Cord around the neck is NOT an emergency!

[JensJulyBoy05]

NUCHAL CORDS

Emilyjj75

I have been disturbed at the number of women I am seeing recently who are being told that the reason for their c-section was the cord wrapped around the baby's neck, and that if it wasn't for the c-section, their baby would have died! Even more upsetting are the women who have suffered the tragedy of a stillborn baby, and have been told the reason the baby died was from a cord around the neck.

THIS IS NOT TRUE.

First you must understand the anatomy of a fetus, as opposed to an adult. We breathe through our necks, and so the appearance of "strangulation" alarms us. Fetuses, however, do not breathe through their necks; they can't, because they live in liquid for 10 months. Instead, they receive their oxygen through the umbilical cord, and do not need to use their trachea to breathe until after they come out. For this reason, the most vulnerable part to a developing fetus is the umbilical cord itself, or the placenta to which it is attached, NOT the neck.

Babies can, and do, die because of accidents involving the cord and the placenta, such as cord prolapse, placental abruption, and other such incidents. The cord itself, however, is extremely strong, and unlikely to be compromised, except with a great amount of force. This article does a good job of explaining the mechanics of the umbilical cord.

Not only does the physiology of a nuchal cord make death by strangulation nearly impossible, but the incidence of nuchal cord is so common, that more babies ought to be dying if it were possible. Cord around the neck (nuchal cord) occurs in one out of every 4-5 births (various sources). That's 20-25% of all babies who are born with a cord around their neck at least once, and sometimes more. If nuchal cord is so deadly, why aren't more babies dying? The answer is that nuchal cord isn't deadly.

In this article from the March of Dimes, an organization which specializes in the prediction, prevention, and treatment of prematurity and defects, it is stated, "About 25 percent of babies are born with a nuchal cord (the umbilical cord wrapped around the baby's neck) (1). A nuchal cord, also called nuchal loops, rarely causes any problems. Babies with a nuchal cord are generally healthy."

Just to be on the safe side, many studies have been done that show that there are no increased risk of negative outcomes with nuchal cords. In these studies, they looked at ___ number of pregancies, and tracked all the factors associated with those pregnancies and labors, and could find no statistical correlation between intrauterine fetal demise (IUFD) and nuchal cords. In other words, while some stillbirths had nuchal cords, it was apparently a coincidence.

http://pt.wkhealth.com/pt/re/ajog/userLogin.htm;jsessionid=JWsYb7l0yWwQkBbbGpVhbxyDWF9PSXQLN8kKZp2Gxc0w1Jn0hh8y!1694406651!181195629!8091!-1

http://www.perinatology.org.tr/journal/issue/20062/fulltext/txt_05.asp

http://content.nejm.org/cgi/medline/pmid;15994613?FIRSTINDEX=80&hits=20&fyear=1985&where=fulltext&tmonth=Dec&searchterm=latza&fmonth=Jan&tyear=2007&searchid=1&FIRSTINDEX=80&resourcetype=HWCIT

http://www.jultrasoundmed.org/cgi/content/abstract/23/1/43

http://www.ncbi.nlm.nih.gov/pubmed/18604054

http://www.ncbi.nlm.nih.gov/pubmed/16374604

http://findarticles.com/p/articles/mi_m0689/is_n4_v34/ai_12185823/pg_3

http://cat.inist.fr/?aModele=afficheN&cpsidt=20200267

While nuchal cords themselves aren't dangerous, I found this article that states, "Furthermore, decreased Wharton's jelly in certain areas of the cord, most notably the fetal and placental insertions, can result in occlusion of fetal blood flow if the vessels are twisted sufficiently[33]" The article itself makes no conclusion about whether or not nuchal cords increase the risk of IUFD, but that statement would imply that the nuchal cord itself doesn't cause death, but may in some cases complicate things because it could also be twisted at the umbilicus or the placental insertion.

I have also heard it suggested that the cord could become tight enough to cut off the blood supply through the artery or vein in the neck. The carotid artery is fairly deep in the neck, so the pressure on the neck would have to be extraordinarily tight, something I believe would be nearly impossible for a fetus with a limited range of movement to accomplish.

If you are a mother who was told your baby would have, or did, died due to nuchal cord, you were misinformed. Do doctors lie? Sometimes. Sometimes they make an error in judgment, a baby dies, or a woman undergoes unnecessary surgery, and they need to have a reason in order to avoid being sued or fired. But I think this is not common.

I think in most cases, the doctor is not aware of the newest studies that show that nuchal cord is not a possible cause of death. I think in most cases, doctors want as badly as the parents to find a reason for why bad things happened to their babies. I think in most cases, a doctor is trying to do the best they know how, and they simply give their best guess to answer the often unanswerable questions.

In any case, it is clear from the evidence out there, and from our knowledge of anatomy and physiology, that having a cord around the neck is not life-threatening to the fetus, and should be treated with no more concern than a baby born posterior.

And would people PLEASE stop perpetuating this myth? I think nuchal cords being seen on ultrasound are an increasing reason for unnecessary c-sections, and goodness knows we don't need any more of those.

Emily

[jramsaran]

Feb. 9, 2009 at 9:21 PM

this is awesome and much needed info by some!

i had a friend of mine tell me that the cord was wrapped around her son's neck when he was born...when i replied "so?" she got really offended....i guess she didn't know

[Helen]

Feb. 9, 2009 at 9:27 PM

The cord around the neck can stop the flow of blood to the brain!

[mom631]

Feb. 9, 2009 at 10:55 PM

when i delivered my second son he had the cord wrapped around his neck 4 times. i delivered natural and had no problems. the doctor just undid the cord as baby came down the canal. and to top it off he was posterior as well. hard birth yes, life threatening HECK NO!!!!! and i have to agree to many docs are opting for surguries that aren't needed. there is a doctor that is up here by where i am from that if your due date is not when he wants or you are just unconmfortable he will induce or c-section you. that is wrong as well. but they do it and cover their butts and everything is just peachie. some docs are not the best. however when you find a great doc who does wonders for you, they are the ones that get shipped off or fired for no reason other than the hospital doesn't like the way the run there office and you loose the only doctor you ever felt comfortable with.

[JensJulyBoy05]

Feb. 9, 2009 at 11:59 PM

Thanks for the comments!

Helen- You should read the post. Maybe even click on the links.

Most women don't realize that this is another one of the many myths dr's tell women to have things their way and scare the bejesus out of them. Quite sad.

(Original Poster)

[Beth-Ami]

Feb. 17, 2009 at 9:46 PM

My daughter was a c and the doctor told me that part of her distress was due to the cord being wrapped around her arm. Her heart rate had dropped tremendously and once delivered her apgar was low as she was purple. I asked my doctor what would happen if we didn't do a c and he said "maybe nothing or maybe she'll be brain damaged."  I screamed "get her out." I am not at all refuting your post (I always found it amusing when women said the cord was wrapped around their necks and they couldn't breathe) just telling my story. My daughter was definitely distressed upon delivery but I do think c sections are an epidemic now. I am very sad that i was unable to have a vaginal delivery with either of my children.