will snap. I have heard anecdotal stories of tight, short nuchal cords snapping. From a legal perspective it is preferable for a cord to naturally tear (and you apply clamps to prevent bleeding)… than for you to actively clamp and cut a nuchal cord. The first is a complication you manage, the second is a complication you create. Given what we know about the importance of placental blood transfer after birth it would be dangerous to clamp and cut a nuchal cord ‘just in case’. In my experience, if the baby’s head can get out, the rest of the baby can. Very occasionally the somersault manoeuvre may be needed (particularly if the woman is not upright). I have not checked for cord, or encountered any problems with a nuchal cord being too tight or short in over a decade. I hope that answers your question 🙂
Your answers always frustrate me! This blog and your perspective is part of the problem not a solution. Your statistics are incorrect. If you lost a child to a nuchal cord would your reply that its is completely safe 99% of the time give you solace? I lost my child at 40 weeks while in labor to a nuchal cord type a. I was not given an option to have a c section because the ultrasound tech nor my dr gave me the option when I had an ultrasound. They also did not do a non stress test on me. They sent me home. Home to let my daughter die. When my daughter went hyperactive and I called my doula in a panic she told me not to worry and that my daughter was “excited by the labor”. Well you know the answer. She died. And I died with her. How much experience do you have with a baby loss parent? Don’t you think if I had been informed that there was a nuchal cord (which is clearly visible on her last ultrasound) I could have made a choice? But no. I was not told. I was not offered a choice. I was sent off to have her die. You can not possibly imagine the pain of baby loss. Now I know many parents who lost their children to nuchal cords and they all say the same thing. Their care givers were complacent and uninformative. This is where it is your responsibility as mid wives and doulas to speak the truths that drs are too afraid to speak. They are bound by fears of lawsuits and the lies that ACOG perpetuates. Did you know that ACOG and the NIH refuse to accept nuchal cords as a cause if death? Did you know that is is because of pressure from insurance agencies and ACOG because they don’t want dr’s to be held liable for nuchal cord accidents? ( I hate the word accident in this regard because it didn’t need to happen) it is proven knowledge that the cord is viewable on all ultrasounds but thu don’t teach the techs on how to see it. This is a travesty. In the light of the tragedy today where 20 children lost their lives how can you possible stand in this sea of lies and continue to aid in the loss of children. I know the path that these parents have to take and it is dark, painful and lonely. One in 150 births in the US are born still. That comes to almost 30000 deaths per year. 2.6 million still births in the world per year! If a mother calls you panicked and her baby is hyperactive you must tell her to get help immediately. If you know there is a nuchal cord you must give the parent the choice to make and educated decision about their options. You have no right to make these choices for them. Please open your eyes to the cold truths. You are inadvertently aiding the bad guys. I know a lot of inside information. I speak the truth. You could save so many lives.
You have your views on this but please be open to the other side because we are small and out numbered. The system is extremely flawed and favors the old way of thinking that “some children are a statistic” – nuchal cords are safe 99% of the time. If your child fell on the other side of this would you honestly think the same? If you don’t know for certain if a baby is safe you cannot guess. I was a first time mom over 40. Did you know that ACOG sent a memo in April 2009 stating that first time moms over 40 are 7-10 more likely to have a stillbirth? My dr treated me like I was 25. He never treated me like I was high risk. He was cavalier in my pregnancy and cavalier in her demise. My doula completely abandoned me after her death. No one took responsibility. Is that how you would handle it too?
You read the labels on th food you eat or the cleaning products you use because you don’t want to injest anything bad but you don’t apply the same concern for birth?
Think. Educate. Share. Be part of a solution not a problem.
Carrie. I am so sorry for your loss and that I am clearly making things worse for you. I don’t feel there is anything I can say that will make your pain any less. If a mother rings me panicked about any concern I would suggest she seeks reassurance… and I would refer her to hospital. Mothers should always be listened to. I would prefer that you do not make accusatory assumptions about how I practice based on your experience of other practitioners. However, I understand you are angry and I will refrain for commenting in case I create more anger/pain. I hope you are loved and supported.
Carrie, you are on the ball, shame many Phd holders are not. many web sites should be banned, they are no more than misleading and a danger to pregnant mums. The Phd always falls from a higher height. She cannot state how many babies are lost to Nuchal cord or damaged nor can she state how many mums are lost to major obstetric haemorrhage (MOH) due to short entangled cords. The rate’s are not listed in current classification, yet we have more than 55% of all stillbirths as cause of death unknown. Let her prove her research and practice. This will be interesting!!
Carrie,
I would be honored if you could contact me at http://www.pyramidofantenatalcchange.org or info@pyramidofantenatalcchange.org
Robert Devine
Chairman POAC
Scotland UK
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Sadly how wrong you are. We in fact presented our findings to RCOG concerning Umbilical Cord Accidents (UCA) 6 months later they had a full seminar http://www.rcog.org.uk/events/underrated-umbilical-cord.
A PhD does not grant you heavenly power over life, in fact many Phd holders get it wrong on a daily basis as referenced in NHSLA (Litigation Obstetrics & Midwifery top of the list costing hundreds of millions each year). In the UK both royal colleges (RCOG & RCM) do in fact ignore Umbilical Cord Accidents (UCA) and have done for many years, our research indicates that this is purely avoidance and commercially driven. Term babies just don’t die of unknown, the insult is over, it’s time they realize every parent wants the best outcome for new life. The continual denial/avoidance of UCA as a major cause of stillbirth, neurological damage (CP) and miscarriage cannot continue “and will not”. One of the founders of modern day obstetrics and midwifery Prof. William Smellie (5 February 1697, Lanark Scotland Uk > 5 March 1763,) was a Scottish obstetrician. Prof Smellie was way ahead of his time in causation of stillbirths which is clearly illustrated in his many books (Over200) and lithographs. Smellies work is referenced at both RCOG & RCM, maybe they forgot to read them. We are supported by highly professional Patrons. We lost a full term healthy baby daughter to Nuchal Cord x2 cause of death after PM concluded umbilical cord compression (Asphyxia) We now know many parents who lost a term baby same way. I suggest you take a few steps back before you miss lead the public. Nuchal Cord Kills and damage’s babies I suggest your home page start with the truth.
“Nuchal Cords: the perfect scapegoat” change to Nuchal Cord (NC) is a a common cause of stillbirth, neurological damage (CP) and major obstetric haemorrhage (MOH), further more an end to labeling pregnant women “LOW RISK” (LR) LR = Higher Mortality
So why are some women claiming that there baby was breathing and crying with the cord still intact and not clamped..seeing the baby does not take its first breath till the cord is cut
Babies usually (should) breathe within a minutes of birth. The cord pulses for usually around 3+ mins. This allow the baby to start breathing and establish regular respiration BEFORE the placenta shuts down = the baby is getting ‘back up’ oxygen as they make this transition. I hope that makes it clearer for you 🙂
So if that is the case how is it not possible for the cord to choke or kill the baby if it can take breaths after being born..trying to get a understanding of why so many mothers claimed this has killed there baby
Because the cord is unwrapped from the baby’s neck immediately after birth… before he/she starts breathing. If it is loose… which the vast majority are then he/she would have no problem breathing even if the cord was left around the neck.
A baby with a very tight nuchal could die in utero even with a fully-functioning placenta if the cord is tight enough to cut off the circulation to their head…
And by my lay person’s understanding it is the baby breathing, and re-routing of the blood flow away from the umbilical veins, that means the cord starts to shut down and the placenta to stop operating. So of course the baby will be breathing and possibly crying whilst still attached to its unclamped cord. In fact, that’s what you *want* to happen.
Interesting article and as an educated homebirther I am familiar with the nuchal cord hysteria. An interesting thing, if you can call it that, happened with my 2nd homebirth. I had a very intense 4 hour labour, that my midwife said behaved like an augmented labour. No breaks in between contractions, extremely painful and hard. My baby was born not breathing and need intense resuscitation to breathe again and spent 8 days in NICU. We were very lucky as despite the fact it took some good minutes of Rhesus, and it was hard work actually getting him to breathe, that he did eventually breathe and has no damage whatsoever. Thankfully my midwife did not give up the Rhesus work, despite all of us thinking he was dead, and despite her thinking she should stop.
What we think happened, due to the way I described feeling him punch through my cervix, was that I was not fully dilated, and we think his cord got compressed coming through my tight cervix. It is the only logical explanation given that I felt him move in labour, and given the short period of time there can be with no oxygen, before brain damage occurs.
His cord was not clamped during rhesus btw, although I don’t recall seeing it pulsing. I do have photos of it as we have birth photos (you are welcome to them if you want).
Anyway, thought I would share ….. I am still glad I had him at home. It is one of those things in life you cannot predict, and I think my trauma would have been worse in hospital, and he may not have survived in hospital, for numerous reasons…
It can be frustrating trying to work out why things happen the way they did. Asphyxia and the need for resus can occur for many reasons. It can be chronic or sudden. The baby’s heart rate (if taken) can give some indication of when the hypoxia occurred but ‘why’ may never be clear.
I have a question: My daughter was born with the cord wrapped around her neck 2x and her body 1x. She was also holding onto the cord and the cord was detaching (barely attached at birth) from her stomach. Have you ever seen the last part of that scenario (the cord detaching)? She was in distress and I had a c-section.
His Sara – not that is a very unusual situation. I have never seen a cord detaching. I would love to see photos of this, and it would be interesting to understand the mechanism of this complication… i.e.. the physiology of the cord… was it normal? The cord is usually very strong and can be difficult to cut.
I haven’t seen photos but the dr showed my husband. She said she’d never seen it either. She said the pathology of the placenta was normal. The part of the cord my daughter was holding onto was decentigrating (?) but I think she said that was pretty common – I don’t remember that part.
It was her opinion that if my daughter had been born vaginally, she wouldn’t have survived bc the cord was so precariously attached. She did some research the night she was born and (I don’t remember exact numbers) but this does happen (the cord detaching) however something around 90% of the time it’s only found in stillbirths (after the delivery).
Sounds like your daughter’s umbilical cord was very unusual and may have detached if labour had continued. I’m pleased she is OK 🙂
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my son was perfectly healthy, active, and full term (39wk 5dys). I went into labor around 3pm, and went to the hospital at 5 pm when my contractions were 3 min apart and 60 sec long. in triage the nurse said I was only 1 cm dilated after monitoring for an hour. my son’s heartbeat was strong, and healthy, but was not showing the normal activity spikes and dips even after drinking some OJ so Dr was phoned and he scheduled a c section for 8pn to save my son the physical strain of L&D. Dr arrived at 7:45 pm during prep for surgery, and in the process of shaving my stomach, they repositioned the FHM by having me roll on my side. Immediately, he began kicking violently, and Dr rushedover with the U/S and as soon as he saw the screen he yelled to “TAKE HIM NOW!!!” and I was rushed frantically into the OR, knocked out, and cut open in a matter of seconds. Upon waking up, I was informed that my son didn’t make it, he was stillborn at 8:05 pm, and the Dr couldn’t get to him in time. they discovered a nuchal cord x4 and once around his shoulder. labs were performed on his DNA, cord, and placenta, with nothing abnormal reported. I was informed that the cause of hos death was “self inflicted cord accident due to nuchal cord x4”.
According to your article, are you telling me that my sons nuchal cord x4 was harmless and his death was caused by other influences?
I am very sorry that you lost your son.
A nuchal cord may, in unusual circumstances cause death. The post is questioning the cultural idea that a nuchal cord is inherently dangerous – when in the vast majority of cases it does not cause a problem. From your description of the heart rate ‘not showing activity spikes and dips’ it sounds like the trace was showing ‘reduced variability’ – this is a pattern that is attributed to a chronic (ie. slight for a prolonged time) reduction in oxygen supply. When a reduction in oxygen occurs due to cord compression the heart rate trace usually shows deep dips from the baseline with contractions… then recovery after contractions. I am unable to tell you why your baby died. I hope that those who were there and have the full picture can de-brief with you and explain what happened for you. Often there is no answer and everyone is left wondering.
Hello Rachel,
I am Monika from India, it is very nice to read a lot from this blog. I am having a 35 weeks gestation till now and I just had a ultrasound showing that my baby is having a single cord wrapped his/her neck. Though I am not scared but being a first-time mother I am worried that should I go for a C-section as suggested by my doctor or should I wait and go for a normal delivery. Also I wanna know if this nuchal cord pose any health concerns for my baby during the gestation or after delivery, so that i get prepared for those.
Thanks
Hi Monika
I address your questions in my blog post re. health concerns. Offering a c-section for a nuchal cord is not evidence based and there are risks to you and your baby with a c-section. Your baby – like a third of babies has the cord around the neck… this has no more significance than having the cord wrapped around the body, or the shoulders… the cord has to be somewhere, and babies move around wrapping it. 🙂
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Hi! thank you for your wonderful knowledge on this topic! I am a birth center, Florida midwife and have been delivering babies since Feb 2002. I haven’t actually counted my deliveries, but believe I am in the 700-800s. I frequently get asked about nuchal cords from my clients or people who find out I’m a midwife and I share this story about my midwifery training:
*The very first delivery I had, the baby had a nuchal cord. My preceptor, who happens to be my mother and a midwife since 1986, coached me through it. The baby’s head was born facing down, the baby restituted and I checked for cord. I found the cord and she showed me how to loop it over the baby’s head. I did so successfully and the baby’s body slid into my hands and took his first beautiful earthside breath and I took my first midwife breath…
*The second baby I delivered was born facing down, the baby restituted and I checked for cord. I found the cord and I looped it over the baby’s head and the baby’s body slid into my hands.
*By now I had the hang of things… The third baby I delivered was born facing down, the baby restituted and I checked for cord. I found the cord and I looped it over the baby’s head and found another loop of cord, I looped it over, too, only to have my mother’s hands come into the scene to remove a third loop of cord, oops I had missed that. That baby was born squalling, but had a purple face for 48 hours.
*The fourth baby I delivered was born facing down, the baby restituted and I checked for cord. I found the cord and I looped it over the baby’s head and the baby’s body slid into my hands.
*By now I was a pro! The fifth baby I delivered was born facing down, the baby restituted and I checked for cord. I found the cord and I looped it over the baby’s head and the baby’s body slid into my hands….see, I told you =)
*BUT THE SIXTH BABY I DELIVERED….the baby was born facing down, the baby restituted and I checked for cord….and couldn’t find it!! I told the mother to not push because I couldn’t find the cord and kept checking for it… when my mother’s hands bumped my shoulder and said, “there’s no cord” OHHHH! Wow, sometimes babies DON’T have the cord around the neck. Weird!!
<3
Thanks for the link to my video!
It is a fantastic video – thanks for sharing. And thanks for providing access to your phd thesis on your website – I enjoyed reading it.
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Thankyou so much for your blog. I am a midwife in transition. My training was very fear based be scared of decels, be scare of Nuchal cords etc. I am working hard to change this and not be scared but instead just be aware and intervene only if necessary.
I think I have read every link and every comment on your blog except I couldn’t watch Kate’s presentation on my phone and I couldn’t access the RANZCOG link because access was needed. I would like to know what obstetricians think and what they think is the best management if different, and why.
So getting back to managing my fear can you tell me in your opinion say I don’t check for cord and its 5 minutes until the next contraction, is it ok to wait that long? I am just worried because I would be worrying the cord might be tight round babies neck and I don’t know. I have cared for many women who have had normal vaginal births and have always been happy to birth the rest of baby with next contraction after head, if not born in same contraction. But someone questioned this practice recently and said it was too long. I think it is normal if baby’s head has rotated and no signs of shoulder dystocia. But if I don’t check for cord is it still ok to wait for the next contraction?
Hi Robyn – it is so good to know that new midwives are thinking!
“So getting back to managing my fear can you tell me in your opinion say I don’t check for cord and its 5 minutes until the next contraction, is it ok to wait that long? I am just worried because I would be worrying the cord might be tight round babies neck and I don’t know.”
There is no definite answer to this one as it requires a more holistic approach and questions to ask yourself include:
Is this a normal labour without signs of fetal distress (not including normal head compression decels) and does the baby look well eg. pink. If yes… then wait. If a tight nuchal cord is really causing problems you will see a change in colour of the baby. If a baby requires assistance then assist him – i.e. intervene with traction. But, remember that traction is an intervention and must be carefully considered in the absence of a contraction – you may be setting up complications such as shoulder dystocia (http://midwifethinking.com/2010/12/03/shoulder-dystocia-the-real-story/). Few babies require any traction.
Which RANZCOG link? As for what obstetricians think is best… it depends on the obs. Their textbooks still generally suggest managing nuchal cords (unlike midwifery textbooks that are beginning to change). But, some obs can think critically and apply an understanding of physiology and research to practice.
Thankyou for your reply, it reinforces how I am feeling. Now to learn the somersault manouvre, and stop checking for cord.
The link is in the comments and it wasn’t RANZCOG after all it’s the RCOG but you have to be a member to access it. http://www.rcog.org.uk/events/underrated-umbilical-cord
Thanks for the link on shoulder dystocia.
I so often had to remind birth attendants (what ever you are at a birth you are not delivering the baby the woman is giving birth) that the three vessels Two arteries and a vein are surrounded by Jelly inside a very tough cord which is able to stretch and straighten and withstand strong pressures as it leaves the birth canal. Once the baby has left the birth canal you can assist the cord to unwind if necessary.
What exactly are you going to do if the fetal heart has dropped – usually changed the position of the woman You cant do much once the baby as the baby is through the internal pelvis.and about to deliver.
Try cutting a cord with even sharp scissors examine the toughness of that cord and look how much pressure had to be put on the cord when they used to clamp the cord to stop it pulsating.
This is protection by nature put there to protect those vessels supplying nutrition and oxygen to the baby. Three times around the neck usually produces birth adavances where the head is slow to come down or goes back a little i- that can ALSO mean shoulder dysocia and for that you move the woman. . I If the woman is on all fours of squatting the baby will come down much quicker and it easier to access cord around the neck – if necessary.
If so then you i hope have a woman already up and about or moving to get the baby born. Three times around the neck is rare. IN cases of shoulder dystocia and tight cords the baby’s face is infused ruddy to purple.
If the woman is on her back then fetal heart will drop due to that positioning as well. MOVE THE WOMAN OVER on her side or on all fours
Think on all of the above and still keep asking questions all women are individuals. and leave the cord ALONE HANDS OFF TECHNIQUE H.O.T. Putting your hands on the baby’s head before it has RESTITUTED (uncorskscrewed its neck) once then 2ND ROTATED (with shoulders) can CAUSE shoulder dystocia.
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My son must have been a rare one. I had a horrible birth, He had his cord around his neck near on 4 times extremely tight. He was 10days over, When he finally was born I had 4 drs, 5 midwives, the main dr did the somersault manouver and a lot of other things, nothing worked. He was purple and lifeless. As you can imagine I was freaking out, he finally breathed 3minutes after being born. He is now 15months and has no long lasting affects, the only thing he does have his Pulmonary Stenosis where he has to see a Cardiologist every 3months. Put me off having anymore, I’m petrified.
That sounds terrifying! Are you sure you didn’t have a shoulder dystocia?: http://midwifethinking.com/2010/12/03/shoulder-dystocia-the-real-story/
I am so glad I stumbled up on your blog!! I am desiring a vbac because with my first delivery I was given an emergency c-section with the reason of the umbilical cord being wrapped around my daughters neck twice. Second delivery was a repeat cs because my doctor refused a vbac and told me all the negative risks which scared me so much that I didn’t even question it. So now years later I’ve taken time to educate myself and this info has been extremely helpful! Praying to find a doctor that will support our vbac desire. If not then we will surely find a midwife 🙂
Good luck… and make sure that the doctor is not just ‘talking the talk’ – ask for statistics of VBACs and to talk to women who have had one with that dr.
I trained as a midwife in South Africa and often had to be dropped at the bottom of a hill below the hut where the laboring Mom was. I scrambled up the hill with my flashlight and bag and went into the hut. I used the pinnards to check the FH and was not too happy with what I heard. Fortunately she was fully dilated and ready to push. I felt for a nuchal cord and it was tight, I grabbed my clamps but she had pushed with great gusto (Thank Goodness) as the cord was short as well as nuchal and it ruptured!! I was lucky enough to quickly find the 2 ends and clamp them to prevent an excess blood loss to the baby!!! More good luck than good management, but the outcome was fine!!
What an amazing article. I am training to be a doula, and your research will definitely be something I keep on file to inform my clients!
Thank you for your blog article. I work in a busy free standing birth center where I see many nuchal cords that are negotiated very easily. I can’t remember ever seeing or having to cut a tight cord to deliver baby. We teach the somersault method which works almost every time. And at the next staff meeting I will present the evidence your shared and change the automatic checking for a nuchal cord once the baby’s head is born.
Rose A. Williams, CPM
Thanks Rose and good luck with changing practice in your birth centre 🙂
Hi, great article. I don’t usually even think to check for nuchal cords anymore. Didn’t know there was a name for the ‘somersault method’, is just my practice if I find a tight nuchal cord when birthing. Glad to read this as am always very annoyed by the media’s perception of ‘cord around the neck’ so-called dramatic births. I am always reassuring parents that it is normal.
Must be so annoying when the baby dies of a nuchal cord too! I am sure my doula was “annoyed” when my daughter died of a nuchal cord. I don’t believe the “somersault” method would saved her when it was 3 times tight around her neck and once across her body. I really wish that doulas and midwives who have lost children came her and commented on how painful it is to lose a baby. Maybe then you might think twice but I guess until it happens to you (Which is bound to happen based on current statistics) you.
Carrie
I don’t remove comments with dissenting viewpoints to my own because I believe everyone should be ‘heard’ and their opinions respected. However, I object to offensive and unnecessary name calling. Please edit your response or I will have to remove it. Thanks.
Your site won’t let me edit it so to whomever reads my above comment please ignore the word “jerk” as it is more offensive than the honest raw opinion of a grieving parent. Sorry if any one finds my reply hurtful or offensive. Just was trying to expand the minds of the people that read this to include the possiblity that not every nuchal cord ends in a happy ending. In fact I know hundreds of parents like myself. Yesterday was walk to remember for those of us who will be missing our children for the rest of our lives.
Carrie
I have edited the post for you. I totally understand your anger and grief. The somersault manoeuvre is for use when the baby’s head has birthed to protect the placental blood flow which is important for resus. All babies cannot be saved and their stories also need to be heard. I am participating in a walk to remember next Sunday and will think of you and all parents who hold their children in their hearts rather than their arms.
I almost lost my son due to them cutting the cord before he was born – and I am sure there are also hundreds of parents who weren’t as lucky as me. I also wonder if these are called nuchal cord deaths. We can never know if we would have had a different outcome if our medical providers had behaved in a different manner – I just wish my carers practiced evidence based medicine, so the outcome could have been the best possible one. I am so sorry for your loss. But please don’t presume that none of us have also lost babies.
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I am almost 37 weeks, my doctor noticed the baby is still breech and wants her to go ahead and turn. While he took a look he noticed that the cord was very close to her neck. He sent me to a specialist that then told me it is wrapped once with it crisscrossing in the front. I ask about if she stayed in this position if I’d be able to deliver vaginally they are telling me no. I wanted to do what is best for both me and her as well as not go against my doctors. Knowing all of this is there any thing I could attempt to do to help motivate her naturally without causing any harm to her before I go to have her? Do you have any suggestions on how I would approach them and keep them talked out of the c section, since if I’m reading this article correctly you wouldn’t see a problem delivering naturally?
This article is about a nuchal cord in a head first position… not a breech position. Occasionally when the cord is tangled around the baby the baby is unable to get into a head down position without creating traction on the cord and placenta. You could try techniques aimed at giving the baby a chance to turn (see the spinning babies web site) and if able she may turn. If not, she won’t and will stay breech. I am guessing the c-section has been suggested because your baby is breech rather than because of a nuchal cord. It is possible to have a vaginal breech birth, but very difficult if you are attended by people who are not confident/experienced in breech birth. Ask your care providers about a vaginal breech birth.
Yes I understood the article to be about the baby in the head down position. That was why I wished to ask since if I took this article correctly neither being in the breech position (this coming from prior knowledge not this article) nor the cord should cause me to have to have a c section. Unless, of course, it could be from the presence of both. My real question was if I did something like on the spinning babies website, if you believed that could cause the cord to do any damage. I’m sorry for not making myself clear about that I think I was a bit panicked on finding out I might have to deliver via c section. This article does talk about the handling of the cord and thought you’d be a good one to ask along with my doctor.
I can understand your anxiety. I can’t give advice or recommendations to individuals because I don’t know the full picture and I am not your ‘practitioner’. However, in general using positions to give the baby an opportunity to move shouldn’t cause a problem. It is different to forcing the baby to move ie. external cephalic version. If the baby can’t move, she won’t. We did this with a breech baby a couple of years ago… mother laid on a ‘plank’ at a gentle slope, head down. We used the rebozzo. Baby floated out of pelvis… then promptly settled back into his breech position when she stood up. He was born vaginal breech and was totally entangled in his cord = why he could not turn. We gave him a chance to turn and he knew more than we did and stayed put.
Hi Rachel. I found your blog a wonderful resource of wisdom during my pregnancy and by chance have followed a link to this plog post. Last year I attempted a home birth with the hopes that my little boy would turn during labour. At 7cm dilation my midwives confirmed that he was definitely bum down. My local hospital had already been informed of a possible transfer. 2 hours after arriving at hospital I hadn’t dilated any further and my cervix was swelling. The hospital recommended an epidural, my midwives agreed. Maybe 3 hours later when I was fully dilated the obstetrician broke my waters. After waiting an hour for my baby to progress by himself (he didn’t) so we started actively pushing. I think they allowed about an hour & a half of this, his bum almost out but his heart rate was really distressed and he’d keep popping back up when i wasn’t pushing. From what I understand his heart rate had been distressed for the 1.5hrs I actively pushed with the contractions. It was at this point my obstetrician (who was supporting a vaginal breech delivery and wanted me to have the birth I’d discussed so passionately with her prior to labour) recommended a c-section. In the operating theatre I felt them cutting me so I was under a general. I later found out that the cord was wrapped around his neck twice quite tightly and which also made it difficult for my ob to get him out in the c-section. I would so love to ask you…. in your experience do you “believe” the caesarean was necessary? (I almost wrote this as a personal message but perhaps there are others that may benefit from your opinion in cases such as this) Kindly and with utmost respect and gratitude.
Hi Rachel – it is really difficult to unpack all that was going on for you and baby. Entanglement with the cord can be a reason for breech presentation ie. the baby cannot turn head down… or cord entanglement can just be a non-influencing occurrence. In labour the baby, uterus, placenta and cord all ‘move down’ together so a short tight cord is unlikely to cause a problem until the baby is almost entirely out = tension as baby becomes ‘lower’. Popping back up between contractions is normal for head down or breech babies as they are born. Active pushing causes baby to become distressed http://midwifethinking.com/2010/07/30/pushing-leave-it-to-the-experts/. What position were you in?
Hi Rachel,
Oh :(. I read your comment & linked article a month ago. My gosh! I really wholeheartedly feel the caesarian was unnecessary. I was given an epidural because I was baring down “too early” and they laid me on my back. Which of course stopped the descent of my son all together. I honestly feel if my midwives weren’t so scared of legislations of a breech birth and allowed me to labour at home my son would have been borne naturally with no complications. His heartbeat was strong & stable right up until we actively pushed. He was pulled out of my stomach with a strong and full scream, they cut the placenta and threw it away, cleaned my baby and gave him to dad. After two hours I woke from the general and finally met my son. All of this trauma, heartache and difficulty because midwives are now too scared to home birth breech; not entirely because breech may present difficulty but because of legislations.
I really appreciate you returning to give us an update. I am sorry that your birth was influenced by fearful practitioners. Legislation and regulations around practice can lead to defensive practice. I hope you are enjoying your new baby boy.
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Fascinating reading. I’m reblogging this so I can read back again later.
I know you have probably answered this question a billion times but lately I see all these stories of cord around neck thank God my baby is alive bc the cord was wrapped around their body and neck. And I do mean im starting to see these stories more which end in a C-section. So my question can a baby that has the cord wrapped around body is warranted as a necessary C-section or could intervention lead baby to be stuck this way vs an unhindered birth? I hope this makes sense. I usually refer other mamas since im vbac hopeful for the future to other moms but sometimes on my Birth Board I see a lot of this and nor am I trying to dismiss their story but I feel like I see it a lot esp it is most common when women choose to vbac @hospital vs home. Esp if they are a vbac and end up with a rcs during labor and are told this reason. Yet I also have a friend who was told her babe’s cord was too short but everything was noted as normal during her TOLAC but she also had refused a cs and went for an induction, *medically indicated* against hospital rules since we are in the US. Sometimes I wonder if the cord is being used as an excuse even though I know its a real possibility esp for other positioned babies like transverse and breech. Feel free to educate me. I hope one day you will be able to do another blog post on this and on other things. I love your blog.
Most babies have their cord wrapped around them somewhere… the very nature of being in a uterus with a long cord floating about + baby moving around for 9 months = ‘entanglement’. And the baby rotates during labour so it is almost impossible not to wrap the cord around him/herself. That is why the cord is designed to be wrapped, stretched and pulled (it is like a telephone cord). During labour the uterus gets smaller and the baby/placenta/cord all move down together. The baby doesn’t move away from the placenta and require ‘more length’. It is a bit worrying that care providers don’t have a basic understanding of the physiology of birth.
You stated: “sometimes I wonder if the cord is being used as an excuse”… Yes 🙂 But I guess for those women who are given this ‘reason’ the alternative is ‘we intervened because we don’t understand physiology and made it impossible for you to birth. Induction and VBAC??? Now that is a scary situation! Syntocinon and a uterine scar… far more scary than a umbilical cord doing what it is designed to do. 🙂
I am aware that I’m late to the game (so to speak), but what are your thoughts on nuchal/breech births? You don’t address them in your article.
I think my thoughts are addressed in the comments/discussion 🙂
A very short, multiple wrapped cord my prevent a baby from turning to head down. However, it is unlikely to cause a problem during birth as the whole uterus/placenta/cord and baby move down as ‘one package’.
Except when I was born. I was too big to turn in my mother’s uterus and had my umbilical cord so tight around my neck I had no ability to breathe. The doctor’s had to do resuscitate me after cutting the cord so I had a viable airway.
Have you read the post re. the physiology of the cord and breathing. The cord is not strong enough to compress an airway (it would snap first). The doctors most likely had to resuscitate you because a. you were breech – breech babies often take longer to ‘recover’ and breathe after birth due to increased acute hypoxia. b. you had had reduce blood flow at the end of labour as the vessels in the cord around your neck became stretched and compressed b. they cut your cord preventing oxygen and blood volume to return to your body after birth (see http://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/)… They could have unwound the cord and made reus much easier with the support of your placenta and increased blood volume.
Your airway would have been viable regardless of where the umbilical cord was – it is a shame that doctors do not explain to mother’s what actually happens during birth… or worse do not understand themselves.
My second baby had the chord wrapped around his neck, but that was not the reason they gave for doing a c-section. Every time I had strong contractions, his heart rate went way down and he was in a lot of distress. I went into labor on my own and they didn’t even want to give me any pitocin or anything to make the contractions stronger because he was in so much distress.
I was a labor & delivery nurse for a decade and have always thought of nuchal cords as normal since they were present so frequently…We did not ever consider them an emergency and c/sections were not cited as the reason for a problem. I have not worked in that capacity for a decade, and perhaps the trend now is to be more concerned about it? I only ever heard concern about it in the lay person’s world, where a “cord around the neck” sounds scarey. Cords were always un-looped after the head came out as standard practice. That’s a new concept to me to leave it untouched and interesting to read about the risks of looping…
How can you know to “do nothing” without electronic fetal monitoring to tell you how severe the cord compression is?
With compression associated with a nuchal cord it only occurs as the baby’s head is almost born (see the explanation in the post). Intermittent auscultation is the recommended method of fetal surveillance for ‘low risk’ women (according to obstetric guidelines). A CTG is only recommended for women at ‘high risk’. In any case, the compression occurs just prior to the head being born as the nuchal cord is stretched… the baby will be out soon and a healthy full term baby will recover well.
Unfortunately I was one of those unlucky few. My sons head never moved past the pelvic bone because of his nuchal cord. He went into distress which led to my emergency c-section. They had a hard time removing him from me, his cord wrapped around his neck three times so tightly he was completely blue and his neck was badly bruised. They managed to bring him back, now he is a happy healthy 2year old! We are lucky
I am pleased you and your son were lucky 🙂
It sounds like your son was compacted in your pelvis if it was difficult to get him out and he was bruised.
This is absolutely fascinating! I was just talking to two friends who aren’t pregnant (I’m 36 weeks), and we were mentioning how many women we know who have had csections. The two main causes I heard were nuchal cord and the mother being “too small.” ( give me a break!) I couldn’t understand how the cord being around the neck would be dangerous. It didn’t make sense from the little I knew! Glad to know my sense of logic was right on!
Some soap boxes are needed, over and over again! This piece a fantastic overview of the subject, graphics and even video round it out making it a Must Read!! Thank you, thank you!!
I came across your article because I recently had a friend who had to have a C section due to the cord being wrapped around the baby’s legs causing failure to progress. She was at a 6 for a very long time, like half a day or something. There were interventions before that like Pitocin, that could have led to all of this, but they saw fit to go ahead with the C section. I didn’t see an e-mail that I could send you an e-mail with so I decided to comment on here. I find your article very interesting because almost a year ago I was at my sister in laws home birth of her son and he had a tightly wrapped cord around his neck and he was already blue and lifeless when the head came out and I believe at that point the midwife clamped and cut the cord and they had to do stimulation and suction along with a manual mask ventilator basically right after he came out. It maybe took around 30 secs or a little longer for him to come to. What your article says makes sense, but I’m just a little confused about if the cord was already causing that much damage in that situation was it not best to go ahead and cut it? He was born very quickly after the head came out like your typical birth, so is your point that those extra seconds of having the cord tightly wrapped around the neck is OK since when the baby is born they will have all that extra blood and oxygen going to them from the cord which in turn will help them come to even quicker and most likely not having to use the mask or suction? Also I’m sure it’s possible for the cord to snap even if you don’t pull it over the head as the baby is coming out from it being pulled too much, especially if it’s shorter, so how do you know when one or the other might be better to do? I also know that the cord being compressed from wrapping around other body parts happens causing amputation and the baby even dies sometimes even if it’s rare, but that does happen. I actually recently read a story of a baby dying before it was even born due to the cord being wrapped around the leg 7 times and every time the baby would try to stretch her leg it would compress the cord more. And this was during labor. So very sad. My first birth about 8 months ago was a home birth of my son and I’m actually pregnant again going to have another home birth. I know these things are rare, but knowing they happen makes me more nervous to have a home birth. The only reason is because at the hospital they have the ultrasound machines to detect things like that during labor if they detect a heart decel or something, but at a home birth you can’t do that. And plus they can do an emergency C section if really necessary. I still want to do a home birth but these things just scare me.
Hmmm there is lots to address in your comment. I’ll do my best…
“I recently had a friend who had to have a C section due to the cord being wrapped around the baby’s legs causing failure to progress” – this makes no sense as her baby was not moving downwards yet as the cervix was still dilating and even when the baby did move down, the uterus, placenta and cord would all move at the same time. Lots of babies are born with the cord wrapped around their legs. The cord has to go somewhere. I’d argue that your friend had a c-section because her cervix did not open in keeping with the timeframes prescribed by the hospital (see this post: https://midwifethinking.wordpress.com/wp-admin/index.php?page=stats&view=postviews&date=2014-08-15&blog=14843460)
“so is your point that those extra seconds of having the cord tightly wrapped around the neck is OK since when the baby is born they will have all that extra blood and oxygen going to them from the cord which in turn will help them come to even quicker and most likely not having to use the mask or suction?” – Yes, a healthy full term baby can cope with a few minutes of reduced oxygen due to a compressed cord and will recover well. Cutting the cord makes it more difficult for them to recover.
“Also I’m sure it’s possible for the cord to snap even if you don’t pull it over the head as the baby is coming out from it being pulled too much, especially if it’s shorter, so how do you know when one or the other might be better to do?” – Yes, the cord could snap (I have never seen this happen). However, if the cord snaps then you clamp the ends and in a court of law you did not do the damage i.e. you did not cut the cord but instead managed a complication. A practitioner can be sued for cutting the cord if there is a poor outcome.
“I also know that the cord being compressed from wrapping around other body parts happens causing amputation and the baby even dies sometimes even if it’s rare, but that does happen.” – Yes, rare ‘cord accidents’ do happen. This post is not about those rare pathological situations but about a very common nuchal cord.
“I know these things are rare, but knowing they happen makes me more nervous to have a home birth. The only reason is because at the hospital they have the ultrasound machines to detect things like that during labor if they detect a heart decel or something, but at a home birth you can’t do that. And plus they can do an emergency C section if really necessary. I still want to do a home birth but these things just scare me.” – An ultrasound scan cannot tell you anything about cord entanglement – this can only be diagnosed by visualising the baby/cord at birth. At a homebirth your midwife will be monitoring your baby’s heart-rate (unless you don’t want this). This is called auscultation and is the most appropriate method of monitoring a baby during a normal birth. Obstetric guidelines support his and warn against using a CTG machine unless there is a know risk. The reason is that a CTG machine = false positives and most babies will at some point be considered to have an ‘abnormal’ heart rate even though they are fine. Listening with a doppler or pinard regularly will pick up abnormalities of the heart rate. No, you cannot have an emergency c-section at a homebirth – you would need to transfer if this was needed. This is one of the risks of homebirth… the delay in emergency treatment. However, real ’emergency’ ie. without warning signs in advance is rare during a physiological birth.
Where ever you have your baby you are not guaranteed safety. You need to choose the set of risk that you are most comfortable with. And it is normal to be scared and worried about birth – it is an unknown and to a great extent uncontrollable 🙂
Thanks so much for responding. I remember reading in your article about how the uterus, placenta, and cord would all move down as the baby moved down. When I read that I did wonder why the hospital would say that about my friend ‘not progressing”. And the fact that the baby wasn’t even moving down yet since she wasn’t fully dilated makes sense, too. Could they have possible meant the baby wasn’t engaged yet? Which sill would have not made sense because the baby doesn’t have to engage early on. I know a lot of times they don’t engage until the women is fully dilated and starts to push. I believe that’s the way it happened with me, or about like that anyway. And that’s good to know that you’ve never actually seen a cord snap on it’s own. I had no idea that you could sue a practitioner like that. Very interesting stuff. With my first birth I guess I had some concerns as well, but coming across things I really didn’t know about makes you have all new worries I suppose. And I tend to get worried easily anyway. But, I’m low risk too so that makes me feel better about having a home birth so I still intend on having another one. Honestly I trust myself, my midwife, and being home more than I do being at the hospital. I use the same midwife as my sister in law did, so I’m thinking after finding this out about the cord issue I should tell her in the chance that might happen to my baby that I don’t want her cutting it. I’m sure you would agree? What are all the instances that a cord should be cut?
“When I read that I did wonder why the hospital would say that about my friend ‘not progressing”.” – 50% of first time mothers will ‘not progress’ adequately according to the graphs used in hospital. Blaming it on the cord provides the woman with a reason.
I cannot think of an instance in which I would cut a baby’s umbilical cord (and lifeline) before the baby was fully born. If this is your midwife’s practice perhaps you need to talk to her about your wishes to have your baby’s cord remain intact until you ask for it to be cut?
She believes in waiting to cut the umbilical cord to let it pulsate and give the baby as much oxygen and blood as possible and that’s what we did with my first and that’s what I’ll do with this one, too.
Also, why do you think these issues aren’t more widely known among midwives?
Because we are taught a particular way and follow those instructions. In other countries they are not taught about ‘nuchal cords’ and do not do anything with them – they are not an issue. It is a cultural thing.
What about the mothers who had babies that died from a tight nuchal cord during labor? It could be possible that it was actually from asphyxiation since it’s possible for babies to take their first breaths before they are out all the way. Do you think this could be cause enough to just clamp and cut since this could happen and you couldn’t tell it was happening?
Asphyxiation in labour occurs because inadequate oxygen is getting through the placenta to the baby. A baby does not need to take in oxygen via their airway until after birth. If a tight cord is causing a problem (rare) – it is not due to strangulation or preventing the baby from breathing. It is because the cord vessels are compressed and not allowing the oxygen from the placenta to circulate. And no, I would not clamp and cut a cord before the baby is born.
Even though it might be rare, I’ve just heard about people saying that their baby died from them being strangled because they were actually trying to take a breath while the head was out but before the body was all the way out, since it’s possible for that to happen. But, I suppose even if you do what you think is best in a given situation there will sometimes still be outcomes that are negative since it can all be so unpredictable.
I saw one lady’s comment a while back on here where she said the cord was wrapped very tightly and the time from when the head was out to when the whole body was born was 5 mins, and I can’t remember if they cut the cord or not. What about in a situation like that, where it’s cutting oxygen to the brain that long, plus no telling how long it had been wrapped in the first place. Isn’t that passed the safe limit when brain damage could happen? Would you cut the cord in that situation, or maybe help the baby out?
A healthy baby is fairly resilient and the number bandied about by maternity professionals is “7mins” as being the limit for coping without oxygen. So, 5 mins is a long time and a very tight, compressed cord would result in reduced oxygen during that time. However, cutting the cord would also result in no oxygen and no capacity to get oxygen via the placenta after the birth. A compromised baby is much easier to resuscitate with the placental circulation intact (http://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/)… I cannot say what I would do in a particular situation until I am in it. The priority would be to get the baby born if the circulation was actually compromised – lots of babies continue to get well oxygenated while their head is out and waiting for the next contraction.
I found it. This is what I was talking about. After reading over it again it wasn’t as bad as I was thinking apparently, but still a scary situation. It’s crazy that the baby turned out OK even after 5 mins. of that the baby turned out OK and they even said the oxygen didn’t seem to be compromised much, if at all. “Hi there, Love your blog and sorry I didn’t realise it was you who spoke at HB Aust conference on the weekend until it ended! Happy to add another anecdote to the ‘healthy baby born with nuchal cord and no intervention’ list. My 4th baby, born at home after 2 hour labour, stayed with head born for 5 minutes and 3 attempts at restitution of shoulders before his body came. I asked my midwife for help as I didnt understand why he wasnt coming out! I said the cord was twice around the neck, she reassured me he would slip through it, but I kept telling her he couldn’t turn all the way to let his shoulders be born and he kept turning back. She asked me to move and said he had a nuchal arm with the cord wrapped around that too and asked if she could try and free his arm, apparently I said yes but she couldn’t move it, and she said the cord had plenty of slack in it so she didn’t think it was tight enough to prevent him from turning. She couldn’t figure out what was going on, neck not turtled indicating shoulder dystocia, and asked me if I wanted to try standing, I did and put my leg up on the side of the birth pool and after some elbowing inside me he slipped out. It was then we discovered his cord harness! It was not only around his neck twice and then his arm but criss crossed in an x over his torso. He was such a well wrapped gift that it was a job to keep him above the water of the (half full, not hot enough) birth pool without it appearing that his cord would snap at his umbi, it was pulling hard and I felt it and I was worried it wasn’t pulsing. My midwife reassured me it would start again, if it wasn’t now, once we got the pressure off it, and when she felt it it was pulsing perfectly. Our bub was lovely and purple but decidedly not interested in doing anything, including breathing or moving, but with a bit of help with the bag he was breathing at 2 minutes. There was never a time when his oxygen appeared to be compromised, he was well oxygenated and was breathing before cord stopped supporting him. Our conclusion was that the lovely wrapping he decided to be born with meant he needed a little extra time until the uterus and placenta came down low enough behind him to allow him to turn enough for his shoulders to be born. His reluctance to breath we put down to the very quick birth, which was shocking for me too, rather than nuchal cord.”
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I had to reblog this post – it’s amazing to me how much fear there still is surrounding cords around necks – time to move another step forward in trusting the birth process
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I did not read all the comments on here but I lost my baby oct 15 2014… everything was perfect and he was healthy. close to the end the dr started putting me on a heartrate monitor because there seemed to be fluxuation in his heartbeat.. they told me everything was fine and sent me home. I got sick again and they monitored me again said everything was fine I didn’t feel like everything was fine. on wed oct 15 I went in for a routine visit and he was gone no heartbeat. when he was delivered that night his cord was wrapped around his neck 4 times. is that likely what took the life of my baby because I had a perfect pregnancy no problems. im just lost looking for answers.
I am so sorry that you lost your baby and it is very normal to search for answers in grief. You knew things were not fine with your baby – a mother’s instinct is the most important ‘assessment’ of baby’s wellbeing. You were also ‘sick’ – did you have a virus or a underlying health complication? I cannot comment on the cause of your baby’s death as I do not have all the information. Will there be an autopsy? Most often no cause is identified following stillbirth. It is very unlikely to be the umbilical cord – for all the reasons I have discussed in the post.
Please get some support to help you in your grief. I am not sure where you are but SANDS is a good organisation and operates in most countries: http://www.uk-sands.org
Hi there. I am so sorry for you loss. I too lost my daughter due to a nuchal cord (type a and b- three times around her neck and once across her chest)
I can tell you from years of experience that this particular community is the wrong place to share your story. They refuse to accept nuchal cord as a cause of death even though they are poorly informed. I feel your pain so much and no one here will be truly empathetic to your loss. I have done much research and attended the stillbirth medical conference. Dr. Jason Collins is probably the most knowledgable person in regard to cord accidents. He made a very informative documentary called Silent Risk which I wish all these midwives would watch.
The reason no one wants to accept cord accidents as a cause of death is because the NIH and ACOG don’t want doctors to be held responsible. I know this doesn’t give you much solace and won’t bring your baby back. Please look for a local chapter of the MISS foundation because being part of a support group for loss parents saved my life. (First candle is also a good organization and a lot of them have Facebook groups) My heart goes out to you. Your angel will be looking out for you until the day you will be reunited.
Carrie – cord accidents are a cause of death. I am not denying that at all. The point of the post is that the vast majority of nuchal cords are entirely harmless and do not cause a problem. If you read Amanda’s story there seemed to be other things going on for her ie. feeling sick. Many women who have lost babies report having felt ill/sick or had a virus prior to the death. In most cases of stillbirth where a nuchal cord is present – the nuchal cord is incidental… a third of babies have a nuchal cord therefore a third of stillborn babies will also have one. In rare circumstances like your own cord entanglement of any kind, including a nuchal cord can result in death. However, I don’t think it is helpful to consider a third of all babies at risk of this outcome. I hope Amanda gets answers – and if the cord is to ‘blame’ that this is identified and discussed… but it is more likely to not be the cord.
I’m not sure how identifying a cord accident would = making doctors responsible… quite the opposite. Doctors/care practitioners are ‘excused’ if the cord caused the complication/death rather than something else they did or didn’t do = why I feel it is often used as a scapegoat.
I just learned so much and was able to let go of an irrational fear. Thank you. I want to pass this on to my readers. http://awonderfulbirth.blogspot.com/
I love the clear way you have described this important subject and I love how these natural processes are being taught to midwives these days so that it can become standard practice. I weep for all of us who were born in the days premature cord clamping and cutting was the norm. Where we started our days with 40% less blood volume than we should have had and we were separated from our mothers. I feel we were weakened as individuals and as a species. There is much healing needed.
Thank you, it’s really interesting your article.
I gave birth to a beautiful baby last December.
Well, I wanted to give birth at home, in water and to do lotus birth, but, for I was at the end of the 42nd week of pregnancy, midwives said I had to go to the hospital just to do a check .
In the hospital they found me with very high pressure (it was perfect during all my pregnancy till the day I went to the H.) and they didn’t allow me to go home,
They did the induction with prostaglandins.
The baby loosed heartbeats at every contraction.
I had the contractions but not the dilatation.
Finally they went for the C section.
They found the baby with the cordon around his neck and shoulder but, anyway he was very healthy and his apgar was 10/10.
Before the C section they visited me several times with the softness of an elephant, at the last visit all my body shivering and I think that may be a cause of wrapping the cordon.
Even if I lost my mental feeling with my baby the moment I entered the hospital, I think he could feel my stress.
What I think about this is that my baby and I just needed some more days.
They should have take my blood pressure under control and allow us to wait two days more.
Obviously they told me my baby was healthy because they went quickly fora C section, and they also told me that I had no dilatation because the baby was wrapped around his cord and couldn’t go down.
Well, finally I’m happy that my baby is ok, but that’s not the way I was thinking to give birth.
I am sorry that your birth was not what you expected or planned for. Please remember that it is not the place of care providers to ‘allow’ or ‘let’ you do anything. They should offer options and information – you should be making the decisions and feel informed. A nuchal cord would not stop a cervix dilating. I think this may have been incidental rather than a cause. I hope you are enjoying your baby 🙂
Fantastic article!
I stopped checking for nuchal cord years ago, and have performed the Somersault manoeuvre -but didn’t know it had a name, just thought myself that it seemed a logical way to deliver a baby with a tight nuchal cord. Cutting and clamping went out about 18 years ago! I had 2 guys fundraising for the Cerebral Palsy Alliance the other day who mentioned that CP was always caused at birth – by things like cord around the neck. Let me tell you – I sure set them straight!
I wish cutting and clamping had went out 18 years ago… it still happens here. Although grabbing and pulling/looping is more common now a-days. Clearly the CP Alliance is not up on the latest research regarding the cause of CP ie. 70% during pregnancy before labour even starts. Pleased you put them straight 😉
As a midwife and childbirth educator I am very happy for this information to get out there to other birthing professionals and to the general public. Cord wraps and cord compression are something that expectant moms worry about and talk with their providers about and providers need to be able to ease their fears.
I agree whole heartedly with the vast majority of this article. I believe in delayed cord cutting, believe that most cord wraps are not that much of a difficulty during the birthing process. However, there is one statement that I feel although technically correct it is not really completely factual.
That statement is “The truth is the cord around the baby’s neck is NOT harmful, as it does NOT strangle a baby who is NOT using lungs to breathe until AFTER birth.”
While it is true that a cord around the neck does not strangle a baby since the baby does not use the lungs to breathe until after birth; and I also believe that most cord wraps are of little consequence to the birthing of the baby because they are usually easily remedied. I cannot, however, get behind the statement “a cord around a baby’s neck is NOT harmful.”
It may not be harmful to the baby during the birthing process but research has shown that it has long lasting effects on the fascial and neurological function of the newborn that can be lifelong and limiting.
These effects can be as mild as difficulty with latching on or sucking with breast-feeding, deficiency or lack of tongue thrust, swallowing issues, digestive issues, colic, or gas. The effects can also range into sleeping issues, neck and head range of motion and control issues, arm and hand motion in control, and breathing issues including childhood asthma. Some of the more serious of effects can be lack of tone, hyper tone, clubfoot, cerebral palsy, seizures and overall fascial tightness in and around the cranial bones which limits the breathing affect of the cranium and may limit brain growth and brain function.
When you look at all these possible effects of the cord wrap after the birth which can impair breast-feeding, child’s physical growth and well-being as well as limit development I think we as birth providers need to think about the effects of these wraps after the birth.
I am sure that for most of you reading this that it may be the first time you have been made aware of this connection. This is tragic because as this article states 1/3 of births have a cord wrap which although it causes no difficult at the birth may have immediate and/or lifelong repercussions.
The good news is there is an easy way to assess the possible impairment the cord wrap has caused and a wonderful and easy therapy that can correct the issues caused rapidly especially the sooner after birth it is begun.
The assessment, Baby Brain Score, can be added to the post birth assessment of the newborn as easily as the Apgar score was added in the early 50’s. It takes very little time, needs no specialized equipment and gives the health care provider an immediate picture of an infants neurological health and potential.
The therapy is Craniosacral Fascial Therapy or CFT which can be begun within moments of birth and done at the bedside with mom and baby without any special equipment. The best thing about it is that it can be taught to midwives, nurses, doulas, doctors and lactation consultants, childbirth educators as well as any other interested adult in two 2-3 day workshops.
For more information please go to http://www.gillespieapproach.com
Hi Elizabeth
Can you provide some links to the research supporting your statement: “It may not be harmful to the baby during the birthing process but research has shown that it has long lasting effects on the fascial and neurological function of the newborn that can be lifelong and limiting.” – I did not find this research during my literature review. I’d also be interested in the research supporting the Baby Brain Score and therapy.
What a great post. As a student midwife in the UK in the 1970’s I was taught to clamp and cut and unwind tight nuchal cords. Thank goodness practice has progressed and we keep learning about the amazing physiology of birth. So from this interventionist point I’ve moved to being a proponent of leaving the cord intact throughout and advise my students that newborns can and should be assisted with the cord intact if it’s necessary. What a long journey for me!
I was also taught to clamp and cut a nuchal cord in the 90s! It is so important that we reflect on our practice and never be afraid to say ‘I was wrong – there is a better way’. It is only by doing this that we grow 🙂
Hi Dr. Rachel, I’m a student midwife in Sydney, Australia and recently I was at a birth with a CoC woman. The fetal heart rate was suspicious throughout all of labour with multiple atypical decels, labour was then augmented and a forceps delivery occurred. When baby came out the cord was wrapped around the babies body, clamped and cut immediately after birth of body, and was deemed the reason for distress. Baby required urgent resuscitation and was then sent to SCN where it spent 5 days. Of course I believed the doctors and midwives verdict of fetal distress, so it was really interesting to read this article! In addition, when I came back the next day to visit mum and bub, the paed said that baby had pneumothorax, a punctured lung. I wonder what your thoughts about this are, and any potential causes you can think of? I have done my own research, but this article regarding wrapped cords as brought some interesting light to an otherwise cloudy birth I attended!
Hi Maxine. It is difficult to comment without having been there and seeing the full picture. Based on what you have written – and taking a general perspective… Variable decelerations indicate cord compression. If the cord is wrapped around the baby’s body – especially if the amniotic sac is not intact (http://midwifethinking.com/2010/08/20/in-defence-of-the-amniotic-sac/) then it can get compressed. If the cord is around the neck this protects against compression as the head and shoulders get squeezed instead. However, if the cord is around the body (especially back and shoulders) it can get squeezed against the body with contractions = occlusion of vessels = variable decels which are not in themselves a problem if the other features of the FHR are good. This is a normal physiological response to cord vessels getting squashed then un-squashed. Add some syntocinon to the mix = can only make things worse for the baby as stronger contractions and less blood flow through the placenta. Syntocinon is the leading cause of fetal distress during labour (not wrapped cords). A lunch can be punctured during resus by overinflation – this should be explained the parents. The poor state of the baby was probably exacerbated by hypovolaemia due to premature cord clamping http://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/
This is a common scenario. Common practices (ARM, syntocinon, premature cord clamping) often result in complications that are then blamed on the woman/baby. Risk management should be about protecting physiology where possible and saving interventions for when they are needed. Not sure if that has shed any light for you… when trying to work out why a complication occurred it is usually best to start with what was done to the woman – you usually find the answer there 😉
Hi Rachel, thankyou for your reply and thankyou for this helpful information! After a reflection of this birth I believe the outcome to be a result of the particular practices of different health professionals. Waters ruptured spontaneously but by all other accounts interventions were made-syntocinin, epidural, FSE and lactate. It seems that these were a result of the health practitioners reliance on intervention and wanting ‘this baby out as soon as possible’ and ‘better be safe than sorry’ rather than a trust in the physiological process of birth. I can’t speak for the health practitioners reasoning but it seems the variances in everyone’s practices are a major factor in varying birth outcomes. In terms of the pneumothorax, the parents found out the same time I did, with no explanation regarding the cause or implications so it seems this hospital does not prioritise debriefing :/ By all accounts mother and baby are doing as well as they can which is a very positive outcome in this otherwise complex birth. Thankyou for you discussion it has definitely helped my learning process!
The combination of syntocinon and an epidural for a primp (if she was one) is usually a ticket to an instrumental birth or a c-section. I hope the mother leaves her birth experience knowing that she is not ‘broken’. Women often leave birth mis-trusting their bodies instead of ‘the system’. She will likely need some support to debrief her experience. Unfortunately ‘doing well’ is usually judged by how well women physically recover and accept that ‘at least I have a healthy child’. She can love her child but not love her birth experience. This is why the CoC experience is so valuable for midwifery students… they get to see the bigger picture.
Couldn’t agree more, thankyou Rachel!
Thank you for this interesting post, I am glad to see that you are reading comments even 5 years later! I have at times wondered if my c-section two years ago was unnecessary, but I wonder what you think. My water broke before my labor started, and I went in for a check about 16 hours later, still in early labor only. My midwife did not do a vaginal exam but did do a non-stress test, during which we saw my daughter’s heartrate go to 60 for several minutes. I went to the hospital and they started Pitocin (which I barely reacted to) and we still had decels that didn’t come up quickly. We tried different positions for several hours which each helped for a while but then the heartbeat would have trouble again. I had only dilated to 3 cm and after an internal monitor placement they decided to give me an epidural to see if that would hurry things up. Before the epidural I needed an amnioinfusion so I would be able to sit up without bad decels. During the amnioinfusion and the wait for the epidural (probably an hour together) I went from 3cm to 8cm, but soon afterwards the heartbeat got so concerning that they decided to c-section. After she was born my husband says she had the cord looped over her shoulder and under her armpit, and someone told him it was a long cord. I couldn’t look because during the placement of the internal monitor I had a flashback to my first daughter’s stillbirth (placental insufficiency at 25 weeks) and was basically non-functional and totally detached after that. During the c-section I was hoping to die and had no interest in meeting my daughter when they brought her. Now I am very grateful to have a living child, but I still wonder if they rushed the c-section, given that she had Apgars of 9, and if I could have done more if I had been mentally present during the second half of labor. It seems strange to have been someone who was telling people that nuchal cords are no big deal (which I had learned from my birth class), and then to have had a section because of a cord issue.
It is be impossible to tell you whether your c-section was necessary without having been there and having full history/information etc. Based on your account about your daughters heart-rate and circumstances… The fact that they were giving you an amnioinfusions suggests that you had minimal amniotic fluid and this can indicate placental insufficiency at the end of pregnancy http://midwifethinking.com/2013/08/14/amniotic-fluid-volume-too-much-too-little-or-who-knows/ If the placenta is not functioning well to begin with, contractions (ie. labour) exacerbate this and can cause the baby to become distressed due to lack of adequate oxygenation. Every time the uterus contracts the placental bed is squeezed and there is a reduction in oxygen transfer. Less fluid = more squeeze. If there is less fluid because in pregnancy the placenta was not functioning well = even greater risk for baby. I think the umbilical cord in your situation was a red herring. Plenty of babies are born with cord entanglement and are fine. However, it often gets the blame for an outcome (hence the blog post).
Apgar’s of 9 are good. Perhaps if everyone had waited you could have birthed vaginally. BUT at the time no one would have known this and did not want to risk waiting until your baby was compromised. She was obviously in a good condition when she was born 🙂
Thanks for your reply! Yes, I had minimal amniotic fluid because it really gushed out when my water broke the night before. Lack of oxygen from squeezing the placenta without much fluid makes a lot of sense. I don’t know how the placenta was doing at the end though it looked okay on the ultrasounds (I had several because of my history and always asked about that), and it looked good to me afterwards but of course I don’t know what to look for. That would have been useful to know, I will ask the midwife to look at it after the next birth. I still have the other one but it probably looks odd after two years in the freezer! 🙂 Thanks again, this is a great blog.
What about in labor when the baby’s heart rate repeatedly dips to 30 bpm despite changing positions? Could that possibly be attributed to a nuchal cord?
It depends when the ‘dips’ are occurring. Variable decelerations are associated with cord compression. Usually due to a cord being compressed between the baby and the uterus with a contraction. Often related to low amniotic fluid or artificial rupture of the waters. The cord is protected from compression when it is tucked into the baby’s neck and is more likely to get compressed if around the body or shoulders. Late decelerations are about placental perfusion ie. how much oxygen is getting to baby via the placenta. They are associated with growth restricted babies and/or induced contractions.
This is fascinating, thank you.
My 4th baby was born before the midwives arrived. I caught him myself. He had a loose nuchal cord. I checked it was attached to me, and how long it was, and then gently looped it over his head. It was no drama and I just instinctively did it without thinking.
It was a lovely birth. Fast though!
they used the somersault technique for my daughter 🙂 she’s just fine lol
We lost our son at 24w exactly may 7th 2016. I hadn’t felt movement and just didn’t feel pregnant an ultrasound showed no heartbeat I was induced and delivered my son sleeping the cord was twisted and wrapped around his neck twice. Tests found no other cause for his death and we’ve been told repeatedly by the Dr’s and staff that the nuchal cord was to blame.
I am so sorry for your loss. In most situations like this there is no know cause of death. It is very painful for parents to have no answers. It often seems kinder to provide a reason than not.
Kelli
Ugh. I am so sorry. It is awful to lose a child due to a nuchal cord. I know. 5 years ago this month I lost my daughter in labor due to a nuchal cord three times around her neck and once across her body. It is truly devastating and rescrambles you in every possible way. I have to tell you that this is not a good place to share your loss. The people here do not “believe” nuchal cords are the reason for your loss. Unfortunately even though thousands of babies die a year because of cords this forum is particularly callous and backward when it comes to acknowledgement and understanding. Thankfully there are other places to find support. The MISS foundation basically saved my life but there are others and also loving Facebook groups of parents who have also lost children like we did. Please reach out to them. You are not alone and this community is working diligently on educating doctors/nurses/midwives and the general public on stillbirth. You are in my thoughts. It is a forever pain that we live with. 💔
Love this thanku so for sharing! Many of my live births the cord was around their neck
This is a great article and very informative. As a Midwife in Florida this is the number one concern in couples and when it is explained that this is normal in pregnancy and birth everyone goes into automatic in panic. Many of my babies have been born with the cord around the neck and with great success, great birth, and recovery.
I am confused. What happened to my baby then? I went into labor… She was moving very painfully/weirdly in my pelvis but I figured she was “getting into position” as most my son was sunnyside up and my daughter may have been too— they both were 36+ hour labors.
When contractions dissipated after 10-12hrs I went about my life… rested, prepared for baby.
The next day picked up my kids (whom I sent off when in labor)… on the way home realized I hadn’t felt the baby all day… and in fact… couldn’t recall if I’d felt her since labor stopped.
Went to labor & delivery after talking to my midwife. No heartbeat.
Delivered… Cord wrapped twice around her neck VERY tight.
I am sorry for your loss Ella. I can’t answer what happened to your baby. However, this scenario happens without a nuchal cord too. The presence of the cord does not mean it was the cause. Labour stopping after contractions have established can be a sign that the baby is in trouble. Babies can be in trouble for all kinds of reasons – usually unknown.
Brilliant informative blog thank you!
Please tell me what experience you’ve had of breech nuchal cord and your understanding of optimal actions in this event. Thanks
I have no experience of breech nuchal cords. I have seen a breech baby ‘packaged’ up in his cord. It was under his legs and around his body… probably why he was breech. It caused no problems with his birth.
Thinking about the physiology of a nuchal cord with breech… it is extremely unlikely that a cord would be so short it would cause a problem. Inside, the placenta is very close to baby’s head at the time of birth (some breech babies come out wearing the placenta as a hat). There would be plenty of length in the cord to accommodate the birth of the baby’s head.
My story with a nuchal cord. I presented to hospital early in labour, after a bloody show, because my contractions fit the 5-1-1 rule as I was told, but the intensity wasn’t too great at that point. Being a first time Mum and not really knowing what to expect, and anxious to “settle into my birth space” as you have written in previous posts, I went to the professionals. My Mum, who has given birth to 4 babies was watching me concentrating through contractions and urged me to go to the hospital. I laboured there for a few hours, having to stop walking when a contraction came. When they put fetal monitors on me they noticed decels, but didn’t tell me at the time. Late that night I requested a VE to see where we were at. The midwife said she couldn’t even find my cervix to measure it. After that the midwife suggested I stay overnight in hospital and they gave me some pain relief so I could sleep. It took a few hours, but my contractions slowed and fizzled out to almost nothing by morning.
In the morning I was then strapped to the monitors and I heard them discussing decels. They told me they were a little worried about the baby’s heart rate and were going to do an ultrasound to see what was happening. The ultrasound revealed the cord around the baby’s neck. The doctor was like ah-ha! You need a c-section. When we questioned this I was told “well we could let you go on, but you’ll need a section anyway. You can either wait until it is an emergency, or you can have a healthy baby now.” There was talk of baby’s head being high (baby was not engaged) and that I could go on labouring for days. If the baby’s heart rate was like this in early labour then what would it be like later etc. Essentially my husband and I felt we had no choice. My midwife (bless her) cried when I was told I needed a section and I was a mess. Within minutes of agreeing to surgery I was being prepped and consent forms were shoved at me, and not long after we had a healthy baby, apgars 9 and 10. The cord was around his neck and looped under his arm, across his chest.
They told me we had made a good call, but to this day I am still unsure about it. No-one knows what would had happened if I had laboured on, and I know so little about what my son’s heart rate was actually doing, but I can’t help but feel that the c-section was unnecessary. The cord was blamed for the c-section and my notes say “fetal distress” (with such good apgar’s though?) This was at a rural hospital in Queensland, Australia.
Needless to say this time around I am doing my research and learning as much as I can (hence my reading this blog) and am hoping for an all natural (albeit hospital – as we can’t afford an independent midwife) vbac (refusing IV, VE’s, continuous monitoring, induction or augmentation, and hopefully pain relief).
Thanks for sharing your story. It is difficult to know what was going on with your first labour. If your baby’s heart pattern really was abnormal before established labour and without contractions then that would be concerning. It sounds like your baby was very wrapped up in his cord!
Good luck with your next birth. Have you thought about getting a doula to support you with your hospital birth? It can be hard to advocate for yourself when you are in labour 🙂
Yeah I’ll have a doula with me, and I’ve been lucky enough to score a student midwife – so I will have continuity of care, even in the public system! Looking forward to giving labour and birth a real go this time!
sounds like you have got yourself well support 🙂
Can I ask you how your second birth went?
I don’t think it’s accurate to say that a compressed nuchal cord cannot gradually evolve into hypoxia over a long labour. You start by seeing those shallow, quick recovering decelerations which often deteriorate over the course of a labour into longer, deeper decelerations as the baby tires. Sometimes shifting position can alleviate the pressure on the cord meaning the baby doesn’t get tired as quickly but if you leave those decelerations without conservative management, they will complicate the labour and increase the chances of an emergency birth being recommended.
The post does not state that a compressed cord cannot gradually evolve into hypoxia. It can – this is one of the reasons ARM is not a good idea. However, a cord tucked around a baby’s neck is more protected from compression than a cord around the body or back. This post is about nuchal cords.
The only place I write about (nuchal) cord compression is in relation to the very end of labour – short term.
I have responded to similar questions in the comments thread – if you do a search for ‘compress’ you will find more discussion and clarification about this.
Very interesting!
Hi! I love, love your work, and so appreciate your deep wisdom and generosity through this website — THANK YOU!!! and happy new year, too! There seems to be a discrepancy between your sentence “Around a third of all babies are born with the umbilical cord around their neck (Sheiner et al. 2006)” and what the link to the Sheiner et al article states: “Of 166,318 deliveries during the study period, 14.7% had a nuchal cord, documented at birth” — so it’s much fewer than a third. 🤗
Hi Forest – thank for the feedback and query re. stats. I’ve updated the statement and the reference.
Each study I’ve looked at quotes slightly different stats. This is due to differences in documentation and practice. Interestingly, if the baby needs resus at birth the care provider is more likely to document a nuchal cord than if the baby had a nuchal cord and did not need resus. 🙂
Excellent article!
Great blog as usual! Thank you for linking to our webpage/animation on http://www.somersaultbirth.com 🙂