What percentage of nuchal cords are problematic?

[wannabe]

Just wondering what the reality is...

[mothercat]

Of more than 150 births that I've done stats on I can remember 3 that had me concerned. Two were babies that the moms described as feeling like they were on bungee cords. We had to get mom into a deep squat to shorten the birth canal enough to let the baby's head out, then just somersaulted and the problem was solved. The third one was pretty tangled and mom agreed to a C/sec. I really hate unnecessary C/sec, but as tangled as this baby was, I don't think he had the cord length to get out.

Did a birth last week with CAN times 2 and it was pretty tight. Baby was fine throughout labor and only had a little trouble getting started. For better or worse that cord was about 36 in.

Is that the info you were looking for?

[MsBlack]

I concur with mothercat--I've seen plenty of nuchal cords, seldom have seen issues with them. None life-threatening so far. I myself had a csec for complicated cord wrap--and boy, that phrase from the mom about feeling that baby was on a bungee cord really fits for me.

It was my 6th baby, I was pretty familiar with the sensations of birth; with him, as I progressed into transition (8cms, was in hosp by that time), I kept feeling him try to come down, then bounce back up again. That was a first for me! He would have bad decels at those moments with very slow recovery, no matter what positions I tried. Because my doc knew how much I wanted a natural birth, he was willing to wait it out longer--but after a couple of hours of this, I called for surgery myself. Doc told me after csec that my boy was waaaayyy wrapped up in cord, woulda been pretty iffy for him and me both, to get him out the usual way. But as it was, baby and I were both fine.

Anyway--never seen that much of a wrap in any of my clients, tho I've seen some variations that did require attention to mom's position during labor (to help avoid worst of compression). And a few babies who needed to be jacknifed/somersaulted out to avoid too much pull on a tight wrap.

[wannabe]

Yeah, that's the sort of thing.

I was wondering where most of them fall on the spectrum of "hey look, the cord was around his neck three times, how interesting" and "woah, this baby's so compromised it's not going to cope with three more contractions".

[3cuties]

When is it really necessary to cut the cord while the baby is still being pushed out? Is this dangerous --- i.e. the baby then no longer has a source of oxygen and may not be able to expand his/her lungs while still being pushed out?

[mothercat]

In more than 10 years as a CNM (OOH), I have yet to find a good enough reason to clamp and cut the cord because it's tight. Either the baby can't get down the birth canal or it can. If the baby can get to the perineum and the head can get out, somersault is my trick of choice.
I keep the two hemostats and scissors in the instrument pack as a just-in-case, but never used them.

I suppose it's a case of doing the most expedient thing. It just seems faster and safer not to try to find the hemostats, apply them correctly, and then cut the cord. I can get the baby out faster by somersault and don't risk harming mom or baby.

Oh, and 3cuties, you're right about separating the baby from it's oxygen supply. There is a perinatologist I admire who tells his residents and fellows exactly that. If you cut the cord and then have another problem like a shoulder dystocia, you have compunded a serious problem unnecessarily.

[mpvelaz]

My DS had a tight nuchal cord and a nuchal arm. I was able to birth him vaginally, but he had several big decels and had to be resuscitated at birth. He had a 2/7 apgar and was taken to the special care nursery for about 24 hours (which I felt was a little unneccesary because he was perfectly fine about 30min after he was born).