October 9, 2009

Dispelling the Fear About the Umbilical Cord

My friend and midwife, Jocelyn, passed this article on to me. I thought it was an important piece to post on the blog since I often hear people express their concern about the umbilical cord being wrapped around some part of their baby. About 1/3 of babies are born with a nuchal cord (the umbilical cord around the neck) or the cord entangled around the baby’s torso. The majority of the time this is completely harmless, the doctor may clamp the cord and cut it as the baby is emerging. Other times, the care provider can actually somersault the baby out and disentangle the baby.

Dr. Stuart J. Fischbein, MD FACOG, BAC, board certified in Obstetrics & Gynecology wrote an interesting article from his perspective about this phenomenon. Please read!

Dispelling a Myth About the Umbilical Cord

The umbilical cord around the fetus’s neck cannot strangle your baby! There, I said it. Now, let’s discuss the logic behind this truth. Nature has devised a system to nourish the developing baby inside the womb of all mammals. The placenta and umbilical cord are an amazing creation of both form and function. The placenta acts as a factory for hormones to support the pregnancy, a filter that among a myriad of tasks acts to bring in good things and remove waste and provides a reserve of blood and oxygen to support the baby through labor. The umbilical cord is the conduit by which nutrients such as sugar and oxygen help feed the baby via its two veins while through its one artery passes the waste by-products of growth.

Understanding how a baby gets its oxygen allows us to understand why a baby cannot strangle or “choke” on its cord. In order to choke, one must be using its trachea to breath air. Clearly, there is no air in the uterus, the baby does not breathe through its throat and, therefore, cannot choke. When an ultrasound reveals the cord around the neck it is a normal human response to anthropormorphasize the intrauterine baby to our extrauterine experience. But this is not the case and there is no reason to have fear. So, let’s dispel once and for all the rumor that a cord around the neck (nuchal cord) is more dangerous than any other situation. About 35-40% of normal term babies are born with the cord around the neck at least once. It can also be wrapped around the body or legs or even at times have a true knot. None of which are usually significant as the cord is designed to deal with this.

Cord compression can occur anytime during pregnancy. The cord is well equipped to handle temporary squeezing as the 3 vessels are cushioned by a matrix called Wharton’s jelly and the surrounding amniotic fluid. In labor, sometimes after the bag of waters breaks and fluid leaks out, the cord can be repeatedly compressed with contractions. This is not uncommon and is not, by itself, a sign of distress. Your practitioner or nurse can listen to or interpret the fetal heart rate pattern to know whether any intervention is necessary. And the compression of the cord almost never is an emergency or a cause for the tragic death of a baby inside the womb. When that tragedy occurs we all want to know why and often, mistakenly, we are told it was a “cord accident”. Compared to the number of times I have heard this mentioned by patients or news stories the real truth is that this is a very rare event.

Another response to this matter from Dr. Fischbein

There is a big difference from what happens when a baby is crowning and the cord is compressed and what I was saying. Of course a cord can be compressed and the heart rate drop dramatically. This a vagal nerve reaction, normal and generally transient. If prolonged then the baby needs assistance to be delivered if delivery is not imminent. Also, in some cases, a tight nuchal cord can cause ecchymosis (black and blueness) and hyperemia from compression of the jugular veins more than the carotid arteries. But to cut off blood flow to the brain completely unnoticed inside the uterus is a very rare event. The point of my article was to dispel the idea that babies can choke simply because the cord is around the neck in utero and that should be used for a reason to instill unnecessary fear which can lead to an unnecessary c/section as Kathryn implies. There will always be exceptions to any rule but I believe it is wrong to counsel all women with a really rare, fear-based, worse case scenario mentality.

While unfortunately, some babies do suffer fatalities during pregnancy and labor, please be reassured that many babies do have a nuchal cord and can be delivered completely unharmed and healthy.

For those interested in this topic, I would like to share another interesting article by midwife, Rachel Reed; Nuchal Cords: the perfect scapegoat (Here is a snippet of it to pique your interest) The nuchal cord has become the perfect scapegoat because it lays blame with the mother/baby rather than the careprovider/system. The result is that fear about nuchal cords is embedded within our culture. Whenever I read a story about an unexpected birth outside of hospital it always seems to involve a nuchal cord. The story being about how lucky the baby was to survive the dangers of a nuchal cord away from the experts who can manage such a complication. In addition, I have heard too many birth stories where the complications were unfairly blamed on the presence of a nuchal cord. READ MORE

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