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.
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.
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 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 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 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.
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