From Susan:
“My first was born by c-section due to brow presentation. I was induced at 41 weeks 4 days. Long labor.
My second was a successful VBAC. I was induced with him also at 41 weeks, 5 days with a Pitocin drip. Contractions didn’t start right away and, after about 3 hours, the doctor broke my water. Things started so slow, but the doctor was very patient and we waited. Finally the contractions were getting a bit heavy and I decided on an epidural. I was given a small amount and was still able to feel the contractions but the peaks had been tapered off. I then dilated quite quickly from 8 to 10 (45 minutes) and had that intense need to push. So I pushed for about 30 minutes and our son was born. But when he came out his cord was wrapped twice real tight around his neck. He was not breathing. His one minute Apgar was 3. He was given oxygen and, within 5 minutes, his Apgar score was up to 8.”
Gloria responds:
Susan, you said- ‘But when he came out his cord was wrapped twice real tight around his neck. He was not breathing, Apgar was 3. Given oxygen and within 5 minutes his Apgar was up to 8.’ Susan, you are making a very common mistake. Attributing your baby’s low 1 minute Apgar to the cord around the neck is not correct. Your baby had a low Apgar at birth because you had an epidural and the pitocin drip was turned up too high. We know this because the second stage was so short. The cord around the neck is the reason the doctors give you so you won’t ask questions about why he was blasted out so quickly.
This kind of pitocin induction is sometimes associated with delayed speech and/or learning difficulties. It depresses the baby’s oxygen levels through the pushing stage. The reason the baby’s Apgar score came up nicely after 5 minutes is because you grew an essentially healthy baby and it was difficult for modern obstetrics to kill him.
So many women are told the baby didn’t breathe or wasn’t pink because of the umbilical cord being around the neck. It is a lie. We don’t see this at unmedicated home births and I have attended births where the cord was tight and up to five times around the neck.
The two most important things with a VBAC are:
1. don’t do anything to increase the strength of the contractions and
2. don’t anaesthetize the woman.
Your former doctor put you and your baby in danger by not following those two protocols. Your uterus was put in unnecessary danger of rupturing by both the Pitocin drip and artificially rupturing the membranes. In hindsight, the cord was around the neck and, thus, probably out of danger but artificially rupturing the membranes is associated with causing the umbilical cord to prolapse–an obstetric emergency.
Susan replies:
“Gloria, it sounds like you just completely described what happened to me and my son–who does have learning difficulties and developmental delays.”
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This photo shows a baby born at home in the U.K. who had the cord twice around the neck and was in a breech presentation. Note his good colour.
that makes me feel better. Ive heard so many different stories about “cord around the neck”. my mom’s scariest birth story (out of 6) is about my sister who was born with the cord tightly around her neck, blue and not breathing. she didnt have any medication though, so Im not sure what would have caused the difficulty in that case. it was a very short labour and a big baby. anyway, after some resuscitation efforts by the hospital staff, my sister was just fine. I sort of wonder whether they overreacted and my sister would have done equally well if they’d given her to my mother to hold instead of “resuscitating” her.
anyway, it makes me feel better that you say the nuchal cord fears are all a lie. I knew that a loose cord is no problem, but you say even a tight cord is fine. are there any situations where the cord around the neck COULD strangle the baby?
There are pictures in the obstetric books of babies who died in utero with tight cords and I think that’s what creates some of the mentality of medical professionals to panic about the cord. It’s sort of like looking at photos of children’s broken bodies in school crosswalks–if you did that on a regular basis, you’d probably never let your child cross a street.
Even though the cases are rare and always seem to involve intrauterine death, the graphics are chilling.
Of course, the last thing one should do with a baby who is having a hard time breathing for any reason is cut the cord. In your mother’s day, that’s what they always did. It’s just beginning to be recognized that baby’s need the backup protection of a pulsing cord in order to adjust breathing/circulation in the first 20 minutes of life. Thanks for your comments, Amy, I really appreciate your input to my blog.
ah you’re welcome. thanks for your blog.
Gloria, I have a question about this. My 3rd baby was born under difficult circumstances. At 42w2d (by LMP), I was dilated about a fingertip, no real contractions, and my daughter was head down. I had NO interventions of any kind — no induction, no AROM, no epidural. About 8:30 the next morning I was wakened (at home) by the feeling of my water breaking. Minutes later I experienced VERY strong contractions and realized that my body was already pushing the baby out — I wasn’t even trying. I screamed for my husband. Suddenly I felt my daughter… not exactly “crown.” She came feet first — both feet straight down — and was a deep, purplish blue. She was born to about her naval, and then got stuck. The paramedics arrived about five minutes later and (sorry for TMI description, but I don’t want to try and use terms I don’t completely understand and end up using them wrong) reached inside me (with his hands) and carefully pulled her out. The paramedics called her initial APGAR 3-4. She was very blue and I don’t believe she was breathing on her own. The paramedics intubated her, and gave her oxygen. On the way to the hospital she regained color, began breathing on her own, and ended up being absolutely fine.
The entire thing lasted less than an hour. We did not have much time to ask questions. Initially I was under the impression that the reason my daughter was blue was because the cord was wrapped twice around her neck. Then I found out that the cord around the neck doesn’t matter since she wasn’t using her trachea yet. When I learned a little about footling breech births, I thought the cord must have prolapsed. But you just said that the cord being wrapped around the neck would “probably” prevent a prolapse, and that makes sense to me. If the cord was wrapped around her neck, and her neck was nowhere near my cervix when her feet came out, and she was already blue then… it doesn’t make a lot of sense to think the cord was prolapsed. (Also, my medical records say nothing about a prolapse, and no one mentioned it to us.) So now I have no idea what the problem was. I know you can’t tell me for certain just based on my description, but do you have any ideas?
It’s not *very* important. My daughter will be turning five in February and she is perfectly healthy. I’d just like to know.
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“This kind of pitocin induction is sometimes associated with delayed speech and/or learning difficulties.”
I truly belive that, but would really like to see some research on it. You know where to find it?
I would like to offer another explanation. My second was born with a tight double nuchal cord as well. However, I did not have any pitocin. No epidural, no drugs of any kind. I did not even have a heplock. There were no interventions other than when my provider told me to stop pushing when she saw the nuchal cord (I consider interruption during 2nd stage to be an intervention). Baby was 42 weeks and labor started naturally and lasted about 72 hours. No AROM. Waters broke while pushing and mec was present. Pushing was about 45 minutes (9.5lbs, 15 inch head).
His first apgar was a 4 and his second a 7.
He was resuscitated.
I know why. My provider tried to unloop his nuchal cords but they were too tight so she clamped and cut on the perineum. Baby came out in the next push no problem. I am suspicious that Susan’s provider did the same thing to her baby since the loops were “real tight”.
I post because this needs more awareness. There is no evidence to support clamping on the perineum and it needs to stop.