A nuchal cord (cord around the neck) is one of many things that mothers-to-be fear about childbirth. The thought of their precious baby being ‘strangled’ by their umbilical cord can cause so much worry.
Luckily, unborn babies get nutrients and oxygen via the umbilical cord, not by breathing it in through their nose and mouth, which may eliminate some fear right there. They don’t need their neck to breathe.
This is one of the many reasons why it’s important to leave a baby’s umbilical cord intact (uncut) for at least 2 minutes after the birth, because it’s the life support system for the baby until his head is born. It’s the very same reason why babies don’t drown during a water birth, because they have an oxygen supply already attached, and don’t take their first breath until they are stimulated by air. You can read more about why it’s important to delay cord clamping here.
Here are some interesting facts about nuchal cords that every mother-to-be and father-to-be must know before they give birth…
1. Up To One Third Of Babies Are Born With The Umbilical Cord Around The Neck
It’s common to hear stories of babies being born with the cord wrapped around their neck – and the reason for that is because it’s quite common! Some doctors and midwives don’t even mention it during childbirth, because they tend to loop the cord over the baby’s head when he or she is crowning, and it’s no big deal. Ideally the cord should be left alone during the birth toprevent further compression or complications.
Studies report figures of up to one third of babies being born with a cord around their neck – thats 1 in 3 babies, which is the same number of babies born by caesarean section in Australia and the United States. Hardly a rare event.
Cords come in a range of lengths, and in this study, cord length ranged from 19 to 133 centimetres. However, the average umbilical cord length is around 50-60 centimetres long.
The above 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.”
“All 3 of my babies had the cord wrapped around their necks even wrapped twice around 2 of them> — Jessica, BellyBelly Fan
So with a longer cord, some babies just like to play skippy in their mother’s uterus.
2. A Healthy Umbilical Cord Is Protected By A Slippery, Soft Coating
The human body is ever surprising with its clever design, which has been built to ensure our survival as a species. Even the umbilical cord has it’s party tricks!
A normal, healthy umbilical cord is and thickly coated in Wharton’s jelly, a soft, gelatinous substance which protects the blood vessels inside the cord. This substance makes the cord slippery, protecting the cord against compression as a result of the baby’s normal movements.
If a medical condition was impacting on the amount of Wharton’s jelly around the cord, then perhaps this may cause complications. However, the umbilical cord is carefully designed for uterine life.
“My first baby had the cord around her neck, her waist and her ankle. The midwife didn’t remember the last time she saw a cord that long!” — Anna, BellyBelly Fan
3. A Nuchal Cord Does Not Get Tighter As Labour Progresses
In her fantastic article Nuchal Cords: The Perfect Scapegoat, midwife and lecturer Rachel Reed 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 is not until the baby’s head moves into the vagina, that a few extra centimetres of additional length are required. However, when a c-section is done for ‘fetal distress’ or ‘lack of progress’ during labour, 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 that their baby’s heart rate was dropping when they were pushing. Studieshave proven that this is normal behaviour 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, the most cases were response to parasympathetic stimulation due to umbilical cord or fetal head compression by mothers 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 – being on your back can make it worse (and more painful).
“3 of my 4 babies had cord around their neck, no problems. My last 3 had delayed cord clamping too.” — Jessica, BellyBelly Fan
4. A Cord Around The Neck Is Not 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. Understandably you want answers. However, several studies have reported that a cord around the neck is unlikely to be the main cause for adverse outcomes.
This study concluded:
“Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary.”
Another study came to the same conclusion.
The cord may be around the baby’s neck (which is very common as stated above) but many other issues can cause adverse outcomes which may be unknown at the time, making it very easy to blame the cord around the neck. Stillbirth is still an area of much research, and even doctors and researchers themselves can’t be certain what causes all cases.
5. Even With A ‘Tight’ Nuchal Cord, There Isn’t An Increased Risk Of Cord Accidents
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.”
“My baby boy has it wrapped around his neck 2 times. I freaked at first when my dr told us but I fed off his calmness which helped me settle down. Figured if he wasn’t panicked I shouldn’t be.”— Robin, BellyBelly Fan
6. Nuchal Cords Are Not An Indication For A Caesarean Section
The College Of Obstetricians and Gynaecologists in the United Kingdom advise that there is no reason to perform a caesarean section due to a nuchal cord.
They state, “No studies were identified of the effectiveness of caesarean section in the presence of umbilical cord around the fetal neck.”
Rachel Reed agrees there is no reason to perform a caesarean 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 as this 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.”
“My first baby had her cord around her neck, it must have been around it for quite some time as I had to have an extra scan at 32 weeks because they couldn’t get a clear view of her left hand. She was born with her hand wrapped up in the cord too. Protecting herself before she was even born!” — Shauna, BellyBelly Fan
h3. 7. Nuchal Cord Accidents Are Very Low
Sadly, in a very small percent of births, cord accidents do happen – and they are not all due to the cord simply being around a baby’s neck.
According to a recent report from the Australian Institute of Health and Welfare, 1 out of every 135 (0.74%) babies born in Australia is stillborn. In the United Staes it is 1 in 160 births. While the classification of a stillbirth varies around the world, in Australia, a ‘stillbirth’ is classed as ‘the birth of a baby who shows no signs of life, after a pregnancy of at least 20 weeks gestation or weighing 400g or more’.
A study in the Journal of the American Medical Association found that placental issues (for example placental abruption) were the leading cause of stillbirth at 26%, which was similar to a study in Sweden. A further 14-19% of stillbirths were due to infection. As for cord abnormalities, 10% were due to (or assumed to be due to, as doctors don’t always know why stillbirth occurs) cord problems. The range of cord problems included vasa previa, cord entrapment, evidence of occlusion [blocked], fetal hypoxia and prolapse. They 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.”
When you do the maths, the likelihood of a genuine cord accident due to being wrapped around the baby’s neck is very small – and in fact may not even be the underlying problem at all.
“My son had the cord wrapped around his neck when he was born at home in water september 2013. No big deal and i unwrapped it myself! I was also wrapped at birth and so were my brothers. It’s normal” — Guðrún, BellyBelly Fan
8. Even Multiple Loops Aren’t More Harmful
The number of loops is not important, remembering from above that the uterus, placenta and cord all move down with the baby during labour.
Rachel 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 is 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 labour.”
A study found that the number of nuchal loops varied from 1 to 4, and the presence of 2 or more loops of cord around the neck was reported to affect between 2.5% to 8.3% of all pregnancies. They stated “0.1% of babies have 4 or more loops of nuchal cords and the maximum reported number was 9”. The study also mentioned that most babies in the study had Apgar scores of 7-10 (where 10 is the best score) after one minute, and only eight babies had an Apgar score of less than 7 after five minutes (5.20%), suggesting that any possible effect is only transient.”
“My baby had his cord around his neck and under his arm. Absolutely no complications and it wasn’t scary for us. It can be okay!” — Ashley, BellyBelly Fan
9. It’s Usually Another Intervention Which Causes Fetal Distress… Then The Caesarean
Inductions of labour, especially with synthetic oxytocin (syntocinon in Australia or pitocin in the US) can cause fetal distress. Once you’re hooked up to the drip, it will remain on until you give birth. The majority of mothers accept an epidural (or other pain relief) after an induction of labour with this method of induction, because it can make the uterus work very hard – it doesn’t act like natural labour contractions. In this time, the mother-to-be can’t feel a thing and has no idea what’s going on inside of her. The blood and oxygen supply become compressed (even moreso because the mother is now immobilised, flat on her back) which eventually can cause the baby to become distressed… requiring an emergency caesarean. However, if there happens to be a cord around the neck, this may be used as the reason for the caesarean.
Take a look at the clip below from the MUST WATCH documentary, The Business of Being Born. It explains how an induction with pitocin/syntocinon can result in fetal distress and caesarean section.
How To Reduce Your Risk Of A Stressful Situation At Birth
The best things you can do if you want to avoid extra stress and complications (for example fetal distress) when your baby is being born, is to avoid inductions of labour and being on your back during labour and birth (which is inevitable if you have an epidural, and common if you have an induction with synthetic oxytocin).
Also, if you have an epidural, you’ll be stuck in bed and can’t move your body, so your 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, caesarean section. Getting informed with good 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 which we’ll never forget too. Having a doula can reduce the incidence of many interventions.
Read our articles about the risks of induction of labour, the risks of epidurals and the benefits of doulas.
Remember: Sometimes, Doctors and Midwives Just Don’t Know
It may be the last thing that you want to hear (and the last thing that 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 cord around the neck, and parents are understandably emotional and desperate for answers.
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. While life sometimes throws some distressing events our way where things just don’t work out as we hoped and dreamed, sometimes there is no-one or nothing to blame. But don’t let that get you down, because Mother Nature works beautifully the vast majority of the time – the population of the planet is proof of that.
A cord around the neck is not to be feared.
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