Saturday, October 31, 2009

Umbilical Cord Around Baby's Neck - Dangerous or Not?

By Misha Safranski
Read additional work by Safranski here

As a confirmed birth junkie, I have heard over and over again birth stories where the baby was born by cesarean for either fetal distress or failure to descend, and the difficulties are blamed on "the cord was around the baby's neck". Is this condition - scientifically termed "nuchal cord" - actually dangerous? A new study backs up previous research showing that nuchal cord is not the threat it's perceived to be.

A study published this year in the Journal of Perinatal Medicine showed there were no statistically significant differences in outcomes of post-term pregnancies involving a nuchal cord verses no nuchal cord. Drs. Ghosh and Gudmundsson performed color ultrasound on 202 women with post-term pregnancies. Nuchal cords were detected in 69 of the women. There were no significant differences in Apgar scores, umbilical cord anomalies, cesarean section, perinatal death or admission of the baby to the NICU (neonatal intensive care unit).

These findings confirm what has been found in most of the past research on nuchal cord outcomes. A 2006 study from the Archives of Obstetrics and Gynecology was on a much larger scale, looking at the outcomes of 166,318 deliveries during a 15 year study period, 24,392 of which had a documented nuchal cord at birth. The authors, Sheiner et. Al, conclude: "Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary."

The interesting thing about the Sheiner study is that despite the equivalent outcomes among nuchal cord babies and those without the cord wrapped around the neck, there were higher rates of labor induction and non-reassuring fetal heart tones during labor among the nuchal cord cases. These two factors are most likely related. We know without a doubt that induction of labor can cause fetal distress. The fact that there were higher induction rates in the nuchal cord group could very well explain the higher rate of transient fetal distress. Induction is nearly always accompanied by AROM (artificial rupture of membranes), which can cause undue pressure on the cord, which can in turn result in blips in the heart tones. Regardless of the cause, the outcomes were still good.

Finally, we look at yet another study which demonstrated that nuchal cord does not result in worse outcomes. In a 2005 study looking at the effects of nuchal cord on birthweight and immediate neonatal outcomes, Mastrobattista, et. Al examined the outcomes of 4426 babies, 775 of whom had a nuchal cord. They found that there were no significant differences between the two groups in birthweight, non-reassuring fetal hearttones, Apgar scores below 7, or operative vaginal deliveries. The cesarean rate was actually highest among the women whose babies did not have a nuchal cord.

The most important thing to keep in mind is that unborn babies do not breathe through their mouth and neck - they receive oxygen through the umbilical cord. This is why it normally doesn't matter if the cord is around the neck (unless the cord is being compressed too much, which is fairly rare). The baby cannot "choke to death" before she/he is born. What we can conclude from the overwhelming majority of data is that nuchal cord - or "cord around the neck" - is not pathological; that is to say, it's not an abnormality. It is a normal condition of the umbilical cord and typically causes no problems with the delivery, even though doctors frequently try to convince parents otherwise.

References:

J Perinat Med. 2008;36(2):142-4. Nuchal cord in post-term pregnancy - relationship to suspected intrapartum fetal distress indicating operative intervention. Ghosh GS, Gudmundsson S. Department of Obstetrics and Gynecology, Malmö University Hospital, Malmö, Sweden.

Arch Gynecol Obstet. 2006 May;274(2):81-3. Epub 2005 Dec 23. Nuchal cord is not associated with adverse perinatal outcome. Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel. sheiner@bgu.ac.il

Am J Perinatol. 2005 Feb;22(2):83-5 Effects of nuchal cord on birthweight and immediate neonatal outcomes. Mastrobattista JM, Hollier LM, Yeomans ER, Ramin SM, Day MC, Sosa A, Gilstrap LC 3rd. Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.


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Related Information:

Gloria Lemay: Cord Around the Neck

Unwrapping a Nuchal Cord [video]

The Umbilical Cord

Nuchal Cord Midwifery Files

Neonatal Resuscitation: Life that Failed

Lotus Birth

In this video on pregnancy myths, OB/GYN Hakakha reminds parents (in the 7th section of this video) that the umbilical cord is often around a baby's neck while inutero and at birth and it is rarely a cause for concern.


7 comments:

  1. My second baby had the cord around his neck. I was glad. Water broke 3 days before labour. I've seen Gloria Lemay say babies with nuchal cords are smart, they can't have a prolapsed cord.

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  2. I agree with the PP. A nuchal cord to me indicates that the infant is consciously protecting his life supply.

    I also heard this about a nuchal hand/arm. I wonder if this is why DD had her arm up.

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  3. I work in a labor and birth unit and see many many babies born with a nuchal cord; it is rarerly a problem. It can be a problem however and is sometimes a cause of stillbirth - not because the fetus "chokes" to death, but because the the carotid arteries in the neck become constricted by a very tight cord, decreasing/stopping blood flow to the brain. Again, very rare. And ya, our inductions and augments just make it worse for the baby.

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  4. My second was also a clever baby :-) I birthed her unassisted two months ago. When her head emerged, my brain told me to palpate around her neck searching for nuchal cord and disentangle it before next contraction. But, my body and instinct knew better, and I felt the necessity of using that seconds between contractions to move my legs to a firmer position instead (I was kneeling). I did follow my inner knowledge, and my daughter slid from my body with the next contraction. She was diving in the kiddie pool in our kitchen :-) I inmediatly disentangled the nuchal cord, and gently took her from the water to my breast. She is perfectly healthy.
    My first child was born by cesarean surgery caused by hospital interventions.

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  5. Both my boys had nuchal cords; #2 had his around his neck twice (and was also facing the wrong direction, how sweet of him). Neither had to have the cords cut early, both had great APGARs, both were and are fine.
    I agree that a very tight nuchal cord CAN be dangerous, but the presence of one isn't necessarily a harbinger for death or injury. Just something to be aware and conscious of.

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  6. My youngest had a nuchal cord. It was wrapped around his neck 4 times and it Also had a true knot in it. He was born quickly and safely with apgars of 9 and 9 but, I believe he had suffered intero. I had been concerned about his lack of movement for the whole third trimester and he had passed meconium, probably a long time previously. He was also much smaller than my earlier babies and came two weeks early which was unheard of for me, I usually go a minimum of a week over. So while his birth was fine I believe that we were very very blessed to have him alive in the end!

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  7. My daughter had the cord around her neck, shoulders and arm and wrist. Although on my discharge papers it says "cord around neck X3". The labour was very prolonged because the cord held her up in my uterus and she wasn't able to descend enough to put pressure on my cervix, she didn't come out until my uterus started pushing her down and out. The cord was so tight the with a great deal of muscle and stregth there was no possible way the nurse could loop it over her head before the rest of her body came out, i had to push out the body and then they cut the cord immediately and without clamping it first. Then rushed her off to give her oxygen and get her going, she was very very floppy and blue and her apgars were TERRIBLE but the 10 minute apgars were around the 8-9 mark, so we escaped any kind of NICU or intensive care unit but did require 4 hourly observations for about 3 days while in hospital. A friend of mine had what can only be described as an identical birth, however as she was checked more often than i was she sat at fully dilated for too long and had a c-sec when it was discovered it was the cord holding the baby in there for so long.

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