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-   -   "he had the cord wrapped around his neck and WOULD HAVE DIED!!" (http://www.mothering.com/forum/213-birth-beyond/1186838-he-had-cord-wrapped-around-his-neck-would-have-died.html)

craft_media_hero 01-22-2010 04:21 PM

So it seems like whenever I mention homebirth, I get one of these cord horror stories in response. Instinctually, I don't believe it, but I'm not a birth professional and don't really know enough to understand what's really happening here.

The most recent was my godmother's story--she had the fetal monitor around her belly, every time she'd have a contraction his heartbeat would "stop", so the doc cut her a full episiotomy, reached in and pulled the baby out. This was all due to the cord being tightly wrapped around his neck and cutting off oxygen. Apparently had the doctor not intervened and cut and pulled the babe out, he would've been stillborn. This is what my godmother was told and what she believes 30y later.

The story before that was that the momma was laboring for about 60-70 minutes. The fetal monitor showed that the heart rate dropped during contractions. Mom received an emergency cesarean, and the babe was born "with the cord tightly around his neck". This was "a close call" and if they hadn't had a cesarean, I am told the babe would have died. FWIW this mom had a very "medical" OB attending her.

Can we talk about this?

It's my understanding that the cord is around the neck in 1/4 or 1/5 births. Can the cord around the neck really cut of oxygen and cause stillbirth? Would the babe be born, cord unwrapped, and isn't it still receiving oxygen from the placenta even if the cord is wrapped?

What about the heart tones slowing or "stopping"? Is this caused by the nuchal cord? Even if the heart rate slows during ctx, could that birth work out ok w/out interventions?

Without the fetal monitor, would these births have simply progressed naturally with the babies pinking up after birth? Or would they really have been stillborn because the cord was too tight? At that point, isn't birth pretty much imminent?

I hated the fetal monitor and only let them put it on my for a minute, and I don't want one in this next birth I'm preparing for either.

I'd like to understand what's really going on here and dispel the "horror cord" myth. Can you all help me out, here?

GreenTeaGinger61 01-22-2010 04:25 PM

I don't have a medical answer for you but my daughter was born, vaginally with the cord wrapped around her neck twice and with a true knot. Her heart rate dropped a bit towards the end but nothing drastic and there certainly wasn't any talk of cutting me open in any way shape or form. She was fine when she was born. The Dr. put her on my belly and had the cord undone in about five seconds. There was a bit of panic but nothing serious. This didn't happen with my other two births.

MaterPrimaePuellae 01-22-2010 04:33 PM

My DD was also born with the cord around her neck (once or twice, I don't remember). Her HB did decrease during contractions, and they had me roll on my side during them. It stabilized.
I do know someone whose baby was stillborn because of a cord around his neck-- but I think (I'm fuzzy on the details) that the baby died before labor. In any case, the baby was delivered in a hospital, and that didn't make a difference for him.
The vast majority of babies who have nuchal cords are just fine.

Especially with the births that happened so many years ago, I would question the quality of the EFM.

ScarletBegonias 01-22-2010 08:52 PM

student midwife here:

both of my children had the cord around their neck, ds also had a true knot.

one reason it's so common because as the baby is descending into the birth canal, often he/she will go through a "loop" of cord and by the time baby is out it's been caught around their neck.

it's typically a non-emergent occurrence, and as the research bears out, the more monitoring/interventions, the more likely that something happening during labor/birth that is non-emergent will *become* emergent directly due to interference.

and i agree with MPP: i would be wary of any results from efm that was going on 30 years ago.

eta: the very nature and construction of umbilical cords make them nearly impervious to *most* compression during labor/birth. they are designed to withstand intervals of great pressure, while still delivering oxygen to baby. all babies will experience heart tone variation during labor. it is completely normal for the heart rate to slow some during a contraction, and then pick up again when the ctx ends. mama is working hard, but so is baby. it's not like baby is just chillin' and hangin' out. baby puts out energy and physical force to make birth happen.

what makes a difference is the rate of decel and recovery: how baby is handling ctx's.

roadfamily6now 01-23-2010 04:21 AM

In addition to what scarlet mentioned, babies don't "breathe" through their mouths or noses while in utero. They get oxygen from the blood that flows through the umbilical cord. A cord wrapped around the neck wont cut off oxygen to the baby in this way.

A true Knot might reduce blood flow thus oxygen rich blood, to the baby.

Charmie981 01-23-2010 02:54 PM

Yes, it's important to note that the issue is not having something around the neck causing asphyxia (as it would when we're yelling at our kids "don't wrap that jump rope around your neck and run!"), but that cord tightly wrapped can cause cord compression, which can interfere with the flow of oxygenated blood from the placenta to the baby. Cord around the neck compresses more than cord around, say, the foot, just because there are more folds in the neck and the cord can be compressed between the neck and a shoulder. The worst cases of cord compression I've seen, though, resulted with cord around the body and therefore getting compressed between baby's arm and rib cage.

Because the blood flow is changed via cord compression, any cord compression is going to show up via EFM, especially continuous EFM. The key is to understand that when cord compression from a cord around the neck is likely to be most severe is when birth is imminent because the cord is being stretched to the maximum. In the case of the massive episiotomy and vacuum extraction, it sounds like birth was pretty close anyway and someone who trusted the mother's ability to birth a baby could have encouraged her to push with everything she has and get the baby out just as quickly, with less tissue trauma. In the case of c-sections for cord compression, I find that they are often the result of a fetal distress call made because baby isn't tolerating contractions well, is having deep, late decels and isn't recovering quickly after a contraction. That is considered a non reassuring FHT, and I guess in those cases the only logical choice is a c-section, although I always wonder...if we weren't obsessively listening to those babies, how many would be born vaginally and recover just fine? It's a purely hypothetical question, of course, because no one is going to see a non-reassuring FHT and say, "well, let's just wait and see what effect this is really going to have on the baby."

There are cases where the cord compression could be severe enough to stop blood flow through the cord altogether (which is what happens when a baby dies in utero due to a "cord accident"), but those cases are rare and every study of EFM ever done says that the only thing continuous EFM does is increase the rate of surgical delivery, NOT decrease the rate of fetal demise.

katelove 01-23-2010 09:16 PM

Quote:
Originally Posted by craft_media_hero View Post
The most recent was my godmother's story--she had the fetal monitor around her belly, every time she'd have a contraction his heartbeat would "stop",

Frankly I don't believe this. Although I'm prepared to believe that this is what she was *told*. It takes a serious insult for anyone's heart to stop beating and, when it does, it requires some considerable effort to get it started again.

What is more likely is that contact was lost between the monitor and the foetal heart during contractions. This is a very common problem with EFM.

It is also fairly common for the heartrate to drop during contractions. This is due to the pressure on the babe's head and is called an early deceleration. It is a normal response and not a sign foetal distress.

A quick review of the literature seems to suggest that a nuchal cord may be responsible for foetal death during labour in some circumstances. However those circumstances - cord wrapped multiple times tightly around neck and/or an unusually short cord which is pulled tighter than a cord of average length would be - are very rare.

eastkygal 01-24-2010 08:14 PM

My second c-section was a homebirth transfer to the hospital. My baby was 11 pounds and posterior, but what I believe ultimately caused a necessary c-section was cord issues. Her cord was wrapped around her arm at least three times, tightly. My water broke before labor started and there was quite a bit of meconium in the fluid. I stayed home for 24 hours without consistent labor. When we transferred to the hospital I labored intensely for more than 7 hours going through all stages of labor in emotion and intensity, but I never dilated passed a three. All during this time Ivy would pass meconium on and off. Also, she would go through short periods of decels, but recovered well. The final decision for a c-section came when she didn't do so well after a period of decels at recovery and I had seemed to go through transition and my contractions were definitely strong enough to have been causing me to dilate, but I did not. I was also 41 weeks and 6 days gestation, which could have been the reason for the meconium, but we were unsure of her stress levels and the cause of her not being able to engage in the pelvis. In the end, seeing her arm and the pressure knots and bruising it caused across her arm and her back, I believe that the cord was too short to allow her to engage. Despite all this, I don't believe she ever lacked enough oxygen. My baby was not born pink, she was born red and lively - ready to nurse. So, after that experience, I believe it would have to be something very very severe to cause a stillbirth.

jenfl 01-24-2010 08:14 PM

My daughter had her cord wrapped around her neck once and again around her shoulder. The midwife was monitoring her heartrate during pushing contractions intermittently, and noticed some decels. She had me roll onto my side (from my back), and DD's heartrate evened out.

She's 2.5 and totally fine.

member234098 01-24-2010 08:58 PM

I agree with all the PPs and want to note to you, the OP, that a cord around the neck will in most cases prevent a prolapsed cord.

This is nature's way of preventing the cord from falling out when the doctor decides to prematurely rupture the membranes.

As for decels in the baby's heart tones, the baby is gently getting ready to live outside the womb and will have some stress as the birthing process takes place, but the baby needs to be ready to breathe.

onetwoten 01-24-2010 11:03 PM

just a few minor points I haven't seen yet. I've seen several people mention that it's normal for baby's heart to decel with contractions-- I also believe that the professionals tend to get nervous a/ if it doesn't change at all with contractions, because well, like someone mentioned, labor is hard work, and if it's not effecting the baby at all, that's a little weird. And also that b/ The most common time for people to get worried isn't the heart dropping- but the heart rate not increasing again after the contraction ends.

There's a large number of babies whose moms don't even know they had the cord around the neck because the dr just loops it over the head as the baby delivers. Most of the time it's no big deal.

craft_media_hero 01-25-2010 01:03 AM

Ahh! Thank you all for responding; I am finding this to be a very enlightening thread.

Charmie981, thank you for your very thorough explanation.

I'm understanding this subject a lot better now and am feeling much reassured about "cord horror" lol.

CharlieToaster 01-25-2010 12:39 PM

I had a birth center delivery and my son had the chord wrapped around his neck. He was rather blue when he was born and it did cause the midwives to cut the chord right away and give me a shot of pit to deliver the placenta right away to be sure but all was fine.

SashaBear 01-25-2010 02:48 PM

The cord was wrapped around my son's neck as well. There was never any indication that he was in danger. When his head came out the dr saw it, told me to stop pushing, unwrapped the cord, and I pushed DS out the rest of the way. No biggie! The dr. didn't even say anything. The only reason I know this is is because DH was watching.

Cheshire 01-25-2010 03:52 PM

Quote:
I'm understanding this subject a lot better now and am feeling much reassured about "cord horror" lol.
My son did die from a cord issue and his birth was horribly traumatic. Having suffered through this loss I've met many other mommas whose children have died from cords being wrapped around necks and from true knots in cords. It's not a "myth" when it happens to you and it happens more often than people know. From the Pregnancy Institute's study:

Quote:
Umbilical cord accidents are the stuff of which nightmares are made. Occurring in otherwise textbook pregnancies, they result in the deaths of one in every thousand babies. The mortality rate is noteworthy enough -- twice as many babies die from cord accidents as from SIDS -- but it only tells part of the story. Another three in every thousand babies are left severely disabled as a result of cord accidents.
I would just encourage you to not doubt all of the stories you hear because, first, you weren't there and aren't a medical expert so you can't be sure, and second, because I'm sure there are plenty of cases where it does save a life versus the cases where it may have been an unnecessary intervention. Give that mother the benefit of the doubt - she doesn't need her birth second guessed because the listener believes they know more about birth than the care providers she trusted.

Galatea 01-25-2010 04:04 PM

My sister's first son had his cord wrapped around 4 times.
It did prevent him from descending or moving and he had major meconium aspiration, so she did have a c-section, and then he was in the NICU for 2 weeks recovering. But he is fine today!

MegBoz 01-25-2010 04:26 PM

Quote:
Originally Posted by Charmie981 View Post
every study of EFM ever done says that the only thing continuous EFM does is increase the rate of surgical delivery, NOT decrease the rate of fetal demise.

I think that's important to note!

Quote:
Originally Posted by jenfl View Post
My daughter had her cord wrapped around her neck once and again around her shoulder. The midwife was monitoring her heartrate during pushing contractions intermittently, and noticed some decels. She had me roll onto my side (from my back), and DD's heartrate evened out.
Yup, this was my experience. I was on my hands & knees, DS' HR was dropping, MW asked me to get down on my left side to push & that helped. I was in the hospital, so they gave me some oxygen to breathe too in order to increase oxygen flow to the baby.

His HR recovered, so the MW said I could get back on my hands & knees (side-lying was more painful AND felt less productive), but when his HR dropped again, she said, "Meg, you may like that position, but baby doesn't."

Cord was wrapped 2X around his neck & once his head was born, MW unwrapped it. With the next push, I birthed his body & DH caught him.
He was fine - great shape after about 45 min total of pushing.

Quote:
Originally Posted by Cheshire View Post
I would just encourage you to not doubt all of the stories you hear because, first, you weren't there and aren't a medical expert so you can't be sure, and second, because I'm sure there are plenty of cases where it does save a life versus the cases where it may have been an unnecessary intervention. Give that mother the benefit of the doubt - she doesn't need her birth second guessed because the listener believes they know more about birth than the care providers she trusted.
I'm sorry for your loss. And you're right - it DOES happen, so we should "Give the mother the benefit of the doubt" & not doubt her story. However, that mother should give the original poster the benefit of not fear-mongering! Telling horror stories & scaring Mamas away from home birth isn't right.

JessicaA622 01-25-2010 04:46 PM

The cord was wrapped very tightly around my son's neck. His heartbeat dropped significantly with every contraction. Once I got his head out the OB had to cut the cord because she couldn't unravel it. If the delivery had lasted much longer I truly believe I would not have my son today. He came out completely white and not breathing. Thank God, he is fine now. That being said, I would NEVER discourage someone from doing a home-birth. What happened to me was not the norm. Would I ever try a home-birth? Based on my experience with delivering my son, no, but that doesn't mean I should go around telling everyone my story and saying that home-births are dangerous (especially when they're not). Some people just need to keep their stories and opinions to themselves. Let people think for themselves!

Cheshire 01-25-2010 05:10 PM

Quote:
However, that mother should give the original poster the benefit of not fear-mongering! Telling horror stories & scaring Mamas away from home birth isn't right.
Every mom should have the right to decide where to give birth with the care providers she wants. But, we also shouldn't leave moms to believe that home births are all rainbows and butterflies.

No one should fear monger and having had three children I've heard plenty of horrible birth stories while pregnant and have one of my own. I do not share it with pregnant women IRL - I hardly share it at all, who wants to hear about babies dying? I do feel my son had a small chance because he was born in a hospital with a NICU team readily available. If I had given birth at home he would have had no chance (he needed immediate blood transfusions, he lost most of his in a matter of heartbeats due to a cord rupture).

Women need information to make informed decisions. Women need to know that good and bad outcomes happen no matter where you give birth. Women need to be free to make decisions that they will be able to live with no matter the outcomes of those decisions.

I agree that mom's shouldn't try to scare pregnant moms towards any decision (there are plenty homebirthers that make every single hospital and hospital birth seem awful - it goes both ways). Learning to offer support without judgment would be utopian - it has to start somewhere so why not with us?

And, as every pregnant woman quickly learns, you can listen to those stories or not, you can choose to surround yourself with people who won't try and scare you either direction but support your pregnancy journey no matter what decision you make.

Mom to E and A 01-25-2010 05:11 PM

I have not read all the replies, but did want to offer this:
My daughter was stillborn last April due to the cord around her neck (5 times) and a true knot. She was delivered in a hospital and had been dead for at least a day or two before I went into labor. I honestly had no idea until the hospital was unable to find her heartbeat with the monitors. Had she been born at home it would have made no difference as she was already deceased before labor even began. So while a little different than your situation, my point is that YES babies can be stillborn becasue of "cord accidents" BUT it can happen just as easily in a hospital. For me, it wasn't labor that killed her.
FWIW, I was told that cords around the neck 1, 2 or even 3 times is fairly common and generally not a big deal.
Congrats on your pregnancy and Good Luck on your delivery...everyone has a horror story about everything...don't let em get to you! Do what YOU feel is best for you and your babe

gcgirl 01-25-2010 05:15 PM

Quote:
Originally Posted by MegBoz View Post
:
I'm sorry for your loss. And you're right - it DOES happen, so we should "Give the mother the benefit of the doubt" & not doubt her story. However, that mother should give the original poster the benefit of not fear-mongering! Telling horror stories & scaring Mamas away from home birth isn't right.
It's my understanding that a trained midwife generally knows how to deal with cord issues. I don't see why the possibility of a cord issue would mean a homebirth is out of the question.

mamakori 01-25-2010 05:19 PM

Both of my children had nuchal cords and both were totally fine (DS #2 had mec., but Apgars of 9). Cord accidents do happen, but in the vast majority of cases, there's no issue. I haven't looked into the statistics myself, but going by what others posted, if 1/5 babies has a nuchal cord and nuchal cords are responsible for 1 death in 1000, that means that only 1/200 or 0.5% of nuchal cords are fatal. That's not zero, but it's pretty similar to the risk of uterine rupture during a VBAC.

Sweetiemommy 01-25-2010 05:43 PM

Excellent points being made on this thread. I do want to give my personal opinion that an experienced midwife is more likely to have a few tricks up her sleeve for dealing with cord issues, as compared to an OB who is more likely to resort to a c-section or to perform some other heroic measures, while he/she has the NICU handy. I'm trying to say that a homebirth midwife has to use a different skill set to ensure safety and has more experience dealing with difficult birth situations in a natural way. The doctor is more likely to intervene in a completely different way. With that said, I haven't heard of any babies having serious complications with cords at home (in my personal experience) but I do hear of them happening at the hospital from time to time. One example, a doula I know told me this story, the hospital OB felt for a cord when the baby's head came out, it was loose enough that a midwife might have just looped it over the head or waited, he decided to cut the cord while the baby was still inside. The shoulders were suddenly stuck and of course the mother was on her back with an epidural. So it was suddenly a very serious emergency and the baby ended up in NICU (he was fine, but it was an ordeal!). Now I'm just being the Monday morning quarterback, but I think a midwife would have handled that completely differently. So whenever someone asks me about cord issues, I tend to say, "my midwife knows a lot more about how to resolve a cord issue than an OB in the hospital." And she's also completely unlikely to break my waters, which increases the likelihood of such things. Anyway, not a scientific response, but I agree with pp who said that cord issues do happen, but being at a hospital isn't going to guarantee a positive outcome.

mamabearsoblessed 01-25-2010 06:15 PM

All of my babies have had nuchal cords. These are our stories... though all my babies were in hosp. births.
First dd was wrapped 3 times, she was perfectly fine at birth.
Ds was wrapped twice with an incredibly short cord, my m/w did cut his cord as he crowned because of the shortness and tight wrap he was not going to come easlily. His first moments were tense for all of us but it was nothing my m/w couldnt' handle and he was safe, thank God.
DD was a requested induction on my part following decreased fetal movement and very very low fluid (after req. u/s nst and bpp found these to be true just as I sensed). Her cord was incredibly long and her body was wrapped so tightly that even though she was engaged she had stoppped moving. WE have pictures immed following birth where her vernix is clumped/lined in spots where her cord lay so tightly against her body. She had 2 true knots, pulled tightly, one under an arm, 1 between her legs, around her neck 3 times, and around her body like spider girl. My m/w was amazed with her birth, the cord was the longest she's ever seen and couldn't believe it. She had no decels during labor or birth as I was on the ext monitor becasue of a nagging fear and worry I had about her cord throughout her pg. I thank God everyday she is here safe and sound, but at no time during her labor and birth did she decel or stress. My m/w did somersault her out because it was clear she had a nuchal cord. Thta said, had my mw even given me 'the look' I would have been in a c/s before she could even suggest it at that point, I went in there with a feeling her birth would be very diffrerent, and very alert to that.
I'm sorry the people in your life feel its appropriate to scare you when you are preparing for the birth of your baby . The most impt undertaking is your confidence in your mw and peace with your decision, your instinctual feelings. A hb mw, like other pps have said, will know how to handle what arises.

Congrats on your impending birth!

mamabearsoblessed 01-25-2010 06:23 PM

just went back and read *all * posts
Cheshire and Mom to E & A ~ I am so sorry for the loss of your Babies, I cannot imagine the pain and heaviness of heart their loss brings.
I know things with my dd2 (and even the others) could have ended very differently, I take nothing for granted.





KimL 01-25-2010 06:27 PM

why wouldn't you believe it? My son would have been a goner if i had not been right there to have an emergency csection.His chord was doubled around his neck and leg. He was in the birth canal and struggling. The very day he was born, a mother (right here from mothering.com) lost a child due to almost the same circumstances, but having him at home.

I was allowed to try and birth naturally, right up until the *hit hit the fan. It was understood that, above all, i wanted to birth this child naturally. Yet, in the end, i am so thankful for my live child.

Even though I'm an extremley alternative parent and person, if I had another baby I would have it at the hospital for this very reason. My childs life isn't anything to take chances with.

bandgeek 01-25-2010 06:36 PM

Quote:
Originally Posted by KimL View Post
Even though I'm an extremley alternative parent and person, if I had another baby I would have it at the hospital for this very reason. My childs life isn't anything to take chances with.
Babies have oxygen deprivation and brain injuries in the hospital all the time as well. Often times they can't prep for a c-section fast enough. Not one homebirthing mama on this board is "taking a chance" with her child's life any more than a hospital birthing mama is.

Storm Bride 01-25-2010 08:08 PM

Quote:
Originally Posted by KimL View Post
why wouldn't you believe it?
Well, I wouldn't believe it, because if true cord emergencies were as common as OBs and their patients make them out to be, the human race would have been extinct a long time ago. That's not to say it doesn't happen...but it doesn't happen as often as they like to make it sound. And, I'll tell you something. IME, about 90% of women who are sectioned for "huge babies" that turn out to be 7-8 pounds (or less) are then told that "it's a good thing we operated, because the cord was around his/her neck and he/she would have died if you'd tried to have a vaginal birth".

Quote:
I was allowed to try and birth naturally, right up until the *hit hit the fan.
You are allowed to try and birth naturally at any time, whether the *hit hits the fan or not.

Quote:
Even though I'm an extremley alternative parent and person, if I had another baby I would have it at the hospital for this very reason. My childs life isn't anything to take chances with.
Babies die because of being born in the hospital, too. You can give birth anywhere you want, but please don't perpetuate the "if it's not in the hospital, it's taking chances with the baby's life" stuff. That's the kind of mindset that resulted in me having a social worker come to my door while I was naked in a birth pool in my living room.

Hannah32 01-25-2010 10:32 PM

Quote:
Originally Posted by Storm Bride View Post
Well, I wouldn't believe it, because if true cord emergencies were as common as OBs and their patients make them out to be, the human race would have been extinct a long time ago.
I don't think that's true at all. It was very common in previous centuries for women and babies to die in childbirth. Heck, it's common in some countries today. But women in previous centuries tended to attempt more pregnancies, thus ensuring the survival of the human race. Really, I think you're using a bit of a strawman argument there.

That doesn't mean that people can't homebirth if they want to, because as it's been said, babies can and do die in the hospital. There are no guarantees, but a modern hospital or a skilled midwife today is probably more adept at handling those emergencies compared to previous centuries.

member234098 01-26-2010 12:19 AM

The reason that so many women died in childbirth 100-200 years ago is because doctors refused to wash their hands in their rounds between the morgue and the maternity ward. It was called puerperal fever and doctors blamed it on the mothers and told them it was a mental condition - "it is all in your mind". If you do not believe me, google Dr. Ignaz Semmelweis and see how his colleagues treated him when he confronted them with the truth and with a remedy - handwashing with chlorinated lime solutions to kill the germs.

It is not universal hospitalization that saves women in childbirth today; it is antibiotics for infections and blood transfusions for excessive bleeding, neither of which needs to be in a hospital.

In the 1940s-70s, women would be recuperating in a hospital for a week after the birth. Today, most women are shown the door after three days.


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