Risk of prolapse?

[FoxintheSnow]

I carry by babies very high and they don't engage until soon before they deliver. With my last pregnancy my water broke and dd was still very high. For this reason, they told me at the hospital that I should not be vertical because the cord could come before her and then prolapse which is deadly. I did a hospital tour last week because my hospital has supposedly become more birth friendly and asked if that was still true and they said yes. Are they correct? I can't find any research on this.

[MsBlack]

It is theoretically true.  If the baby is high enough, and the water flows fast/hard enough with a big gush, then in theory a loop of cord could be pulled downward toward the cervix or even through it.  A cord prolapse can be evident--a loop of cord dangling into the vagina, completely outside the cervix.  Or it can be 'occult', that is, hidden--the loop is still inside the cervix but is right next to the baby's head so that as baby descends, the head will compress the cord too much.

However, it is still unusual for the cord to prolapse, even with a high baby and a lot of gushing.  Other factors have to come together for this to occur: the break in the amniotic sac must be at the bottom of the sac, just over the cervix.  A higher leak will let out water, but not cord.  The cord has to be long enough, and the relative positions of baby and cord have to be just right.  In a high percentage of births, the cord is wrapped or looped around the baby somewhere--around neck, over a shoulder, arm, leg--thus the remaining cord length is not enough to allow for a dangerous prolapse.  Or the cord is just far enough away from the flow of water that it can't get drawn downward into the flow.  Also, most often when the water breaks, the baby itself is drawn downward with the flow, thus blocking the cord's downward progress.

My 4th baby's water broke at the grocery store on his due date.  He was high and slightly malpositioned, so he did not descend as the water flowed (which is what most often happens--water breaking brings baby down to plug or nearly plug the leak).  I gushed and gushed, in the grocery store and all the way home (a 10min drive).  The cord did not prolapse.  I've seen a few women leak for days, sometimes gushing pretty hard because baby was high--but still, no prolapse (and they did not stay horizontal, just went about their lives til labor came).  Their mws checked in pretty often, getting reports of baby movement and coming over to listen to heart tones while awaiting labor.  No cord problems.

So yes, in theory it is possible for a high baby plus water breaking to cause a prolapse.  But it is still pretty rare because various factors must all line up together to make it possible--and those factors usually DON'T line up so perfectly.  When my water broke that time, I had a distinct feeling of my DS's fingers tickling me on one side, fairly low in my uterus but not the bottom.  I was bending over a freezer case at the time, and the tickle made me straighten up and yelp a bit--that's when the gush started.  From the feeling of where his hand was at the time--and how it all happened, I'm pretty sure he broke the water himself with his fingernails, and that the tear was just high enough to prevent a prolapse.  He was born 30hrs later, no cord or other issues!

[mwherbs]

Standing with uningaged is A theory. But they do have a lot of instances of cord prolapse when artificially rupturing membranes so not completely proven or sound. I have several people show me how laying down actually makes a prolapse more likely , Put yarn in a bottle of water if you tip it sideways more likely to flow out.

[wombatclay]

The thing about hospitals is that IF a condition has a known risk factor and IF you present with that risk factor and they don't act on it and THEN you develop whatever the condition might be... they could be held negligent.  So protocols are often put in place to protect the hospital or caregiver from a hypothetical worst case scenario, instead of being tailored to the needs of the individual patient.  Birth is no different (the arguements surrounding VBAC are a classic example).

In the case of cord prolapse... yes, it happens and yes, it can be devastating.  But if you are already in the hospital you should be able to work something out with your individual care provider.  (often a care provider can overwrite generic hospital protocol... for example by "signing off" on various things.  A heplock instead of an iv, intermittent instead of continuous monitoring, use of the tub despite ruptured membranes, etc)  Perhaps your care provider would sign off on a variety of labor/birth positions as long as you had more frequent or even constant monitoring (ask about telemetry units!  some are even water proof)?  Or you might agree to a sterile VE after your water breaks to check for cord in combination with heart tone monitoring.  I'm NOT a fan of attaching things to babes, but the hospital might be on board with monitoring the babe's blood oxygen while you move around.  I don't know... a lot will depend on what you want and need to make this a good birth for everyone involved.  But talking with your care provider about options is a good place to start!