trying to find solid information

[chirp]

on techniques to unwrap a loosely wrapped, or cut a tightly wrapped cord...

and other more hands on things that i might need to know when UCing.

a big part of me just believes that my body will know what to do...and my mind will know it if my body is unable to perform what needs to be performed...but i still need some actual information about hands on techniques for helping the baby out if necessary...

i'm thinking of making, like, cheat sheets for myself and my husband.

i've looked on the resources list for this board, but can't seem to find much "technical" information. the reader/info junkie in me needs this to feel prepared!!

thanks!!

[Astraia]

I was just reading up on this, actually! I was on this page, which has info on handling nuchal cords w/ somersault maneuver (instead of cutting/unwrapping for tight cords):

http://www.gentlebirth.org/archives/nuchlcrd.html

And that site is actually really good for a lot of things, I've spent a long time reading through posts on there.

[Serenyd]

somersault maneuver for tight umbilical cord

http://www.ncbi.nlm.nih.gov/pmc/arti...328444/?page=1

[guest8990]

what we plan on doing for our UC, is the cord will NOT be cut for any purposes.. if it is loosely around the babies neck, we will unwrap, if it is tight, we will unwrap after the rest of the body comes out, unless it seems to be hindering that process.. IMHO, baby cant breath with just his head hanging out of my hooohaa, so it wont hurt if its there just a tad bit longer.. and we will just unwrap it when the rest of him slides out! i know it may not work that way for us, i will probably freak out and tell DH to cut it, but thats the plan.. i want a intact cord, until it stops pulsing.

[PreggieUBA2C]

Originally Posted by Serenyd

http://www.ncbi.nlm.nih.gov/pmc/arti...328444/?page=1

Wow. That mama looks comfortable... Nothing like birthing a baby upwards. Up with gravity, I say. Ugh.

Turn the whole thing up-side-down and I can dig it though.

My 2 UC babes came flying out once their heads were out. I haven't had the time to actually slow their descent or to hold their heads either, so both landed on the floor. Thankfully, I was rather close to it and they didn't have far to go.

I have no idea where their cords were, but with ds4, his cord was too short for him to nurse or come any higher on my torso than the top of my belly, where he lay his head until the cord stopped pulsing. We'd planned either an extended placental attachment- like overnight- or a full lotus birth which we would decide once he was born, but it took so long for the placenta to come- at least too long for the babe to lay on my belly and not nurse when he was rooting (ended up being just over 2 hrs for the placenta)- that we decided to cut his cord once he started rooting and the cord was still (about 20 minutes- eek!).

His cord didn't hinder his birth at all, though. He was born in three contractions over three minutes which was the sum total time of my labour.

That 'manoevre' does seem to me to be a natural way (one of many, that is) for the mother to respond to the birth anyway. Lots of mamas hold their babies' heads once they are coming out, so if the cord was tight, the somersault seems to me to be what would just happen naturally. There really isn't any other option for the babe; if the head is going to stop an inch out of the mama, then the body is going to have to flip around it, even if nobody touches the head.

It's not like the head becomes a stopper; the baby's body is still being pushed down and out and will have to go out, past the head if need be.

[sweet_tart_vt]

My last 3 births have been UC, and while I didnt have any cord entanglement issues; my 2nd UC, 5th baby, had a very short cord. She had remained breech until 39 weeks when we had an ECV which was successful (would never do again tho), and when she was born on our bathroom floor, with me on my hands/knees it was kind of like she was suspended like on a bungee cord when she emerged... not even long enough for her to get lowered down to the floor. I am not at all in favor of early cord clamping/cutting, so I just sat on the floor with her and had to sit "indian style" and leaning over a bit to nurse while we waited for the placenta (only about 15mins thank goodness as it was not the most comfy of positions!)
As far as entangled cords, I know most of them can be unwrapped pretty easily by slipping a finger or two underneath the cord and either disentangle the body part/s or make a large loop of cord if you can and allow the body to birth through the cord. If i ran into a cord too tight to untangle,
esp. if it was around the neck, I think I would cut it right then and there even though I am opposed to early cutting in general. Id rather prevent a possible trauma/crisis if it seemed babe was distressed.
I like your idea of cheat sheets! Knowledge is power, that is something I have always stood by. I am sure your body will birth your babe wonderfully, just a it was designed to do, but it never hurts to follw the boy scout moto, does it? lol. Maybe you could print out some basic pictures of possible birth posions/scenarios and put notes on them for you and your DP, and maybe a copy of infant CPR. I would think the more simple the better so you can just flip to a page and have it there in from of you. A 3 ring binder would work well.

Blessings for a wonderful birth!
~Shelby~
SAH UC mama to 6, cooking #7.

[chirp]

thanks for you replies!

i agree that i would definitely be cutting the cord if the baby seemed in anyway to be harmed/hindered. If not dangerous, then maybe not right away...but I did want fairly explicit directions on how to cut a still-pulsing cord, in case of emergency too.

the somersault maneuver looks excellent, my dh and i will be practicing with a doll.

minues any cord entanglement issues we'll probably just leave it attached for an hour or so.

a three ringed binder is an excellent idea.

and the gentle birth archives!! i'd forgotten about that site...which i frequented in my last pregnancy b/c babe was breech. in the end my mind, body and babe just came to the understanding that vaginal birth wasn't happening.

thanks again!!

[PreggieUBA2C]

Originally Posted by sweet_tart_vt

if it was around the neck, I think I would cut it right then and there even though I am opposed to early cutting in general. Id rather prevent a possible trauma/crisis if it seemed babe was distressed.

The link to the midwifery archives above deals with why clamping and cutting in this instance can do more harm than good. Essentially, it is the babe who has endured distress from cord issues that most needs the cord left intact for as long as possible, barring anything so tight that the babe cannot even descend.

Apparently, it is nearly always much better for the babe with cord wrapped around the neck, even if is causing decels, to let the birth progress without interference because once the babe is born, bloodflow will no longer be hindered and s/he can be replenished quickly. If the cord is cut while blood is not freely moving, then the babe will be in worse shape upon birth, having been first depleted and then cut off.

Most often, babes whose cords are cut under these circumstances require ventilation whereas those in distress with wrapped cords who are then birthed without interference require none- anecdotally from the same archives above.

The midwives offer anecdotal evidence of this through apgars following both types of scenarios, although there isn't a whole lot of evidence overall.

Personally, I would leave the cord and do whatever I could to birth the babe as quickly as possible, accepting tearing or whatever if need be.

[mariaz]

Our second birth was an unintended UC. We were headed to the birth center but my daughter had other plans.

When her head came out we could see she had a double nuchal cord and her poor little face was purple. I just gave a really big push and was able to get her out within about a minute of her head emerging.

We left her cord attached for just a little while (less than 30 minutes) and she did well.

My advice would be to just continue to push and get the baby out as quickly as possible so that blood flow can resume.

[Astraia]

I'm pretty sure a purple head (well, very dusky anyway) is fairly normal. DD did not have the cord around her neck, and her head was very dusky/purple and her body was white, but she pinked up ASAP.

I've heard a doctor say (and seen it online) that babies with cords around the neck aren't a problem- that the babies are smart and put them there for safe keeping!

If the baby is distressed, you can bet I would absolutely NOT be cutting the cord, under any circumstances - FIRST why waste valuable time in clamping and cutting when you have a distressed baby to attend to, and SECOND the baby is still getting oxygenated blood through a pulsing cord, and you'd be severing the only lifeline, probably driving baby even further into distress (I've heard people say that as long as the cord is attached the baby is fine- but a limp white cord is not doing that kid any good. But still, cutting it- waste of time). (ETA- unless, like PreggieUBA2C pointed out, the cord refills once the compression comes off)


Also remember that as the baby is moving down and out, your uterus is moving down also and bringing that placenta with it! So even a really short cord isn't a huge problem as your uterus contracts, the cord "lengthens." Waiting 1-2 contractions for the body to be born really isn't a big deal in most cases. A lot of babies cry on the perenium (or like my brother, sneeze 3 times explosively). And while i have no proof of this, I feel like if the cord is so short that the baby CANNOT be born past the head, no matter what, unless you cut- you would have had signs of this earlier on. In an assisted birth, you'd probably see fetal heart tone weirdness, an abnormal labour pattern, etc. As a UC mama you'd probably have a feeling that something was up.

[chirp]

Originally Posted by PreggieUBA2C

The link to the midwifery archives above deals with why clamping and cutting in this instance can do more harm than good. Essentially, it is the babe who has endured distress from cord issues that most needs the cord left intact for as long as possible, barring anything so tight that the babe cannot even descend.

Apparently, it is nearly always much better for the babe with cord wrapped around the neck, even if is causing decels, to let the birth progress without interference because once the babe is born, bloodflow will no longer be hindered and s/he can be replenished quickly. If the cord is cut while blood is not freely moving, then the babe will be in worse shape upon birth, having been first depleted and then cut off.

Most often, babes whose cords are cut under these circumstances require ventilation whereas those in distress with wrapped cords who are then birthed without interference require none- anecdotally from the same archives above.

The midwives offer anecdotal evidence of this through apgars following both types of scenarios, although there isn't a whole lot of evidence overall.

Personally, I would leave the cord and do whatever I could to birth the babe as quickly as possible, accepting tearing or whatever if need be.

bolded is exactly what i meant re: cutting (although i realize you weren't quoting me.)...that is the situation in which i would cut. and then we would go right to the hospital.

other situations we would be willing to just try and get the baby out as quickly as possible, utilizing the somersault maneuver, or just unlooping it.

[chirp]

Originally Posted by Astraia

I'm pretty sure a purple head (well, very dusky anyway) is fairly normal. DD did not have the cord around her neck, and her head was very dusky/purple and her body was white, but she pinked up ASAP.

I've heard a doctor say (and seen it online) that babies with cords around the neck aren't a problem- that the babies are smart and put them there for safe keeping!

If the baby is distressed, you can bet I would absolutely NOT be cutting the cord, under any circumstances - FIRST why waste valuable time in clamping and cutting when you have a distressed baby to attend to, and SECOND the baby is still getting oxygenated blood through a pulsing cord, and you'd be severing the only lifeline, probably driving baby even further into distress (I've heard people say that as long as the cord is attached the baby is fine- but a limp white cord is not doing that kid any good. But still, cutting it- waste of time). (ETA- unless, like PreggieUBA2C pointed out, the cord refills once the compression comes off)


Also remember that as the baby is moving down and out, your uterus is moving down also and bringing that placenta with it! So even a really short cord isn't a huge problem as your uterus contracts, the cord "lengthens." Waiting 1-2 contractions for the body to be born really isn't a big deal in most cases. A lot of babies cry on the perenium (or like my brother, sneeze 3 times explosively). And while i have no proof of this, I feel like if the cord is so short that the baby CANNOT be born past the head, no matter what, unless you cut- you would have had signs of this earlier on. In an assisted birth, you'd probably see fetal heart tone weirdness, an abnormal labour pattern, etc. As a UC mama you'd probably have a feeling that something was up.

this is what happened with my first.

[PreggieUBA2C]

Originally Posted by chirp

bolded is exactly what i meant re: cutting (although i realize you weren't quoting me.)...that is the situation in which i would cut. and then we would go right to the hospital.

other situations we would be willing to just try and get the baby out as quickly as possible, utilizing the somersault maneuver, or just unlooping it.

How would you cut a cord that was still inside? If the head can be born, then it seems to make physical sense that the body can too, even if the head stops just outside the opening and goes no further. If it cannot come that far, then how would you access the cord to cut it?

[chirp]

Originally Posted by PreggieUBA2C

How would you cut a cord that was still inside? If the head can be born, then it seems to make physical sense that the body can too, even if the head stops just outside the opening and goes no further. If it cannot come that far, then how would you access the cord to cut it?

i would attempt to birth the body first. i'm not sure how ANYTHING can happen in birth...i can really only tell if something isn't right.

i really think i should know how to cut a cord in case of emergency though. it's easy to say "why waste the time?" or "babies in distress need their blood." But if there is anything "birth" has taught me it's to be prepared for the unexpected. and at an unassisted birth, the only thing my baby has is me, so i should be as prepared as possible. right?

[PreggieUBA2C]

Originally Posted by chirp

i would attempt to birth the body first. i'm not sure how ANYTHING can happen in birth...i can really only tell if something isn't right.

i really think i should know how to cut a cord in case of emergency though. it's easy to say "why waste the time?" or "babies in distress need their blood." But if there is anything "birth" has taught me it's to be prepared for the unexpected. and at an unassisted birth, the only thing my baby has is me, so i should be as prepared as possible. right?

Indeed.

I am in the same boat. I am asking about this because it would be somewhat of an intuitive leap, even for me, to know that a severely short cord is preventing the head from coming out, and then my babes' heads are so big that I am sure that nothing in addition to their heads will fit in or out of me. I would be in a seriously dangerous position if my babe couldn't come out because of a 3" cord, for instance. I just don't understand how I would know, conclude, or do anything about that if it happened. I guess I would trust my body to push the babe and placenta out immediately, because what else would help?

If not, how would you cut a cord that's still inside? And if it's come out and around the neck, why would you cut it rather than birth the baby? I am wondering about the physical aspect here; if the head is out, then why couldn't the body come out? Even if it took a few minutes, it would be better for the babe to have the benefit of cord blood once the compression is off than to be cut and then once birthed need ventilation, no? I don't have anything for ventilation, as a side note, so that would necessitate medical intervention.

I am totally not being contentious- I am sincerely curious.

I understand that some things can seem scary and sometimes people just start doing things because they think that doing things will help, but obviously that's not always or even necessarily true, and I am wondering if that is more likely the case in nuchal cord-cutting than that it's actually helpful in all but the most unusual and serious cases.

The other thing is that I don't birth with a mirror and my dh isn't likely to even know what he's looking at, if he were looking, which he doesn't.

I guess the scenario I am trying to envision here doesn't work out in my experience, so if there ever were such an issue, I'd have to go with whatever at the time. I'd probably consider calling for help though, if the only way to figure out what was wrong was to call for help.

I am sincerely interested in your perspective, not at all to argue or debate, just to share ideas and understandings.

[chirp]

Originally Posted by PreggieUBA2C

Indeed.

I am in the same boat. I am asking about this because it would be somewhat of an intuitive leap, even for me, to know that a severely short cord is preventing the head from coming out, and then my babes' heads are so big that I am sure that nothing in addition to their heads will fit in or out of me. I would be in a seriously dangerous position if my babe couldn't come out because of a 3" cord, for instance. I just don't understand how I would know, conclude, or do anything about that if it happened. I guess I would trust my body to push the babe and placenta out immediately, because what else would help?

If not, how would you cut a cord that's still inside? And if it's come out and around the neck, why would you cut it rather than birth the baby? I am wondering about the physical aspect here; if the head is out, then why couldn't the body come out? Even if it took a few minutes, it would be better for the babe to have the benefit of cord blood once the compression is off than to be cut and then once birthed need ventilation, no? I don't have anything for ventilation, as a side note, so that would necessitate medical intervention.

I am totally not being contentious- I am sincerely curious.

I understand that some things can seem scary and sometimes people just start doing things because they think that doing things will help, but obviously that's not always or even necessarily true, and I am wondering if that is more likely the case in nuchal cord-cutting than that it's actually helpful in all but the most unusual and serious cases.

The other thing is that I don't birth with a mirror and my dh isn't likely to even know what he's looking at, if he were looking, which he doesn't.

I guess the scenario I am trying to envision here doesn't work out in my experience, so if there ever were such an issue, I'd have to go with whatever at the time. I'd probably consider calling for help though, if the only way to figure out what was wrong was to call for help.

I am sincerely interested in your perspective, not at all to argue or debate, just to share ideas and understandings.

exactly.

actually the place i'm approaching this homebirth from is one of not being afraid of asking for help if necessary. last time i was so worried about the prospect of having a c/s, and then got one. this time, however this birth has to happen is how it happens. if baby had a dangerously short cord, like you metioned above...i would probably be able to feel that something wasn't right and would immediately go to the hospital...which thankfully in our situation is only 5 minutes away in the same town. i would not attempt to cut the cord inside of me, unless some part of it were visible. or accessible.

i'm trying to think about a situation where the head would be born, but the cord possibly unaccessible, and the body would not be born. shoulder dystocia?? which hopefully could be fixed by a change in position. of course then the problem becomes not entirely about cord entanglement...it's a whole new can of worms.

[PreggieUBA2C]

Originally Posted by chirp

exactly.

actually the place i'm approaching this homebirth from is one of not being afraid of asking for help if necessary. last time i was so worried about the prospect of having a c/s, and then got one. this time, however this birth has to happen is how it happens. if baby had a dangerously short cord, like you metioned above...i would probably be able to feel that something wasn't right and would immediately go to the hospital...which thankfully in our situation is only 5 minutes away in the same town. i would not attempt to cut the cord inside of me, unless some part of it were visible. or accessible.

i'm trying to think about a situation where the head would be born, but the cord possibly unaccessible, and the body would not be born. shoulder dystocia?? which hopefully could be fixed by a change in position. of course then the problem becomes not entirely about cord entanglement...it's a whole new can of worms.

I know the pain of c/s. In my case, I would have to be quite sure that the risk of death were greater should I not call because the risk of death for me if I do is quite high. I have endocrine issues that most drs refuse to recognise but those same ones have been fine with 'bringing me back to life' when they've ignored this. Ugh.

I am not afraid to call for help, because I would really only do so if I really needed it- reeeeaaaalllllly needed it- but I am forensic even during labour and have little to no tendency toward haste or panic, which is what I rely upon. My dh isn't the same but trusts my assessment of my situation. If I were unconscious, that would be a different story, of course.

For me, bleeding and endocrine problems are of much more concern than really anything else. For the babe, I don't have any concerns unless I need to, but I have in past made sure to learn what I can do in situations where the babe needs a bit of help. I wanted to make sure I wasn't missing anything by participating in this discussion. Thanks for obliging!

It is so helpful to have a forum to discuss freebirthing. I'm pretty independent, but it's nice to be able to bounce ideas off other mamas of similar minds.

ETA: I actually hold to interdependence as a higher ideal than independence, but it's hard to express that in first person; "I'm pretty interdependent" doesn't seem to evoke the intended understanding even though it is far more accurate.