Cord accidents - Mothering Forums

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Old 05-07-2005, 03:53 PM - Thread Starter
 
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It was my understanding that, a cord wrapped around a baby's neck was "no big deal", and generally, easy to deal with during labor.

And yet, more than once here on MDC I have read about a mama that lost her baby to a cord accident- a twist in the cord, or the cord wrapped around the baby's neck.

How big a deal is it really, and why do some babies die, or have problems from cord issues, and others it just involves "pulling it over their head" and they are fine?

Is there anything that can be done to prevent cord accidents? I've never put any stock in the old wive's tales regarding cords, but perhaps, is there some truth to them?

He who can no longer pause to wonder and stand rapt in awe is as good as dead; his eyes are closed.  ~Albert Einstein
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Old 05-07-2005, 03:57 PM
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Having had a wonderful pregnancy thusfar without any complications or worries about the baby (thank God) .. this is the last of my big worries...

I am hoping some experienced people can shed some light... or is it something that just *happens*...?
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Old 05-07-2005, 04:10 PM
 
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I think it does depend, somewhat, on the overall length of the cord. I don't know. To put some fears to rest (hopefully!), my dd was born with a nuchal cord that was easily handled. Ds was born with the cord around his neck TWICE and it was easily handled. No problems whatsoever with either of them. (In fact, ds was crying when it was just his head out!) Dd's cord was normal length, and the midwife commented that ds' cord was 'really long.' Other than that, I don't know what could make the difference (except, of course, possibly management of the issue?)

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and Brigid Eleanor (11/20/08)
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Old 05-07-2005, 04:38 PM
 
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Breathless, I was wondering that too. I think we must have read coleslaws very tragic and sad news about her baby this morning.

I will have to say that *I* personally in the last 15-16 years that I have been literally "obsessed" with obstetrics, births, and women's birthstories, I've heard more stories about babies being born with cord injuries than anything else. Yet, I read time and time again that some babies are easily born with the cord wrapped around their necks and with knots and are perfectly fine. Is it the luck of the draw? I don't know. I know that when I was really militant natural birth supporter, that this was the one issue that didn't seem to bother me when people had medicated births or cesareans -- I just knew to many, read about too many who had lost their babies that way (some before they were ever born).

Two babies, one of them being my husband's youngest brother, in my husbands family have died from cord injury -- prolapse cord and then one had it wrapped tightly around the neck twice and around the arm tightly. Recently a friend of mines cousin lost her baby to cord injury. Baby was breech, cord was really long, and some how strangled herself on the cord. It was wrapped weirdly all around her body and constricting her neck. My neighbor's MIL was/is a mountain woman and worked with a midwife for years (she is also a LPN) and said they had more complications with babies with cord issues than anything else, including breeches.

I have to say that cord injury scares the bejezus out of me, especially since I carry my babies breech or transverse, because it just seems to be the luck of the draw. At the OB office I go too, they now do ultrasounds at 35-36 weeks to check position of baby and to look at where the cord is. They have the new GE Volusion machine that actually color codes the cord that shows how many vessels it has and where the cord is. I know some probably think this is awful and just another intervention to interfere with normal birth -- and to some extent I agree, but I have to say I am interested in seeing how things look with my breech baby in 3-4 weeks and her cord.

One of the reasons I personally am against ECV is risk of cord injury, but I am firmly in the belief that if a baby is breech and they can't be turned by low intervention techniques like Websters, tilts, or accupuncture, then there is a reason they are that way.
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Old 05-07-2005, 04:54 PM - Thread Starter
 
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The thing is, 3 of my children have had cords around their necks at birth.

Only one was in distress, and I attributed it later to the doctor's interventions (AROM, Pitocin, Narcotic pain relief, IFM, lithotomy position, no food, etc.). The baby was "saved" by the episiotomy they cut, and the fact that they had me stop pushing once the head was out, and cut the cord.

Was I just lucky?

He who can no longer pause to wonder and stand rapt in awe is as good as dead; his eyes are closed.  ~Albert Einstein
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Old 05-07-2005, 05:15 PM
 
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Another issue is that many unknown stillbirths are called cord accident for lack if a better explanation. Some parents feel better to have an explanation, some doctors feel it might protect them from liability. But it is sort of a catch-all description for deaths that might be a variety of causes.
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Old 05-07-2005, 05:25 PM
 
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Some cord accidents happen in utero when the baby grows with the cord a certain way, like around the whole torso or neck, and the cord strangles the baby as they get bigger. Its very rare. Most of these no big deal cord things are just the way the baby comes out, there`s probably plenty of room with certain cords and they are not cutting off air at all, they just come down with a cord around the neck that slips off easily. Its like shoulder dystocia, many babies have a sticky shoulder moment and are fine, but some get stuck very badly and die.

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Old 05-07-2005, 06:12 PM
 
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I don't know what causes the difference.My ds was born with the cord around his neck, but it was easily slipped off. My dd had the cord wrapped 3 times around her neck, and the midwife said she'd never seen a nuchal cord that tight. Lauren's heartrate was in the 40s and not recovering, and she needed oxygen after birth for a few minutes.
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Old 05-07-2005, 06:37 PM
 
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Originally Posted by Clarity
Another issue is that many unknown stillbirths are called cord accident for lack if a better explanation. Some parents feel better to have an explanation, some doctors feel it might protect them from liability. But it is sort of a catch-all description for deaths that might be a variety of causes.
I was going to say that. I wonder in how many of these deaths the cord wrapping around the neck, or having a knot, is coincidental and not actually the cause of death?

Correlation does not guarantee causation.
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Old 05-07-2005, 07:32 PM
 
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I agree with Clarity and Kristin. Many times we have no solid explanation for stillbirths. Yet, everyone needs a reason, so sometimes there are guesses.

Some babies have very little wharton's jelly (the white gel that surrounds the vessels) and this can cause issues with knots or really short cords. This is very, very rare. There is no way to determine by u/s (despite a new trend wanting to do so) which babies are more at risk.

Ultimately, we cannot control all injuries and/or deaths. Whether it's before birth, during birth, or afterwards - or even with our eight year olds. We are not in control of our fates - yet there seems to be a drive to believe so.
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Old 05-07-2005, 07:36 PM
 
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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.

I read one story where a midwife thought it was a short nuchal cord that was holding the head up, so she cut the cord before the head was completely born. The baby actually had a shoulder dystocia and it took an additional five minutes for the baby to be born. It had severe brain damage from the insult.

I just think that we need to leave things be more often. Nuchal cords are not an issue the vast majority of the time. If they were, you'd hear it during labor with heart tones and even then, those babies stay high and seem to dive right down at the right time to birth rather quickly.
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Old 05-07-2005, 07:54 PM
 
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My second DD was born with the cord wrapped around her neck, twice, very tightly. Midwife didn't unwrap it until after her entire body came out. She was not in distress and had great apgar scores.

I was told, after DD1 was delivered via cesarean, that her decels were probably caused by the cord being wrapped around her shoulder, or maybe she was grabbing hold of it too tightly. Because there were absolutely no signs of distress and she had PERFECT apgar scores! I believed this story, too, until I got a copy of my records and did a little more research, and now I think it was because of the Cytotec they gave me (without my informed consent). Of course, no doctor is going to tell you that the problems you had during childbirth were caused by things he did!
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Old 05-07-2005, 08:15 PM
 
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Originally Posted by OnTheFence



I have to say that cord injury scares the bejezus out of me, especially since I carry my babies breech or transverse, because it just seems to be the luck of the draw. At the OB office I go too, they now do ultrasounds at 35-36 weeks to check position of baby and to look at where the cord is. They have the new GE Volusion machine that actually color codes the cord that shows how many vessels it has and where the cord is. I know some probably think this is awful and just another intervention to interfere with normal birth -- and to some extent I agree, but I have to say I am interested in seeing how things look with my breech baby in 3-4 weeks and her cord.
Maybe I am missing something here... but the cord is floating in water. How would seeing it on an u/s 3 weeks before birth tell you much about the position of the cord before the birth (or the next day, even). Doesn't the cord move around and change position as the baby changes position?
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Old 05-07-2005, 08:23 PM
 
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Maybe I am missing something here... but the cord is floating in water. How would seeing it on an u/s 3 weeks before birth tell you much about the position of the cord before the birth (or the next day, even). Doesn't the cord move around and change position as the baby changes position?

I wouldn't say anything is floating in water that late. It's pretty tight in there at the end. kwim?

But I agree w/ you 100%. If there are no signs of distress then, how does looking at it 3 weeks ahead of time, when there's plenty of time for the baby to roll a few more times, show that there will be distress later? Makes no sense to me.

My brother was born w/ the cord around his neck a few times. I think 3. He was fine. There is an old wive's tale that babies born that way can't die from drowning. My brother drowned in a bucket of water (the phone rang and my mom put the bucket in the bathtub before answering it!) but my mom knew cpr and he was perfectly fine.
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Old 05-07-2005, 08:30 PM
 
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Yeah, it's definitely tight in there, but there is still generally a layer of fluid cushioning the baby. And the cord will still be at least be partially floating, as there is always the insertion point into the placenta itself that would be sticking out. Even if baby was laying on it, one roll and it would be in a totally different position.

Theoretically, a baby could be fine during an u/s, and have a cord accident later that day. I agree with Pam that we just can't control these things. They're not meant for us to control. If we were meant to control the baby's cord, there would be something we could do about it.
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Old 05-07-2005, 08:32 PM
 
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My DH had his cord wrapped around his legs, well, it had actually grown into his legs, and it had to be cut out. The doc told his mom that he would never walk because of it. But my dh started walking at 18 months. He still has the scars in his legs from where the cord was, though.
My ds had his cord wrapped around his arm a couple of times, but he was fine.
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Old 05-07-2005, 11:30 PM
 
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Hi ladies, it's me. I sincerely want to thank BW for starting this thread. As you can imagine (since I think I'm the reason this thread got started), I have many questions about this myself. I have learned a lot from all of your comments, particularly pamamidwife. I have dabbled in the angry phase of grief today and was ready to march into my midwives' pratice and demand some answers on how they could have missed this and what else they could have done. I do have questions, but they have become more rationale and focused thanks to some of the information I have read here. Like some of you said, it may not have been the cord. We thought it was because of what my dh saw when Grace was born - it appeared to him like it played a role, but hasn't given me details and I haven't asked. The doctor (long story why it wasn't a midwife) said that it may be the case too. I didn't see anything until they put her in my arms wrapped up in blankets (which was fine with me). They are doing tests on her placenta and her and did bloodwork on me. Maybe we will find something out then.

Please continue the discussion if there is more to be said and know that you are helping a greiving mom get through one of the hardest moments of her life. I thank you for that with all my heart.
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Old 05-08-2005, 12:08 AM
 
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This is a very interesting topic. My first child Amanda died because the placenta abrupted, but, there were also several hemerages in the cord.

My son was born with the cord around his neck and shoulder. The cord again, had several hemerages and the placenta was torn. He came out screaming and healthy. The doctor later said he was amazed that ds was so healthy.

In the 10 years since my daughter was stillborn, I've done a lot of searching for answers. One thing I've come to believe is that life and pregnancy are a very delicate balance. Most stillbirths do seem to be from cord or placenta accidents, but there is little that can be done to detect a problum.

Coleslaw, I am so very sorry for your loss - I wish I had some answers for you - all I have are cyber hugs Please know your in my thoughts as yoj move through this.
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Old 05-08-2005, 12:36 AM
 
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Maybe I am missing something here... but the cord is floating in water. How would seeing it on an u/s 3 weeks before birth tell you much about the position of the cord before the birth (or the next day, even). Doesn't the cord move around and change position as the baby changes position?
I have no idea but I will be sure to ask. My babies don't really move after a certain time period. I've had a breech baby now for sometime and she can't move due to the septum. (she seems quite ticked at times too because of this)
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Old 05-08-2005, 02:13 AM
 
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My daughter had her cord wrapped around her neck FOUR times and she was still born vaginally, albeit with assistance from forcepts. The nurses were amazed as none of them had ever seen a cord x 4 and this is a fairly large hospital with 2500 + births a year. My doctor (a wonderful woman) did everything she could to get my daugher to come out, since due to repeated decels I had only one or two more pushes left until a c section. While she spent 3 days in the NICU, more due to the fact that no one knew if she should be closely monitored or not, in the end I was grateful to have a beautifil healthy baby to take home. A skillful Dr. or midwife, I believe, can handle most situations without problem, but it is the rare occurrence that will take a baby's life that skill or experience can do nothing to prevent that is so frightening!
Take care Mama and don't worry!
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Old 05-08-2005, 02:36 AM
 
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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.
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Old 05-08-2005, 02:53 AM
 
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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....

--------------------------
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
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Old 05-08-2005, 12:50 PM
 
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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.
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Old 05-08-2005, 12:54 PM
 
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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?
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Old 05-08-2005, 02:37 PM
 
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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.

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Old 05-08-2005, 02:48 PM
 
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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
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.

Mom of a 7 yr old, 4 yr old, and 1 yr old. Wow. How did that happen?
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Old 05-08-2005, 05:33 PM
 
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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?"
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Old 05-08-2005, 05:53 PM
 
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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.
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Old 05-08-2005, 08:11 PM
 
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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!
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Old 05-08-2005, 08:27 PM
 
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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.
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