Do you think a cord around the baby's neck is an emergency?

[SarahInCA]

A friend and I have been having this discussion/debate.

I once read (maybe someone told me?) that since the baby isn't getting their oxygen from breathing during delivery, a cord "choking" the baby around his/her neck isn't a true emergency. It's more of a cultural belief/fear that is rooted in misinformation. I shared that with a friend who expressed her concerns about me having a UC, and she is adamantly defending that it is an emergency. Is it? I have no idea where I got my information, so I'd love any links anyone has that I can share with her. Or correct me if I'm wrong.

TIA!

[beckyand3littlemonsters]

I guess it would depend on how tight round the babies neck it is be use it can be either looped over baby's head before delivering baby's body or baby can be born through the cord loop.

[MsBlack]

Only rarely is a cord around the neck an emergency...a little more often, it can be 'concerning' for short time if it pulls a bit tight during baby's descent/emergence. Cords happen to be around necks (or otherwise tangled around baby's parts) nearly 30% of the time! Think how few of us would be here, if it were always an emergency--far fewer humans would exist, because so many would have died throughout history (prior to modern midwifery and medical knowledge about dealing with emergencies). 30%, afer all, is nearly 1/3 of us.

But I'm not surprised your friend feels this way, since many an OB has told a woman following needless cesarian, "it's a good thing we did this because the CORD was around the baby's NECK and could have DIED". Right. could have died--far less often than babies die from medical mismanagement in various ways! Because no, it's not an emergency the great majority of the time. Most often, cords just do NOT pull tight during birth, the cord around the neck is a total non-issue.

The problem that can arise with a tight cord is not that baby can't breathe--it doesn't need to, in utero. The problem is that if it pulls really tight, it can shut off blood flow--we have major blood vessels in our necks. But even that has to go on for some minutes before causing harm of any sort. So, if a cord pulls tight around the baby's neck, the baby may feel the stress of lowered oxygen for a minute or more. Then birth occurs, and the cord can be unwrapped quickly; circulation immediately resumes, baby starts to breathe and all is well.

You might google 'nuchal cord' to see some links. I speak from experience and study as a mw, don't have any links...and I can tell you, the GREAT majority of the time, cords around necks do NOT present a problem. Cords are usually long enough to prevent enough tightening to compromise baby's circulation at all. Even the one time I saw a cordwrap times 4, and it did pull pretty tight during descent, the baby was a little stunned--a little slow to breathe...but only a little. We gave him some basic stimulation, he started breathing and was fine.

Like various other 'possible emergencies' at birth, things can and do happen-even causing death. That is just birth. But cordwrap 'emergencies' are very rare--especially considering how often they occur. Some suggest that a cord around the neck is a good thing, most often--because if it's wrapped somehow, then cord prolapse becomes impossible. Another very smart part of natural design, eh?

If your friend is open to learning more, then great. If she's already convinced, then I wouldn't bother talking with her much about (if at all) about UC. Sometimes the most ignorant are the least likely to be open to new info--and the most likely to impose their negativity upon others!

[GuildJenn]

My first child died due to a cord around the neck twice, so it can be an emergency. It is rare to have such a poor outcome - about 1 in 10,000.

Most of the time in a situation with a professional (I don't know anything about UC & monitoring) the problem is caught because BOTH of the following occur during a contraction: The heart rate of the baby drops (pretty normal) AND it doesn't come up as quickly (not normal and a sign of distress). In my case the monitoring failed, and then a c-section was not available in the critical last 15 minutes.

Most of the risk seems to be when the cord is very tight. As Ms. Black said, it's not uncommon for babies to have cords around their necks. But it can be an emergency.

[MsBlack]

Guild Jenn--

I'm glad you posted that info

And it's true, as a mw I can keep an eye on baby's heart tones to know if any problems are arising, and when. In the case I mentioned of a very tight cord, there were indeed sudden poor heart tones as baby descended--very concerning to me. But it was a 6th birth in a woman with a smallish baby and very roomy pelvis; I just prepared myself mentally for what might be evident upon birth because that babe was coming down *fast*. Too fast to do anything but catch.

Interestingly, once mom started pushing, she just continued to contract with no rests--which seemed odd to me at the time, but turned out to be the best thing for her baby. While rests between contrax are usually beneficial to both mom and baby, in this case, the cord was already tight enough to be a problem for baby staying in any longer at all. He needed to be born ASAP--and was. And while one might be also concerned about his potential for just exploding out of her--which can mean too sudden of an emergence for baby's best health, and can cause large tears for mom, in this case the tightness of the cord actually prevented his emergence from being too sudden for him or his mom (no tear). It was amazing to me.

[lachingona1]

My son was born with the cord around three times. It tightened really tight during decent therefore he was born blue and not breathing. We unwrapped the cord, stimulated him, and he pinked up pretty quick. I had no brake between contractions and pushed him out super quick.

[MegBoz]

My DS' cord was around his neck twice. It was a hospital birth with a great CNM. She noticed the decels & so they gave me oxygen & had me lie on my left side. That resolved it, so I got back up on my hands & knees where I had been. But, as the MW said, "Meg, you may like that position, but baby doesn't." So I got back down on my left side & birthed him that way after about 45 min total of pushing.
Once his head was born, MW unwrapped the cord, then with the next push, DH caught him.

Not sure if the nuchal cord is definitely what caused the decels, but they were very easily resolved with a position change. (I didn't keep breathing the oxygen the whole time.) So it clearly wasn't an 'emergency' & could easily have been handled the same way at home.

[Lizbiz]

I think a cord around the neck could be an emergency. But most of the time it is not.

My daughter's cord was around her neck once and we knew it going into our UC. The ultrasound showed it and we talked it through with our doctor - who was very unconcerned about it. When our daughter was born, we simply unwrapped the cord and pulled her up. Not even a minor issue. Her cord was long and it wasn't wrapped tightly. Her heartrate was steady throughout labor and pushing phase was fast.

[sugarandspicex4]

Well, if you think about it, almost anything birth related could turn into an emergency.

Normal nuchal cord issues aren't an emergency. If they look a little blue after getting it looped off them, rub 'em pink. One of my children was born with a double knotted cord and, oddly enough, was born perfectly healthy. What should have killed her, didn't. And what shouldn't kill, does.

I would be more panicky if I noticed the cord coming out before the head over her head coming out with cord looped on it.

[BabieBeat]

Is a nuchal cord around the baby's neck an emergency, maybe ~ maybe not...

Nuchal cords come under the category of the Umbilical Cord. There are 2 types of nuchal cords, A & B. Type A encircles the neck in an unlocked pattern. Types B encircles the neck in a locked pattern and this second type is responsible for 1 in 50 stillbirths according to Dr. Jason Collins, MD of The Pregnancy Institute, www.preginst.com, in New Roads, LA.

All nuchal cords have the potential to be extremely problematic. I think the most important aspect of any type of cord issue is to be aware of its presence, so if baby starts having changes in patterns of movement or heart decelerations you will know the probable cause. Umbilical cord accidents (uca), including nuchal cords, true knots, twists, torsion, kinks and long or short cords account for 30% of the 30,000+ stillbirths in the USA yearly. That is 82 each and every day in our country. They are not a "rare condition or event " and should be watched for in the last trimester of pregnancy especially. So, what to do?

First off, being educated, informed and learning how to become your baby's "en utero" advocate is one way to become empowered in the happy outcome of your pregnancy and baby's delivery day!

1. At your 20 week ultrasound have your baby's umbilical cord and placenta checked for normalcy. Begin to keep track of your baby's patterns of movement. Get to know when baby is awake and when baby is asleep. Keep a journal.
2. Have an additional ultrasound at 28 weeks. Once again have the umbilical cord and placenta checked for normalcy. Pay special attention to the umbilical cord at this time. Make sure it is not knotted, twisted, wrapped around baby's neck or body, too long or too short or kinked.
If no problem is found at this ultrasound, which will be the case in the majority of moms, "kick counting" should be done on a daily basis for the duration of your pregnancy which is supported by ACOG.
If a problem is detected or you are the mom of a previous stillborn baby, a plan of action needs to be decided upon with your doctor. Possible daily fetal heart rate monitoring at home interpreted by your doctor, very diligent kick counting and / or more frequent ultrasounds may be implemented.

All moms need to be their baby's "en utero" advocate. A change in baby's movements such as speeding up or slowing down could be the sign of a compromised baby ~ call your doctor for further medical evaluation ~ and trust your gut.

[Ish'smom]

http://www.youtube.com/watch?v=DQBYJ...eature=related

Here is a very good video that shows just how not a prooblem a nuchal cord generally is.

[amyjeans]

We would really only be concerned if the cord came out first. All of my previous births (4, 1 hospital and 3 UC) had their cords around their necks. After discussing this with several midwives and open minded doctors- we understood that the wrapped cord can be helpfull because then the likelihood of it coming out first is slim.
Dh just unwrapped the cord each time. What is interesting is each baby born, their cords were all different lengths. I also believe their they are breathing or obtaining oxygen through the umbilical cord until their first breath of air via mouth- now a pinch or knot in the cord might be cause for distress. That's just my opinion.

[teamsalem]

Usually not. Most times the cord around the neck is really loose and can be pulled over the baby's head. When it is wrapped tightly, it is an emergency of sorts. When you can't unloop it over the head, it sometimes is tight enough to need to be cut before the shoulders are delivered.

[MsBlack]

Originally Posted by BabieBeat

Nuchal cords come under the category of the Umbilical Cord. There are 2 types of nuchal cords, A & B. Type A encircles the neck in an unlocked pattern. Types B encircles the neck in a locked pattern and this second type is responsible for 1 in 50 stillbirths according to Dr. Jason Collins, MD of The Pregnancy Institute, www.preginst.com, in New Roads, LA.

All nuchal cords have the potential to be extremely problematic. I think the most important aspect of any type of cord issue is to be aware of its presence, so if baby starts having changes in patterns of movement or heart decelerations you will know the probable cause. Umbilical cord accidents (uca), including nuchal cords, true knots, twists, torsion, kinks and long or short cords account for 30% of the 30,000+ stillbirths in the USA yearly. That is 82 each and every day in our country. They are not a "rare condition or event " and should be watched for in the last trimester of pregnancy especially. So, what to do?

First off, being educated, informed and learning how to become your baby's "en utero" advocate is one way to become empowered in the happy outcome of your pregnancy and baby's delivery day!

1. At your 20 week ultrasound have your baby's umbilical cord and placenta checked for normalcy. Begin to keep track of your baby's patterns of movement. Get to know when baby is awake and when baby is asleep. Keep a journal.
2. Have an additional ultrasound at 28 weeks. Once again have the umbilical cord and placenta checked for normalcy. Pay special attention to the umbilical cord at this time. Make sure it is not knotted, twisted, wrapped around baby's neck or body, too long or too short or kinked.
If no problem is found at this ultrasound, which will be the case in the majority of moms, "kick counting" should be done on a daily basis for the duration of your pregnancy which is supported by ACOG.
If a problem is detected or you are the mom of a previous stillborn baby, a plan of action needs to be decided upon with your doctor. Possible daily fetal heart rate monitoring at home interpreted by your doctor, very diligent kick counting and / or more frequent ultrasounds may be implemented.

All moms need to be their baby's "en utero" advocate. A change in baby's movements such as speeding up or slowing down could be the sign of a compromised baby ~ call your doctor for further medical evaluation ~ and trust your gut.

Um...do you realize this is the Unassisted Birth forum?

[Devaskyla]

I know this is an older post, but I just wanted to say there's more & more evidence that the typical management of a nuchal cord/slow to start baby is the real problem in the majority of cases, not the cord itself. If it's left alone, as soon as there's no tightness, it will reoxygenate the baby & give the baby is full amount of blood so that the lungs and other organs have the blood they need to function.

My middle son had a nuchal cord. It was unlooped after he was born. My third son had a true knot which wasn't discovered until after the placenta came out.

[tutucrazy]

This midwife has a lot to say about this misunderstood issue: http://midwifethinking.com/2010/07/29/nuchal-cords/

"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). 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."