Help me understand cord around the neck fears

[CrunchyChristianMama]

Why are people soooo worried about the cord being around a baby's neck. I hear c/s being blamed on it and all kinds of things. They say the baby will strangle...how can they strangle if they don't breath yet through their mouth??? Am I totally missing something here?

[MegBoz]

Good Q, I'm curious as well.
My DS was a natural birth in a hospital. His HR was dropping a bit to around 80s while I pushed. My MW had me get down on my left side instead of hands & knees & they gave me oxygen which helped. I only pushed about 40 min.

When his head emerged, the cord was wrapped around twice. The MW simply unwrapped it, then with the next push he was born into my DH's hands.

I don't know if the cord was the cause of the decels, but the decels were minor anyway & easily resolved with being on my left side instead. He was just fine.

[jeliphish]

It would be considered "strangling" because the cord would be compressed, thus preventing the placenta from providing the oxygen. In most births the cord is wrapped perhaps once around the neck....or neck/under arm. When the cord is ample enough in length there is usually no problem at all as it does not compress in any manner. Usually the problem is when there is either a short cord or the cord is wrapped so many times around the neck that it will not allow the baby to desend down or out without cutting the flow of 02 to the baby from the placenta.
DD1 had a cord long enought to jump rope lol. It was wrapped around her neck but it was not an issue. dd2 had such a short cord that she was barely able to lay on my pelvis after birth without pulling on the cord too tight. If it had been wrapped around her neck it would have been a totally different outcome.

[billikengirl]

I think even with adults it's not just the compression of the windpipe, it's the compression of the blood vessels in the neck that carry blood to and from the brain that is bad.

Still, I don't worry about it too much because it's something my midwife is prepared for and knows how to handle.

[sundance doula]

I think this is a perfect example of the "birth is a medical emergency" phenomena modern media has created. I have yet to watch a mainstream movie or tv show that shows birth in a normal light. Birth is always portrayed a crisis and an emergency, this is what women expect when they have their baby. It's a travesty.
--Jen

[JavaJunkie]

My first baby was stillborn due to a cord accident. The cord was wrapped around her neck once, but that isn't what caused her death. There was a stricture in the cord...a tight twisting. It was severe enough to cut off all nutrients and she died.

Like a pp said, the cord being wrapped around the neck(particularly only once) is rarely an issue. When it is an issue, it's usually because of multiple(3x or more) wraps, and/or a very short cord.

[Astraia]

I often hear it as a reason for the c-sec but only AFTER it's been performed.

Like, "They said my contractions weren't strong enough so I was on drugs to help it go faster and then the baby's heart rate started dropping so I was rushed in for an emergency c-section. The doctor said it was good we got in when we did because the cord was around the baby's neck!"

It's like the dr is trying to reassure the mother that it's not the HOSPITAL's fault or the fault of the drugs they were pushing, but that everything would've gone to hell in a handbasket no matter where she was or what they did because the c-sec was necessary.

I've heard it for all kinds of reasons- baby had a big head, baby was big, cord around the neck, mom was too short anyway, pelvis was too small, baby's head wasn't flexed properly and so on.


And yes there ARE times where cord around the neck is bad, but from everything i've read I believe it's just when it's too short.

[Cativari]

As others have said a cord around the neck is typically NOT an emergancy.

FWIW DD had her cord wrapped once or twice. DS had his cord wrapped 4 times around his neck but still had a jump rope even before it was undone. I remember the doctor (family doc) unwrapping and counting. He'd never seen such a long rope.

ETA: the doc didn't seem concerned about DS's cord being wrapped around so many times, just thought it was a little unusual that's all.

[wombatclay]

Yup, it's one of those things that can be bad, but usually isn't. The problem is that it is also one of those things where you don't know if it'll be bad or not until the very last minute. So in a "defensive medicine" setting you're going to find a stronger push to intervene "just in case" or to use a nuchal cord as a "reason" for a prior intervention.

And yes... the risk is two-fold. On the one hand, there can be cord compression which compromises the babe's access to O2 and on the other the cord could be "too short" to allow the babe to descend fully. But as pp have said, one or two loops is pretty common and usually not an issue in terms of safety.

[MsBlack]

I would have to say that with cordwraps around the neck, it is not cord compression that is occuring--if anything at all occurs apart from a normal birth, that is. In the rare instances when cord around the neck becomes a problem, it is not cord compression that is at the basis of the problem, because when the cord is around the neck you have the head on one side and the shoulders on the other side of the cord, both being bony structures that are bigger than the neck (even when the neck has a cord around it). Can you see what I mean? The normal greatest pressure is on the head and shoulders, with less on the neck/cord.

However, the problem arises with 'strangling'--cutting off 02 flow and potentially most or all of the baby's circulation--when the cord pulls very tight around the neck. This cuts off blood flow in the baby's carotid arteries and jugular veins. I have seen this once, fortunately the cord only pulled that tight during the last couple of minutes of descent and birth was fast. By turning the baby's head toward the mom's thigh so baby kind of somersaulted out instead of birthing straight out from her yoni, mom got the baby out, and I was able to hold baby very close to her yoni as baby emerged, without that cord getting any tighter (only just!) And as soon as baby was all out, there got to be just enough slack in the cord to unwrap it.

That was also a very long cord and was wrapped 4times around the neck; it was tight enough that baby's neck skin was indented where the wraps had been (for some hours after birth). Baby's head was deep purple and body white until I got the cord loose, when circulation immediately returned to the whole body. His heart rate was a bit low and he was a bit slow to breathe, slightly stunned, but he came round nicely with just a bit of being stimulated by his family.

Interestingly enough, it was mom's 7th baby but 1st hb...and cord around the neck was the one thing she worried about the whole pregnancy--not a lot of angst, but some that never went away.

I don't know as OBs know about this somersault technique and anyway, being surgeons....nuff said.

Situations of cord compression are far more likely when the cord is wrapped around an arm, for instance, or all the way around the body--then, during descent when the arm is pressed hard against the body, or the torso is recieving the pressure, the cord can be compressed and circulation compromised some or a lot, depending.

Of course you can get cord compression from a cord prolapse but that is another topic. Just saying....

[Bluegoat]

I would agree with the previous posters.

That being said, I have an aunt who had a cord incident at birth, which resulted in oxygen deprivation, and cerebral palsy. Also a cousin with a similar scenario. In the case of my aunt, the doctor was likely at fault for not seeing the problem and acting quickly.

So things can happen with relation to cords around the neck, but usually it's straightforward to deal with.

[ericswifey27]

Originally Posted by Astraia

I often hear it as a reason for the c-sec but only AFTER it's been performed.

Yep. that was done to me. I was devasted to end up with a csection, even more so after reading my records and figuring out it was medically uneccessary. After they took him out, they pulled that on me about the cord, "oh thank goodness we got to him, the cord was wrapped around the neck". Apgar 9. I remember latching on to that idea of him being "saved" to try and make myself better about it, but it didn't work. Because it wasn't true: If it had been true, of course I would support surgery to save my child, but that wasn't the case here.
It reminds me of the Never Cry Wolf scenario. It is hard for us to know/believe when there truly is an emergency, because of the lines we've been fed, ykwim?

My heart goes out to those mamas who have had cord emergencies.

[Astraia]

Originally Posted by ericswifey27

Yep. that was done to me. I was devasted to end up with a csection, even more so after reading my records and figuring out it was medically uneccessary. After they took him out, they pulled that on me about the cord, "oh thank goodness we got to him, the cord was wrapped around the neck". Apgar 9. I remember latching on to that idea of him being "saved" to try and make myself better about it, but it didn't work. Because it wasn't true: If it had been true, of course I would support surgery to save my child, but that wasn't the case here.
It reminds me of the Never Cry Wolf scenario. It is hard for us to know/believe when there truly is an emergency, because of the lines we've been fed, ykwim?

My heart goes out to those mamas who have had cord emergencies.

I'm sorry you went through this It would almost be nice if you could believe the dr and believe it was medically necessary, it would be so much easier to get your head around if it was, I'm sure.

And I agree - it is like crying Wolf. I'm at the point where no matter what my doctor says, I'll take it with a grain of salt. I don't know if there's anything he'll tell me that I'll take at face value.

It's a sad and scary place to be in.

[jennica]

Originally Posted by MsBlack

In the rare instances when cord around the neck becomes a problem, it is not cord compression that is at the basis of the problem, because when the cord is around the neck you have the head on one side and the shoulders on the other side of the cord, both being bony structures that are bigger than the neck (even when the neck has a cord around it). Can you see what I mean? The normal greatest pressure is on the head and shoulders, with less on the neck/cord.

But doesn't the cord have to go from belly to neck, loop around, and then back down to placenta? So aren't two portions of the cord lying across the shoulders, which from your description would be compressed against the mother's body? So how can being looped around the neck be considered so safe when it exposes the cord in two places to being compressed?

I always thought the thing that protected babies in regards the cord was wharton's jelly. If there are adequate amounts of wharton's jelly, then even if the cord is compressed it shouldn't cut off blood to the baby. I always wonder about when the cord is compressed, is it that there is not a healthy amount of wharton's jelly inside of it? I know ds's cord was long and thin and wrapped loosely around his neck and he has some heart tone issues before he was born. But there were other factors; he was born fast and with a cephalohematoma, and I had nubain. I wonder if because the cord was thin, that meant there was not much wharton's jelly inside? Or, if the other factors were what caused the issues. I think it's hard to know afterward what caused some issues, and so if the cord is around the neck, parents are told that is what the problem was.

[MsBlack]

Jennica--

First, good point about wharton's jelly--and that is why usually babies don't have cord problems, even though many have a neck wrap of some sort. Wharton's jelly plus other elements of cord construction, I should say, work together to make the umbilical cord a very safe and effective method of baby/life support in utero. And yes, it seems that some cord accidents (with or without a wrap) occur because of a lack of Wharton's Jelly (inadequate amt)--I think this is important to understand and I'm glad you mentioned it.

We have to remember for one thing that the whole design of pregnancy and baby development and birth are highly complex and very elegantly designed, taking all matters into account (such as the baby swimming itself into cord wraps of different kinds, and the pressure baby moves through during descent). And when we hear somethng like 'cord accident' it is good to remember that while such things can occasionally happen, it is usually due not just to the cord getting into the wrong place (around the neck, say), but ALSO because of underlying problems with the cord. It is all elegantly designed, yes, but imperfection is also built in--genetic or chromosomal issues, random mistakes in the actual carrying out of the genetic plan, etc.

As for the way you describe the cord being around the shoulders--no. I mean, the cord COULD end up around the baby's shoulders, but I'm speaking of cord around the neck in the usual way. Maybe if you get a piece of rope or a necktie, you can demo for yourself. Up from navel to neck, around neck one or more times, then trailing back down the belly or back (toward placenta). This is what I have seen (with variations) and I could be wrong but it has sure looked to me IRL that the larger and boney structures of head and shoulders do offer some protection from cord compression when cord is around the neck.

[erin_brycesmom]

I don't know...research has shown over and over and over again that nuchal cords including tight loops do not cause any significant morbidity and are not a reason for a c-section. IMO, there has to be an underlying problem with the cord itself for a nuchal cord to become dangerous but then it's not really the nuchal cord that is the problem. It was a very wonderful MW here on MDC that made me realize that having a blue head at birth is normal and that there is no reason to fear a cord continuing to tighten as the fundus follows the baby down so it's not like you have a bungee cord situation going on. People always make a caveat for the instance of short cords but I think it is extremely unlikely for a cord to be so short that a nuchal cord would become dangerous because a cord that short would find it hard to make it's way around a neck in the first place.

[MsBlack]

"I think it is extremely unlikely for a cord to be so short that a nuchal cord would become dangerous because a cord that short would find it hard to make it's way around a neck in the first place. "

Quite so!

It tends to be the long cords that babies are able to get wound up in. And when this happens, baby getting cord around the neck, well that just helps to prevent cord prolapse...which seems possibly more likely if you have a real long cord in there. Again, the whole system is so elegant....

It can happen that a cord is extremely short, I even saw one picture of a baby attached directly to the placenta (no cord to speak of). This baby had to be delivered by csec, of course. The phenomenon was noted on u/s, and the pic was from the u/s--but it is pretty rare for cord to be too short for birth to happen. Shortest cord I've seen was a hospital birth where baby could only just get out--but he did get out.

Of course that is different from a nuchal cord--just agreeing that a short cord is unlikely to also be a nuchal cord.

[khaoskat]

Originally Posted by JavaJunkie

My first baby was stillborn due to a cord accident. The cord was wrapped around her neck once, but that isn't what caused her death. There was a stricture in the cord...a tight twisting. It was severe enough to cut off all nutrients and she died.

Like a pp said, the cord being wrapped around the neck(particularly only once) is rarely an issue. When it is an issue, it's usually because of multiple(3x or more) wraps, and/or a very short cord.

Actually having gone through this myself, I have done the research on multiple cord wraps. I was refused an attempted ECV because it appeared on US that the cord was wrapped 4 times and then threatened with the dead baby card if I didn't consent to an immediate c/s. Needless to say I didn't consent and went home AMA. I searched the web and everything I found said that even multiple cord wraps are not an issue for a vaginal delivery.

http://en.wikipedia.org/wiki/Nuchal_cord

As a matter of fact, the lead OB for my group had no issue with letting me go into labor (as a matter of fact when I refused the initially offered c/s, they tried to get him to come in and talk to me to talk me into the immediate c/s). He listened to what happened, he didn't bat an eye, got the people involved to come talk to us and we went home. I was monitored for potential problems (NST's every 2 days) till delivery. We attempted a breech delivery, even with the cord wrapped allegedly 4 times. In the end I did end up with a c/s, because she turned from heads up to transverse, stuck her arm out of the birth canal and started waiving at everyone and playing with everything in her reach. Except for the c/s, this was a textbook perfect delivery. Never any indication of any fetal distress or abnormalities during my whole labor, as a matter of fact, even though this was am "emergency" c/s, it was done slowly, a spinal was administered in the OR (was going drug free prior to this), DH was given a chance to get changed an in the OR...even the nurse said "Everything is perfectly fine, no need to rush or put her under, baby just stuck its arm out".

BTW - she was wrapped 6 times - 2 around her body and 4 around her neck.

[Vespertina]

Originally Posted by erin_brycesmom

I don't know...research has shown over and over and over again that nuchal cords including tight loops do not cause any significant morbidity and are not a reason for a c-section. IMO, there has to be an underlying problem with the cord itself for a nuchal cord to become dangerous but then it's not really the nuchal cord that is the problem. It was a very wonderful MW here on MDC that made me realize that having a blue head at birth is normal and that there is no reason to fear a cord continuing to tighten as the fundus follows the baby down so it's not like you have a bungee cord situation going on. People always make a caveat for the instance of short cords but I think it is extremely unlikely for a cord to be so short that a nuchal cord would become dangerous because a cord that short would find it hard to make it's way around a neck in the first place.

Yup. I debated with some people on FF about nuchal cords, including a physician who agreed that nuchal cords themselves aren't dangerous. Cord stricture is dangerous, but not common. Cord compression is also dangerous.

[Kidzaplenty]

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