Cord Around the Neck

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.”

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

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.

Nuchal cord

About gloria

I live and work in Vancouver BC Canada. I've been in the childbirth business for 30 years. I teach midwifery and doula courses both online and in person.
This entry was posted in Hospital birth, VBAC Very Beautiful & Courageous. Bookmark the permalink.

20 Responses to Cord Around the Neck

  1. Amy says:

    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?

  2. gloria says:

    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.

  3. Amy says:

    ah you’re welcome. thanks for your blog.

  4. 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.

    • comadrona says:

      Michelle, it sounds like your body did the best thing for your baby – what some homebirth midwives call a “safety labour” – i.e. slow to begin with, then very quick at the end. I have seen this happen several times when, for some reason, baby is needing the labour to be slow and gentle at first then the last bit happens in a rush. The cord may or may not have been a reason, we will never know. But blue/purple is not a terrible colour for babies – grey/white is much more ominous. I think your baby probably would have got started all by herself if her cord had been left unclamped and uncut, too. I wonder if it was something to do with her turning breech at the last moment – this is not unheard of, both turning breech or turning head-down in labour. The way breech birth is handled can also contribute to the baby’s outcome. In general it is best not to pull or twist the head/ neck but to keep hands off and let the body hang down and wait for the head to deliver. If the process is rushed, it can cause breathing and other trauma.

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  6. Eydis Hentze says:

    “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?

  7. erin says:

    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.

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  10. Colin says:

    Dear Gloria,

    We recently lost my daughter to Hypoxic-ischemic encephalopathy.(Death certificate)

    We have been told and have read the umbilical cord was tight around the neck and could not be removed (heart beat 70-90 dropped from 130)……………..so they decided to cut the cord while only her head was showing ,we think in the resulting death of my daughter (Neo-natal )

    I am still awaiting on the POST MORTEM results ,but from my research i dont understand why they cut the only supply of oxogen and blood to my baby when they had no knowledge she was capable of breathing on her own.
    Apgar 1min 0
    Apgar 5 min 0

    I read that the cord should not be cut even if the cord is really tight due to the percentages loss of blood and oxogeyn.

    My wife and i are devastated as we were told for nine months at every check that we had a healthy baby and we were very lucky.

    Are we just looking for someone to blame at this horrible time or do we have a just cause to find out what truely happened ?

    The hospital here in LONDON ,ENGLAND are not commiting and are giving many excuses at the moment and are awating the PM themselves.

    With hope and kind regards

    Colin ……………..email……………. scotswearkilts@googlemail.com

  11. Colin says:

    Sorry OXYGEN …….Stress!!!!

    • comadrona says:

      Hi Colin, You have my deepest sympathy, I too lost a baby daughter at birth (many years ago) very suddenly due to oxygen deprivation. Perhaps leaving the cord unclamped and uncut might have helped but it would be hard to say that. Sometimes babies just don’t cope well with the stresses of labour and birth – though of course the vast majority do. Or there might have been some other underlying reason which you will never know. Unfortunately autopsies only reveal the probable cause about half the time. It is agonising not to know, and a subsequent pregnancy is often beset with anxiety. The interesting thing about stillbirth is that the rate (about 1/100 births in developed countries) has not really improved in more than 30 years. We still don’t know why this happens – it just does. May I wish you both a place of peace very soon, knowing that something this bad takes many years to accept. Try not to be afraid for the next birth if you should choose to go forit, fortunately it is rarely repeated.

  12. Betsy Dewey says:

    I agree wholeheartedly with what you say, and it might be highly unusual, but I need to chime in and say that I did indeed see a home birthed baby whose head was blue and he wasn’t breathing, cord wrapped around his neck 3 times. I tell the story in my book (which will be available in about two weeks) – it was the pivotal moment in my life when I saw the midwife go into the “zone” deeper than any musician or athlete I’ve ever seen. She was masterful in removing the cord and coaxing the baby to breathe. It took only seconds and I have ever since then, been totally in love with home birth, giving birth to both of mine at home.
    For the record, he has had some speech challenges.

  13. Kate says:

    Colin, I am so sorry for what happened to your son.

    I have emailed you the birth story of my son Alex, who had a tight nuchal cord cut at the perineum minutes before he was born. This happened in 2004.

    His birth story contains links to Judith Mercer’s work and Rachel Reed et al on nuchal cord management, somersault technique etc.

    Placental transfusion is essential for re-perfusing babies with compressed cords/ hypoxia at birth, which was our babies were denied from a terrible practice of cord clamping.

    My son survived – he is a beautiful boy but he struggles with compulsive behaviour and learning difficulties.

    Kate

  14. Kate says:

    Colin, I am so sorry for what happened to your daughter.

    I have emailed you the birth story of my son Alex, who had a tight nuchal cord cut at the perineum minutes before he was born. This happened in 2004.

    His birth story contains links to Judith Mercer’s work and Rachel Reed et al on nuchal cord management, somersault technique etc.

    Placental transfusion is essential for re-perfusing babies with compressed cords/ hypoxia at birth, which was our babies were denied from a terrible practice of cord clamping.

    My son survived – he is a beautiful boy but he struggles with compulsive behaviour and learning difficulties.

    Kate

  15. April says:

    I have read your stories and my heart goes out to all. I actually found this site looking for answers on possible skull development issues that may develop from the cord being around the neck. I was born w/ the cord around my neck 3 times. I know it took them a few moments to get me breathing but I am healthy. My left earlobe is deformed somewhat due to the cord being around my neck. I am 47 years old now and after growing up with sinus problems (not allergies) I am now experiencing chronic pain in the lower portion of the back of my skull. I do have a significant bump at the base of my skull since birth. I am seeing a neurosurgeon. Is it possible that this could be from the cord and I have been blessed not to have had issues sooner in life. I have other symptoms. Has anyone heard of this?

  16. Sara says:

    If the cord around the neck is pulsating then there is no problem, in my opinion, because it keeping pumping oxygen and blood into the baby. Am I right?
    and IF the cord isn’t pulsating, then how about unwinding it, and covering it with warm moist towels in hope to get it pulsating again while the same time resuscitating the baby, if the baby looks distressed and limp

  17. Midwife Lynda says:

    it breaks my heart to read “the doctor was so patient” AFTER you were induced AND your membranes were artificially ruptured – especially with a VBAC client. I am so thankful this ended well… peace to all mamas in labor

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