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What to do about the cord?

3K views 57 replies 20 participants last post by  yvonnemlv 
#1 ·
We are planning our 3rd baby to be born at home with daddy catching. We have heard various ideas about what to do with a cord that is wrapped around the baby's neck. Dr. White's "Emergency Childbirth" essentially says to not worry about it, especially if the baby is still getting blood from the placenta. A doula friend of mine said that cutting is necessary as soon as it is apparent that the cord is wrapped around the baby's neck.

With my 1st, the OB cut the cord, as it was wrapped twice around. With my second, the cord was wrapped around once and the OB slipped it over the baby's head.

It is my understanding that about 80% of births have "cord issues". So any thoughts about what we should do? The baby is due two days from now...

Regards,
Jenna
 
#2 ·
Hi Jenna, welcome to MDC! I see this is your first post and you came straight to the UC forum.
I'm curious, from where did you find us?

The cord is not going to be an issue in the vast majority of spontaneous births. (By spontaneous, I mean that your body decides when to get the baby out, not you deciding that at some arbitrary time.) In that case the baby's head should move down through the birth canal in one or two contractions, and the rest of the body should follow in one or two more contractions. It's not normal for the baby to be hung up in the birth canal -- that's a signal that something is amiss. It doesn't necessarily mean that the baby is in distress, but there's definitely a greater potential for distress. So you really want to shorten that time as much as possible, by allowing the birth to be completely physiological -- no distractions to the mother, no coaching on when to do this or that, no checking for dilation, etc. Just let the body do its thing, and let it tell you what to do, in terms of position, movement, noises, bearing down, etc.

Your doula friend is wrong. (I'm guessing she only attends hospital births?) In the majority of cases, like you say, the cord is wrapped around the neck. However, in the vast majority of those cases, it is not constricted, nor is it constricting the baby, so it is still able to supply the baby with blood (and therefore oxygen) which is extremely important for the baby to have until it starts breathing on its own (which may take a minute or two.) For the baby to be cut off from its oxygen source prematurely is to put its body into a state of shock and distress, which is why so many hospital-born babies need help getting started breathing. The only time the cord should be cut before the baby's body is born is if the baby is in severe distress (grey instead of purple or red scalp/face,) and needs to be born immediately in order to start CPR, and it is suspected that the cord is preventing this from happening.
 
#3 ·
I think.. take it as it comes. If it is loose and not compressing the neck so much, then let it be. If it is loose enough to remove, you may want to do that. The cord acts as a backup system to the lungs during those first few minutes of life while the systems all start working outside the womb, so I feel it is best to try and leave that intact as long as possible.

mostly, follow your gut, both of you and it should work itself out all right. Hope you have a wonderful birth!

--yvonne
 
#5 ·
Blueviolet-
How did I come to MDC? I have been subscribing to Mothering for the last four years or so and have felt continuously supported in the choices that my family has made for our family with the concurring philosophies in the magazine.

Part of this lead me to train as a doula. Of course, with that training, the stress is on supporting the mother and doing nothing clinical.

I have every confidence that the baby and I will work naturally together throughout the birth. My husband is not going to be checking for dialation or "coaching" in the hospital sense. We both believe, I especially, that women's bodies were meant to and constructed to birth naturally. Our first two births went well and I think that my body knows what to do.

Thank you for your popsting. I'm sure that my husband will enjoy reading it, along with the others.
Regards,
Jenna
 
#6 ·
I have to add that I've read that in cases in which the cord is especially short, it's usually possible for the baby to just somersault out. In other words, the head stays at the perineum as the body comes through.

I'm interested to hear what others have to say about this...
 
#7 ·
I have talked with a couple of my local midwives about this topic -- I am an apprentice and a doula and I see a lot of different practitioners deal with this differently. What I have come up with is that there are two schools of thought, the more predominant do-something-with-the-cord school, and the always-somersault-the-baby school.

So, right this moment, as a person who catches babies, this would be my order of preference --

feel around the baby's neck for cord, as gently as possible. If there is cord, try to unwrap it. If it won't unwrap, see if you can slide it down over the baby's shoulders so that the baby is born through the coils, kind of like being born through a coiled spring. If that doesn't work, see if mama can push shoulders out on the next contraction and somersault baby out. Clamp and cut the cord as a last resort.

Some midwives would rearrange that list and just try somersaulting the baby out every time you see a cord. I think that would work most of the time and seems less interventive because you don't have to feel for the cord, which is invasive. However, I have seen a couple of births where the babies were just totally tied up in the cord, with it wrapped around shoulders and abdomen and neck and I wonder if slack wasn't created somehow if they would have had enough remaining cord to descend. In one of those cases it was an ob birth and she cut the cord. In the other it was a hospital midwife and she helped the baby birth through the spiral. The other thing about the somersault maneuver is that I like to manipulate the baby's head and body as little as possible and I wonder about whether or not trying to guide the baby's body in a particular direction might lead to more tearing.

It would take a lot to get me to clamp and cut a tight cord. Maybe a more experienced midwife could comment on the difference between a baby who doesn't descend because of cord issues and a baby who doesn't descend because of tight shoulders. I saw a baby once in the hospital who had her cord cut and clamped and then had about a 90 second delay before her sticky shoulders released and she was born. I was holding my breath the whole time and praying. The person who was caring for this mom didn't even try to move the cord, though it was wrapped around twice and appeared tight.

One extremely important thing -- you MUST clamp the cord before it is cut. This would be hard to do on the perineum without hemostats. I just can't think of any reason why you would need hemostats at an unassisted birth. I can't remember the last time I unwrapped ours at a homebirth.

Good luck!
 
#8 ·
So I am on the somersault side of things. It is way too compromising to cut the cord on the perineum and if you can loosen the cord enough to put clamps on then it is going to be loose enough to somersault.
I think that careful handling of the cord after delivery of it in that you should use something that has no rust on it and has been boiled up or baked---
 
#9 ·
I don't check for cords. At all. If there's one thing that routinely hurts women in birth, it's someone checking for a cord around the neck.

The difference between a stuck shoulder and a cord issue is that the baby with the stuck shoulder will not rotate. Most babies, even with short cords, will. That's because with the stuck shoulder, the baby cannot rotate. If the problem is a short cord that's hanging baby up, there's still rotation MOST of the time.

I don't think it's necessary to even move the cord over the head. In my eyes, that's alot like cutting it. Any fiddling with the cord will start the contraction of the Wharton's Jelly and begin the vessels clamping down. Exposure to air is also bad, as it does the same thing.

I have done the somersault thing a couple times, but I realized that I don't have to do it most of the time. If the baby's coming out with a somersault, it will come out without any fancy maneuvering at all. At least, that has been my experience. The cord may get tighter as it emerges, but it's not that big of an issue overall unless the baby is flying across the room or pool.
 
#11 ·
I would have to agree with pam for the most part I do think that there is an occasional need to somersault a baby but I haven't moved a cord over a head in years maybe 15--- but I also think that touching a cord is not the end all and be all because more than 20 years ago it was standard practice and we would see almost all baby's cords continue to pulse. So I don't think that they are that fragile either so especially if mom or dad has hands there and touches something don't get worried- its going to be alright.
 
#12 ·
This is a good discussion, very interesting!

Defenestrator wrote: "feel around the baby's neck for cord, as gently as possible. If there is cord, try to unwrap it. If it won't unwrap, see if you can slide it down over the baby's shoulders so that the baby is born through the coils, kind of like being born through a coiled spring. If that doesn't work, see if mama can push shoulders out on the next contraction and somersault baby out. Clamp and cut the cord as a last resort."

I'm trying to figure out to phrase this so it doesn't sound like I'm arguing with you.
I guess I want to offer the viewpoint (and if I remember right Pam touched on this) that is not "just the way it is" when you give birth. (This is new territory for me writing on this, so I feel like I'm stumbling a bit, so bear with me...) I feel like, in a way, checking for the cord in a normal spontaneous instinctive birth is like timing contractions, checking dilation, supporting the perineum, etc. In other words, like we cannot trust the process to unfold normally, we have to get in there and proactively protect ourselves from it. This is an intervention and an interference, to some degree. Some people might feel it's a small enough thing that the potential benefits would far outweight the risks, but to me it would feel completely unnatural to stop in the middle of that most intense part of the birth and think, "I have to check for the cord now." A partner could do it, but that would put the partner in the role of midwife (which neither my husband nor I wanted.)

There's also the question of whether or not it's actually necessary and whether it can in itself cause harm. As to the former, I admit I'm not really understanding the logic behind creating slack in the cord -- why would that help the body to born? And to the latter -- what if the cord is especially fragile? Or if, like Pamamidwife says, any handling of it in the air begins the process of ceasing the flow of blood through it.

It just seems to me that the best course of action is first to let nature do its thing, and only when that fails to try something else. I wouldn't plan on doing anything with the cord unless I had a clear intuitive message that something was wrong. (One thing that is so striking to me about so many UCs stories -- as different from assisted births -- is how often the mother has a deep knowing when something is amiss, and automatically does what needs to be done, often without any medical training at all.)

I also wonder if fears about the cord and the feeling that something should be done with it has to do with not really comprehending (generally speaking, in our society) what normal birth is. If birth is always acted on by outside sources, and if those acts become so habitual that they no longer seem "other" or separate from the basic process, then it will not even occur to us that the body would behave differently if not so acted on.

"The other thing about the somersault maneuver is that I like to manipulate the baby's head and body as little as possible and I wonder about whether or not trying to guide the baby's body in a particular direction might lead to more tearing."

I agree about not manipulating the baby's body -- but in picturing the somersault maneuver what I was thinking was that the body would automatically somersault out as a reaction to a short cord... seems like simple physics to me.

"One extremely important thing -- you MUST clamp the cord before it is cut."

I'm curious, do you know the rate at which blood loss would occur if the cord was not clamped? I'm assuming -- if the clamp is a 'must', that it would be significant?
 
#13 ·
cords do not have to be clamped before cut-- the reason we do it is because some few babies have some continued circulation to the area and if this happens the baby can loose too much blood this way. I have seen and done cords where you cut then clamp when done this way after the cord has stopped pulsing for a while the residual blood that was just in the stump drains and the clamp is there for insurance incase there is some increased circulation to the area.
If you think about lotus births there is no clamping there----
 
#14 ·
RE: clamping the cord before it is cut:

I have never seen a cord cut on the perineum without clamping, but I have seen one extremely short cord break at birth as the baby was born and blood sprayed everywhere. The blood loss certainly seemed significant -- perhaps it wasn't enough to actually endanger the baby but it certainly made for a chaotic scene. I can imagine the fear and panic that might occur as a baby *appeared* to be bleeding to death, whether or not it actually was.

It is totally different, of course, to talk about the need to clamp the cord after birth, once it has stopped pulsing and the placenta has been birthed. I think that an unclamped cord would probably trickle bleed at that point (and I have seen some oozing when the cord tape wasn't tight enough) but wouldn't cause the immediate panic that spraying blood would. I have not personally experienced a complete lotus birth, but I have helped a family cut their baby's cord at 24 hours and we didn't clamp it at all then.

So, a clarification -- I was talking only about clamping if you were going to cut a cord around the baby's neck before birth. And, as I said before, I would be extremely, extremely hesitant to cut a cord on the perineum. Essentially, I would have to be convinced that the baby wasn't coming out any other way.

I wish I had more time to answer your post, blueviolet, in a more eloquent way, but in 100 words or less I guess I want to say that I agree with nearly all of what you said. I think that the problem that I ran into is that the best answer to the op's question would be "Birth is a natural process that rarely requires intervention. If there is a problem with the cord at the moment of birth you will most likely have an intuitive sense of what needs to be done to fix it." But what the op's question and seems to be asking for is for some kind of alternative technique to the extremely interventive method of cutting on the perineum, so I answered in that spirit. I am still constantly evolving my opinions on all kinds of interventions, from heart rate checks to position suggestions, and will likely change my opinion on dealing with nuchal cords many times over the next few years as well. I am definitely willing to be convinced that it is worth waiting until you actually see a problem before acting and that we have to make sure that the action isn't harmful itself.

Good discussion.
 
#15 ·
Quote:

Originally Posted by pamamidwife
I don't check for cords. At all. If there's one thing that routinely hurts women in birth, it's someone checking for a cord around the neck.
Yeah! The only thing I can add to this discussion is: OUCH! My daughter had her cord around her neck. My midwife checked, she tried to loosen it, and it freakin' killed me! I begged her to stop, and my baby was born with the cord still wrapped there. No problems (until after it was cut.)
 
#16 ·
ok so if a cord is cut before it stops pulsing it is a pretty brisk bleed-- would not want that to happen very often- you have to remember a baby has very little blood. so if you have something to tie a cord off with if the cord breaks and is spurting do it. The best idea is to just wait to cut a cord until after the placenta is born and it stops pulsing. if you do not wait you may want to tie off before cutting
 
#17 ·
So, mwherbs, that is opposite what you said before, that the cord didn't need to be clamped before cutting it. I just want to make sure people are following this as is your intention: that it does need to be clamped before cutting if the placenta is still attached because the baby is still sending blood out, in the promise that it's still going to receive what it needs from the cord coming from the placenta. There's a perfect exchange that occurs before the separation of the placenta.
 
#18 ·
Quote:

Originally Posted by pamamidwife
So, mwherbs, that is opposite what you said before, that the cord didn't need to be clamped before cutting it. I just want to make sure people are following this as is your intention: that it does need to be clamped before cutting if the placenta is still attached because the baby is still sending blood out, in the promise that it's still going to receive what it needs from the cord coming from the placenta. There's a perfect exchange that occurs before the separation of the placenta.
???????????????????????
I did write 2 posts and to sum up and in agreement with what you are saying
you do not have to clamp a cord to cut it- IF IT HAS STOPPED PULSING and the placenta is delivered--- or even if the placenta isn't delivered and it has stopped pulsing-- but tying it off afterwards is just insurance that won't hurt
I do not think it is ever necessary to cut a still pulsing cord but in the eventuality that I don't know about or incase a cord breaks at birth and you do not have clamps-- use your hand to grab the end of the cord and then use a cord tie to tie it off because the baby wasn't really ready to stop using that pathway for oxygen----
the best use of cord clamps I have seen is to define the area a cord needs to be cut for siblings---- cut between here and here--- could be done with ties as well------
 
#19 ·
Defenstrator, I just want to say that I'm glad that you're posting here, the different ideas make for a good thought-provoking discussion. I definitely don't want you to feel like I'm trying to run you off. You have an openness of heart and thought that is very important to me personally, in terms of the kind of people that post in this forum.


Defenstrator wrote: "So, a clarification -- I was talking only about clamping if you were going to cut a cord around the baby's neck before birth."

I think any confusion about what you meant was probably because I quoted you out of context, I do that a lot because I have in my mind the whole thread when I post, forgetting that some people may just be reading one or two posts before replying.


"And, as I said before, I would be extremely, extremely hesitant to cut a cord on the perineum. Essentially, I would have to be convinced that the baby wasn't coming out any other way."

Yes. I think that's the concensus, here at least!
 
#20 ·
Blueviolet (and mwherbs, who sent me a pm) no offence taken! I love discussions like these where basic assumptions are questioned. And I have no problem admitting when I am wrong or when I haven't been clear enough to communicate what I intended to communicate.
 
#21 ·
:

good discussion! not to take it out of the philosophical and into the basics, but just thought of a quick question, instead of starting a whole thread on it...we don't plan to clamp, but we do have dental floss around in case we need to tie the cord for some reason. all the talk about sterilizing has mentioned scissors and shoe laces/embroidery floss; would dental floss need any pretreatment? my inclination is no, but i have less fear of bacteria than most, so i'm not sure if i'm missing something. tia!
 
#22 ·
Hi SP -- my placenta hadn't come out after 2 hours, so we did end up cutting
Finn's cord then. Didn't tie it off, just ran the scissors under hot water and cut it 1inch from belly button. It healed nicely and fell off just 6 days later.
 
#24 ·
Our planned UC of baby #3 is now two days "overdue". When I started this thread, I hadn't expected such a great discussion. Instead, I thought that I'd a get a quick answer (which) I did and the discussion would end there.

Now having read the wisdom contained in the discussion, I am wondering about our cord options. I'd figured that once the baby was born, we would wait until the cord stopped pulsating and then clamp at 1.5 to 2.0 inches from the baby's body, as recommended by the pediatrician. I also had assumed that the placenta would come out within a short time, i.e. a couple of minutes to up to, maybe, 10 minutes. Clearly, from the experience of some who have posted on this thread, the placenta does, and can, remain in utero for a while.

I was advised by a doula that if the placenta is not out within five minutes that the cord should be pulled on gently to detach it from the uterus. She said that if this is not done then the cervix closes up and the retained placenta needs to be removed surgically. My thought about this is the "pulling" is an intervention that leads to the subsequent intervention of "surgery". Additionally, the thought of going to the hospital after a successful UC to have a retained placenta removed is terrible to me.

I am open to any suggestions about what is best to get the most blood into the baby, where to clamp (if this is even necessary), and thoughts about a lotus birth.

Thanks in advance,
Regards,
Jenna
 
#26 ·
" was advised by a doula that if the placenta is not out within five minutes that the cord should be pulled on gently to detach it from the uterus. She said that if this is not done then the cervix closes up and the retained placenta needs to be removed surgically. My thought about this is the "pulling" is an intervention that leads to the subsequent intervention of "surgery". Additionally, the thought of going to the hospital after a successful UC to have a retained placenta removed is terrible to me."

just my opinion.. but i waould personally never pull a cord of a placenta that has not detached it's self.. I never never heard that cord traction would encourage seperation...and *forcing* seperation can encourage heavy post partum bleeding...and in rare cases uterine prolapse.. i did hemmorahge after my third birth due to the midwifery student applying to much cord traction..i tend to think that if yor placenta is taking a while to detach it is probably for a reason.. it think the risk of your cervix closing on the placenta is much less than the risk of doing some damage by pulling the cord....generally i would only pull the cord very slighlty to feel for a *give* to see if the placenta is detatched...i would more rely on uterine massage, herbs and breastfeeding to encourage the birth of the placenta....and again in my personal experince.. pulling the cord to detach the placenta you risk fragmenting it.. and a retained piece of placenta might be harder to deal or recoginize and can also cause post partum bleeds.. i would be more likely to seek medical attention for a retained placenta than take my chances with pulling the cord, but I also have a lot fo faith in delivering it without the need to resort to inavsie things to get it out ya know what i mean..
 
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