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Nuchal Cord: When baby’s cord is around their neck

Cord wrapping rarely causes difficulties for the baby during birth

Lisa Litton, CNM, ARNP

What if the baby’s cord is around their neck? Should I worry? This is a question that comes up often during prenatal visits for those planning out of hospital births, often after hearing a birth story which includes the dramatic climax of “and the cord was wrapped around her neck!”. Cord wrapping is actually fairly common, and it’s not an inherently dangerous situation as many think. It rarely causes difficulties for the baby during birth, and when it does, it is most often a very temporary issue with a quick resolution.

A slippery substance called Wharton’s Jelly protects the umbilical cord

While it is fairly common (20-29% and as high as 37% for later gestation) for a baby to have its cord wrapped once or more around the neck, it is rarely a problem in labor since the wrap tends to be loose and the cord is designed to be wrapped without causing issues. Your baby’s umbilical cord is protected with a slippery substance called “Wharton’s Jelly”. This magical jelly protects the umbilical cord from pinching off the baby’s blood (and therefor oxygen) supply. In fact some babies come out with an actual knot in their cord, called a true knot, and yet the baby has grown well with no problems in labor, all because of this amazing slippery substance!

The baby’s heart rate is monitored throughout labor with a doppler

If there is a problem with the cord being tighter than usual and it is causing your baby distress, we will be able to hear this by monitoring the baby’s heart rate with the doppler device we use throughout labor to check their heart rate. If the problem with the baby’s heart rate dropping is fairly minor, and the laboring woman is close to giving birth, we advise changes in positions and administer oxygen, which often results in a resolution of the heart rate problem. If these simple interventions do not work, we do not hesitate to transfer to the hospital if it seems the best course of action. Our primary goal is the health and safety of you and your baby.

As midwives we are prepared to overcome any issues with a tight cord wrap

There are rare instances in which a cord around the neck only becomes a problem (causing signs of distress in the baby’s heart rate) only in the last few seconds of pushing, as the baby is descending into the birth canal. In this rare scenario, the baby may need assistance with taking their first breath. We are prepared to do this by gentle stimulation (rubbing their back) and giving them oxygen by mask until the baby can breathe on its own. Our actions as midwives in these first few seconds after the baby comes out are most often sufficient to overcome any issues with a tight cord and the baby recovers quickly with no long-term health issues. More often than not, we discover that the baby’s cord is wrapped around their neck only after their head is born. You might hear us say “nuchal cord present” which means that we feel the cord on your baby’s neck and we either slip it over their head, or “somersault” them out of it at birth, and place your baby right into your arms, exactly where they need to be.