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.
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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.
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
I lost my daughter August 2011 to what they believe was a cord accident. I felt less movement but still some movement. The confusing part to me is that some people say you will naturally feel less movement in the final weeks, as the baby becomes engaged. But then others say you will still feel the same amount of movement. And yet even others say that if you feel erratic, more constant movements then you should be concerned. There is so much conflicting information! My husband and I went to my weekly appointment at 38 weeks, there was no heartbeat. They said there was nothing they could have done about it, even if I had been in labor at the hospital. If they had saved her by emergency c section, she most likely would have been born with severe brain damage, as too much time would have passed with not enough oxygen/blood flow.
They induced my labor, she came out 24 hours later. Perfectly healthy, gorgeous baby. Cord around her neck several times…nothing else wrong. They believe that had to be it, there was just nothing else wrong. I had a perfectly blissful, uneventful pregnancy. (morning sickness excluded
It is frustrating that those of us in this minority are swept under the rug so that other expectant mothers don’t have to worry that they will be one of us. I bet none of us thought it would happen to us…but guess what? It did. However, has anyone else considered that God chooses these babies? People claim to be religious, yet when something extraordinary happens many chalk it up to bad luck. Each soul has to enter this earth for a certain amount of time, some very brief some very long. Has anyone considered that the reason this is a rare occurrence may be because these babies are needed for something, or perhaps too pure for this earth? They fulfilled their mission on this earth that God had intended for them, and now they are back in the arms of God where we should all be so lucky to be one day. (and not all of us will get there). Let’s not put all our faith in doctors and science. Doctors are not God and cannot control everything.
December 31st 2011
My babies incident happens on two days before delivery date.announced date for delivery was 2nd jan 2012.we used to consult regularly to doctor in ernakulam medical centre hospital in cochin with experienced gynec.from the begining there was no problems for fetus inside till a day before 31st when she take ecg in hospital, everything was normal…when my wife wake up in the morning of 31st when she checked for movements inside it was silent,no moments..once she felt she suddenly move to hospital with her mom and took scan.dr.found there was no cardiac activity inside baby.then she admitted to hospital and dr.gynec has checked she said something goes wrong inside it my be cord has wounded on baby.then they given trip-medicine for normal birth and the nxt day she dlvrd,the baby has dead cause two cords were wounded on babies neck and her fingers were fold on her neck with cords.as per doctors explanation it was normal it may happen it is no ones mistake……..doctor has always said like this there is no problems everything is normal so u have to admit only on 2nd jan,but instantly all this things happened….
someone can advise whatzzzz really happened????for lose of our baby.
is it some one mistake or natural phenemenon of a utrus one in hundred/????
degas antony
h/of linda
cochin,india.
degascochin@gmail.com
Hi Degas,
I am so sorry for your loss. I am not a medical professional but to my knowledge, I’m not aware of any fail proof way to determine in utero that a cord wrapped around a baby will injure that baby. I wish there was.
Warmly,
Jen
how we can tackle this cord winding incident from baby?????
is there any solutions in this medical world ??????
My baby was born on the 2nd January . She had the cord wrapped around her neck 2 times . It was a horrible labour because the baby with every contraction I had her heart rate was dropping dramatically . After a few hours of monitoring her they decided it was best to prepare me for an emergency c-section . Just before transferring me to the operating theatre they checked and I was 10cm so they decided it would be quicker to deliver naturally . My baby was born 4 mins later and didn’t start breathing . They had to resuscitate her and it took 4 mins to get her to take her 1st breath . The silence was the worst time of my life. I didn’t think she would make it. After 8 hours inthe nicu she was with me in my arms for the 1st time ( obviously I didn’t get a cuddle at birth ) I am very lucky to say she is now a healthy 4 week old baby . I still feel traumatised though from what we went through and I wish there was a way we could have known that she was in trouble beforehand. I did however in the last week of my pregnancy feel a dramatic difference in the amount of movement that she was making so I just want to say follow your instinct . If your worried go see your doctor and get them to do a full check because I’m sure if they do a 3d or 4d scan they could have seen the cord there . My prayers are with all of those babies lost .
Mum of 3,
Thank you so much for taking the time to leave a comment. I can’t imagine how long that 4 minutes felt. Excruciating probably doesn’t begin to cover it.
I’m glad she’s doing ok now.
You might find it help to google “birth trauma resources” as I suspect there must be an on-line or in-person support group for moms who have experienced similarly scary events around the time of birth. I have always found it healing to talk to people who “get it” and maybe you will find the same.
Thanks again for your comment and take care,
Warmly,
Jen
My Babys apgar at birth was 1then at 5 mins it was 4 then the next was 9 .
My daughter just give birth to a baby girl three weeks before her due date with the cord around her neck 5 times. Even though she was only 3 weeks early her baby barely weighed 4 pounds. At birth she didn’t breathe on her own for several minutes and spent 5 days in the NICU. This was my daughter’s first pregancy at the age of 37, therefore she was treated as a high-risk pregancy. She spent the last two months of her pregancy on bed rest, because the baby was not passing all of her “baby stress tests”, plus the fact that my daughter wss showing signs of protein in her urine. During her last two months of her pregancy she was seeing her doctors twice a week with ultrasounds once a week and baby stress tests every visit. She was admitted to the hospital 4 times before delivery because the baby could not pass her “stress test”, each time only to the sent home. Ten days before her baby was delivered by an emergency C-Section, I went to one of her many ultrasounds, right away I could see something rapped around her neck. I asked the ultrasound tech if that was the cord around the baby’s neck, and she just “brushed” it off. My God, if I could see the cord around her neck, why couldn’t the tech? In total my daughter must have had 15 ultrasounds including several 3-D ultrsounds. I hate to think what would have happened if the doctors had waited longer to deliver her. On the day of delivery, my daughter was admitted for induction and a planned vaginal delivery. As soon as she arrived at the hospital the doctors knew the baby was not doing well, no induction measures were done as my daughter was already having very mild contracts (which she could not feel), however the baby could not tolerate, within 15 minutes she was in surgery and the baby was born within 10 minutes. The doctors told us that the low birth weight was probably due to the cord being rapped around her neck 5 times. Again thank God everything is turning out alright. There is a saying “When babies are born they are in the process of leaving Heaven to parchute to Earth. It is uncomfortable sometimes, but everything happens for a reason”. This little angel was certainly blessed.
Dear friends,
My wife is in 38th week of pregancy and yesterday doctors told that there is a cord around the neck of the baby. Dr is leaving the suitation to us. We still have another 20 days as per the EDD. As per dr, if you want, you can opt for Cesarean else wait for another week or so for normal labour. They are not giving us any moral support but they are suggesting that there is risk in waiting for normal labour. My wife doesn’t want to go for cesarean as our 1st baby was born 5 years back in Normal labour.
After reading the above messages, i am worried. is it safe to wait for normal labour till EDD. Can some dr/expert suggest us on the same. Also what are the symptoms of danger to baby because of card on the neck. is there any chances of card getting released in 38th week? is cesarean manditory for such cases?
Shiva,
I am not a medical professional, so I cannot provide medical advice. That said, no one can predict if your baby will have a cord accident. The chances are very good that s/he won’t, but no one can give you a definitive answer.
While many deaths are blamed on cord accidents, it’s hard to determine, short of an autopsy, the actual cause of death. Sometimes babies die in utero, for reasons that we don’t understand, but rather than saying that, sometimes doctors/parents blame the cord as a way of giving a “reason.”
I’ll post your question on my Facebook profile, the http://www.vbacfacts.com FB page and the Midwifery Today FB page. Check out those links to see the responses.
Warmly,
Jen
Shiva,
There have been over 20 comments left via the three links I provided above. Hope this helps!
Warmly,
Jen
I am a medical professional, and can’t give you medical advice over the Internet, but can tell you what I know about cord accidents. Cord accidents that cause harm to the baby in pregnancy are knots in the cord, or when the umbilical cord prolapses and gets compressed by the baby’s head (neither of which seem to be the case for your baby!). Cord around the neck is VERY common and is NOT life threatening. Approximately 1:3 babies will have a nuchal cord, and the vast majority of those babies are not affected at all by it. A few who have a tight nuchal cord will experience minor stress towards the end of labour but will still come out just fine. A small number will be stressed in earlier labour by their nuchal cord, and will give clear signs through the heart rate that they are stressed, and may be born by caesarean. It is important for you to know that a nuchal cord seen on ultrasound does not always mean that the nuchal cord will still be there at birth. It is certainly not an indication for a caesarean section, and you will not find any evidence or research or obstetric guidelines to suggest that it is. If your obstetrician is suggesting or recommending something that doesn’t seem right to you, ask him or her for the guidelines and research that support that recommendation. If there aren’t any presented to you, consider that it is not a good medical recommendation, and may in fact be one driven by personal opinion or financial reasons, which is never a good reason to submit to major abdominal surgery!
Thats right, about 1/3 of normal vaginal births have the cord around the neck. There is no greater risk of cord compression in this mode than any other. Babies are built for labor. If for any reason the cord does get compressed the baby will tell you via it’s heartbeat. Again, babies are built to tolerate transient cord compression. Under no circumstances is a nuchal cord a reason for elective c/section. Finally, babies cannot strangle on a cord. In order to strangle they have to be breathing air through their trachea. Which, of course, they are not! Stories about stillbirths blamed on nuchal cord are just man searching for a reason for a tragedy. This fear mongering boils my blood, too.