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Cord accidents - Page 2

post #21 of 77
Hugs to Coleslaw and MsMom. I'm so sorry for both of your losses. Even those words seem so trite. My heart aches for you.

Colleen, one of my clients in December had a four time (or it could have been five, we're not sure) wrap. Baby had some decels when active labor kicked in, but we didn't hear anything after they resolved. Baby was born in the water and my assistant/apprentice caught her, unwrapped the long cord and everything was fine.

It is interesting, though, that "what if the cord is around the neck?" is one of the most popular questions from people on the fence about homebirth.
post #22 of 77
I think that in the face of still birth and the numbers are high as to no know cause incidental findings like nuchal cord get reported and/or blamed , what else does an expert say to a mom who has experienced a loss.
Other things that are rare cord accidents that would have to do with still birth like not enough wartons jelly to protect it , or a cord that is falling apart and detaches before birth or a true knot that tightens before birth-- I have seen true knots in live well babies but this could be a cause for still birth--- there are some issues with cords, placentas and pregnancies that have identical twins/triplets/quads...
as you can see these are very rare things and you may have never heard of any of them. One more common dangerous cord accident is a prolapse where the cord is born long before the baby is born-- happens more often in preterm birth before 36 weeks, the younger/smaller the baby the greater the danger - early rupture of membranes and baby is not enguaged or the baby is enguaged but so small in mom's pelvis that cord can fit too and certain presentations like footling breech , because the feet are smaller than a head and the cord will deliver before the head.
a while back this subject came up and I did some research-- there were some findings on more than 3 wraps with very long cords relative to long term outcomes not deaths... but who knows what this means could be managment, or that babies with certain problems move around more and make longer cords that equal more wraps....

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as far as cord being wrapped around the neck- think about this - the baby is not using its throat and neck for breathing in air until after the chest is born... also think about how tightly you are going to be able to coil a pressurized hose can you coil it around something that will stop its pressure and flow? how hard do you have to push, press to accomplish this? how tightly can you wrap it around a something rounded about the size of your wrist--- the devitalized cords we see after birth are not the full lively things they are prebirth
post #23 of 77
I think I'm going to start keeping track in my own practice, because it seems that I almost have more babies with a wrap of cord around the neck than not. I do think that they are just so common, that they are likely to be incidental findings in a stillbirth. In order for a cord wrap to cause a baby to die, it has to be tight enough to cut off blood supply to the baby. As mwherbs pointed out, babies don't breathe prior to birth, so they don't get strangled, as in unable to breathe due to a tight cord prior to birth.
Unfortunately, and frustratingly, most stillbirths are not found to have a definite cause. Makes it so much harder to find closure, and then move on and possibly consider another baby.
coleslaw, I'm so, so sorry about your daughter. Wishing you love and support in this time of grief.
post #24 of 77
Wanted to add, I'm not sure what good doing an ultrasound at near term for cord position is. What are you going to do with that information?
In January, I had 5 births, all with nuchal cords. This morning, I attended a lovely birth, with a tight nuchal cord. All 6 babies perfectly fine at birth. If I'd known the cord was around the neck to start, would we offer cesarean to all these women? And when? Just monitor close during labor? But shouldn't we do that anyway?
post #25 of 77
Quote:
Originally Posted by pamamidwife
oh, and nuchal cords are very common. I wish providers would stop looking for them with the birth of the head. This is not only very uncomfortable, but it puts the baby at risk by handling the cord and exposing it to air. If the cord is so short that it needs to be cut (again, very rare, but many providers think that if they cannot loop it over the head it should be cut), the baby is suddenly being suffocated without an oxygen source until it is born and hopefully breathes on its own.

THANK YOU for saying that pam!!!! both my preceptors are also RNs at the local tertiary hospital, and i can really feel their fear around birth, regarding this issue and many other issues. every time i've caught a baby thats come out too fast to have her cord manipulated (looped over head, loosened over shoulders, or cut), the cord has been plenty long enough to allow the baby to be born.
post #26 of 77
Quote:
as far as cord being wrapped around the neck- think about this - the baby is not using its throat and neck for breathing in air until after the chest is born... also think about how tightly you are going to be able to coil a pressurized hose can you coil it around something that will stop its pressure and flow? how hard do you have to push, press to accomplish this? how tightly can you wrap it around a something rounded about the size of your wrist--- the devitalized cords we see after birth are not the full lively things they are prebirth
The first part is something that I had considered before. I think that we are afraid because we forget about that.

Now the second part is really interesting. I didn't consider that its pressurized, that makes a lot more sense.
post #27 of 77
I looked at the original thread... So sorry for your loss! It does sound like one of those things where the cord is merely incidental.

If the cord has to be tight enough to cut off blood supply, I suppose there is no way to prevent that. But during labor, if heart tones are monitored, wouldn't a serious cord issue cause some fetal distress? Then the mother could transfer to the hospital and have a cesarean, rather than simply scheduling one because of a questionable cord position in late pregnancy.

Ultrasounds show many false positives that lead to moms scheduling c-sections because they have been led to believe they will have 10-lb babies, or even having abortions in early pgcy because the u/s showed some defect that was later not found in the aborted fetus. I think if c-sections are scheduled for every woman who has a "questionable" cord, the rate will rise much higher.

DD2 had a loose cord around the neck, no big deal. My midwives said that most babies in their practice have the cord around the neck at least once. But doctors think it's a really big deal - when we took her to see the ped, the first thing she said was "The cord wasn't around the neck, was it?"
post #28 of 77
My mom had me unassisted (well, with two friends and a toddler present) and she tells me that my cord was around my neck three times and in such a clump that it came out funny and she ended up with a tear. She slipped the cord off me after I was born and said I did take a little while to pink up. But I'm fine and I'm pretty sure I didn't suffer any brain damage.
post #29 of 77
I was transferred from our birth center to the hospital across the street for serious heartrate decels from dd during the pushing stage. I was only in labor for a total of 4 hrs, showed up at the birth center at 2:45 at 8cm, 10cm by 3:00, heart decels detected by 3:10. After 3-4 of them were they plummeted w/ each push and stayed down the decision was made to transfer.

I got an IV (not routine at the birth center but was at the hospital) at 3:31 and was placed int he ambulance. Dd was born at 4:04 in an LDR room. Episiotomy w/ forceps assisted birth.

They discovered after she was born that the cord was wrapped twice around her neck (tightly) and it was short. Between the two it was surmised that with each push it was tightening more, causing the decels.

Dd was wisked across the room with the fear that she would be in major distress but was fine. Her APGARs were excellent. They actually rushed her there so quickly that noone mentioned to dh or I exactly what her sex was... I had to ask!

While I'm not thrilled w/ the ambulance transport and the hospital birth, I am happy that dd was okay. In speaking w/ my midwives afterwards they suspect that dd was okay because of how quickly my labor went... that she may not have been w/ a typical drawn out first time mom labor. I also am VERY grateful that the midwife insisted on putting me in an LDR room and not the OR which is where they were going to take me. I was told that they had the OR all ready and waiting for me to be sectioned...and I'm convinced I would have been if my midwife hadn't been attending me.

We are now pregnant w/ our second child and have already had our first appt w/ the birth center. The midwife and I went over a lot of dd's birth and they are pretty confident that we will actually be able to stay at the birth center this time around. They are way more concerned about my 4hr labor and making sure that I get there on time... I'm not really into having my child on the PA Turnpike!
post #30 of 77
FWIW - 5 out of my 6 kids have had nuchal cords. My first dswas born totally wrapped in his cord (over the shoulder, between the legs, etc.). He did have some variables in labor, but luckily I was giving birth in Israel with midwives who took it all in stride. Apparently the house physician was not so calm about it. I have seen more c/sec's for the same type of variable decels here in the US than I care to count. DS was born with APGARS of 9/10, so obviously didn't hurt him.

I wanted to add that in addition to cord around the neck often being an incidental finding, there is some speculation that clotting disorders (MTHFR, Factor V Leiden, etc) might play a role in some of these still births that have no apparent cause (clot in the cord, in the placental bed, or perhaps one that traveled to the baby?). Awareness of these disorders is rising and these women are at greater risk for still birth and 'late' miscarriage.
post #31 of 77
Quote:
Originally Posted by MinnieMouse
They are way more concerned about my 4hr labor and making sure that I get there on time... I'm not really into having my child on the PA Turnpike!
Sounds like me exactly! I had a 4 hour labor with my first, but a 5 hour labor with my second. It took me until my 5th to have one 'unattended' b/c the mw didn't make it on time. (#3 was 2 hours, #4 was 1 1/2 and #5 was 50 minutes).
post #32 of 77
One of the most memorable birth stories I ever read was Carla Emery's (she's the author of The Encyclopedia of Country Living). She was checked and found to be 5 cm, but as soon as the nurse walked away she felt like she had to push! Her DH ran after the nurse while she started pushing. The doctor ran in just in time to catch her son as he shot out in only 2 pushes -- from halfway-dilated to birth in exactly 12 minutes

Turns out her son *was* one of the babies with a very tight nuchal cord around his chest and neck. She says he was dark blue like ink. If he'd spent longer in the birth canal than he did, he might have been in trouble -- her body saved the day, apparently. She asks, what if she had had anesthetic and couldn't feel the urge to push? What if she hadn't trusted her body and resisted pushing because the nurse said she wasn't complete?

So for me, giving birth naturally with attendants who trust my body is one big way I will choose to minimize the risks of cord injury, should I have another baby.
post #33 of 77
We all know that babies don`t breathe in utero, yet if a cord is really compressed, either by being in a true knot or malformed or too tight like the last poster described, it cuts off air to the baby from the cord.

I disagree that cord accident is a term just loosely thrown around by doctors to explain stillbirths that are unexplainable. Does anyone have evidence of this happening often? At the infant loss support group I attended there were 4 unexplained stillbirths and all of the parents there understood that even after autopsies that they couldn`t explain their babies deaths. Also, in a group of 20 women only 2 of the deaths would I consider to be caused by intervention, the rest just happened.
post #34 of 77
Quote:
Originally Posted by liseux
Does anyone have evidence of this happening often? .
Yes. I work L&D and the OB's will admit as much. Often a stillborn baby will have a cord around the neck, true knot or whatever and they will tell the parents 'we may never know what happend, but the only thing that was apparent at birth was (cord around neck, around the arm, true knot)'. However, the cord might not have been tight and it is hard to evaluate knots after blood is no longer pumping through the cord (with the fetal death, not the birth). We all know that many babies are born with tight cords, true knots (I've seen women that gave birth to live babies with multiple true knots), etc. Anyway - it's often hard to know what is a incidental finding and what is causitive.
post #35 of 77
"Often a stillborn baby will have a cord around the neck, true knot or whatever and they will tell the parents 'we may never know what happend, but the only thing that was apparent at birth was (cord around neck, around the arm, true knot)'. "
This makes sense to me only in that it would be weird if the doctor or mw didn`t mention everything that was observed. What the parents choose to infer from that is up to them. I agree that there is no way in really knowing, even an ultrasound can`t tell you very much about the cord and what will change about it before birth.
post #36 of 77
sometimes it is parents inferring but it is just as often that I will hear a doctor say with some conviction that there was a cord around the neck... also other hospital staff will say things like it was some sort of cord accident... and if you get the facts no known cause-- even in what I would consider uneventful births there will be alot of "drama" around nuchal cords. It is not just parents on their own making these mistakes.
post #37 of 77
"It is not just parents on their own making these mistakes." Of course not. A professional can always put things into your head about went wrong that might not be true. It happened to me. But since we all agree that cord accidents can happen, then chances are its not always a mistake, right? Sometimes its really a cord accident. Luckily, most of the time cord issues are minor or non-existent because the cord is long enough not to be an issue.
post #38 of 77
I had a natural labor all day but was not dialating much and not effacing at all. So then I ended up having a section that night. When they took DS out, the doctor said the cord was wrapped around his neck twice. His head was slightly molded from the birth canal, and the cord was stretched VERY THIN, so basically the cord was holding him in and was too short for him to come out. I guess I'll never really know if I "needed" a c/s or not, but anyway that's what ended up happening. (But he was never "in distress", heart rate and everything was normal.)
post #39 of 77
mwherbs wrote: "One more common dangerous cord accident is a prolapse where the cord is born long before the baby is born [...] and certain presentations like footling breech , because the feet are smaller than a head and the cord will deliver before the head."

Cord prolapse is *common*? How many have you seen in your practice?

Anyway... another thing to consider about cord accidents, as far as prolapse with a small head/breech goes, is that the cord is lighter than the baby, so if the mother is standing when the water breaks, the baby will move down first. Which is one reason AROM is not that great an idea, the mother has to be on her back so that gravity cannot assist in pulling the baby down before the cord, and in the fact the lighter weight of the cord will make it more likely for it to be pulled toward the vaginal opening with the flow of water.
post #40 of 77
so as problems in pregnancy and birth go cord prolapse is a very small number but is most common cord accident--- keeping with the topic- and my statement included "preterm" as a risk factor for prolapse

Int J Gynaecol Obstet. 2004 Feb;84(2):127-32.
Umbilical cord prolapse and perinatal outcomes.

Kahana B, Sheiner E, Levy A, Lazer S, Mazor M.

Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

OBJECTIVES: To determine obstetric risk factors and perinatal outcomes of pregnancies complicated by umbilical cord prolapse. METHODS: A population-based study was performed comparing all deliveries complicated by cord prolapse to deliveries without this complication. Statistical analysis was performed using multiple logistic regression models. RESULTS: Prolapse of the umbilical cord complicated 0.4% (n=456) of all deliveries included in the study (n=121,227). Independent risk factors for cord prolapse identified by a backward, stepwise multivariate logistic regression model were: malpresentation (OR=5.1; 95% CI 4.1-6.3), hydramnios (OR=3.0; 95% CI 2.3-3.9), true knot of the umbilical cord (OR=3.0; 95% CI 1.8-5.1), preterm delivery (OR=2.1; 95% CI 1.6-2.8), induction of labor (OR=2.2; 95% CI 1.7-2.8), grandmultiparity (>five deliveries, OR=1.9; 95% CI 1.5-2.3), lack of prenatal care (OR=1.4; 95% CI 1.02-1.8), and male gender (OR=1.3; 95% CI 1.1-1.6). Newborns delivered after umbilical cord prolapse graded lower Apgar scores, less than 7, at 5 min (OR=11.9, 95% CI 7.9-17.9), and had longer hospitalizations (mean 5.4+/-3.5 days vs. 2.9+/-2.1 days; P<0.001). Moreover, higher rates of perinatal mortality were noted in the cord prolapse group vs. the control group (OR=6.4, 95% CI 4.5-9.0). Using a multiple logistic regression model controlling for possible confounders, such as preterm delivery, hydramnios, etc., umbilical cord prolapse was found to be an independent contributing factor to perinatal mortality. CONCLUSIONS: Prolapse of the umbilical cord is an independent risk factor for perinatal mortality.
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Eur J Obstet Gynecol Reprod Biol. 1983 Apr;15(1):17-23.
Neonatal mortality and morbidity associated with preterm breech presentation.

van Eyk EA, Huisjes HJ.

A retrospective study was performed on 88 live-born preterm infants with breech presentation. The neonatal mortality (NNM) was 18.2%, and 13.3% after correction for congenital malformations incompatible with life. 62.5% were delivered vaginally, and 37.5% by cesarean section (CS). In spite of the fact that most CSs were done for indications associated with increased fetal and neonatal morbidity and mortality, overall morbidity was comparable in the two groups. Mortality was higher in the vaginal group. Entrapment of the fetal head (7.3% of vaginal deliveries) and prolapse of the cord (4.5%) were major complications of preterm breech delivery. They resulted in two cases of neonatal death (NND) and three cases of neonatal asphyxia. Prolapse of the cord was in all cases associated with footling presentation. The authors consider these results in favor of routine CS in preterm breech presentation

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now I think that after their statement of one maternal incident!!!!!!!! I don't exactly agree with their conclusion of c-sectioning breeches

J Obstet Gynaecol. 2004 Apr;24(3):254-8.
Related Articles, Links

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Correlation of fetal outcome with mode of delivery for breech presentation.

Bassaw B, Rampersad N, Roopnarinesingh S, Sirjusingh A.

Department of Obstetrics and Gynaecology, University of the West Indies, Trinidad. electivestudents@hotmail.com

The objective of this retrospective analysis of 344 singleton pregnancies of gestational ages greater than 24 weeks conducted at a tertiary hospital was to determine the fetal outcome in relation to the mode of delivery of the fetus with a breech presentation. Caesarean section was performed in 157 mothers, and 187 babies were delivered vaginally. There was no statistical difference in the perinatal outcome for breech fetuses delivered either abdominally or vaginally. Cord prolapse and arrest of the after-coming head were responsible for five fetal losses, four of which were delivered vaginally. Neonatal morbidity comprising nerve injury, birth asphyxia and seizures occurred in 11 newborns, nine of whom were delivered vaginally. One mother sustained a massive intra-operative haemorrhage during a caesarean section which necessitated an emergency hysterectomy. We conclude that a policy of planned vaginal birth for selected breech fetuses with a low threshold to proceed to caesarean section may be in the best interests of both mother and child.
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