Cord around the neck is often sited as a medical emergency and quoted to me as a reason not to homebirth or birth in the water. As many as 1/4 of births have the cord at least once around the neck and it has never posed a problem in the 20 odd years that I have witnessed birth. (A quick google search says anything from 20 to 50% of births).
I have been with a woman whose baby had the cord around it’s neck 6 times. she didn’t get semi recumbent on the bed, which is a god send of great decision making. Can you imagine her having huge contractions and then sitting for 20 mins on the baby while an epidural had been inserted. I’m sure the fantastic outcome wouldn’t have been the same.
After facilitating waterbirth studies, one of the most popular midwifery questions is how to check for cord and how to clamp and cut. WHAT? I can’t believe that midwives are clamping and cutting the only chance of oxygen supply to a baby that they feel is already compromised. Explaining that checking for a nuchal cord is not necessary as the baby will find it’s own way out to be unwound is totally beyond the comprehension of most. I realise that’s because they have never waited and been witness to this but the overwhelming attitude that we must save the day is outrageous.
If I saw a nuchal cord I would suggest looping it over, and have done this on numerous occasions; or help birth the baby through a loose cord, or corkscrew it until the baby has turned free.
This is an abstract of a clinical trial they did clamping or leaving the cord. As you can see the outcome from leaving it was perfect so why interfere?
Cord Around the Neck: Should It Be Severed at Delivery? A Randomized Controlled Study
Oscar Sadan, Zehavit Fleischfarb, Shmuel Everon, Abraham Golan, Samuel Lurie, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon and Sackler Medical School, Tel-Aviv University, Holon, Israel
ABSTRACT
Umbilical cords often become encircled around portions of the fetus, usually the neck. The incidence ranges from 21% in one loop to 0.2% in three loops. In the present study, we assessed the practice of severing the cord, which was encircled once around the neck of the fetus, after delivery of the anterior shoulder and prior to extraction of the body. This was a prospective, randomized, controlled study. The study and the control groups included 30 women each. Cord around the neck was diagnosed during labor by ultrasound. It was cut intentionally in the study group and left intact in the control group. Demographic data were obtained. The course of labor was assessed. Neonatal outcomes measured were cord pH, Apgar scores at 5 minutes, and need for resuscitation. Length of maternal and neonatal hospitalization was determined. No differences were found between the study and the control group before, during, and after labor regarding perinatal variables such as meconium-stained amniotic fluid, fetal heart rate patterns, Apgar scores at 5 minutes, and umbilical cord pH after delivery (7.29 ± 0.07 [SD] in the study group and 7.32 ± 0.06 [SD] in the controls; p = 0.1). Single nuchal encirclement by the umbilical cord during labor, after delivery of the anterior shoulder, can be severed or left intact. We could not detect any adverse perinatal outcome in such deliveries.
If they could be severed or left intact who would chose severed?
One client who was carrying a breech baby and had received no ultrasound was having an antenatal. it was 37 weeks ( approx) and I heard what I thought to be an abnormality in the fetal heart. After much soul searching and discussion her partner and herself decided to have a scan of the baby’s heart. During this scan the Ob pointed out that it was breech as we thought and there was an atrial ectopic beat which he felt would correct itself after birth and not be an issue for labour. (We did have to listen to why she shouldn’t birth at home of course). It was noted then that there was a nuchal cord. At the birth the baby had an apgar of 9 and 10 and the cord was just unfurled once the baby had been passed through her legs.
I wish that midwives who work in hospital would fore go policy, procedure, fear and training ( which is there for all of us in some regard) and listen to women and believe in birth just a little more.
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"but the overwhelming attitude that we must save the day is outrageous."
"I wish that midwives who work in hospital would fore go policy, procedure, fear and training ( which is there for all of us in some regard) and listen to women and believe in birth just a little more."
very valid and true points! But the chokehold is so strong!
I have had four children, 3 induced hospital and last one at home, with just me and husband. ALL of them had cord around their neck. Hospital ones were like an "emergency" situation. However, while birthing my baby number 4, her cord was around her neck 3 times. I unwound it, and then the rest of her was out.
I see cord around the neck quite differently than I did before. I am so glad nobody else was there, because I quite believe it would have been intervened upon immediately (ie., cut).