Nuchal Cord- Debunked

A nuchal cord occurs when the umbilical cord becomes wrapped around the fetal neck. A mother’s fear of her baby being strangled is understandable. Fortunately, a normal, healthy umbilical cord is protected from blood vessel compression.
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The umbilical cord provides the baby with nutrients and oxygen, so baby doesn’t actually breathe until after birth. This is the same reason babies don’t drown during a water birth, because they have an oxygen supply already attached. They don’t take their first breath of oxygen into their lungs until they are stimulated by air.

Nuchal Cord Facts
Listed below are some interesting facts about a nuchal cord from Doctor and Midwife Rachel Reed, who studied nuchal cords for her PhD.
1. Around One Third Of Babies Are Born With Nuchal Cord: The reason we hear stories about babies being born with cords wrapped around their neck is because nuchal cords are common. Most doctors and midwives don’t even mention during birth because they simply loop the cord over the baby’s head when he/she is crowning. Unless it’s a dire emergency, the cord should be left alone during the birth, to prevent further compression or complications.
Cords come in a range of lengths. In this study, cord length ranged from 19 to 133 centimeters with the average umbilical cord length being around 50-60 centimeters long. The study stated -“In this study, the long umbilical cords seemed to be associated with the increased rate of multiple nuchal cords and true umbilical knots. However, long umbilical cords did not contribute to adverse perinatal outcomes by themselves. In theory, fetal movement produces a tension on the cord that creates ample free length for delivery plus the length of the wrapped cord. Although an entangled cord may be at risk for intermittent or partial occlusion (blockage) of umbilical blood flow as previously reported, the excessively long cord may have self-protective effects to protect the fetuses from the risk of decreasing umbilical blood flow.”
The number of loops is not important. The uterus, placenta and cord all move down with the baby during labor. Doctor Reed says, “… as long as the cord is long enough to get the baby’s head out (i.e. the length of the vagina— which is not long when stretched into a baby’s head shape) then the rest of the baby can come out. It’s extremely rare— but possible— that the cord is too short to allow descent of the baby. Then you would get a lack of progress and eventual fetal distress… often these babies get into a breech position before labor.”
1. A Slippery, Soft Coating Protects The Umbilical Cord: The human body has been built to ensure our survival as a species. Even the umbilical cord has it’s own set of party tricks. A normal, healthy umbilical cord is filled with Wharton’s Jelly, a soft, gelatinous substance which protects the blood vessels inside the cord. This substance helps to protect the cord against compression as well as true knots (which can occur in around 1% of births) as a result of the baby’s normal movements. The umbilical cord is carefully designed for uterine life which is why for the vast majority of babies, the cord is well protected. However, if a medical condition was impacting the amount of Wharton’s Jelly in the cord, or if the cord was not in good condition, then perhaps there may be complications.

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2. A Nuchal Cord Does Not Get Tighter As Labor Progresses: Australian midwife, researcher and lecturer, Doctor Rachel Reed, studied nuchal cords for her PhD and put her commitment and knowledge on this topic and reviewed all of the available studies to publish a literature review. In her well-researched article, she explains, “The baby is not ‘held up’ by the cord because the whole package — fundus (top of the uterus), placenta and cord are all moving down together. The uterus ‘shrinks’ down (contracts) moving the baby downwards, along with their attached placenta and cord. It’s not until the baby’s head moves into the vagina, that a few extra centimeters of additional length are required. However, when a c-section is done for ‘fetal distress’ or ‘lack of progress’ during labor, the presence of a nuchal cord is often used as the reason… “ah ha, look ” your baby was stressed because the cord was around his neck” or “…the cord was stopping her from moving down”. The cord is unlikely to have had anything to do with the stress or lack of progress.”
Some women say their baby’s heart rate was dropping when they were pushing and studies have proven this is normal behavior for a baby experiencing pressure around the head. One study concluded, “There was a very high incidence of abnormal FHR (fetal heart rate) during the second stage of labor. However, most of these cases were response to parasympathetic stimulation due to umbilical cord or fetal head compression by mother’s over push and descent of fetal head, or temporal diminishing of uterine placenta blood flow. It suggests that it is unnecessary to interfere immediately, unless truly fetal distress.”
Giving birth in an upright position can help, whereas being on your back can make it worse— and more painful. Induction of labor with medications like synthetic oxytocin (Syntocinon or Pitocin) can also increase the likelihood of fetal distress.
Even a tight nuchal cord isn’t uncommon. A recent study found a tight nuchal cord occurred in 6.6% of over 200,000 consecutive live births, where they classed ‘tight’ as being unable to manually unloop the cord over the baby’s head. In their findings they state, “Those with a tight nuchal cord were not more likely to have dopamine administered or blood hemoglobin measured on the first day, nor were they more likely to receive a transfusion or to die.”

1. A Nuchal Cord Is Not Often Associated With Adverse Outcomes: This may be hard to believe or hear, especially if you’ve lost a baby and his or her cord happened to be wrapped around the neck. Since one out of three babies is born with a nuchal cord, it makes it quite likely that a nuchal cord will also be present in babies born with complications too. However, several studies have reported that a cord around the neck is unlikely to be the main cause for adverse outcomes. One study concluded: “Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary.”
Many other conditions (including unknown complications) can cause adverse outcomes, making it very easy to blame the visible cord around the neck. Stillbirth and loss is still an area of much needed research. Doctors and researchers themselves can’t be certain what causes 100% of cases. Something parents can do if they are worried about their baby is to keep an eye on baby kicking.
2. A Nuchal Cord Is Not An Indication For A C-Section: The College Of Obstetricians and Gynecologists in the United Kingdom advise that there is no reason to perform a C-Section due to a nuchal cord. They state, “No studies were identified of the effectiveness of cesarean section in the presence of umbilical cord around the fetal neck.” Doctor Reed agrees that there is no reason to perform a C-Section ‘just in case’ due to a nuchal cord. “They very rarely cause a problem. Why not wait and do a C-Section if/when a problem occurs? If you really want to avoid complications relating to cords, then don’t rupture the membranes (break the waters) to avoid cord compression— a much greater risk than a nuchal cord. Incidentally when the cord is around the neck, it is often protected from compression.”
3. Nuchal Cord Accidents Are Very Low: Unfortunately, in a small percent of births, a range of cord accidents do happen– and not all of them are due to a nuchal cord. Stillbirths that were assumed to have occurred due to nuchal cord included cord abnormalities such as vasa previa, cord entrapment, evidence of occlusion (blocked) fetal hypoxia and prolapse. A study in the Journal of the American Medical Association stated, “Nuchal cord alone was not considered a cause of death. This important cause of stillbirth has been somewhat overlooked in prior studies because of the difficulty in differentiating between harmless nuchal cords and cord conditions associated with pathophysiology leading to stillbirth.”
The likelihood of a genuine cord accident due to being wrapped around the baby’s neck, cutting off oxygen, is very small. In fact, it may not even be the underlying problem at all. There may be a visible nuchal cord, leaving everyone thinking it’s a no-brainer as to the cause of death. But without an autopsy (which parents may or may not feel comfortable having done), other reasons may be completely overlooked.

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1. It’s Usually Another Intervention Which Causes Fetal Distress: Inductions of labour, especially with synthetic oxytocin (Syntocinon in Australia or Pitocin in the U.S.) can cause fetal distress. Once you’re hooked up to the drip, it will remain on until after the birth. Many mothers-to-be accept an epidural after these inductions, because synthetic oxytocin can make the uterus work very hard. Artificial oxytocin doesn’t work the same as natural oxytocin (doesn’t cross the blood-brain barrier) nor are the contractions like natural labor contractions. With an epidural in place, the mother-to-be can’t feel a thing, but her baby is still under the effect of the strong, constant contractions due to the synthetic oxytocin. The uterus works harder and faster, meaning the blood and oxygen supply can easily become compressed— not just from the induction, but also because the mother is now immobilized, flat on her back. This can lead to the baby becoming distressed, requiring an emergency C-Section. Then everyone thanks the doctor for saving the baby. This is called the cascade of interventions— you start one intervention (the induction), then more are required. It can quite easily snowball into an emergency C-Section. However, if there happens to be a cord around the neck at the same time, this may be used as the reason for the C-Section, with no further investigation performed.
How To Reduce Your Risk Of A Stressful Situation At Birth: The best things to do if you want to avoid extra stress and complications when your baby is being born, is to avoid an unnecessary induction of labor. Ask for evidence or proof that the baby needs to be born right away, not just because you’ve reached your estimated due date. Seek actual test results or signs that something is not working well. Being on your back during labor and birth can cause problems too. Being stuck in bed is inevitable if you have an epidural, which is the usual next step if you have an induction with synthetic oxytocin. Because a laboring woman will be stuck in bed and can’t move her pelvis with an epidural, her baby doesn’t have help to move down into the most optimal position. This may result in difficulties being born, requiring forceps or vacuum, or worst case, emergency c-section. Getting informed with quality, evidenced-based information, and not just what you hear from friends or family, is crucial to set yourself up for the best outcome. We research our major purchases before we buy them; we need to research major life events too.
NOTE: Sometimes, Doctors and Midwives Just Don’t Know.
It may be the last thing you want to hear (and the last thing care providers want to say), but sometimes, doctors just don’t know why complications have occurred. It can be especially hard when it looks to be as obvious as a nuchal cord, and parents are understandably emotional and desperate for answers. Yes, a cord accident can sometimes occur, but there are lots of things we still don’t understand about childbirth. Conception is a magical, mysterious thing. It’s complicated yet simple at the same time– and the same goes with birth. All we can do is trust the process. Mother Nature works beautifully the vast majority of the time– the population of the planet is proof of that. It’s not your fault if something goes wrong and it’s very likely there was nothing you could do to have prevented it. A cord around the neck is a very common occurrence, and needn’t be feared. However, if you have any concerns or feel that something isn’t right, count your baby’s kicks and always speak to your care provider for reassurance or diagnosis.

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