Cord accidents - Page 3

[Greaseball]

Prolapse is not always the huge emergency, either. My midwife delivered a baby at home after the cord prolapsed. She offered the mother the choice of going to the hospital, and the decision was made to continue at home. A happy outcome for all.

[mwherbs]

here is an address with quite a bit of info including % of incidence of the various cord problems

http://www.emedicine.com/med/topic3276.htm

[crazy_eights]

Originally Posted by mwherbs

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.

OT here - I don't know that much about studies done on the subject, but I spoke with a perinatologist who DOES vag. breech deliveries (and his wife has homebirths, fwiw, including one that was breech) and he told me this: the problem with preterm breech deliveries is that until 36 (or was it 34? I think it was 36) weeks gestation, the breech presenting part is smaller than the head. He claimed that there was a greater risk of the breech delivering through an incompletely dilated cervix and then having head entrapment from the larger head not fitting through. This seems to be part of what is shown by the study here.

[doctorjen]

Originally Posted by Greaseball

Prolapse is not always the huge emergency, either. My midwife delivered a baby at home after the cord prolapsed. She offered the mother the choice of going to the hospital, and the decision was made to continue at home. A happy outcome for all.

I don't know about the specifics of this case, but in general cord prolapse is one of the true real emergencies in obstetrics. If the cord truly presents before the baby, cord compression is almost certain, and unless that compression can be alleviated, or the baby delivered quickly, injury due to lack of oxygen can happen pretty quickly.

[applejuice]

From my readings on the subject, I have come to the conclusion that a cord wrapped around the neck in a cephalic presentation is more of a natural prevention against a cord prolapse.

If a baby's blood and oxygen supply are not compromised by obstetrical drugs in the mother's system or by laying on her back, there should be enough oxygen to get to the baby unless the cord

is too short,
or too long,
or in a knot,
or some other birth defect exists.

The cord was around all of my children's necks, all births planned, begun, and completed at home, and my Father said the cords were wrapped around all of our necks also, all but one, at home...

[applejuice]

Originally Posted by Mom2six

OT here - I don't know that much about studies done on the subject, but I spoke with a perinatologist who DOES vag. breech deliveries (and his wife has homebirths, fwiw, including one that was breech) and he told me this: the problem with preterm breech deliveries is that until 36 (or was it 34? I think it was 36) weeks gestation, the breech presenting part is smaller than the head. He claimed that there was a greater risk of the breech delivering through an incompletely dilated cervix and then having head entrapment from the larger head not fitting through. This seems to be part of what is shown by the study here.

ITA!

I have said it before on these forums...the problem with breeches is not the breech itself, but other factors as prematurity.

Excellent post, Mom2SIX!!!

[AngelBee]

I found a site www.missinggrace.org that may have more info on cord accidents and stillbirth.

[crazy_eights]

Originally Posted by AngelBee

I found a site www.missinggrace.org that may have more info on cord accidents and stillbirth.

I was just poking around reading at this site and some of it really doesn't sit well with me. They want bereaved parents to arrange for this OB to come speak at local hospitals to teach about monitoring for cord issues. But in it, it mentions that in ONE WEEK he had 3 women that he was monitoring b/c cord issues seen on u/s and delivered them early - and they say these babies probably wouldn't have made it without his intervention. I have worked OB in 2 hospitals with a fairly lg. numbers of deliveries (4,500/year and 7,000/year) and 3 term demises in a MONTH would be huge. And they want you to arrange to bring this guy in to train residents to be monitoring ALL pregnant women by u/s for those at high risk for cord accidents. The whole thing just doesn't sit well with me. Sounds like just another invitation to intervention and c/sec.

ETA - another thing from this site, from a list of things that you should go to L&D for monitoring: "Obvious uterine contractions less than 10 minutes apart for one hour, you need to be monitored. Continual Brackston-Hicks, or false labor, can be hard on the baby and can cause fetal stress."

HUH?

[AngelBee]

Originally Posted by Mom2six

I was just poking around reading at this site and some of it really doesn't sit well with me. They want bereaved parents to arrange for this OB to come speak at local hospitals to teach about monitoring for cord issues. But in it, it mentions that in ONE WEEK he had 3 women that he was monitoring b/c cord issues seen on u/s and delivered them early - and they say these babies probably wouldn't have made it without his intervention. I have worked OB in 2 hospitals with a fairly lg. numbers of deliveries (4,500/year and 7,000/year) and 3 term demises in a MONTH would be huge. And they want you to arrange to bring this guy in to train residents to be monitoring by u/s for women at high risk for cord accidents. The whole thing just doesn't sit well with me. Sounds like just another invitation to intervention and c/sec.

Sorry...I have not checked out the site. I heard info about it on talk radio anfd have been meaning to check it out. It was started by a mother who lost her daughter, Grace, due to a cord issue.

[gossamer]

Something that mom2six touched on is the issue of blood clots etc. Having a baby die due to a cord accident or such doesn't necessarily mean an external visual anamoly (can't spell that word). More and more in the fight against pre-eclampsia, doctors are finding out and testing for blood clotting disorders that only present themselves during pregnancy like factor V Leiden, factor II, thrombophilia etc. Death from a cord accident doesn't always mean something like it was knotted or too tight around the neck, it could mean there were several blood clots that restricted the flow of nutrients to the babe. Just some more food for thought.
Gossamer

[mwherbs]

Originally Posted by gossamer

Something that mom2six touched on is the issue of blood clots etc. Having a baby die due to a cord accident or such doesn't necessarily mean an external visual anamoly (can't spell that word). More and more in the fight against pre-eclampsia, doctors are finding out and testing for blood clotting disorders that only present themselves during pregnancy like factor V Leiden, factor II, thrombophilia etc. Death from a cord accident doesn't always mean something like it was knotted or too tight around the neck, it could mean there were several blood clots that restricted the flow of nutrients to the babe. Just some more food for thought.
Gossamer

yes I agree with this, and for some moms if this is known or found there are treatments that can help prevent this from repeating. This is one reason for moms who have had losses- to be tested for auto-immune diseases and clotting disorders there is a battery of tests that are done via blood work . (many are tested by physicians if they have had more than 2 miscarriages)

[~*~MamaJava~*~]

This thread is just so interesting for me...my DS2 (born in hospital, vaginal birth, 10 days over due) had the cord around his neck 6 times, under his arm once, and it had 2 true knots in it.

The nuchal cording was tight when he came out, he was purplish but not blue.

His apgars were good, and his oxygen saturation was perfect. The cord was quite short between him and the placenta (I guess since so much of it was wrapped around him).

Now, my doctor (and the nurses) told me it's a miracle that he lived, and that he appears to have no brain damage. They attributed his smallish size (6lbs 3oz) to the knots.

I had a ultrasound a few days before he was born and nothing was detected, but due to the amount of cording etc the Dr says he was probably like that for quite some time (whole last trimester). He was very quiet in utero as well, which makes me think she was right.

Additionally - the pushing phase with him lasted only 10 mintues (as opposed to 1 1/2 hrs with #1) since I got up and squatted to push him out quick (even though we had no idea he had this problem).
I thank God for MDC and the mamas here posting about natural birth, because I'm quite sure had I been lying there on my back, drugged up, Lucas would not be in my arms today. Can you just imagine if I had an epidural and it slowed it all down? Maybe some of you who are expert in these matters could tell me for sure, but I would think he wouldn't have made it.
I'm crying just thinking about it.

to you mamas whose babies are with God.

[homemademomma]

Originally Posted by doctorjen

I don't know about the specifics of this case, but in general cord prolapse is one of the true real emergencies in obstetrics. If the cord truly presents before the baby, cord compression is almost certain, and unless that compression can be alleviated, or the baby delivered quickly, injury due to lack of oxygen can happen pretty quickly.

yup

[~*~MamaJava~*~]

[QUOTE=applejuice]the problem with breeches is not the breech itself, but other factors as prematurity.
QUOTE]

Hey - that's interesting. Really?

[pamamidwife]

totally. when people talk about the head getting stuck in a breech, it's related to either a small footling breech or a preterm baby (whose heads are larger than their torso).

term babies have heads that are equal to, or a little smaller, than their torsos. If you imagine a frank breech (but first with the feet by the head) coming, the width of the hips, torso and legs together are bigger than the head.

[sugarmoon]

Okay, Totally OT, but....

Congratulations Gossamer! I didn't know you were pg!!!!

I will think of you, everyday, from now until you are holding your sweet baby in your arms!

I'm getting all teary

[applejuice]

Originally Posted by ~*~MamaJava~*~

Originally Posted by applejuice

the problem with breeches is not the breech itself, but other factors as prematurity.

Hey - that's interesting. Really?

Yes, other problems that make a breech a problem for vaginal delivery are cord problems, hydrocephalus, placenta previa (maginal, complete) previous surgery to the uterus, odd shaped uterus that prefers the head up and may not contract well, a pelvis that prefers the sacral position, and incoordinate contractions.

[MoonStarFalling]

Hi all, this is an interesting thread thanks for the info and the great discussion.

Addressing the issue of cord accident being thrown around as a cause for stillbirth. I just wanted to add my .02. BTW, my daughters were momo twins who were stillborn due to cord entanglement, I'm involved with several stillbirth groups and have written an article on stillbirth, it's causes and in paticular cord accident management. More than half of all stillbirths are classified as SADS (Sudden Antenatal Death Syndrome). In my experience, doctors are most likely to *not* give a reason for the death even if they suspect one. It's just plain *easier* to use "SADS" instead of running the many many tests and procedures required to find the true cause of death. Secondly, there is no standard protocol for stillbirth autopsies. Every office does them differently and not everyone is an expert on placentas and looking for evidence of cord injury. Even if a family requests an autopsy (I requested one but was denied), the information simply goes in the trash. There is no central repository for stillbirth research or statistics so we have no way of knowing exactly how many babies die of what and what evidence was used to come to that conclusion.

I'd like to address some fears mothers may have. From reading the thread, I feel like most of us are concentrating on accidents that happen at birth or during labor. It's in my experience that most fatal cord accidents happen in the last month of pregnancy, but before labor. There are warning signs you can be aware of, as was mentioned by the pp. I experienced most of these the day my daughters died (and yes mom2six, continual Bx hicks was a sign for me, they felt different from regular bx hicks though, it was more of an all day tightness which was sometimes painful):

Excessive hiccups (baby), hyperactivity (baby), decreased movement (please do kick counts every day!), fetal heart rate under 100 or more than 150 bpm, fetal shuttering or quivering, localized pain in the uterus (usually happens at night, it will be a sharp pain towards your side and will happen a few times in a row), frequent contractions (The Pregnancy Institute http://www.preginst.com/)

If you're truly concerned about cord accidents, please read Dr. Collin's research at http://www.preginst.com/. Like the pp mentioned however, he is *very* pro c/section. I don't agree with his belief that all pregnant women must have weekly or daily u/s to look for cord issues. However, I do agree that if you're experiencing the above symptoms, you should get a NST.

[coleslaw]

twinangels04, I am so sorry for your tragic losses. What a terrible thing to go through - to lose two babies. My heart goes out to you.

I need for you to know that the information you presented has me reeling. In the week before Grace's (in utero) death (she was 37 weeks gestation), I experienced most of the symptoms you describe. I mentioned them to the only midwife I saw the week symptoms started up until the day before her death. She never did anything about them and attributed them to Grace suddenly turning breech. Even before reading your post, I have been putting the story together and thinking she missed something that she shouldn't have. I am convinced now (for more reasons than just the info you presented) that if a NST was done on the Monday before her death, they would have seen distress, done a c-section and she would be OK. I am going to document everything and present it to the head midwife on Monday when I go for my check-up to see what happens. I am also sending it to a friend who is an OB/GYN for more opinions. Needless-to-say, I am devestated at the idea that it's possible my daughter's death could have been prevented. I'm at a loss and need to get my thoughts together. Thank you for the information.

[Greaseball]

Why in the world were you denied an autopsy?!