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Nuchal Cord - Scapegoat or Real Danger?

cesarean fetal distress fetal heart rate nuchal cord pushing stage umbilical cord

When you hear that a newborn baby's umbilical cord is wrapped around their neck, it can be a frightening moment, and you might ponder the potential life-threatening implications. You may also consider how fortunate it is that the baby's life was saved in the hospital! In this post, I will shed light on the truth surrounding this entirely commonplace scenario in the delivery room. I will explain why there is no need for undue concern.

Let's begin by examining the umbilical cord more closely. In the middle of the umbilical cord, there is a thick vein that carries oxygen-rich blood and essential nutrients from the placenta to the baby. This thick vein is flanked by two thinner arteries, which transport carbon dioxide and waste materials back to the placenta for disposal. These three vessels are encased in a gelatinous, jelly-like substance called Wharton's jelly. Thanks to the presence of Wharton's jelly, the umbilical cord possesses flexibility and elasticity, safeguarding the delicate vessels within from harm. The umbilical cord begins developing early in pregnancy, measuring approximately 50-60 cm in length, with an average of 55 cm. While your baby is still in the womb, and there's ample space to move around, they often twist, turn, and maneuver, causing the umbilical cord to sometimes loop around their own body and neck. In fact, it's not uncommon for babies to even form knots in the cord with their movements! Hence, a cord wrapped around the neck is a regular occurrence, with approximately one in every three babies being born this way. Interestingly, research has suggested that umbilical cord entanglement is slightly more prevalent in male babies, possibly because they generally have longer cords. Therefore, a cord wrapped around the neck - what is also called nuchal cord -  is entirely normal and poses no cause for concern. Thanks to Wharton's jelly, the cord can withstand bending, and it does not pose any issues during fetal development.

Of course, there are unfortunate instances where a baby does not survive in the womb, and upon delivery, the umbilical cord is found wrapped around their neck. This occurs in roughly a third of fetal deaths, just as it does in around a third of perfectly healthy births! As the exact cause of fetal death is often unclear, it's easy to attribute blame to nuchal cord. However, this is an oversimplified explanation.

What about the scenario when a cord is around the baby's neck during birth? Even if the cord is wrapped around the baby's neck, possibly multiple times, it rarely becomes taut. Typically, the loop remains loose due to the cord's elastic and gel-like nature, presenting no issue whatsoever. In rare instances when the cord does become taut, our instinctual fear might lead us to believe that the baby is in danger of strangulation. Fortunately, this is not the case, as the baby has not yet initiated breathing during birth. Instead, they continue to receive oxygen through the umbilical cord. While it's true that tension in the cord can temporarily reduce blood circulation, leading to a brief oxygen deficiency at the moment of birth, cutting the taut cord immediately would be the worst course of action. Thankfully, medical professionals do not take this approach. Even when the cord is under tension, there is always some circulation. If it were cut immediately, the baby would have to rely solely on their underdeveloped breathing in an oxygen-deprived state. That's precisely why the better and, fortunately, standard practice is to leave the taut cord as is, allowing the entire body to be born. As the baby emerges, the tension in the cord is released, instantly restoring circulation and resolving the baby's oxygen deficiency. The loosened umbilical cord can then be carefully looped over the baby's neck.

There is also the fear that a cord around the neck might obstruct the baby's descent, potentially necessitating a surgical birth. This may seem logical, but it is an unfounded concern. During birth, the baby, uterus, and placenta all move together and descend in unison. Furthermore, at the moment of birth, the baby naturally curls up, reducing the distance between their belly button and the placenta even further than at the beginning of labor. In extremely rare cases where babies are born with very short cords, experienced midwives can effortlessly adjust the newborn's position after birth to address any concerns.

In the case of cesarean births, doctors often inform parents that the umbilical cord was around the baby's neck, but again: this occurs in approximately a third of cases, just the same way as with vaginal births! Upon hearing this, parents may find comfort in the belief that the surgical procedure was necessary due to the umbilical cord's presence causing fetal distress. However, in reality, there is no basis for this assumption. A cord around the neck is a completely normal physiological occurrence, as it happens in approximately a third of cases. Fetal distress is far more likely to result from interventions such as amniotomy, Pitocin administration, or induction, or even the need to lie down on the bed in supine position during labor.

For this reason, the common practice of manually checking for a cord around the baby's neck during the pushing stage in hospital births is entirely unnecessary. Since the cord does not pose a threat during birth, such checks are not warranted. This is further supported by the fact that during undisturbed births, mothers often take it upon themselves to loop the umbilical cord over their newborn's neck after birth.

In summary, it is indeed common for babies to have their umbilical cord wrapped around their body or neck, and they might even create loops or knots with it. However, this is a completely normal physiological occurrence, and there is no need for worry whatsoever. It does not endanger the baby and does not complicate the birthing process.

Enjoy the remaining time until birth!


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