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Umbilical cord around baby’s neck rarely causes complications

Updated 2/21/10:  Initially, this article was entitled, “Umbilical cord around baby’s neck cannot strangle,” but I recently changed it to “Umbilical cord around baby’s neck rarely causes compilations.”

My intention with this article was to address the visceral and fearful response parents often have when they see a cord wrapped around their baby’s neck which is called a nuchal cord.  I wanted to clarify that babies receive oxygen through the umbilical cord, not through their mouth, so they cannot be “strangled” in the conventional sense of pressure to the throat.

Yet despite my good intentions, it quickly became clear that the title was confusing to not only parents and health professionals, but insulting to those who did lose a baby from cord compression.  As a result, the title was changed to something more accurate.

Even though nuchal cords are common and occur 25% – 35% of the time, rarely a baby’s cord will be wrapped so tightly around their body that the cord is compressed and oxygen delivery to the baby is compromised.  When this occurs, a cesarean is prudent and in its absence, a stillbirth could occur.  Fortunately, stillbirth from cord accidents, which include nuchal cords and nuchal knots, are rare and occur in 1.5 per 1,000 (0.15%) deliveries.  If your baby does have a nuchal cord, the risk of infant death is less than 0.4% – 0.6%. Thus, even though nuchal cords occur in about one third of births, they rarely result in the death of a baby.

However, this is no consolation to those who have experienced the horror of their child’s death because when you are the statistic, it doesn’t matter how rarely something occurs.


How many times have you heard, “I’m so glad I had a cesarean because the baby’s cord was around his neck 3 times!!”  What people do not understand is about one-third of all babies are born with the umbilical cord around their neck/body and it does not mean the baby is in harms way.

As the American Congress of Obstetricians and Gynecologists (ACOG) asserts in their 2009 stillbirth management guidelines:

Because umbilical cord problems and abnormalities occur in nearly one third of all normal live births, the practice bulletin recommends excluding other causes before attributing stillbirth to cord complications. When stillbirth is thought to result from a cord problem, there should be evidence of obstruction or circulatory compromise.

“Parents want answers when they have a stillbirth, so clinicians should not be afraid to request an autopsy,” Dr. Fretts said. “Without a thorough evaluation it will be difficult to counsel women on their risk of having another stillbirth.”

Approximately 8% to 13% of stillborn babies have chromosomal and genetic abnormalities, such as Down’s syndrome, Turner’s syndrome, Edward’s syndrome, and Patau’s syndrome. Yet another cause of stillbirth may be infection with parvovirus, cytomegalovirus, syphilis, or Listeria monocytogenes.

The March of Dimes:

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.

Sometimes fetal monitoring shows heart rate abnormalities during labor and delivery in babies with a nuchal cord. This may reflect pressure on the cord. However, the pressure is rarely serious enough to cause death or any lasting problems, although occasionally a cesarean delivery may be needed.

Suite101: Fetal Umbilical Cord Problems: Potential Causes Umbilical Cord Accidents in Pregnancy:

According to Dr. Jason H. Collins at The Pregnancy Institute, umbilical cord accidents [knots & nuchal cords] leading to stillbirth occur in 1.5 of every 1000 births.

Schäffer L, Burkhardt T, Zimmermann R, Kurmanavicius J. Nuchal cords in term and postterm deliveries—do we need to know? Obstet Gynecol. 2005;106(1):23-8.

Nuchal cords do not influence clinical management at delivery, and neonatal primary adaption is not impaired. Our data show that ultrasonographic nuchal cord assessment is not necessary at the time of admission for delivery.

Mastrobattista JM et al. Effects of nuchal cord on birthweight and immediate neonatal outcomes. Am J Perinatol. 2005;22(2):83-5.

The cesarean delivery rate was significantly different among the three groups [infants with 0, 1, and 2 or more loops of cord encircling the neck] and was the highest among the group of women whose fetus had no nuchal cord (p < 0.01). A nuchal cord at term is not associated with untoward pregnancy outcomes.

Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet. 2006 May;274(2):81-3. Epub 2005 Dec 23.

Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary.

Outcome of infants born with nuchal cords. Journal of Family Practice, April, 1992 by William F. Miser

Several studies in the past have implicated nuchal cords as a cause of fetal death.[1,17-20] Harrar and Buchman[17] reported 14 unanticipated death occurring in the second stage of labor due to nuchal cords. in contrast, several authors agree with the present study that nuchal cords do not increase fetal mortality.[7,10-12] Shui and Eastman[8] found a higher fetal death rate in those deliveries not involving nuchal cords, and concluded that coiling of the umbilical cord around the infant’s neck was a rare cause of perinatal death. Horwitz et al[9] found the neonatal death rate to be 1%, regardless of the presence of nuchal cord.


The cord may become coiled around various parts of the body of the fetus, usually around the neck. Nuchal cord is caused by movement of the fetus through a loop of cord.

One loop around the neck occurs in approximately 20% of cases,27 and multiple loops occur in up to 5% of pregnancies.28

Nuchal cord has been associated with labor induction and augmentation, prolonged second stage of labor, and fetal heart rate abnormalities. One report has described a decrease in umbilical cord pH at delivery with nuchal cord, but the difference found (7.32 vs 7.30) does not appear to be clinically significant.29

Nuchal cord can be detected using color Doppler ultrasound, with a sensitivity of over 90%.30

Nuchal cords rarely cause fetal demise and are not intrinsic reasons for intervention.28,31 Given the minor decrease in pH, fetal monitoring in labor would appear to be prudent, but no data are available to address this issue.

Note that they discuss pressure on the cord, not on the baby’s neck, because the concern is the cord being compressed to a point that the blood cannot make it to the baby.

K left this comment below:

My first homebirth baby had his cord wrapped around his chest and arm, then twice around his neck. While we had to untangle him, he was fine.

It is so tragic when a baby is lost, and I think that it is easy to point to something like a wrapped cord as a probable cause. Largely, though, they really don’t know. They may know that there were decelerations in heart rate. Without a crystal ball, though, they really can’t know why they happen. It can be sensitivity to the epidural medication (it does get to the baby), it can be tetanic contractions caused by induction agents, it can be cord compression, or it could be about 100 other things.

Wrapped cords are amazingly common. So common that cords come covered with a kind of lubricating jelly so that they don’t “catch” on themselves and get compressed. There are some very cool photos of cords that were knotted at birth (babies were fine in the photos that I’ve seen).

Tragic things sometimes happen, we really can’t always identify why.

Updated January 16, 2012

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174 comments to Umbilical cord around baby’s neck rarely causes complications

  • Natalie

    I have had 5 babies, all vaginal births. My 3rd pregnancy was a hard one, my baby boy had RCDP type one which we didn’t find out until after he was born. While caring for him for 2 1/2 years I found out I was pregnant with my 4 the baby, a boy. I was 5 months pregnant with him when a month after my 3rd son’s birthday, my 3rd child passed away. I was in complete stress for the rest of my pregnancy. He was extremely active in utero. At about 37 weeks in the, middle of the night, my water broke and I was in active labor during my sleep. The contractions weren’t very strong, I guess that’s why I was able to sleep through it. My husband woke me up and told me I was moaning in sleep and my water had broke. We decided to go to the hospital. As soon as we got there they signed me in and called the doctor. They put me in the labor and delivery room and I had to push. The doctor was running down the hall when my son’s head started coming. ( only 15 min after I arrived at the hospital). The umbilical cord was wrapped tightly around his neck twice and had a true knot. My sons head was black when he came out, they didn’t have time to take it off his neck or cut it. It took them 10 min to revive him. Later the nurses told me he had jaundice from all the bruising and all the veins in his eyes were busted. He didn’t get back to normal until a month and a half later. He was a very fussy baby. He is 8 now and has ADHD and a very gifted “different” (has no interests in sports or having friends except at school). What I was wondering, is when he is sick, he ALWAYS gets Croup( which is an inflammation of the upper airway). Is there a chance that it could be caused by the umbilical cord when he was born? No one ever checked his throat to see if there was damage. I think I will have to ask his doctor. But I do believe that everything I have dealt with from him is because his umbilical cord. Also, if it doesn’t strangle babies then why was his head black and blood vessels in his eyes burst????

  • Basil

    My boy born today had his cords wrapped around his neck bu nevertheless a robust healthy chi;d. But he is now currently under oxygen as he had lips darken everytime the oxygen is removed, What would be the effecr of this to the child and how ong ould oxygen assist be required?

  • Helen

    Hello Natalie & Basil,

    I was born with chord around my neck. I was by all standards “healthy and normal” child, yet I have always found it very difficult to communicate with others and form relationships. Trained as a psychologist (the irony) I now recognise that I suffer(ed) from asperger’s syndrome (a mild form of autism). I was also a very hyperactive as a child, I was not diagnosed with anything, but I believe I suffered from ADD as well. Anyway, in my case I believe most of my problems stemmed from being deprived of sufficient levels of oxygen during the final phase of the pregnancy.

    I have recently come across a treatment called Hyperbaric Oxygen Therapy (HBOT). The book I am reading ‘The Oxygen Revolution’ by Paul Harch (MD) explains that a lot of tissue damage and inflammation in our body is as a result of depleted oxygen in take. He explains how “O2 is effective in the reparation of any neurological condition. Oxygen stimulates DNA to produce growth and repair hormones and the protein receptors on cells that respond to these hormones…..repetitive exposure to hyperbaric oxygen causes new blood vessels to grow, and it can metabolically energise the cells. As a result, we get permanent changes in brain function as new blood supply grows….”

    This oxygen treatment is normally used with deep sea divers who suffer complications when resurfacing after a deep dive.
    Please take a look at this treatment. Unfortunately most doctors are currently still unaware of its remarkable healing possibilities. It is not simply a case of receiving oxygen with a face mask, it has to do with using pressure to help the body receive high levels of O2 throughout the body in to the tissue to reverse any damage and to induce the body’s natural healing process.

    I hope this helps. I am looking in to having this treatment myself despite it being quite some time since I was born!!

    I wish you both the very best.

  • M 31 week pregnant.yesterday I had mu us it shown single loose turn of ummbical cord around baby neck.but baby is fine doing.heartrate is normal.m worried is this normal.plzreply.

    • Jen Kamel


      One third of babies are born with a cord around their neck. It only becomes an issue if the cord becomes compressed which rarely happens. If during labor this occurs, it will likely show up as fetal distress. The odds are overwhelmingly in your favor that this will not become an issue and your baby will be born healthy. Try not to stress or worry. <3



  • Tori Wilkey

    Today my mother had to give birth to a still birth child. The baby was weeks when he had died inside of her and he had died from the cord being wrapped around his neck three times.
    My cousin on my dad’s side was also born with the cord wrapped tightly around his neck and that cause him to be slightly gifted (different) and now has the mentality of a 7 year old at the age of fifteen.
    I guess my family just always happens to be the one point five of the thousand.

  • Ana

    I’m so happy I found this article, I’ve heard horror stories about the umbilical cord getting wrapped around the baby’s neck. I’m 24 weeks pregnant with my first child and this really frightened me.

  • Mum of 3

    Once again I am back to fill you all in on my daughters progress. My daughter was born early Jan 2012 . She had a double (very tight) Nuchal cord . I knew something wasnt right as her movements slowed down then stopped the night before she was delivered. i think the main disaster was that they cut the cord after i delivered her head but BEFORE I gave birth to her body as it was just too tight. The Drs said they’ve never seen or experienced one like it before . She is now a lovely 2 year old girl. She struggled from birth with developmental and speech delays and all of her specialist agree that her issues were almost certainly caused by the way in which she arrived in this world . Luckily for her we have done therapy since she was 6 months old and she is catching up steadily with all of her milestones . I agree and believe that these accidents are very rare (luckily) however someone has to be the statistic. So I want to make everybody aware that you have the right for more information and demand if you have too . If I had listened to them she would have died the day she was born . They told me I was being silly and wanted to send me away with a sleeping pill ……. Luckily I made them check my baby’s heart beat and it was at 60 beats per minute. Trust your instinct !!!!

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