Midwife Rachel Reed assesses the risks of a common condition which many parents fear.
“Only very occasionally will a nuchal cord prevent the baby descending once the head is born, in which case the midwife can use a ‘somersault’ manoeuvre to free the baby so that the cord can remain intact.19 If this manoeuvre is unsuccessful, the worst case scenario is that the cord snaps as the baby descends, and requires clamping.”
Nuchal cords are rarely found to be the cause of adverse outcomes in studies of pregnancy and birth. Several authors have concluded nuchal cords “ordinarily do no harm” (5,6,7).
Some studies have associated nuchal cord with an increased rate of variable fetal heart rate decelerations during labour, and tight nuchal cords to a higher proportion of fetal distress and low Apgar scores. (3,4,8) However, in these retrospective studies the definition of tight nuchal cord were those ‘clamped and cut before delivery of the shoulders’ – therefore short-term morbidity was more likely caused by the interventions rather than the presence of nuchal cord (3).
(To learn more about nuchal cords, how babies can and are born with loose/tight/multiple nuchal cords, and why they aredisproportionately associated with risk and adverse outcomes, please read Nuchal Cords: the perfect scapegoat.)
Practitioners that respond clinically, not routinely, to a nuchal cord – and with the least intervention possible – are more likely to protect normal physiology and anatomy and avoid iatrogenic injury.”
**Trigger Alert: Hospital Images**
Prof. Ochoa says:
”Our study demonstrates that late clamping of the umbilical cord has a beneficial effect upon the antioxidant capacity and reduces the inflammatory signal induced during labor, which could improve the development of the newborn during his or her first days of life.”
I have watched umbilical cords be left intact, by trusting midwives, until the placenta is released. This can take upwards of 30 minutes. During that time I can see the cord change from a rich thick purple cord to a limp white cord that is obviously not transferring any blood. How I know it is not transferring any blood is because the placenta is no longer attached to the mothers uterus. It is usually sitting in a bowl close to mom and baby.
Completely hands off I can see that the cord is transferring oxygenated blood to the baby for longer then 2 minutes, which is what most care providers believe delayed cord clamping is. The image below is 45 seconds post birth, 12 minutes post birth and 23 minutes post birth, retrospectively.
“UMBILICAL CORD PROLAPSE
Prolapse of the umbilical cord is a true obstetric emergency, and understanding of its predisposing factors can assist in speedy diagnosis and treatment. Although cord compression occurs routinely in normal labors and is commonly seen during fetal heart rate monitoring, severe cord occlusion can result in dangerous alterations in fetal and placental circulation. Historically, the incidence of cord prolapse has been reported as approximately 1 in 300 deliveries. More recently, however, the reported incidence has fallen to about 0.2%, or 1 in 500 of all deliveries, mainly as a result of changing obstetric management, including antenatal ultrasound diagnosis of funic presentation or vasa previa as well as almost universal use of continuous electronic fetal monitoring.”
Types of Cord Prolapse
There are three types of cord prolapse:
Overt cord prolapse
Occult cord prolapse