My baby's survival of birth was quite possibly a miracle (pics of knot added) - Mothering Forums
Birth and Beyond > My baby's survival of birth was quite possibly a miracle (pics of knot added)
QueenOfThePride's Avatar QueenOfThePride 12:55 PM 10-03-2007
During pushing, my baby's heart rate dipped into the 60s-70s and stayed there even between contractions, so my midwife forced me to push with all my might with no breaks whether I was contracting or not. I hated it, it was the most horrible pain I've ever felt - as most of you know first hand. When his head popped out, he had a nuchal cord, which is nothing, but the nuchal cord had a true knot right there in it that was pulling tight. My midwife made me push the shoulders out right away, which I did. I'm not sure if she slipped the cord off his neck when the head was out, or after the shoulders were out. But I reached down and pulled my baby the rest of the way out and onto my chest and he came out screaming, so it was all good.

I know true knots in the cord are rare, but it must be even more unusual to have the knot in the part around the neck, hey? It made a pressure point where it was getting pinched as he was born. There are so many what-ifs I keep turning over in my mind. What if it pulled tight earlier in pregnancy and he died in-utero? He flipped repeatedly between breech and vertex into the 36th week. Around week 33 or 34, he flipped and then stopped moving for several hours. I just knew that he was tangled up in his cord. I knew it. I went to the hospital to make sure his heart was still beating, and of course, it still was. I had a NST and it was all OK. Throughout much of the pregnancy, I had a feeling that the baby might not make it. I knew there was something going on with the cord. I never told DH or anyone because I didn't want them to worry, and I didn't want to make it real by saying it out loud. Another what-if: What if I had an epidural and couldn't push him out as quickly as I did? I feel like my hard work of having a natural birth could possibly have saved his life.

At my 6 week PP checkup, my midwife and I were talking about the birth. She said that she had very recently before my labor had a mom lose her baby at 30 weeks from the exact same thing - knot in the cord around the neck. It pulled tight for that baby. :

I'm just so grateful I have my healthy baby. I feel a mix of relief, and now letting myself be afraid for what could have happened. Wonder at how I knew there was something wrong and possibly life-threatening with his cord. How did I know?

I think God sent angels to make sure this child lived. What great plans are in store for this child? This morning as he slept on my chest, I felt like it was such a miracle that he was there.

My placenta had already been sitting out for almost an hour when DH took these pictures. The first is a close-up of the knot. The second the midwife is showing how if the cord is pulled it cuts off blood supply.

loraxc's Avatar loraxc 02:52 PM 10-03-2007
My DD had a true knot, although there were no decels. I had no idea what the implications of the knot were till afterwards--then I was really shaken up when I read about it. I do worry a little about #2 having a knot.
majormajor's Avatar majormajor 04:42 PM 10-03-2007
oh how scary for you. i couldn't read this and not respond. my daughter was born by emergency c/s because of a nuchal cord. but, like you, i knew there was a problem throughout the whole third trimester. i KNEW she needed to be born by c/s. i had regrets about not moving to the c/s sooner--we waited until her heartrate tanked in labor, even though she'd had decels that always recovered for hours... like i put her through oxygen deprivation unnecessarily... was it scary for her? painful?

but now she's 2, and i'm fairly at peace. i am thankful that i knew how she needed to be born, and remind myself that it all worked out the way it was supposed to. she's here, she's fine, and i am so thankful for her every day.

we both experienced something really scary, and there's certainly a lot of trauma to that. scary is too weak--it's TERRIFYING to think your baby came so close to a tragedy. it has permanently affected the way i feel about birth and labor. but ultimately, it WAS ALL OK. and that's what i try to focus on. if you keep replaying the fear and focusing on that, i think it's bad.

good luck. feel free to PM me if you want to talk more!
pamamidwife's Avatar pamamidwife 05:38 PM 10-03-2007
While I wasn't at your birth, nor would I ever invalidate anyone's experiences knowingly, there are a few things that I'd like to point out just so women reading this won't freak out.

True knots do not cause issues in the vast majority of births. If there is a stillbirth or fetal death and there is a knot in the cord, it's blamed on the knot. Sometimes this could be the case, other times its because the parents want some reason and the providers need to give a reason. Most stillbirths have no reason and that's the true tragedy of it.

The two arteries and the vein in the umbilical cord are protected in a sausage casing-like manner with Wharton's Jelly surrounding them. At times, a baby can have a small amount of Wharton's Jelly and that can cause any compression of the cord - including knots - to cause serious risks. However, the amount of Wharton's Jelly is usually normal to more than usual - and not less than.

It takes ALOT to compress a cord to the point where it will harm a baby. It will often cause variable decelerations of the heart, but not to the point of where the baby will suffer. Even low decelerations in pushing is normal - even without a knot - simply because of increased pressure on a cord somewhere. These babies typically do beautifully, provided there are no drugs involved in the birth. Babies have AMAZING reserves.

(I'm assuming, QueenofThePride, that your baby needed no resuscitation? Still, I can understand hearing that heart rate as a midwife and needing to get that baby born as quickly as possible - it was a good thing you were having a natural birth! It's why I love homebirth and especially vertical - upright - births. It makes a huge difference on the baby! I can see why your baby had this issue, but your baby was likely going to be ok simply because of the type of birth you chose. I'm not saying that it wasn't necessary to get your baby out as soon as you could.)

Nuchal cords (cords around the neck) is something feared by everyone, but quite simply the least dangerous fear and the most common. Babies are not breathing like us - they do not get "strangled" by their cord. Nuchal cords happen quite often - and while, again, we may hear some variable decelerations, they are not risky.

We forget that even with a placenta that is high in the fundus, the uterus follows the baby down the pelvis. The uterus/placenta doesn't stay up high while the baby stretches the cord down as it's being pushed through the pelvis. It follows the baby, so even the shortest cords can accomodate the birth of the baby.

When we add factors like pushing on the back, purple pushing, medications - pitocin, epidurals, narcotics...all these things can contribute to issues that weren't very risky to start with.

Babies that are very active are likely to have long cords (the pulling on the cord in early stages of development creates more give and thus, a longer cord: isn't mother nature amazing???) and as a result, nuchal cord wraps not only around the neck but other parts of their body and true knots. True knots typically happen earlier in pregnancy when the baby is smaller (it takes quite alot to get a knot made).

I say this not as an invalidation of anyone's experience, but that these dangerous things are very, very rare in an undisturbed, natural birth. Some of the things that doctors jump at could easily be remedied with a position change (how about off the bed on the back altogether?) to alleviate strain on the baby.

We have all these ideas about the cord that seem to undermine the perfect design system that was created in the first place. The vessels are amazingly protected - and the cord floats naturally (a lot, actually) in utero. The design system effectively adjusts for baby and baby's activity - we don't have babies that are still inside us. We have babies that move - some of them alot!

I think that what I'm trying to say is there are alot of misunderstandings about the cord issue. Of course, it doesn't help that doctors give the cord around the neck as the main reason for cesareans. Sometimes it's not as easy as that, but a combination of factors. Sometimes, but very, very rarely, it is as easy as that. What typically happens is similar to the stillbirth issue: they go in for the cesarean or birth, see the nuchal cord/true knot and blame that. Fetal distress happens for a number of reasons, but most of which is caused by induction/augmentation of labor, medications in labor and maternal positioning in labor.

I hope if someone finds what I'm saying offensive, we can discuss it further. My goal is always to point out what we know to be true physiologically in pregnancy/labor/birth. The design system is more perfect than we could ever realize...even with what we know, most of it is misunderstood or we apply our own comfort/interpretation as extrauterine beings to this process.
QueenOfThePride's Avatar QueenOfThePride 05:56 PM 10-03-2007
I agree with everything you said, pamamidwife. Nuchal cord is nothing, and true knot is usually nothing, but my baby had both together. The knot was on his neck where it was getting pinched in the birth canal (I think).
pamamidwife's Avatar pamamidwife 06:03 PM 10-03-2007
Yep, and I'm glad you had the birth you at least saved your baby from resuscitation and (in the hospital) a subsequent harsh transition in the end. It also likely saved you from an episiotomy! (Many docs would have done this right away)
QueenOfThePride's Avatar QueenOfThePride 06:28 PM 10-03-2007
LOL, I did birth in the hospital, but it was with a CNM who sat on her hands and went by my birth plan as much as possible. And I did actually have pitocin too. My membranes had ruptured (and I stayed home) for 18 hours with no real labor despite nipple stim and walking. It was my decision to start pitocin. But it was a low dose, and my labor only lasted about four hours, so it only needed a little push. CNM even turned the pitocin down when labor was in full swing.

My CNM said that the nurses were looking at her wanting her to get the vacuum on the baby, but instead she just coached me to push harder. I was hanging on to the squat bar for dear life and screaming and pushing as hard as I could, but my leg went tingley and I had to lay down to birth. From complete dilation to birth was only about six contractions. I have no idea how long it took.

And my baby did have a gentle transition, I caught him and he stayed naked skin-to-skin on me for about an hour. We refused suctioning, vit K, eye ointment, everything really. As soon as he had come out screaming, everyone pretty much left us alone.
JamieCatheryn's Avatar JamieCatheryn 06:50 PM 10-03-2007
Well, every new life is a miracle, but all the more that he was in the end born so smoothly and perfectly despite a rough trip out. I'll bet he was tangled up during the third trimester and got slowed down from it, maybe even a little sleepy from a decreased blood flow for a little while when the knot first happened? I'll bet the early membrane rupture and the Pit didn't help positioning any either. Congratulations on your son, and the life he's living today and whatever is in store for him. Praise God and good job momma, for getting him out in perfect timing when it came down to it.
Jilian's Avatar Jilian 10:33 PM 10-03-2007
Thanks for sharing youur story, I'm so glad everything turned out ok. The what-ifs are scary huh? We're doing the what-ifs too, DS was born at home with a suprise heart defect that we discovered at 2 weeks. Thank god for natural births! I got him out fast, a long pushing phase could have killed him. All I have to say is that women's bodies rock! Our bodies really do know what to do.

Pamamidwife, I heart you. Your posts are always so informative. :
ldsapmom's Avatar ldsapmom 03:49 AM 10-04-2007
Pam, can I come be your birth knave? I could just follow you around and soak up your knowledge.

My first baby had a true knot in his cord, and the doctor told me at his 20 week ultrasound. She didn't freak out, so I didn't freak out. That was probably the only good thing she did for me .

Cords are like garden hoses with the water on, that's what my midwife told me .
mother4good's Avatar mother4good 02:17 PM 10-04-2007
Your story resonates with me so much. I just had a baby last week. All along we calculated that he was one week ahead of the LMP estimate, but he was still not coming. Everyone told me to relax and he would come when he was ready, but I "knew" there was something more to it. At 36 weeks I lost my mucous plug, had mild ctx for about 12 hours, then it all stopped. For like 4 weeks, nothing! Finally the doctor, running through some scenarios for me (I asked) mentioned a possible cord issue, but he said it was so unlikely to be the reason that we was not even worried about it. But in my heart I went "yes, I know". weird, huh?

All along, I had been feeling like this might be our "intervention" birth. Like a C-section or at least some interventions would be needed. I told my husband I did not want a homebirth this time for that reason.

Well, when I finally went into labor, I told DH I wanted to go to hosp right away in case it stopped again so I cold get pit, and at the very least because I had decided to get an epidural so if there were an emergency, I could be prepped faster. (I also lightened it by telling him maybe we could just relax this time.) I am very anti-drug and have had a homebirth and a bradley birth, so he just stared at me and said "I have never heard you talk like this before". I can't explain it but I knew I needed to do it. He said he would suport me if I felt that strongly.

In the hospital I was a 7 with absolutely no pain. I doubted myself a few times, but eventually stuck to my guns and ordered an epidural. The nurse and even the anesthesiologist tried to tell me I didn't need it, but I just *felt* I would.

Well, the ctx stopped and I thought oh man! I made the WRONG choice. but no, it was not just the drugs. As feared, our baby could not descend due to a very tightly wrapped chord. He was decelling. My OB is so awesome and knew how much I wanted a natural birth, so he "helped" me dilate and deliver him vaginally with no tearing. Thank God I had asked for a one dose epidural that would wear off in 2 hours, so it was not really working much by the time I was pushing, I could really push pretty well, but for "surface" pain (sensation on my skin) it was still working pretty well, so I did not feel the perineal or cervical stretching as much. I know I could not have handled that drug free and he would have had to section me, but I was calm. It hurt, but it was do-able. Thank God! Also, they were supposed to have started another drug if the labor went long. Somehow, although it was hooked up, it did not begin to drip, so I never got it. When our baby came out he was in some distress (pea soup meconium) and the cord was so tight he could not come out. My OB said my pushing was really great, so he told me I had to get him out right now and he cut the cord while he was inside me. (I know most docs would have vut me at that point, but he was so encouraging.."you can do this!") I know that was risky, but I am so glad he did it. I got him out in one really huge push and no tear for me! (I am still sore from all this!) and then they had to resucitate him and do a bunch of stuff that would have usually upset me, but I was really in awe of it all. A hundred years ago, my little boy would have died. I never thought I would be sitting here in awe of the medical world I fight against so much. But I am. They saved him and I feel so blessed. The whole experience at the hospital was different for me this time. Even the young nurses who came in and helped my terribly weak and sore body into the shower, despite the blood and the smells...I was so in awe of their compassion. I had to stop and ask myself if I could do that for a stranger. It has given me a whole new outlook on these people.

It is so odd for me to be in this place, but here I am. And bottom line: I have a beautiful healthy baby and no C-Section scar because I listened to my inner voice and went against my better judgement. Funny how life teaches you stuff huh? I am so glad both our babies are fine.
pamamidwife's Avatar pamamidwife 04:22 PM 10-04-2007
I am really not providing any information that's new - it's just somehow hidden behind all the "cord around the neck" myths that seem to permeate our culture (anyone see "knocked up"? there was talk about that even there!).

Our bodies are amazing. Given natural circumstances where women are free to move as they wish, no forced or sitting pushing, no drugs - our processes and labors work to HELP our babies, rather than against them.

Our bodies aren't antagonists to our babies. Sometimes there are complications, but in unhindered birth this is very rare. That's when we need surgeons. But not in 40% of all births.
QueenOfThePride's Avatar QueenOfThePride 04:24 PM 10-04-2007
Thank you for sharing, mother4good.
zonapellucida's Avatar zonapellucida 04:28 PM 10-04-2007
I am so glad everything turned out okay!!!!!
mrskennedy's Avatar mrskennedy 10:43 PM 10-04-2007
Pamamidwife, I love you and I love your blog!

. . . . .
PP's, glad your babes are ok!
Snork's Avatar Snork 06:30 AM 10-06-2007
I have to say I agree that your baby is very blessed. Some nuchal cords are fine, some are a problem. I tell my clients that one in 5-6 babies (guestimate from my own experiences) have a nuchal cord, and maybe only one in ten of those have an issue with it. But when it is an issue it really is. Less than average protective whartons jelly, thin unhealthy cord (small placenta), otherwise compromised baby (mother smokes for instance) all add to the risk factors and some of those we dont know about until after the birth.

Sure some true knots are no problem. However the majority DO cause a problem. I have seen many midwives AND doctors chatting about how amazing that the knot didnt cause a problem till we take a closer look at the cord and find it was NOT a true knot at all, just a large bubble of whartons jelly with vessels near the outside, and was mistaken for a knot. What I am saying is that I have seen babies stillborn due to true knots, it does happen, but not all true knots cause this. Combined with a nuchal cord, you did have a near miss and your baby is very blessed.

Glad your precious baby is okay. You did good!
wannabe's Avatar wannabe 12:57 PM 10-06-2007
Originally Posted by Snork View Post
Less than average protective whartons jelly,
Snork, in the OP's pics it looks like there's no Wharton's jelly on either side of the knot would that be a reason for or a result of the knot?

My first baby had a true knot in his cord, and the doctor told me at his 20 week ultrasound.
Now that is something I would NOT want to know!

We have all these ideas about the cord that seem to undermine the perfect design system that was created in the first place.
well, there you go - you believe a benevolent god created you from scratch for everything to work perfectly. The reality, that we're cobbled together from whatever mutations arose and got kept, is why we DO need surgeons in a good 5+% of births.
Rockies5's Avatar Rockies5 01:37 PM 10-06-2007
I just had to comment on the very cool pictures. You'll always be happy you took them.

and congratulations on the LO.
Rockies5's Avatar Rockies5 01:41 PM 10-06-2007
Originally Posted by wannabe View Post
The reality, that we're cobbled together from whatever mutations arose and got kept, is why we DO need surgeons in a good 5+% of births.
wannabe, this is a belief that you follow. No more a reality then any other belief out there.

I believe your % of when surgeons are needed in birth are off.
Marilyn82's Avatar Marilyn82 04:15 PM 10-06-2007
notneb's Avatar notneb 05:55 PM 10-06-2007
OP, congrats on the safe birth of your babe. Those pictures of the knot are so neat! I wish we had taken some. My DS also had a true knot in his cord, although it didn't cause any problems during birth. I was so impressed with the size of it when he was first born. It was baseball sized and pulsing along with the rest of the cord. DH was totally impressed. He still talks about it... "And then his shoulders were born, and the rest of him slipped out, and all I could see was this GIANT knot in the cord and his HUGE purple feet."
veganf's Avatar veganf 11:18 AM 10-07-2007
I'm glad everything turned out well for you and baby!

I've had one baby with a nuchal cord, one with a true knot, but never both together. My babe's true knot did not look tight like yours though. Here's mine (not exactly G-rated):
ldsapmom's Avatar ldsapmom 03:57 PM 10-07-2007
The difference in tightness between pictures (the post above mine and the OP's) could be because of time passed when the picture was taken -- each cord's amount of time exposed to air. Once the cord is exposed to the air, the Wharton's Jelly solidifies, and the cord goes from being nice and plump and full-looking, to appearing as a flat ribbon. Vegan, yours could have appeared tighter, and been pulled tighter, had it been left longer exposed to air -- I am assuming your was only exposed for minutes as your placenta is still attached. Another point, while it is still attached to the placenta, there is still transfer, and that can keep the cord still pulsing and full with that cushy Wharton's Jelly.

Of course I am of the belief every baby's survival is a miracle .

Thanks for the pictures, ladies!
JessicaS's Avatar JessicaS 07:19 PM 10-07-2007

My dd's cord had a true knot, her cord was also short, which seems to happen in my family, she just got "stuck," they could see her head but she wouldn't come out.

I was in a pretty NB friendly hospital and they were bewildered, she was "right there" she just wouldn't come out. They didn't do the c-section from the decels but I went into shock.

The cord issues weren't known until after they were taking her out though. The surgeon and my Dr went "'Oooohhhh look at that cord!!!"

My Dr called her "knot in cord" baby for months afterwards. (he is kind of weird)

Just a fluke thing, my mom and sister both had c-sections due to short cords but they also both had VBACs afterwards so I feel confident that there won't be a repeat.
MiamiMami's Avatar MiamiMami 07:29 PM 10-07-2007
My dd had a true knot as well. She was born via unnecessary c-section for FTP after a whopping 4 hours on pit and AROM :

After she was out the OB's made me believe it was divine intervention causing the FTP, otherwise she might not have survived delivery. :
loraxc's Avatar loraxc 06:29 PM 10-08-2007
I meant to mention that my DD also had a triple nuchal cord along with the true knot. I saw the knot, and it looked very much like veganf's picture. I never heard a single nonreassuring word about DD's heartrate throughout my 34-hour labor (and I transferred at 26 hours for augmentation and pain relief...DD was posterior). Funny how these things happen.

After she was out the OB's made me believe it was divine intervention causing the FTP, otherwise she might not have survived delivery.
I am so freaking sure that if I'd had an OB they would have sectioned me and given me this same story.
jennica's Avatar jennica 02:51 AM 10-09-2007
Originally Posted by Snork View Post
What I am saying is that I have seen babies stillborn due to true knots, it does happen, but not all true knots cause this.
But how do you know these babies were stillborn because of the knots? How do providers determine cause of death in cases like that? Is it just pinned on some physical thing that the provider can see, like a knot or a nuchal cord? What if a baby had a knot in the cord, but also a birth defect that was not physically apparant? Would you blame the knot, or are you only speaking of cases where all other causes of death have been ruled out? I think this statement you made above is very scary for women to read, and it is said with much confidence, however, to me it seems like pure speculation, and therefore should not be stated as solid fact if we really don't know why these babies died.
ericswifey27's Avatar ericswifey27 03:05 AM 10-09-2007
Originally Posted by MiamiMami View Post

After she was out the OB's made me believe it was divine intervention causing the FTP, otherwise she might not have survived delivery. :
Mine too. About my apgar of 9 baby: " Oh look at the cord wrapped around his neck. Thank goodness we didn't wait any longer" or something to that effect. Barf. No we in that decision.
jennica's Avatar jennica 03:14 AM 10-09-2007
Originally Posted by wannabe View Post
well, there you go - you believe a benevolent god created you from scratch for everything to work perfectly. The reality, that we're cobbled together from whatever mutations arose and got kept, is why we DO need surgeons in a good 5+% of births.
Whether we were created or whether we evolved, the result is the same. Either we were designed from scratch by a creator and therefore our bodies are made to work perfectly, or, we evolved over hundreds of thousands of years and therefore we evolved to work perfectly. The reason that every single baby is not born vaginally with no problems at all, in either theory, is likely the same reason why every single baby is not born perfectly healthy, or why every single adult does not live to see old age, or why every single human is not fertile, or countless other examples. I don't know the answers to any of those questions, but sometimes stuff happens, and things don't run smoothly, despite our perfectly designed bodies, and/or, our perfectly evolved bodies. However, we are not "cobbled together". If a mutation arose that did not work, it quickly died out. Only mutations that worked survived.