02/10/2020
It is still a really big misconception that if a baby is born with a cord wrapped around their neck that the baby is danger. And while the situation can become dangerous (In rare cases) your healthcare provider will know what to do whether it be a midwive or an OBGYN. Sometimes it's just a matter of unwrapping the cord if it is loose enough to do so
Facts about nuchal cords (umbilical cord wrapped around the neck at birth):
#1. About 1 in 3 babies has one! YES, REALLY! There’s nothing to be scared of, complications are rare (we will look at facts and peer reviewed information below). They’re usually perfectly normal and fine, the OB, midwife or birthing person will simply unwrap it! The baby is not being harmed, since they don’t breathe air yet, and the vessels in the cord are surrounded by a thick and strong substance to protect them from danger and compression.
#2. The cord does not get tighter as the baby moves down and out, because the uterus and placenta move down with it!!!
#3. Although cord accidents are possible, the risk is very, very low. Even if the cord is looped multiple times! The cord being compressed can be an issue but in a “normal” physiological birth, where the birthing person can listen to their body and follow what it needs along with moving around, this is also low risk of happening. Avoiding artificial management of labor and induction greatly reduces the possibility of issues.
#4. Some professionals speculate that nuchal cords are actually protective, especially if the baby has a long cord! The wrapping of the cord prohibits it from slipping through the cervix after your water is broken, which is a rare, but serious complication of labor. This is just a theory.
#5. It all usually happens so fast that you may not even know if your baby had a nuchal cord! All but 2 babies have had a nuchal cord, out of all the births I’ve been to. None of them knew until we told them and showed the picture I snapped. The provider simply unwrapped the cord. And placed baby on the mothers chest.
Fun fact: I’ve also been at a birth where a baby also had a nuchal hand, which means he was born with his hand right beside his face and his head, hand, and wrapped cord came out all at once! ❤️
Fun fact 2: An umbilical cord can also have a knot and it be a non issue (there is difference in true knot). How we are created and what our bodies do are simply amazing. The wharton's jelly that is actually a tissue like substance within the cord, protects it when it’s knotted and or compressed some.
So ⬇️⤵️⬇️
What do we know about nuchal cords in utero? Research has found that a nuchal cord is not associated with morbidity or mortality for the baby during pregnancy (Carey & Rayburn 2000; Aksoy 2003; Clapp III et al. 2003; Gonzalez-Quintero et al. 2004). Unfortunately some infants pass before labor ever begins, and there is often no known reason, which can add to the devastation for the parents and family. When these infants are born they are often found to have the cord around their neck (same as a 3rd of all babies). We know and understand the need to find a reason, it seems as though providers choose to pick the obvious. However, this doesn’t seem helpful in the long term, perpetuating this fear. Parents need honest answers about the loss of their baby, even if the answer unfortunately, is ‘we don’t have answers’.
Loose nuchal cord- This is the most common type of nuchal cord and is not associated with any complications for the baby. Birth through the cord loop, or the cord can be unwrapped by his mother (or someone else) after birth. However, it is common practice for midwives to loop a loose cord over the baby’s head before the birth of his body (although some evidence shows this may not be beneficial). This practice may cause the umbilical blood vessels to vasoconstrict, reducing blood flow (Coad J, Dunstall D. Anatomy and physiology for midwives. 3rd edition London: Churchill Livingstone; 2011.) In extreme cases traction on the cord could cause it to tear, interrupting oxygen flow to the baby and resulting in blood loss from the torn cord. This tells us leaving it alone is probably best
Tight nuchal cord- According to nct.org.uk- Very rarely, a nuchal cord can be tight and very short (Reed R, Barnes M, Allan J. Nuchal cords: sharing the evidence with parents. Br J Midwifery 2009;17(2):106-9.) This will become evident because the baby’s body will not birth after the head despite contractions. The cord becomes tighter, and if left may snap because the uterus is stronger than the cord. However, a technique called the somersault maneuver can assist a baby to birth without further descent of the head and cutting of the cord.
If the umbilical cord becomes overstretched or compressed during labour, it usually leads to fetal bradycardia temporarily. These brief “variable heart rate decelerations” are not harmful. If the baby's heart rate slows to below 100 beats per minute and does not return to normal (120 to 160 for most babies) within a few minutes, measures will be taken to relieve the presumed cord compression. This includes giving oxygen and fluid to the mother or having her change position. Tocolytics may be given to slow down the contractions. If it is still not relieved, a caesarean delivery may be done- according to the pubmed study linked below.
Although the nuchal cord group had a larger percentage of infants born with Apgar score of less than 7, nuchal cords are not a major cause of fetal asphyxia [4, 7]. Similarly in this study, fetal bradycardia and variable/ late decelerations were found more often in the group with tight nuchal cords (23.53% as compared with 8.77%) and it was statistically significant (p≤0.05). Apgar scores at one minute were significantly lower in tight nuchal cord subgroup (p≤0.01). But nuchal cords did not increase fetal mortality nor had significant effect at Apgar scores at five minutes as shown in many other studies [4, 6, 7, 9] pubmed study below.
Unfortunately, until evidence-based practice is implemented widely, the issue of nuchal cords need to be discussed with parents before birth and their wishes communicated to their caregivers. We need providers to stop using the nuchal cord as a scapegoat and start following up to date, evidence based information and practices.
What do birthing families need to know? • In antenatal/prenatal sessions, let parents know that a third of all babies have the cord around their neck.
• This is almost always fine and nothing needs to be done. The cord is stretchy and rubbery and protects the blood vessels taking oxygen to the baby.
• Once the baby is born, the mother or the midwife can unwrap the cord.
• Rarely will a nuchal cord prevent the baby descending once the head is born, in which case the midwife can use a ‘somersault’ manoeuvre to free the baby so that the cord can remain intact. If this manoeuvre is unsuccessful, the worst case scenario is that the cord snaps as the baby descends, and requires clamping and or the provider has to clamp and cut.
• If the baby is slow to breathe at birth, an intact cord continues to provide oxygen and enables normal blood volume to be resumed. It may be helpful for the mother to stimulate her baby by talking to him, rubbing his back etc. Some hospitals/homebirth pro diets will provide resuscitation, should it be necessary, next to the mother so that the cord can remain intact for longer. Women can discuss this with their midwife/provider antenatally/prenatally.
• Women can/may want to discuss management of nuchal cord with their midwife/provider during pregnancy. Some may want to state clearly the umbilical cord is not to be cut without their explicit verbal consent.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921575/
https://midwifethinking.com/2015/05/13/nuchal-cords/
🔹Post words, information and credit Cari Samuelson, Sacred Sage Births 
🔹 Creator of image Thrive Birth Services of Delmarva with words on #1-5
🔹Information from PubMed, Midwife Thinking, Holistic Midwifery, Varney’s Midwifery and various other studies
