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%¹² 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, nuchal cords are rarely the cause of stillbirth.
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.
Per Wikipedia:
Retrospective data of over 182,000 births, with the statistical power to determine even mild associations, proved conclusively, that a single or multiple nuchal cords at the time of delivery is not associated with adverse perinatal outcomes, is associated with higher birthweights and less cesarean sections in births. (5,6,7) Nuchal cord does not need any additional obstetrical intervention unless there is evidence of fetal compromise. The most common clinical sign of fetal effects are fetal heart rate decelerations during labor or a change in fetal behavior prenatally.
Per 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.
Per 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.
Per 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.
Per 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.
Per eMedicine:
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.
Per 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.
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.
As long as the cord it not compressed to the point it is unable to transport oxygen, it’s fine. People tend to forget that the baby is not “breathing” via the “windpipe” while in utero.
I don’t think that THIS is the concern doctors have about the umbilical cord. Don’t unborn babies still need blood supply (i.e. oxygen) to reach their brain? I would think that doctors would rather be concerned about blood not reaching the head because the umbilical cord is wound too tightly and can get tighter if delivered without extreme caution.
Also, this “VBAC Fact” opens itself to further scrutiny as the article in question isn’t even cited.
Sure, this MAY dispel the myth that a child can’t breath… but it doesn’t dispel the myth that it can’t be terribly dangerous.
This “fact” leaves much to be desired and is possibly dangerous because of its incompleteness.
Joshua
Joshua,
When I find something I want to share that I read on another website, I don’t provide citations because you can go to the original post, read it, and obtain references there. When I personally write articles, links are provided to the sources.
Also, I don’t believe I or the author of the original article said this was THE concern, only A concern.
Warmly,
Jen
This article from a medical website backs up the general tone of what’s being purported here: http://www.drspock.com/article/0,1510,5332,00.html
A full one third of babies are born with the cord around the neck. It is only rarely a problem. I have had two with the cords wrapped; one it was around three times and had absolutely no affect. The other, the cord was so tight only her head could come out. The Dr simply cut it right then and she was born fine. The cord alone is not a justification for major abdominal surgery; only if baby is showing signs of distress.
Ten years ago I had my 10lb. baby boy at home with midwives. My little guy was wrapped three times in his cord. My cousin gave birth the same week, same thing, but she get a c-section in the hospital. I just bit my tounge when her mom spoke of how glad she was that her daughter was in the hospital “where they could take care of such emergenceies”. I am a midwife and understand that there is GREAT danger, but experiance and knowledge go a long way in such cases. And just in case you are wondering, My son is a healthy, normal, above average intelligence, boy.
My first baby’s cord was short and was compressed to the point that it couldn’t transport oxygen. And she had no heartbeat before she came out. But with emergency assistance she was in the end OK. I don’t know how rare this is. I’d love to know.
My Grandson was stillborn this year 2009.
The cord was round his neck three times, tightly.
The hospital said this was the likely cause of his death, They estimated he had been dead for about 1 day before he was born.
So, you say it wasn’t a case f being starved of oxygen, but surely the oxygen was starved from getting to his brain to cause death in this way?
There have been reports since the 1950s of babies deaths being due to cords around the neck. Go Google it.
Gran,
I’m so sorry about your grandson. How devastating that must have been. Fortunately such events are very rare, but that is no consolidation to those who experience such tragedy first hand.
Did you go to the article I was linking to for more information? It addresses the visceral response people, especially non-medical professionals, generally have when they see, or hear of, the cord being around the baby’s neck.
I did google it and this woman said it better than I did:
Here is what the March of Dimes has to say about nuchal cords:
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.
Warmly,
Jen
I totally accept that there is much less danger associated with nuchal cords than common belief.
I value this forum for discussion.
I do not have children but am a strong advocate of natural birth and home birth.
whenever I mention any of this to my mother she recounts my birth as an example why you “can’t take a chance” with home birth.
I was born with cord around neck and around top of one arm. The arm was severely discoloured due to prolonged lack of circulation and the doctor cancelled his leave (it was Christmas) as he expected to have to amputate my arm within days of birth.
As it went it all turned out fine – hooray I have both arms!
Could there possibly have been a difference in this prognosis and outcome with a home birth instead of hospital birth?
Thank you very much
Warmly
Lynda
Hi Lynda!
To say, “What a relief your arm wasn’t amputated” is a huge understatement!
I am not a medical professional, so I think it would be interesting to have some homebirth midwives respond with how they would have reacted.
Here are my lay-person thoughts. Since the OB expected to amputate your arm within days of birth, and it wasn’t something that had to happen immediately upon delivery, I would suspect that the location of birth would have made little impact on the outcome. If your mom was at home, and the midwife or OB (there are a few rare OBs who attend out-of-hospital births!) saw the discoloration, you could have transferred to the hospital to have your arm further evaluated.
Warmly,
Jen
I would have to agree with the general tone that it is not an emergency in and of itself. When my son was born the doctors blamed a ‘tight nuctual cord x2′ for his being in distress, NOT the fact that they gave me NON-REVERSIBLE drugs to induce labor which threw my uterus into a contraction it would not relax from.
His heart rate was undetected for the majority of that half hour, we could only find it by visualizing it on ultrasound. We still had to wait for my OB to get there since there wasn’t anyone actually on duty for emergencies.
They can blame the nuctual cord, but I’m not convinced it wasn’t an actual reaction to the drug (cytotec) as well. Everyone kept telling me how ‘lucky’ i was that I was at the hospital when it happened- and I kept saying, ‘But babies are born all the time with the cords wrapped around their necks, it was only an emergency because of the initial mismanagement of care.’ That was always responded to with a, ‘Well, all that matters is that he’s healthy!’
It may have been my first pregnancy and birth, but I can’t express how instinctual and primal my knowledge of what was supposed to happen was. Unfortunately I didn’t have a big enough support system and ended up through the ringer.
If you are ever being induced for medical (or any other) reasons, Say no to Cytotec!
My mom gave birth to a still born girl. She had passed away just 24-36 hours before she gave birth. She knew because her stomach turned hard as a rock. The baby girl was delived as I said, still born with the cord around her neck. The doctors told her back then (1979) that the cord had stangled her.
I just got back from hospital today and my baby girl strangled to death with her cord once around her shoulder and then wentaround her neck twice, and I saw the baby after it was induced and there’s no way we could prevent this or help her to untangle. It just happened. She was 18 weeks only.
Rachel,
How devastating. I am so sorry for your lost.
Warmly,
Jen
Would you know how often pressure from a nuchal cord would result in the need for an ‘emergency’ birth? I had no idea that there were so many births with a wrapped cord, curious as to how many of those may in fact be problematic due to the pressure concerns even though strangulation is not an issue.
CB,
I don’t know.
This article was very interesting: 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.” Unfortunately, he does not cite where this statistic is from and I have yet to find any studies to verify it.
More on nuchal cords:
If you find further information on specific rates of complications, can you forward them to me as well?
Warmly,
Jen
My baby was born today at 17 weeks due to a cord being wraped around his neck 3 times tightly. I think it really depends on if the blood can flow properly to the baby
Stel,
I am so sorry.
Warmly,
Jen
I am so sorry to read about your loss. I lost my son Zachary at 37 weeks to pre-eclampsia. The March of Dimes has an amazing support group called SHARE – you should come and check it out.
Take care.
-Zsuzsi
My daughter was born 31st august 09 with nuchal cord x 3. She had significant heart decelerations and we had to get her out quickly. She needed resuscitation when she was delivered. For a week before I was induced (severe separated symphasis pubis) she had a low heart rate and restricted movements. All of this was put down to the cord being wrapped round her neck. I have been so traumatised about what could have happened I am receiving counseling and it has taken me 5 months to google this.
SD,
I am so relieved that your daughter is ok. That must have been horribly frightening! I hope your counseling facilitates healing and provides you with some peace and comfort.
Warmly,
Jen
I think that nuchal cords ARE a reason for concern. My son was stillborn 2.5 months ago because the cord was wrapped around his neck and right leg. Even if the majority of babies are not affected by a nuchal cord, there are babies that die from this. If it is determined that the cord is wrapped around a baby, I feel very strongly that a mother should be monitored closely. I find it very insensitive that anyone would say this is not a reason for concern. Maybe that’s the problem here. Maybe if more people were concerned about this, less babies would be stillborn.
Heartbroken,
I’m so sorry about your son. I agree with you that if a nuchal cord is suspected, the baby’s heartrate should be monitored. I was trying to express how common nuchal cords are and how rarely they result in a stillbirth, thus putting the risk into perspective. I did not say that nuchal cords are not a reason for concern. I did imply in the opening sentence that nuchal cords are not a reason for an automatic cesarean section unless oxygen delivery to the infant is impacted. Yet the research I cited found that even though nuchal cord babies were delivered by cesarean at a lower rate that non-nuchal cord babies, the outcomes were the same. I’m so sorry that you were the statistic.
Warmly,
Jen
Heartbroken, I am so sorry for your loss. But it’s impossible to know, without having been there and having all the details, whether or not your son’s death really was because of cord wrapping. There are many instances of women being told that their child died because of this or that reason, that later was discovered not to be the case. When there is an unexplained stillbirth, and the baby has cord wrapping, it is very easy to just point to that as the reason. But if we go by odds, 1/3 of stillbirths would likely have cord wrapping, just like normal babies. Many stillbirths could be from other unknown causes and just have wrapping coincident to the actual cause.
Again, I am so sorry for your loss. But I think we cannot just leap to conclusions based on a few anecdotes posted on a blog, kwim?
It is always heart breaking to hear about babies who are born still. There are many reasons why this can happen.
There is such a large percentage of babies who are born with cord wraps somewhere. Undoubtedly, babies who are born still may also have cord wraps around them. Though this has been given as the reason for the stillbirth many times, more often than not, it is not the cause for the stillbirth. If the cord is developed properly (many babies who are born still, especially those early or those who pass before labor begins oftentimes have associated missing Wharton’s jelly and/or the placenta itself is also improperly developed thus making a cord wrap a risk, though most babies most likely would not have been able to withstand labor with improperly developed placenta/cords anyway). I think it is a huge disservice to grieving families (who are rightly looking for an answer as to why this happens, though sadly there isn’t always a reason to give them) to tell them that the cord wrap is to blame. I’m sure well-meaning providers began to use the cord as an excuse to give families a reason to assist them in their grieving process, but this misinformation has continued too long. Without an autopsy further examining the cord and vessels, blaming the nuchal cord to provide some closure for parents is not sound medicine.