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#31 of 45 Old 01-25-2010, 10:37 AM
 
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Originally Posted by craft_media_hero View Post
So concerning true cord injuries---
Are these injuries predictable before birth? Is the only option c-section?

Bandgeek said she didn't believe that doctors in a hospital would have been able to handle anything differently; that makes me wonder if worrying about this can even be productive. If nothing can be done, then it makes no sense to stress it, yk?
Based on my research and in talking to many parents about their birth stories, I do not believe much can be done, no. Oxygen deprivation causes damage quickly. Think about it....the higher the c-section rate goes and we're not seeing ANY improvement in outcomes.

Our case is quite odd. DD had severe oxygen deprivation but never had a single heart decel. She came out not breathing, but HR 130-140. Very odd. She had to be intubated and was not breathing completely on her own until she was 4 day sold.

This is how it usually happens (hospital birth scenario which is the majority of people I've talked to):

As labor progresses, the baby starts having small decels, then all the sudden crashes. HR below 80 or they lose it altogether. Mom goes in for emergency c-section. Baby is stillborn or close to it. Baby is resuscitated, intubated, and put in the NICU. Baby suffers brain damage. Some are lucky. Many are not. Some cannot be resuscitated and die. From the time of the first sign of oxygen deprivation to the time of the c-section, many babies have gone 10+ minutes with very little or no oxygen.

So this is what has happened...doctors are doing the c-sections when they see small decels and not waiting for the crash. You'd think this would help, but for some reason, we're not seeing better numbers. I think it's partly because of inductions. A lot of the time this happens with pitocin which causes harder contractions and compresses the cord too much. These are usually the people who end up suing and winning. So on one hand, we have doctors taking babies out before they have a crash, possibly saving a few in the process (the others would have never crashed and were sectioned unnecessarily...you just never know who will be who) but on the other hand you have doctors CAUSING some of the problems. I think that's why the fetal outcomes haven't improved. It's been a toss-up.

An ultrasound can't catch it since the cord and baby move around during labor. It can happen to any mom, even the ones who did everything perfect. It happens to small babies and big babies.

My best advice? Stay away from any intervention that could cause a problem...pitocin, breaking water artificially (especially if baby's head isn't engaged yet), meds and epidurals that keep you stuck in the bed, unable to change positions easily, ect. Then the rest is just up to fate. If you think you need to go in for a c-section, go in. Maybe it'll be alright, maybe baby has already been oxygen deprived a long time. Sometimes even with oxygen deprivation, the baby has very few lasting effects. I'm not sure how often this happens, but I'm sure it's rare. I've only met one child who had severe deprivation and ended up with only mild CP. Usually they are like my DD. Because once the deprivation happens, the brain swells. When it presses against the skull, it gets damaged. Why that little girl's brain only swelled a little, I don't know. Sometimes they put cooling caps on their head to keep the swelling down. I didn't even know it was an option with DD.

All of that was based mostly on my experience and in talking to other parents.

The *numbers* say 50% cannot be predicted or prevented, even with a c-section. That's not set in stone I think since they can't go back and redo it to see how it might have turned out if they'd just done this or that. I think in my case, nothing could have been done. We're not even sure it happened during labor. It's possible it happened up to 2 days before labor started based on the ultrasound of her brain swelling when she was born.

I can't find where I read it, but I think it was something like 1 in 6000 this happens to, but I can't remember if that was all of them, or just the severe ones. Sorry.

I definitely think that no one should forgo a homebirth out of fear of a cord injury. It happens, and it sucks, but it's not the end of the world. And it's just as likely to happen in the hospital. I don't know the exact statistics on that either, but we all know there's no statistically significant difference in the safety of homebirths and hospital births, so it just makes sense to me that you just have to do what feels right for you.

When people asked me when I was pregnant with DD and they found out I was having a homebirth "What if something goes wrong?" I would reply, "So I'll go to the hospital, big deal! It's only 10 minutes away." I never dreamed that things could go wrong so quickly. Not in a million years. But it does. I don't regret my homebirth at all. I did a fair bit of "what-iffing" after she was born, but I know a lot about how birth works and now I believe nothing would have helped. And it's sad that she's disabled and very sick. But she's a wonderful little girl that has taught me SO much. I wouldn't trade her for anything. Like I said, cord injuries suck, but they aren't the end of the world. We all want perfect, happy, healthy children, but that's not what we always get. Sometimes they have genetic disorders, sometimes they get cancer. Heck I know a little girl that had HIE when she was 18 months when she choked on a goldfish cracker. She could walk and talk and now she can't and is g-tube fed. You can't go through life trying to prevent every little thing. Obviously you stay on alert and keep an eye on your kids while they bathe and try and keep them from choking. But they have to eat, they have to bathe, and we have to birth them. And $hit happens.
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#32 of 45 Old 01-25-2010, 11:44 AM
 
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bandgeek

Here's my cord story from my oldest dd (who is a happy and healthy 6 1/2 year old) condensed.

I was at home, walking, showering, etc. When my doula arrived, she was concerned that the fetal hb was not recovering between contractions. The mw arrived, agreed something needed to be done. She tried to reach in and manually feel/fix the cord and could not find/reach any problems. She looked very puzzled. We tried different positions. Finally, she felt the hb was getting too low, as each contraction slowed it and it wasn't recovering. She sent me to the hospital telling me she thought I needed an emergency c-section. I was only 5 cm and it was my first birth.

The result was a lot of nonsense at the hospital that I'll omit. Let's just say, despite my, my husband's, and my doula's telling them the fetal hb was showing distress, no one listened or checked. When I told them after only 30 minutes of being there that I had to push, no one believed me. They told me to wait. Finally, the threat of pushing prompted the nurse to hook a monitor and announce she couldn't find a hb. I was 10 cm (from 5 to 10 only took about 90 minutes!). My doula encouraged to push and push like a mad woman. I did. I did get an episiotomy. Three pushes, she was out.

Here was the cord deal: the doula and the doctor gasped. The cord was wrapped around her neck, her middle, AND her thigh TWICE, AND there was still so much cord left that it was long enough to touch the floor with a fold in it. It was freakish. The OB (in practice over 30 years), the doula (over 15 years), and later the mw (over 20 years) all said they had never seen such a long umbilical cord. Because of all this cord, it was hard to pinpoint exactly where the problem was lying inside to cause the problem. But it sure explained why the mw couldn't get it all situated when she tried, and why I carried on the big side, and why the baby never really "dropped."

My mw explained that had she known that my body would have ramped up for labor that fast, she would have kept me at home. I was the amount of time the baby could have been in distress, rather than just the distress itself, that made her transfer me. Does that make sense?

Hope my story helps in some way.

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#33 of 45 Old 01-25-2010, 01:49 PM
 
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Dispelling a Myth About the Umbilical Cord

Here is Dr. Fischbein's explanation and the best one that I've found. I think Gloria has a blog post about it too, but I can't find it now.

Hope this helps.

To PlayaMama: My brother died shortly after he was born but the doctor's didn't have anything to blame it on. I don't mean to be harsh, but I doubt it was your brother's cord that killed him. :-( *hugs*

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#34 of 45 Old 01-25-2010, 02:01 PM
 
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FTR: My DD's cord was not around her neck. It was wrapped over her shoulder. It may have gotten caught between her shoulder and my pelvic bone. Or it's possible that wasn't enough to cause the problem and it happened before labor started somehow.

I'm not sure what the blog post was saying jessica_anne. Obviously that they can't strangle themselves. That much is clear, and I agree, since they don't need to receive oxygen from breathing with their lungs until after the cord is cut. But I'm not sure if they're saying the cord is too tough to be pinched off. It sounds like it, but it's quite a claim, considering there would be no other reason for oxygen deprivation in babies except maybe an abruption, which happens in some HIE cases, but certainly not all.
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#35 of 45 Old 01-25-2010, 08:27 PM
 
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I think Dr. Fischbein was just dispelling the choking thing, a lot of docs will tell their patients that a baby can strangle on their cord and some people buy it because you usually aren't thinking that clearly when you are in labor or shortly after a c-section. Knots can happen as well as the cord getting pinched off - otherwise prolapses wouldn't be a problem. :-/

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#36 of 45 Old 01-25-2010, 08:31 PM
 
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I went back and read it again and this is what bothers me:

"And the compression of the cord almost never is an emergency or a cause for the tragic death of a baby inside the womb. When that tragedy occurs we all want to know why and often, mistakenly, we are told it was a “cord accident”."

So what else would cause the oxygen deprivation if it wasn't a cord accident?
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#37 of 45 Old 01-25-2010, 08:44 PM
 
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Good Lord, this is one of those things people go on and on about. It's SO normal for a baby to have the cord around the neck. Heck, they thrash about to no end in there! Even my daughter Bella, who was born with a lovely thick cord thirteen days ago (SO much Wharton's jelly it was insane...) had her cord around the neck.

The reason I think there's so much hype is that well, you hang yourself with rope, which kills you therefore people presume it's the same way with baby's cords being around the neck. Not so.

Now naturally there are circumstances under which infants are indeed strangulated by their cords: if mama smokes during her pregnancy, this can lead to a decrease in Wharton's jelly, which can mean less protection for the blood vessels inside the cord, so if the cord does get tangled around the neck (or the body too - don't forget the body!) it is more likely to constrict the vessels and lead to blood supply being cut off. Some recreational drugs (for example heroin and cocaine) also can lead to the same result.

I think what people get confused by is the natural correlation between strong contractions and the heart rate dropping. Additionally as the baby moves VERY low in the birth canal, it's practically impossible to get a proper reading on the heart rate (as I found out first hand) which can make it sound like there's no heart beat in between contractions. That scenario, combined with a baby who then has the cord wrapped around the neck, is probably where many of the "horror stories" have come from.

But seriously, there are many babies born with umbilical cords around the neck. It's rather commonplace actually. Rarely are there complications that might lead to an emergency situation. But, people do generally love a dramatic story, don't they! The people telling the stories, and the people who believe them need to go and do a little reading up about the "dangers" of which they preach, however...

Mama to Josie , lost 10/10/08 at 37.4 weeks .
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#38 of 45 Old 01-26-2010, 02:37 AM - Thread Starter
 
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Originally Posted by PreggieUBA2C View Post
You could ask a midwife what the time from emergency to cut is in the hospital nearest you or that does emergency c/s. At both hospitals in my area when I had c/s, the time duration from decision to cut was 45 minutes!!! BUT that was only for in hospital emergencies. If I were transported by ambulance, with a call ahead, I would be cut within 20 minutes from the time we placed the 911 call.

So, for us, a UC was actually safer in both situations. If everything went well, great, and if I needed a transfer for repeat c/s, it was still safer to be at home and call 911. The medics were literally within one minute of my home too, and when we did have to call them another time for something completely unrelated, they were there within 2 minutes with an oxygen mask on the person needing it. So stabilizing if necessary would have been within a reasonable amount of time too.

If you can obtain this info, it may cast some more light on the safety issue. Where we used to live, the difference was that if we were already in hospital, it woud be a maternity surgery, but from an ambulance, it's straight to the ER, and much faster because they have an anesthesiologist on at all times, unlike the maternity ward.
We live literally across the street from the hospital. I can see it from my bedroom window. It is good to know that their response time is faster from a phone call to the ER than from Labor and Delivery to c-section.

If we UC, I honestly don't intend on doing any fetal monitoring. I intend on tuning in and being really focused on my body, what it needs, and pushing the baby out once I feel the urge to push. I don't really intend on even checking the cervix or anything . . . maybe I'll have dp check if it's "grapefruit" sized, but I just think that if I'm sitting there timing ctx and checking myself and fetal monitoring, then I'm going to be a nervous wreck and should just go over to the hossy. Maybe choosing not to monitor the heartbeat could be considered irresponsible, but w/ dd (hospital birth), I got there pushing and had the monitor on for maybe a minute and I hated it---having it or not having it didn't make any difference in the birth. I know all births are different, but I don't think I could even go into this with the intent to UC if I really felt like horrible sh.t was going to happen anyways---I think if I felt that way I'd have no choice but to surrender myself to the hospital.


I just want to thank you all so much for sharing on this thread. I know it's not all about cord, a lot of this discussion is about fear, how people over-exaggerate, and how "necessary" or unnecessary is the medical approach to birth. So thanks a lot for sounding it out with me.

Happy and in love with my family!
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#39 of 45 Old 01-26-2010, 01:55 PM
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i never did any fetal monitoring in the technical sense. i think that it can work for some people and not for others.

for me, as an analytical person, i knew that monitoring of any sort during pregnancy, labor, and birth would keep me in the rational mind, rather than allowing myself to be deeply present (mindful) with the process therefore hindered me.

but, i think that for other people, it is absolutely the right thing to do. each of us is different and our needs are different. that is also why some choose UC, some choose MWs, and some choose BCs and/or hospitals.

it's nice to sound things out with each other. it's a powerful learning process.
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#40 of 45 Old 01-27-2010, 05:58 PM
 
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That's why they are called cord "accidents". An active baby can really get himself wrapped in it. Generally, the wharton's jelly inside the cord can help keep the vessels from becoming too compressed, but if there is a true knot, or if the baby is so wrapped in his cord that he is "bungeeing" (descends, but then bounces back up into the uterus,) or the cord is wrapped 4 or 5 times around the neck/body, it can indeed cut off circulation long enough for the baby to die. It happens, and if the baby's decels are caught early enough(if mom is in labor) then you can get help and save the baby. Maybe. if it occurs before labor, then the mom might not know til she notices her baby hasn't moved for 24 hrs...it's not common, but it does happen. I lost a brother that way as well. My mom blamed the doc til the day she died, but that is one of those things which is unpreventable...you only know symptoms if you are in labor, or feel the baby isn't moving well- then you get checked out. But sometimes it sneaks up on you, and there it is...
so for our UC, we just figured we would deal with it if we had to. Only had the fetoscope used once during labor, when I started pushing...
JayJay, great info- I didn't know about the connection between smoking and Wharton's jelly and my mom was a HEAVY smoker...thanks!
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#41 of 45 Old 01-28-2010, 12:24 AM
 
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Originally Posted by craft_media_hero View Post
We live literally across the street from the hospital. I can see it from my bedroom window. It is good to know that their response time is faster from a phone call to the ER than from Labor and Delivery to c-section.

If we UC, I honestly don't intend on doing any fetal monitoring. I intend on tuning in and being really focused on my body, what it needs, and pushing the baby out once I feel the urge to push. I don't really intend on even checking the cervix or anything . . . maybe I'll have dp check if it's "grapefruit" sized, but I just think that if I'm sitting there timing ctx and checking myself and fetal monitoring, then I'm going to be a nervous wreck and should just go over to the hossy. Maybe choosing not to monitor the heartbeat could be considered irresponsible, but w/ dd (hospital birth), I got there pushing and had the monitor on for maybe a minute and I hated it---having it or not having it didn't make any difference in the birth. I know all births are different, but I don't think I could even go into this with the intent to UC if I really felt like horrible sh.t was going to happen anyways---I think if I felt that way I'd have no choice but to surrender myself to the hospital.


I just want to thank you all so much for sharing on this thread. I know it's not all about cord, a lot of this discussion is about fear, how people over-exaggerate, and how "necessary" or unnecessary is the medical approach to birth. So thanks a lot for sounding it out with me.
I would have no issue whatsoever with freebirthing in your situation- across from the hospital that is. I woudn't anyway, but I wouldn't even feel the urge to defend myself against naysayers if the hospital was that close.

Fwiw, I freebirthed ds4 in a remote town, 4 hrs away from the nearest hospital but with medevac available and once arranged, it would take 30 minutes to arrive at that hospital. My dh used to work for the dr there and he said nobody ever left town in less than an hour and usually two hrs even with severe injuries because of the difficulties that are so common with flying there and arranging the medics and pilots.

Still, I accepted that what would be would be, and that staying in a motel for weeks from term to go to a terrible and ill-equiped hospital for the birth was not a reasonable option for us.

Presently, we are 30 minutes from a hospital and we wouldn't wait for medics because they'd be coming from the same direction as the hospital, so 30 minutes here and 30 minutes back.

I have not yet done any monitoring during labour or internal checks. My last labour was precipitous- 3 minutes- so it was never an issue and the one before was four weeks long, so same deal from my perspective. Babies came when babies and mama were ready.

I would change evrything I do if I thought it necessary though, without hesitation. I do trust my intutition and have furnished myself with ample knowledge and understanding about how this all works, although I don't think that's essential to a happy outcome; it is what I personally need to be present for my pgs and births and as a mother in general.

Well, I've been absent for 8 months, and during that time, it turns out that I have completely transformed. You are all precious. Thank you for being here and sharing your lives. You are truly a gift. namaste.gif Jan. 23, 2012

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#42 of 45 Old 01-28-2010, 12:27 AM
 
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I have had the privalege of attending about 80-90 births in the last few years and I would say out of those only about 12-15 DIDNT have a cord around some part of the baby. it is so extremely common. Midwives are trained on what to do and what to look for, for short cord, wrapped cord etc...

Yes complications can occur and know what to do/ information is key. This information would not and does not stop me from planning my UC.

Laurie, wife to James, mom to 3 girls: 8,5 & 4 and 1 handsome boy,2: planning May 2010
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#43 of 45 Old 01-28-2010, 12:13 PM
 
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JayJay, great info- I didn't know about the connection between smoking and Wharton's jelly and my mom was a HEAVY smoker...thanks!
You're totally welcome - my OB actually told me that in great detail. He's been in the business for 30 years and is very honest and very good. He actually told me this after another lady lost her baby from a cord accident (neck) in the same hospital, and she was a friend of mine who smoked. Now, who's to say exactly WHY it happened, but having lost a baby already, he wanted to reassure me I had a very very low risk. He's always full of useful information!

Mama to Josie , lost 10/10/08 at 37.4 weeks .
and my rainbow baby, Isobella Mai ...born 1/12/2010 ! in profile...
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#44 of 45 Old 02-02-2010, 02:23 PM
 
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My son had his cord wrapped around his neck twice, as did my sister. Both were born without complications. People love to tell horror stories, especially if you're doing something "unusual" like homebirth.

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#45 of 45 Old 02-05-2010, 10:49 AM
 
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I have not read all of the replies. My cousin was born with the cord wrapped twice around his neck. He was a midwife attended homebirth with a great midwife who generally handles amish and mennonite births. The cord was compressed.

It isn't always an issue of stillbirth or whether or not the baby pinks up. He did pink up fairly quickly. The midwife did not monitor hearttones often. However, he did have significant anoxia and as a result has cerebral palsy. It obviously isn't a matter of baby breathing, but instead, a matter of the amount of O2 in arterial blood and other tissues.

I have also worked with one child who had severe anoxia at birth, pinked up well, and now has a mild intellectual disability. The parents didn't notice many developmental issues until school. Could the kiddo have had these issues otherwise... yep. Is it most likely due to the anoxia.... yep. Anoxia at birth is real, and it can cause many different issues aside from stillbirth.

My DD was an unintentional UC born with the cord around her neck. However, the cord was not compressed, she came out fast, and she never experienced any loss of O2.
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