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Tuesday, February 10, 2009

Cord around the neck is NOT an emergency

I have been disturbed at the number of women I am seeing recently who are being told that the reason for their c-section was the cord wrapped around the baby's neck, and that if it wasn't for the c-section, their baby would have died. Even more upsetting are the women who have suffered the tragedy of a stillborn baby, and have been told the reason the baby died was from a cord around the neck. For the most part, this is completely untrue!

First you must understand the anatomy of a fetus, as opposed to an adult. We breathe through our necks, and so the appearance of "strangulation" alarms us. Fetuses, however, do not breathe through their necks; they can't, because they live in liquid for 10 months. Instead, they receive their oxygen through the umbilical cord, and do not need to use their trachea to breathe until after they come out. For this reason, the most vulnerable part to a developing fetus is the umbilical cord itself, or the placenta to which it is attached, NOT the neck.

Babies can, and do, die because of accidents involving the cord and the placenta, such as cord prolapse, placental abruption, and other such incidents. The cord itself, however, is extremely strong, and unlikely to be compromised, except with a great amount of force. This article does a good job of explaining the mechanics of the umbilical cord.

Not only does the physiology of a nuchal cord make death by strangulation nearly impossible, but the incidence of nuchal cord is so common, that more babies ought to be dying if it were possible. Cord around the neck (nuchal cord) occurs in one out of every 4-5 births (various sources). That's 20-25% of all babies who are born with a cord around their neck at least once, and sometimes more. If nuchal cord is so deadly, why aren't more babies dying? The answer is that nuchal cord isn't deadly.

In this article from the March of Dimes, an organization which specializes in the prediction, prevention, and treatment of prematurity and defects, it is stated, "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."

Just to be on the safe side, many studies have been done that show that there are no increased risk of negative outcomes with nuchal cords. In these studies, they looked at ___ number of pregnancies, and tracked all the factors associated with those pregnancies and labors, and could find no statistical correlation between intrauterine fetal demise (IUFD) and nuchal cords. In other words, while some stillbirths had nuchal cords, it was apparently a coincidence.

http://pt.wkhealth.com/pt/re/ajog/userLogin.htm;jsessionid=JWsYb7l0yWwQkBbbGpVhbxyDWF9PSXQLN8kKZp2Gxc0w1Jn0hh8y!1694406651!181195629!8091!-1

http://www.perinatology.org.tr/journal/issue/20062/fulltext/txt_05.asp

http://content.nejm.org/cgi/medline/pmid;15994613?FIRSTINDEX=80&hits=20&fyear=1985&where=fulltext&tmonth=Dec&searchterm=latza&fmonth=Jan&tyear=2007&searchid=1&FIRSTINDEX=80&resourcetype=HWCIT

http://www.jultrasoundmed.org/cgi/content/abstract/23/1/43

http://www.ncbi.nlm.nih.gov/pubmed/18604054

http://www.ncbi.nlm.nih.gov/pubmed/16374604

http://findarticles.com/p/articles/mi_m0689/is_n4_v34/ai_12185823/pg_3

http://cat.inist.fr/?aModele=afficheN&cpsidt=20200267


While nuchal cords themselves aren't dangerous, I found this article that states, "Furthermore, decreased Wharton's jelly in certain areas of the cord, most notably the fetal and placental insertions, can result in occlusion of fetal blood flow if the vessels are twisted sufficiently[33]" The article itself makes no conclusion about whether or not nuchal cords increase the risk of IUFD, but that statement would imply that the nuchal cord itself doesn't cause death, but may in some cases complicate things because it could also be twisted at the umbilicus or the placental insertion.

I have also heard it suggested that the cord could become tight enough to cut off the blood supply through the artery or vein in the neck. The carotid artery is fairly deep in the neck, so the pressure on the neck would have to be extraordinarily tight, something I believe would be nearly impossible for a fetus with a limited range of movement to accomplish.

If you are a mother who was told your baby would have, or did, died due to nuchal cord, you were misinformed. Do doctors lie? Sometimes. Sometimes they make an error in judgment, a baby dies, or a woman undergoes unnecessary surgery, and they need to have a reason in order to avoid being sued or fired. But I think this is not common.

I think in most cases, the doctor is not aware of the newest studies that show that nuchal cord is not a possible cause of death. I think in most cases, doctors want as badly as the parents to find a reason for why bad things happened to their babies. I think in most cases, a doctor is trying to do the best they know how, and they simply give their best guess to answer the often unanswerable questions.

In any case, it is clear from the evidence out there, and from our knowledge of anatomy and physiology, that having a cord around the neck is not life-threatening to the fetus, and should be treated with no more concern than a baby born posterior.

88 comments:

Joy said...

Good thing my baby lived, she should be dead according to this myth. At least the doctor I was seeing with her didn't freak out. He just unwrapped the cord, no big deal.

Anonymous said...

Our 2nd son had the cord around his neck. It wasn't suffocation that was the problem, it was that when my wife pushed, it would tighten and cut off his blood supply and made his heart rate drop to around 40 bpm.

It may not always be dangerous, but there are cases where it can be.

Emily said...

Anonymous: In one of the articles I linked, she describes the physiology of the baby's descent. What you are describing is physically not possible. As the baby moves down, the placenta and uterus move down with the baby, so the cord is never "pulled tight," as we might imagine it. Baby's heart rates do drop normally during contractions anyway, and while your son's heart rate dropped dangerously low, it is unlikely to have been caused by the cord (except in the case of cord prolapse.) Two other factors that can cause unfavorable heart rate drops are pitocin and narcotics, such as nubain, or those found in an epidural.

Melissa said...

My little sister was born naturally and she had the cord around her neck.

alisaterry said...

This is very well put, so I'm going to link to you!

Anonymous said...

My first son had his cord around his neck 3 times and there was no length left for him to descend. His head never reached my cervix. After 30 hours of hard labor with intense contractions coming every 2-3 minutes, I was still only at a one. My doctor ruptured my membranes and found meconium in the waters. Shortly after, my son's heart rate began dropping down to 60 bpm or lower and did not recover with any tricks they tried. He went into fetal distress. My doctors did a c-section. My son had to be on oxygen for 12 hours in the NICU. Don't tell me that the cord wasn't the problem.

Recently I gave birth to my second son by a successful VBAC. He had the cord wrapped around his neck once. However, there was still plenty of length left for him to descend. During my contractions, his heart rate had declined, but would recover afterward (no pitocin was given). The doctor said that the cord was getting pinched somewhere, but since my baby wasn't going into distress we were fine proceeding. He was born healthy, and spent no time in the NICU.

One time around the next was no problem. Three times around the neck with no length to descend was a big problem.

Emily said...

Anonymous: I'm sorry to tell you that you were misinformed.

As I said in a previous reply, the cord does not prevent descent, except in the case of *extremely* short cords, which is very rare. Were you induced? Did you have cervadil, cytotec or pitocin? All those things can result in unproductive labor and fetal distress (including meconium). Also, artificial rupture of the membranes can cause fetal distress. It doesn't sound to me like his cord was too short - it sounds like he was born before he was ready.

In your second birth, the doctor's assertion that his cord was getting pinched was also incorrect. A pinched cord is an extreme emergency and would be cause for an emergency c-section.

Christina said...

I just delivered 1/29 and my son had double nucal and when I would push his HR dropped down to 60-70 bpm with and without contractions and pushing made it worse. I think that there is an exception to everything. I hardly think that medical professionals would misinform their patients.

Emily said...

Christina - most doctors don't misinform their patients on purpose (although some may). Many doctors are just not informed themselves on the latest studies. Many doctors are going on information they learned in medical school 20 years ago, and many doctors still rely on "common knowledge."

Anonymous said...

Emily, I wasn't aware you were present at my c-section so that you could tell that my son's cord being wrapped around his neck three times WITH NO LENGTH left for him to descend (his head never reached my cervix; he was wrapped all the way to the placenta) was not what was keeping him from descending. You are so caught up in the general outcomes of a nuccal cord that you fail to recognize the uniqueness of each individual cord, baby, and mother. Generally, nuccal cord does not cause fetal distress, but neither does pitocin. Of course there are exceptions! In any case, my doctor did not decide to do a c-section because of nuccal cord (he only discovered that when he went in to get him); he performed the c-section because of fetal distress. Born too early? I think not. He was dying. Just because you have read a few articles about studies and looked at a couple studies yourself does not give you the authority to make medical judgments on any individual case, and I find your attempts to do such offensive.

And no, I was not induced.

Emily said...

Anonymous - you are correct, I was not there, and so I cannot say with 100% certainty that what occurred was truly a nuchal cord issue. However, I can tell you this: of the literally hundreds of birth stories I have read/heard/been told in the last year, I have known exactly -1- case of a true cord length issue. Yours might well also be one of those rare cases, but you must understand why I am skeptical of all the many, many women who claim that theirs was also that "one rare case."

Robbie & Barbara said...

Emily,

We lost our daughter to Nuchal Cord X2 on her due date due to cord compression, after a post mortem and 2 years of research and investigations please don’t tell us that Nuchal cord carries no risk to the unborn.
Your article is offensive and the studies you relate too are UN reliable, misleading and harmful to mums and baby’s, please can you consider removing you site from the web as we find it very hurtful and dangerous. Emily, every baby is different when considering, size of baby, cord length, position of placenta, and baby position at the onset of labour. If you think that statistical medicine applies to all you are completely wrong.
It’s you who is applying a rule on baby’s with Nuchal cord, yes many baby’s survive but many don’t and many are damaged (CP & Epilepsy) you like to quote statistics, well we telling you that 60% of infant deaths are recorded as unknown which means the true picture of Nuchal cord deaths can be much higher, in fact it is and its been ignored for years.
You had 3 baby’s and had no problems with Nuchal cord, however if one of them was damaged due to lack of oxygen or died due to Umbilical Cord Accident (UCA) you will want people like you banned from making publications, people like you who comment on issue’s that has never affected your life.
Further information and reliable studies on cord pathology please reference - SILENT RISK – www.preginst.com
Emily, please stop hurting people and find something else to do with your time.

W.H.O - Department of Reproductive Health and Research (RHR), World Health Organization
FETAL DEATH
Intrauterine death may be the result of fetal growth restriction, fetal infection, cord accident or congenital anomalies. Where syphilis is prevalent, a large proportion of fetal deaths are due to this disease.

Emily said...

Thank you for your comment, and I am sorry for your loss.

I stand by my article. Every single reputable organization stands by the claim that nuchal cord is not inherently dangerous, and is normal, occurring in 1 out of every 4-5 births. Even if every single study done on nuchal cords was flawed in some way, if they -all- have the same conclusion - that there is no correlation between IUFD and nuchal cords - then they are reliable as a body of work.

I am not passing judgment, making assumptions, or posting false information. Everything I have posted here can be found somewhere else in the world. I have no reason to remove this post, as it is just relaying information that was written somewhere else. If you take issue with these studies, statistics, or articles, please take it up with the authors of the same.

Robbie said...

Emily, please give up you are wrong and dangerouse


American Journal of Obstetrics & Gynecology
Potentially asphyxiating conditions and spastic cerebral palsy in infants of normal birth weight.
General Obstetrics And Gynecology

American Journal of Obstetrics & Gynecology. 179(2):507-513, August 1998.
Nelson, Karin B. MD; Grether, Judith K. PhD
Abstract:

OBJECTIVE: Our purpose was to examine the association of cerebral palsy with conditions that can interrupt oxygen supply to the fetus as a primary pathogenetic event.

STUDY DESIGN: A population-based case-control study was performed in four California counties, 1983 through 1985, comparing birth records of 46 children with disabling spastic cerebral palsy without recognized prenatal brain lesions and 378 randomly selected control children weighing >or=to2500 g at birth and surviving to age 3 years.

RESULTS: Eight of 46 children with otherwise unexplained spastic cerebral palsy, all eight with quadriplegic cerebral palsy, and 15 of 378 controls had births complicated by tight nuchal cord (odds ratio for quadriplegia 18, 95% confidence interval 6.2 to 48). Other potentially asphyxiating conditions were uncommon and none was associated with spastic diplegia or hemiplegia. Level of care, oxytocin for augmentation of labor, and surgical delivery did not alter the association of potentially asphyxiating conditions with spastic quadriplegia. Intrapartum indicators of fetal stress, including meconium in amniotic fluid and fetal monitoring abnormalities, were common and did not distinguish children with quadriplegia who had potentially asphyxiating conditions from controls with such conditions.

CONCLUSION: Potentially asphyxiating conditions, chiefly tight nuchal cord, were associated with an appreciable proportion of unexplained spastic quadriplegia but not with diplegia or hemiplegia. Intrapartum abnormalities were common both in children with cerebral palsy and controls and did not distinguish between them. (Am J Obstet Gynecol 1998;179:507-13.)
(C) Mosby-Year Book Inc. 1998. All Rights Reserved.

Robbie said...

CP
The Risks of Neurological Damage due to a physiological condition in the womb Nuchal Cord
Cerebral palsy:
Is a condition characterized by an impairment of the body's ability to control movement and posture. It results from faulty development of or damage to the "motor" areas of the brain, which are responsible for controlling movement. In some cases, cerebral palsy is accompanied by other manifestations of brain injury, such as seizures, intellectual impairment, behavioral problems, hearing deficits, or vision disorders.
The brain damage that causes cerebral palsy remains permanent from the time of injury. There is no cure for cerebral palsy, and it is not contagious. Accordingly, most medical authorities describe cerebral palsy as a "condition" rather than a "disease." Although the brain damage that causes cerebral palsy cannot be cured, the functional problems associated with cerebral palsy can often be improved through therapy, medication or, in some cases, surgery.
If you believe your child acquired cerebral palsy because of medical malpractice, please contact the cerebral palsy attorneys of Kenneth M. Sigelman & Associates .
How common is cerebral palsy?
Approximately 500,000 people in the United States have been diagnosed with cerebral palsy. More than 5,000 children, the vast majority of whom are babies or infants, are diagnosed with cerebral palsy each year. The incidence of cerebral palsy (number of cases diagnosed as a ratio of the total population) has remained relatively constant over the past 30 years. This should not be interpreted as evidence that, despite all of the progress during that time with regard to enhanced access to prenatal care, more reliable assessments of fetal well-being through the use of fetal heart rate monitoring, fetal acid-base measurement, and biophysical profile scoring, there is nothing that medical professionals can do to prevent cerebral palsy. Experience and common sense tell us that this cannot be true. Rather, the unchanging incidence of cerebral palsy is a direct result of continually increasing survival rates for critically premature or otherwise frail babies who, without benefit of recent improvements in prenatal or neonatal intensive care, would not have survived beyond the newborn period. These babies are at substantially higher risk of suffering brain damage than are babies born at or near term.
What are the causes of cerebral palsy?
There are several possible causes of cerebral palsy. Lack of oxygen to the brain can ultimately cause brain cells to die, resulting in permanent damage. The lack of oxygen can be caused by various types of problems with the placenta, umbilical cord compression, or maternal problems such as a stroke due to toxemia (also called eclampsia) or a ruptured uterus.
Trauma to the baby's head due to improper use of forceps or a vacuum extractor at the time of delivery can cause bleeding in the brain, resulting in cerebral palsy. Other possible causes of bleeding in the brain include a stroke due to broken, abnormal, or clogged blood vessels in or leading to the brain, or by respiratory distress due to prematurity.
Cerebral palsy can also be due to infections acquired by the baby during passage through the birth canal, such as herpes, CMV (cytomegalovirus), or Group B strep.

Emily said...

Robbie - as I said before, these are not -my- conclusions, these are the conclusions of the research community. Please tell -them- they are wrong, not me.

First - the study you provided covered a limited area and a very small sample size (46), so cannot be extrapolated to determine correlation in general.

Second - the conclusion states there is only a loose association with "potential asphyxiating conditions," which is theorized to be, in some cases, related to nuchal cord. And even then, that can only be associated with the quadriplegia, not the diplegia or hemiplegia, and had no association with the incidence of CP. Basically, it means nothing.

Third - the study you provided just continues to support my original point, that there is no association between nuchal cord and IUFD. These babies lived.

And about the article you posted for CP, it says nothing about nuchal cords being a cause of hypoxia, and therefore CP. It does mention cord compression, which is not the same thing, and which I already posted in my article is a valid concern.

Unless you are planning to post a link to a study that shows a definitive link between IUFD and nuchal cord, please stop flooding my comments section. I will delete any further comments unless they are pertinent to the point at hand.

Robbie & Barbara said...
This comment has been removed by a blog administrator.
Robbie said...
This comment has been removed by a blog administrator.
Emily said...

Robbie - as I posted in my last reply, I will delete any comment that is not pertinent to the discussion at hand. You have provided me plenty of links to show that cord compression is a risk factor. I have not disputed that. You have shown -zero- links or evidence that nuchal cord is a risk, or even that it increases the incidence of cord compression (it doesn't).

Anonymous said...

Emily, it’s obvious that you do not consider parents like us who lost a baby to Nuchal cord compression prior to birth; this only makes us believe you are not willing to prevent this happening to others.

I sense you are afraid to admit you are wrong, this subject is not about who’s right or wrong, its about prevention and saving baby’s life’s , you know we are correct, it’s evident you do not consider parents like us who lost our baby to Nuchal cord compression prior to birth.

We finish with this; prove Nuchal Cord is not a danger.

Emily said...

"prove Nuchal Cord is not a danger."

I did. See original post.

Pamela said...

Cord accidents likely happen when there is something wrong with the umbilical cord, typically from a pre-existing condition from maternal factors.

Normal, healthy cords will not stay pinched for long, and they float out of the way because they are buoyant.

Cords around the neck do not strangle babies or kill them. Other factors play into such scenarios. To say it was "the cord around the neck" is too simplistic and breeds the fear of this normal - and expected - phase of fetal development.

We know that more active babies have longer cords - likely to ensure that the wraps will allow for more slack during birth. The design system isn't flawed, it's just that we're missing other factors that are to blame for cord accidents.

Anonymous said...

When I was was in labor I could feel when my baby had moved down and I was ready to push. The nurse told me to wait for the Dr. She then came in and told me she was going to eat first. I was really out of it at that time but my family told me it took her about an hour to 1 1/2 hrs before she came in to deliver. When he started coming out his cord was wrapped twice and really tight. She said, "we are going to have to wake this one up". My family was scared because he was blue. They did give him some oxygen after the cord was cut off. My son has had speech problems, some learning difficulty, bed wetting, and we are now dealing with him being very defient and aggressive. He is now 7 yrs old. Could this have caused these problems?

Emily said...

Anonymous - do you mean to say you felt like pushing and did not until the nurse returned? And did you have any medications, pitocin or pain meds, in your system?

Mom2heavenlybabes said...

Emily (and readers) ~
My name is Melissa and I am a bereaved mother to two babies in heaven one was a miscarriage at 8 weeks but my first was due to brain death as a result of a very tight double nuchal cord at birth. My son Brendan Phillip had to be resuscitated after having been born just within 15 minutes of a low heart rate pattern during a normal, full term delivery. Emergency c-section was called for but I was able to push him out before staff could be assembled. It appeared to be very clear that the cord tightened as he came down. After six days and many tests in the NICU, it was determined his brain was shutting down and was dying. I have come to understand that the nuchal cord does not strangle a baby but becomes compressed when tightened whether around the neck or in some other entanglement including torsion (too much twisting.) Compression can also occur from abnormal composition such as lack of wharton's jelly that allows the cord to have give or a straight cord (no or too few helixes.) Also, nuchal cord (or any entanglement) depending on which direction its wrapped can come off the neck and form into a true knot which is dangerous to the baby also for tightening and compression.
www.preginst.com
http://www.youtube.com/watch?v=N5Sdh9TB8bI&feature=related
Dr Jason's Collins of The Pregnancy Institute and National Center of Stillbirth Research has done over 20 years of research on umbilical cord accidents including nuchal cord and how they relate to IUFD and pregnancy outcome. His studies show that there is strong incidence of repeat in the same mothers due to physiology and genes (depending sometimes on the actual cord issue.) However subsequent pregnancies can be checked for cord issue and can be managed for best outcome through a unique Home Fetal Heart Rate Monitoring Program. In my three subsequent pregnancies, two of which had a nuchal cord repeat that caused problems to my babies at birth. They did fine in home monitoring and on the monitoring during labor so intervention was not necessary and I was under the watchful care of a good hospital in those deliveries. There are some newer studies that show relation of nuchal cord to IUFD.

Conclusions: Nuchal cord keeps appearing and disappearing over time. Its incidence increases with gestational age and is more likely to persist if it is diagnosed later in pregnancy. Studies indicate that despite the frequency of seemingly normal babies after birth involving nuchal cord that problematic decelerations in fetal heart patterns are almost twice as likely in these cases and more likely causes brain damage or possible brain death. Also cord compression in general is the major cause deceleration patterns.
Does the nuchal cord persist? An ultrasound and color-Doppler-based prospective study
Neena Lal, Deepika Deka and Suneeta Mittal
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India: Journal of Obstetrics and Gynaecology Research
Volume 34 Issue 3, Pages 314 - 317
Fetal bradycardia and variable decelerations occurred almost twice as often in the nuchal cord group.
Outcome of infants born with nuchal cords Journal of Family Practice , April, 1992 by William F. Miser
Bruce et al,[19] who studied 8038 births and found cord compression to be the major factor associated with variable decelerations. Similar increases in both moderate and severe variable decelerations in labors complicated by nuchal cords have been reported by other authors.
Recent studies of fetal monkeys and lambs have shown that fetal heart rate changes are mediated by both chemoreceptors and baroreceptors. Variable deceleration occurs only after the umbilical blood flow is acutely reduced by 50%; lesser degrees of cord compression do not significantly affect the fetal heart rate.
Several studies have shown that this cord compression results in reduced blood flow to the fetus and subsequent changes in the umbilical artery blood gases. If compression is high enough to occlude the artery, the fetus is unable to exchange carbon dioxide adequately, resulting in hypercapnia and subsequent acidosis. Acidosis is significantly more common in newborns with nuchal cords. This acidosis is of a "mixed" (68%) or a pure respiratory (23%) type and is corrected quickly by prompt ventilation of the newborn.

Emily said...

Mom2 - As I stated in an above response, what you describe is not physiologically possible. As the baby moves down, the placenta and uterus move down with the baby, so the cord is never "pulled tight," as we might imagine it. Even if the placenta were somehow anchored, and the baby suspended from it like a pendulum, the force required to pull the cord tight enough to compress the cord would be tremendous. In other words, not possible. Now, other cord anomalies, such as those you mentioned, could contribute to IUFD, but then the fault lies with the anomaly, not the fact that it was nuchal.

Baby's heart rates do drop normally during contractions anyway; it is unlikely to have been caused by the cord (except in the case of cord prolapse.) Three other factors that can cause unfavorable heart rate drops are lithotomy position, pitocin and narcotics, such as nubain, or those found in an epidural.

As for your studies, you said, "There are some newer studies that show relation of nuchal cord to IUFD." Please link me to those?

You also listed the Lal, et al, study, which only shows the incidence of nuchal cords to increase with G.A., which is sort of a "no duh" study. I hardly expect a 12 week old fetus to get a nuchal loop with a cord that isn't even long enough to accomplish that.

You also claim, "Studies indicate that despite the frequency of seemingly normal babies after birth involving nuchal cord that problematic decelerations in fetal heart patterns are almost twice as likely in these cases and more likely causes brain damage or possible brain death." You are (erroneously) concluding from two different studies which have nothing to do with each other that nuchal cord = possibility of brain damage.

In the first study you listed, the Miser study, it was concluded, "his study suggests that nuchal cords occur commonly, but are rarely associated with significant neonatal morbidity or mortality." Which proves my point in the first place.

The second study you provided, the Bruce study, concluded cord compression was a major factor in variable decelerations. While true, it has nothing to do with nuchal cords. Everyone agrees cord compression is a Bad Thing, and nuchal cord is not the same thing, and is HIGHLY unlikely to cause cord compression, unless there was a defect with the cord or placental insertion, which again, is not related to the fact that it is nuchal.

You have still not provided me with any studies or scientific information that indicates nuchal cord is anything more than ordinary.

Anonymous said...

Emily, I was the one that posted the comment on May 2nd. Yes, I did have pitocin, epidural and something for the nausea because I was so sick. I was ready to start pushing but did not because I had to wait ont he dr. I had no pain because of the epidural and was so exhausted that I feel asleep while waiting. I could barely wake up when the dr came in ready to deliver. It has always made me wonder if the cord being wrapped around his neck had something to do with the things we are dealing with. I just didn't know if the lack of oxygen could have been a key component in his problems or not. He is a very lovable, sweet, and typical boy although as a baby always developed later than normal. He is very bright but does have some difficulty mainly in reading. He also had to be in speech but now is doing great. As I said before, for a long time has had problems with his legs hurting, has always wet the bed at night, the speech problems, and now we are trying to figure out what is going on with some outburts we have had recently. At the time of the episode I am saying to myself that something is definetly wrong but other than that on a day to day basis he is your normal kid.

Pam

Emily said...

Pam - If you felt like pushing and had to wait 1 1/2 hours before you could, that is the most likely reason for your son's lack of oxygen at birth. The baby being trapped in the birth canal is dangerous.

Secondarily, epidurals and pitocin both, but more often epidurals, are known to distress the baby and result in difficulty getting oxygen. In the old days of sedation by scopalomine, the doctors just called it "blue baby syndrome," since so many babies came out blue as a result of the narcotics.

Anonymous said...

I found you through NB (Melissa's) blog and just had to say thanks for your post! I know this is an older post, but a good one! As a OB nurse (L&D and Postpartum/ newborn nursery) with 5 years experience,I definitely agree with the articles you posted matching my experiences in a hospital with over 3,500 births a year. My daughter was a *gasp* tight nuchal X 2 (Apgars 8/9, thank you very much) so I know on several different levels that the vast majority of the time nuchal anything is a non-issue. Keep on researching and keep on blogging, I'll definitely have ot add you to my favorites list!

Kathy said...

Emily,

This is Kathy from the "Nursing Birth" comment; I'm using my Google account instead of WordPress so I can get emails about follow-up comments through Blogger.

I tried to post my comment, but it was too long, so I posted it here.

Anonymous said...

I must say I cannot agree with this post and after having a son that was stillborn due to a cord around his neck, I am appalled that someone would write this. For those of us that have lost babies due to this situation, I would love to see you present in the delivery room telling the mother who just lost here baby that cords being wrapped around babies necks are not emergency situations.

I think you should keep your opinion to yourself unless you have actually lost a child due to this.

Anonymous said...

who do u think you are to give medical advice to people who have actually lost there children to nuchal cord accidents you have no idea first of all about the loss to this and even though babys dont breath trew the throught lack of oxygen due to nuchal cord results in death in some cases maybe not all but its very offensive for you to sit here and act like you know everything about nuchal cord accidents when truly you know nothing giving mothers false knowlege about this i also lost my son at 33 wks pegnant due to a nuchal cord accident and it happends maybe not alot maybe not to everyone and yes maybe alot of babys are born with a nuchal cord but it does happen so to all you people who believe this person take it from someone whos experienced a loss first hand that it does happen and ALWAYS moniter fetal movents and to all the parents who have lost there children my prayers go out to u please keep me in your prayers also.

Nicki said...

Hi. Please don't misinform ppl like you are doing. It's true that the cord being wrapped around the baby's neck is not always an emergency, But don't say it flat out isn't. My niece died between yesterday morning and the night before because her oxygen supply was cut off by the cord being around her neck twice. my Sister's due date was supposed to be tomorrow the 11th of July. It is very real as an emergency. Just because it is being used as an excuse for ppl to get c sections is no reason to demean this situation as a potentially life threatening one. That is the part you should be mentioning in the title, instead of giving some desperate person with the same problem false hope that it's okay.

Nicki said...

Guess what everybody. I think Emily needs to validate herself by being inflexible and unwilling to accept that things aren't the way she thinks they are. Maybe she had the cord wrapped around her neck when she was born, it does cause learning deficiencies, at least it did with my little sis. Maybe she's been struggling with that for her whole life and is prone to being defensive when someone challenges her hard worked for findings. That could be a reason for her unwillingness to see that the people who have actually dealt with the umbilical cord compression are neither stupid nor blinded by emotion. They just know what they experienced. And I'm sure everybody understands that the babies aren't strangled like we outside of the uterus would be. When the baby tries to position him or herself for birth he/she is moving around a lot. The oxygen deprivation is form the tightening then compression of the cord which leads to asphyxiation from the decreased blood flow through the cord. DUH!! Just because you've read something doesn't mean you don't have to think about it. We get it. Please be teachable. It makes you look better as a person, and you have to be teachable to raise children (of which you have three, right?)What really strikes me most is your lack of compassion. These people chose to share their experiences with you to help you see the errors in your post and you reacted, to the relationship that you set up by starting this blog, with a condescending attitude and with pride for here til next never. If you don't think they are right, etc. then say so. Please don't act like you know what's up tho. You very well could know what's up but you approach the situation with the arrogance of 10,000 conquistadors. Come on.

Emily said...

Anonymous-es and Nikki -

These statements are not my opinion, advice, false hope, or inconsideration. I will restate what I have in earlier comments:

I stand by my article. Every single reputable organization stands by the claim that nuchal cord is not inherently dangerous, and is normal, occurring in 1 out of every 4-5 births. Even if every single study done on nuchal cords was flawed in some way, if they -all- have the same conclusion - that there is no correlation between IUFD and nuchal cords - then they are reliable as a body of work.

I am not passing judgment, making assumptions, or posting false information. Everything I have posted here can be found somewhere else in the world. I have no reason to remove this post, as it is just relaying information that was written somewhere else. If you take issue with these studies, statistics, or articles, please take it up with the authors of the same.

If you find specific errors in my post, please point them out to me and I will be happy to fix them.

Neringa said...

CORD AROUND THE NECK IS REALLY AN EMERGENCY IN SOME CASES.. I lost my Monoamniotic Twins due to the umbical cord accident.. I do not agree to the post, that it is not an emergency.. In some cases it is!! I know more persons who had the same sad experience, so please do not say that the nuchal cord is not dangerous.. Nuchal cord needs close monitoring! I was misled by posts like yours and I could not save my children. They would have been 2 years now! In your place I would change the post to include those rare cases when the nuchal cord DO CAUSE problems

Anonymous said...

well i think you are full of s**t emily i lost my beautiful daughter who was full term (2days over) in march this year, i had a 12 hour labour everything was going right easy labour, wasnt induced and had no pain relief and her heart rate etc was absolutely fine untill about 40mins before she was born my midwife broke my waters and she had meconium or what ever it called when the baby poo's in the sack, which meant she was distressed.the midwife only called the Dr because she was trying to come out face first and then her heart rate dropped down to 100bpm and kept going down from there so they put me on oxygen and by the time the doctor got there it was too late for a c-section so i had to push her out as fast as i could it was only after she was out that we realised that the cord was around her neck 3 times which was why she was coming out face first and causing her to lose oxygen as it was getting tighter as i was pushing and caused her death. she was perfect and healthy apart from that reason so dont tell me that the cord being around the neck is not dangerous and unless you have lost a child to this you will never know so how dare you comment on something you know nothing about i have never read anything so offensive u should be ashamed of yourself and all the stories from mothers who have lost their babies this way should prove that to you. GET A LIFE!

SuSuseriffic said...

Well written post. I linked to it.
http://icanwesternmd.blogspot.com/

Anonymous said...

Obviously people did not understand your point.
I have known doctors to tell women that their baby basically strangled to death in their womb by the cord at 30 weeks or so. I'm not sure if the women didn't understand the way it was explained or if their doctors let them believe what they wanted. It's scary that they would let the women walk away believing such a thing.

Anonymous said...

I just wanted to add a comment and say that I did further read, from a very reputable site, that in 80-90% of cases where the dr thinks the baby died of a cord accident if an autopsy is perormed they DO find a reason for death other thatn a Nuchal cord. They said it is generally either a medical problem with the baby, the palcenta, and infection or disease that the mother had or in some case an issue with the placenta OTHER THAN Nuchal cord. That would mean that only aout 20% of diagnosed nuchal cords accidents are truly that - however, without an autopsy the dr nor the parents will ever know for sure.

Jeff said...

This blog is the very first research I've done in regard to "nuchal cords" so I post this comment fully acknowledging my ignorance of the subject. My second daughter was born with the cord wrapped tightly around her neck. It was a completely different birthing experience than that of my first daughter who arrived without complication.

Like most fathers' I was waiting in the wings for my big moment of "cutting the cord". The doctor and nurses were ribbing me a little bit about my constitution and the potential of me passing out. When my daughter "arrived", the mood changed very quickly. I won't say that it was as dramatic as a scene from "ER", but the intensity level definitely increased over concern about the cord being wrapped around her neck. She was blue - dark blue. I immediately thought the worst. When the doctor quickly cut the cord, all thought of Dad cutting the cord abandoned, the seriousness of the situation seemed to me reinforced. This was not a Kodak moment. We had some woods yet to get through. She (the doctor) did not unwrap the cord as was described in another post, she rather quickly slid the scissors between the cord and my daughters neck as soon as she was far enough out to do so. It was my impression that my daughter could not come fully out until the cord was cut, like she was tangled in it. Again, whether that's true - I can't know for sure, that was my impression at the time. I was letting the professionals due their job without a lot of annoying questions from an well-intentioned father. When she made it the full way, she was whisked to the table and heavily massaged pounded, rolled over this way and that way, with oxygen tubes shoved down her throat, suction tubes shoved down her throat all the way to the bulb. She very rapidly turned from blue to the whitest white I've ever scene for a human being - especially her face. A ghost.

As the nurses worked frantically, they regained their cheerful demeanor. I had the feeling that they might have been putting on a show of it for my benefit. I was video taping and trying to put a calm face on for my wife as well.

While working, one of the nurses said "We're doing a little physical therapy on her here. Her lungs sound a little wet so we are trying to get that fluid out of there to help her a little bit... just give her a little extra oxygen since that cord was around her neck".

They worked her for a long long time. Throughout our stay, it seemed that we were constantly monitoring every test to make sure that the cord delivery didn't have any lasting effect. Her voice took days to recover from all of the projectiles shoved down her throat.

She is now 9 months old and appears to be a perfectly healthy baby (thank God). The author of this post (Emily) claims that nuchal cords are no emergency, (and she's done far more research than I have obviously) but from my own experience, they "ain't no picnic either".

I understand that the baby is getting oxygen from the cord and not from "breathing", but you can't help but to have an emotional reaction to a cord wrapped around a blue baby's neck. I feel for all of the parents on this blog who lost children either as a result of nuchal cords or some other complication in the guise of nuchal cords. God bless all of you no matter what side of the debate you find yourself on.

Anonymous said...

I had 5 out of 6 babies born with cords wrapped around their neck and body. 2 out of the 5 had short cords. The only 1 that had issues was the one where I was told not to push for 5 hours. They did have to give her oxygen. Knowing what I know now, I would say that was from listening to someone else tell me what I was feeling. Most of the time our bodies tell us what needs to be done. We have just gotten so good at ignoring our instincts and instead rely on experts telling us what we need to do.

I am sorry for all those who lost babies. I probably would be the same way if I lost a child to a cord issue and no one would be able to tell me any different.

In most cases cords do not cause problems. I think that we should stop scaring people into thinking that it is a 100% of the time problem.

Anonymous said...

Thanks for the very enlightening article. It seems like emotions run high, so much so that the studies get ignored. My husband is a doctor. He is keeping a list of things that the medical community "knew without a doubt" but then once newer studies came out or the negative effects of what was "known" began to be realized, now they "know" that the opposite is in fact true. (for instance in certain procedures it was recommended to do a blood tranfusion for the patient, but now they've realized that tranfusion actually compromises the immune system so it is not recommended). My point in saying this is that sometimes old things are still taught in med school (by the older doctors) and if doctors are not actively trying to learn more, they may be misinformed and hence unintentionally misinforming patients.

Also, sometimes doctors tell patients what they think they will best be able to understand. I am a chiropractor. I know that some of my colleagues tell patients that they have a "pinched nerve" because that is what people understand. It is not exactly true. They truth is much more complicated and involves explaining neuroanatomy and physiology, which often just confuses the patient. Patients often want a quick answer that they understand. I think that this may also be why people are told it was the nuchal cord, when it might not be. That is easy to explain and to be understood.

Just some thoughts....

Anonymous said...

My daughter had a tight double nuchal cord. I don't feel like nuchal cord is necessarily an emergency, but I do agree with those who say it sometimes can be and is dangerous.
Because our daughter also had a birth defect (gastroschisis), the insertion point of the cord at her umbilicus was weakened, so when the doctor went to unwrap the cord from her neck, it actually ruptured and came completely off of her body. It tore to such an extent that even in a hospital, in a situation where neonatologists and neonatal nurses were already present in the room in anticipation of her birth, they had a difficult time clamping the vessels and stopping the bleeding.
In (rare) cases like hers, I could definitely see where nuchal cord could be a potentially deadly complication... and I'm sure there are other situations that are just as dangerous.
One thing that I have learned in the past couple of years is that, as good as your information and your intentions may be, you always have to consider that every situation is unique.
Before my daughter's birth, I was totally and completely opposed to epidurals, however I ended up needing one while in labor with her. (I wasn't progressing- I was dilating but not effacing- she was caught up in her cord and couldn't descend so there was no pressure on my cervix to help me efface... we figured this out after she was born and had obvious bruising all across her face where the cord had been wrapped.) The doctors started threatening me with a c-section, so finally I decided to get an epidural and within 45 minutes she was born. I know from the reading and research I've done that my experience with the epidural was an exception to the rule, but now I am not nearly as militant about how awful epidurals are, and how they aren't good for anyone!
Just something to think about...

Jason said...

I agree with the chiropractor. I tell my patients the same thing. A "pinched nerve" is an easy way of explaining a much more complicated problem. One could understand how a mother could be told or see a cord around their baby's neck as dangerous. Some people think flies cause garbage because everytime they see garbage, they see flies. Or that police officers cause crime since evertime they see a crime scene they see police officers. Studies are done to prove what is already known and justify an agenda they are trying to meet. Attorneys ask questions they already know the answers to. The moms are understandbly emotional and don't want to be told that what they have been taught to believe is wrong. Do you think a pediatrician wants to accept that mercury or aluminum are contributors to neurobehavioral disorders? Or dentists using mercury and fluoride harms their patients? No, they either change their beliefs (rare) or reinforce their thinking. The nurses here would seem to have the best answer, since they are actually involved and educated, caring for thousands. Where are all the OBs on here practicing new and impressive ways of care???

Lisa said...

Perhaps, some of this debate is due to talking about different things. Commonly instances of nuchal cord are not dangerous; occasionally they are. The difference may lie in HOW the umbilical cord goes around the neck.
Lisa

American Journal of Obstetrics and Gynecology 1997 Jul;177(1):94.
Nuchal cord type A and type B
- Jason H. Collins MDa

Abstract
Nuchal cord type A and type B need to be distinguished at delivery. Type A encircles the neck in an unlocked pattern. Type B encircles the neck in a locked pattern. In a prospective review of nuchal cords the type B pattern occurred in 1 in 50 births. Cesarean section and stillbirth were associated with type B nuchal cord.(Am J Obstet Gynecol 1997;177:94.)

Article Outline
The Perinatal Umbilical Cord Project is a continuing review of the issue of nuchal cords. Two patterns have been recognized. Type A pattern is described as a nuchal loop 360 degrees around the fetal neck where the placental end crosses over the umbilical end. This pattern can undo itself. Type B pattern is described as a nuchal loop 360 degrees around the fetal neck where the placental end crosses under the umbilical end. This pattern locks and cannot undo itself. Type B was noted by Giacomello1 as one of particular concern and possibly prone to favor fetuses that are in the breech position. Another concern is that this nuchal cord pattern forms knots if it passes down and over the fetal body. Another observer of this pattern, Hamilton,2 also recognized this difference and its potential for fetal harm. In a review of 1000 stillbirths at Liverpool Maternity Hospital “6 cases were directly due to cord around the neck.”

In the continuing prospective study (Perinatal Umbilical Cord Project), >1000 no-risk pregnancies have been examined for nuchal cord. Of 850 completed deliveries, three cases of nuchal cord type B were identified. Two had fetal distress and were delivered by cesarean section; one was stillborn at 32 weeks (nuchal cord three times, type Bx1) and was breech before its delivery.

Previously it was reported that, of 288 deliveries, 11 true knots were discovered and no type B pattern was seen.3 An updated report now suggests that 14 knots were documented in 850 births. Three type B nuchal cord patterns were also observed. Therefore 17 type B patterns were originally formed out of 850 births, or 1 in 50 births. The potential for fetal morbidity or mortality suggests that this detail is an important distinction to make at delivery. If possible, an ultrasonographic distinction should be noted if a nuchal cord is detected during a prenatal scan.

In an extensive review of nuchal cord literature, no other mention of type B pattern is noted. This difference between A and B nuchal cord types may be important. Previous studies on this topic may be incomplete without this detail noted. It could be the explanation of the misconception that most infants with nuchal cords are born safely, but maybe not the ones with type B nuchal cords.

Anonymous said...

Generally, nuccal cord does not cause fetal distress, but neither does pitocin.

Bwaahhhahah! Ha...hahahahaha!!

That's got to be the effing richest thing I've read in a looonnnnnnggg while.

Vicki said...

Doctors DO lie to cover their bacon.I have a family member who lost her baby daughter due to fetal distress. Her little heart failed and there was signs of maconium in her waters 6 hours before a c section was finally preformed.Doctors and nurses knew the baby was in distress 1/2 an hour after being induced but let her labor for over 12 hours. The poor little bub fought for all that time and could fight no more. When the C section was finally done the doctors said she was a stillborn due to the cord being wrapped around her neck 3 times.This is not true as a scan was done the day before and the cord was fine. The doctor even stated on the death certificate it was the cord again untrue.An autopsy proved that it was maconium stained lungs that caused her to die. If the doctors and nurses did thier job that day, a C section should have be ordered at the first sign of maconium due to the fact that the heart rate was not right. But NO they ignored it and then LIED.I believe doctors take people as fools and lie to cover thier mistakes.I thank you for your artical and totally agree with it and to the poor mums on here that disagree, firstly I am so sorry for your loss.But please dont attack what has been stated.It may be that your poor baby did have the cord around thier neck but chances are they may have gone into distress aswell.And you too may be lied to by doctors to save themselves from being sued.In my view the doctor and nursed that did this to our family can rot in hell.

Tiffany said...

I was pleased to find this blog. I would like to see the difference in c- sections between the private and public health care sectors when there's a cord around babies neck? I have lost so much due to the medical system and misinformation, or, lack of concern because I was on the public system. At five months pregnant, I felt my baby slowing in movement. I went to the hospital where a nurse put the doppler on my tummy. She said all is well..go home. I told her I can't hear anything accept my stomach gurgling. Still she insisted..to home. Two weeks later, excited to see the sex of my baby on the ultrasound..I saw what I knew instantly was my dead child. Words can't explain the pain I felt as I kept pleading "move Bubby move". Only by accident 4 years later did I see the file on babies autopsy. I read it to the effect that baby was fully formed with no signs of retardation. It then stated coldy that cause of death due to placenta being severely kinked.
No record of my babies sex. No file of my prior visit regarding slow movement. No explanation of death was ever willingly given. No dignity at all. Just as I experienced a sever lack of medical support..I wonder if those on private health care are given the opposite end of the spectrum. As my sister worked in hospitals and witnessed most c-sections were performed on those not on the public system, I would asume yes.

I know that my baby starved slowely to death. The nuitrients and oxigen could not reach bub. The fetus needs that connection for survival. Experiencing what I have, I understand the medical examples given above , refer to the cord being hindered in supplying babies needs, not pressure on the throat. I also acknowledge that if baby needs oxygen in delivery due to a ruptured sac, or the blood is severly denied to the brain, then, the cord around babies throat be an issue. However my initial request remains.. I would not be surprised if there are more c-section "emergencies" due to this issue in the private sector..

Emily said...

Tiffany - thanks for your comment. As for your question, in general, c-section rates increase as the monetary reimbursement for them increases. That is, the more money that doctor will make for a c-section, the more c-sections they will perform.

http://californiawatch.org/health-and-welfare/profit-hospitals-performing-more-c-sections-4069

http://transform.childbirthconnection.org/resources/datacenter/factsandfigures/


http://www.ncbi.nlm.nih.gov/pubmed/10437337

to list a few links...

So in fact, private hospitals are more likely to give more c-sections, for a variety of reasons. I'm not sure that anyone has drawn up a correlation between given reasons for a c-section and socioeconomic status, but I bet that would make for a very interesting report.

I'm sorry, by the way, for your loss and your experience. Certainly in public hospitals, women are often less likely to receive compassion or respect, and that's a tragedy. Professionals just don't seem to have as much time or consideration for people who can't pay them. I, too, would be interested to know if more details for medical procedures are given to the more wealthy/insured patients...

Tiffany said...

I do thank you for this blog..
I understand the Mothers here being emotional: Mothers by nature are protective and highly sensitive/vigilent regarding thier baby's life/loss. You've shown compassion and credibility by showing both sides of this argument given the fact each post is moderated first.

I have one personal question that plagues me. Could my baby have been saved? I heard no heart beat but the nurse insisted there was one. Could they have opened my womb and unwound the cord at 18 weeks had they detected a slowing heart beat?

Emily said...

Tiffany - Again, I want to say I'm sad for your loss. There isn't anything in the world to make up for losing a child.

I don't know all the details of your pregnancy, but from what you tell me, I don't think there's anything they could have done to save the baby. Even if the cord was wrapped around the baby's neck, that's not what likely killed him/her. Most of the time if the cord is to blame, the issue is with some kink, knot, or twist in the cord, usually near the point of insertion to the placenta. So even if they could have opened you up and unwound the cord from the neck (which so far as I know is not possible), whatever was cutting off the blood flow might still have been missed, or even been further damaged by trying to twist and untangle the cord. Either way, the only choices would be to have had to remove the baby at 18-20 weeks, which would have killed or severely injured him/her, or leave him/her in the womb, in which case the cord issue would still have killed him/her.

And there is also the very real possibility that the cord had nothing to do with his/her death. It could have been an undetected infection, a problem with the placenta, a chromosomal abnormality or it might have just been that baby's short life plan. Something like 20% of all intrauterine deaths are never solved.

I'm not sure that information gives you any comfort, but I'm pretty confident that there's nothing they could have done. ((hugs))

Tiffany said...

Thank you my Dear..

Anonymous said...

What is your answer then to a heart rate dropping to 40 bpm? Do you claim to know more than an OB or their midwives? My daughter had a nuchal cord x 2 and her heart rate would drop to 50 bpm. I had a midwife and the look in her eye told me this was a very serious complication. I had absolutely no drugs and her heartrate was still dropping very low. I'm glad I had a c-section. I wouldn't want to imagine what would have resulted had my daughter's heartrate continued to drop. And it was dropping from 70's to 60's to 50's before it was decided an emergency c-section was needed.

Emily said...

Anon - I don't claim to know more than OBs or midwives. I do, however, claim to be more aware of current research on the subject. It's unlikely that the cord was the reason for your baby's decels. There are a whole host of factors that can cause decels, aside from medications, but the known fact is there is no statistical correlation between fetal distress and nuchal cord. Certainly a c-section was called for, and I'm glad the baby was okay.

Anonymous said...

I am week 36 and just found out that my little has his cord wrapped around his neck. Now since I am not from the medical profession, internet seems to be the source to make an informed decision whether to go for a c-section or not.
Based on articles like these, I was about to make a decision that I should wait for a vaginal birth - just when this line caught my eye in an article,
"Fetal mortality rates due to nuchal cords are around 0.16% , but when you are part of the statistic the miniscule number does not matter".

So I did more research and hit upon cases where couples lost their child/children due to nuchal cords or some one knew someone who lost their precious little one due to a nuchal cord.

I would like to say to the author of this article that it is her moral duty as a blogger to post complete facts and/or both sides of the picture when she is commenting on a topic - especially one that could lead someone astray to causing the death of their baby. So instead of the title of this article to what it is, it should be , 'Cord around neck is NOT ALWAYS an emergency'. And then you could give examples when its not an emergency while also reporting cases where it was.

As a blogger your article should be balanced - otherwise it just shows how both an unbalanced blogger/writer and a person you are.

Lastly, if you can't bring yourself to apologise to the many bereaved mothers here, then atleast have the courtesy to edit the title and the content of this article so that you do not mislead some one else - just like you almost misled me.

Thanks.

Emily said...

Anonymous - Could you please link me to the article which states a mortality rate of 0.16% for nuchal cords? I have never seen a single study which shows any statistical correlation between nuchal cord and infant mortality.

As for those who say their child died of a nuchal cord, or who say they know someone whose child died of a nuchal cord, they are simply repeating what a doctor has told them, which is a guess, at best, and a deception, at worst. There is no proof that those deaths were caused directly by a nuchal cord.

I have often heard the criticism on this particular article that I haven't presented "both sides." But I will say the same as I've said before - this is one issue which appears to really only have one side. There is NO STUDY ANYWHERE that establishes a connection between nuchal cord and IUFD. I will be happy to make changes to the article if you show me otherwise.

If you are concerned with slight percentages, you might be interested to know that the risk of infant mortality with planned cesarean section is about 0.17%, and that percentage is well-established with no debate. It's interesting that you seem to prefer taking a proven risk than a groundless one.

Anonymous said...

My water broke at the hospital. There is no way I had cord prolapse and the cord was wrapped 3x and tight around the beck. I want to know what makes you think you understand this entirety. Are you a scientist, perinatologist, ect? What makes you think your qualified. I know for a fact my child died of a nuchal cord so before you go off with your unconfounded non-sense maybe you need a little more education than you have.

Anonymous said...

Since you need more info. on the subject. Maybe you should speak with someone that has really devoted themself to the research. Contact Dr Jason Collins of the Pregnancy Institute. Babies do die of cord accidents and more frequently than you think. The problem is that there is still lack of indepth research. It takes someone like Dr Jason Collins that does extensive research to get to the bottom of things not these mediocre studies you are talking about.

Emily said...

Anonymous - Thank you for that information re: Dr. Jason Collins. I did some reading, specifically his written information on Umbilical Cord Accidents, found here. In his own paper, he points out there there is no study anywhere that suggests a link between nuchal cord, with no other risk factors, and IUFD. He also mentions that the medical community, in general, considers strangulation by nuchal cord impossible, although to refute that consensus held by *every professional on the subject* he cites an obscure single case study from 1927. Hardly solid evidence there.

Dr. Collins goes on to say exactly what I said in this article - that nuchal cord could certainly possibly pose a threat when combined with other risk factors, and that there could be other issues contributing to a death where a nuchal cord is visually apparent, such as torsion or compression. Currently, there is no way to assess prenatally the tightness of the umbilical cord, no way to predict cord compression, and no way to spot or prevent small, undetectable cord compromises, such as torsion at the point of insertion. In short, there is no way to predict or prevent most cord accidents, and nuchal cord alone is not a risk factor, as Dr. Collins points out in his own writing. Nuchal cord is simply too common to be dangerous by itself.

But let's say for argument's sake that nuchal cord poses a threat. In Dr. Collin's writing, he indicates that deaths due to ALL cord accidents, including cord compression and other problems, is about 2/1000 births. Death specifically due to nuchal cord would be extremely rare (if it were possible), and would therefore constitute a fraction of that rate. For comparison, in his paper Dr. Collins points out that deaths due to shoulder dystocia run about 1/1000, and death due to GBS infection about 1-2/1000. Using that logic, if you were to c-section every woman who presented with a fetus with a nuchal cord on ultrasound, with a less than 1/1000 risk of IUFD, you would also have to c-section every woman at risk for shoulder dystocia (which I already pointed out in another article is also impossible to predict), as well as all women who presented as GBS+. You can probably already see that that would be completely ludicrous, as the death rate from complications of surgery would far surpass any theoretical risks of such rare conditions.

As it is, there still exists no studies or data that shows that nuchal cord alone causes IUFD. Dr. Collins does have a point, in that there should be more research into trying to determine what other complicating factors increase the risk of cord accidents. Until there is some way to effectively assess or predict these risk factors, there is no way to eliminate that risk.

So, there is still no medical or scientific reason to think that nuchal cords alone present a higher risk of mortality. And if you wanted to eliminate all possible risk of death from cord accidents, you would have to cut open every woman. But then, you'd have all the risks of surgery. This is not logical or prudent. The best thing is proceed on good faith and careful monitoring, and accept what God has given you in life.

Sesasha said...

Thank you for compiling links to those studies and making it so easy and efficient to find them. The Midwife Thinking blog also has an excellent post on the subject. It seems that complications from nuchal cords are far more common when the care provider tries to manage the situation, as is the case with many interventions. http://midwifethinking.com/2010/07/29/nuchal-cords/

Well written and excellent post. Thank you.

Anonymous said...

Emily, I am not going to comment on "your specialty." If you think what you said was so absolutely true (regardless of how much education you really have), and as stubborn as you sound, nobody is going to change you and the way you think. So I'm not going to try either. HOWEVER, I am going to say this: You really don't sound like a very sympathetic person at all. There have been so many bereaved parents who posted on your board earlier telling you what happened to their babies. And all you have been doing is getting yourself all wrapped up in the argument and in trying to prove yourself right. You almost never ever express a word of consolation or empathy towards all these bereaved parents. I don't know what you really do for a living (a midwife, maybe?), but honestly, if I were to look for a midwife for the birth of my next baby, I would certainly want to choose someone with much more kindness and empathetic heart. I don't want a cold, argumentative person like you as my midwife. You are too self-absorbed to be able to see what others are going through and to feel for them. Even if you are 100% correct and you get all the "facts" straight, it doesn't make you a good person or a good midwife. At some point, you need to start showing some empathy towards others.

Emily said...

Anon - thanks for your comment. I did in several responses express sympathy for the loss of a child, and in one case, happiness that it turned out all right. I'm not sure what else you are looking for...a hand-written letter of condolence?

In any case, no I'm not a midwife. I'm also not a therapist or a counselor, or a Hospice worker. It's not my goal to provide emotional support - my goal is to provide facts and studies in order for parents to make an informed decision as to their medical treatment during pregnancy. This is the same information they can get anywhere else on the web.

Using your logic, you might also say that PubMed is heartless and irresponsible for posting these studies and not specifically consoling those who experienced a loss in which the explanation given is contrary to their published scientific information. But I don't recall ever hearing a complaint issued against PubMed.

If the information is not to your taste, or my blog is not to your taste, you're free to not read it.

Anonymous said...

When I was born, I had the cord around my neck. As my doctor descibed to me years ago, I was not breathing and was blue from lack of oxygen. I had a very low heartrate. There were no narcotics involved. I became healthy before long but I still carry the scars from where the cord was around my neck. I am in the health industry today and work with hundreds of children patients and some ask about my neck, I tell them tales of many things but rarely the truth. This is an interesting article, but it can be+deadly+that+the+cord+is+too+tightly+around+a+pts+neck.+To+ignore+this+fact+and+what+I+have+seen+would+be+pure+ignorance.+Not+everything+is+in+a+journal+or+the+internet.+Medical+professions,+rarely+if+ever,+do+not+lie+to+patients.+Listen+to+what+these+parents+who+lost+children+say.+They+know+why+they+don't+have+their+babies+with+them+today.

Emily said...

Anonymous - Who knows what other factors contributed to your oxygen deprivation as a baby? There are many other things, including second phase management and placental issues that can cause problems. Granted, you did have the cord wrapped quite tightly around your neck, but you survived. I think it's quite rare to have the cord wrapped so tightly around one's neck that it leaves a scar - so it would also be almost impossible for a baby, whose cord was not wrapped as tightly as yours, to have died solely from that.

Anonymous said...

For what it's worth, my baby son was stillborn on 3rd may 2012. The cord was so tight around his neck that after pushing his head out, i couldn't push his shoulders out (the rest of his body). The cord was holding him back. I struggles, unlike my other 3 births. I could also see the indentation marks around his neck where the cord lefts its imprint into his skin.....so what's the verdict to this??

Emily said...

Anonymous - I'm sorry for your loss. :( It's certainly possible for a cord to be so tight as to cut off the blood flow, but not necessarily likely. There are plenty of instances in which a baby's cord was so tight, they could not descend. However, the birth attendant is generally able to turn the baby around and slide the backside out, then flip the baby over and unwind the cord. Now, I'm not saying your baby didn't die from a nuchal cord - he might well have. But there are many factors that can also cause death, including a pinched umbilicus, and many other causes that have yet to be determined. As was mentioned, the cause of fully half of all stillbirths are never discovered. And there has never been any statistical evidence to even suggest that a nuchal cord is associated with intrauterine death. So, it may have been a factor, it may not have been, but it's not a recognized significant risk factor.

Ellie and Alex's Mom said...

In 2009, My third child was born with the cord wrapped around his neck after an uncomplicated pregnancy and a six-hour, easy labor and a few pushes. I didn't need pain meds or to be induced.

Earlier in the pregnancy, my doc was concerned because the placenta was low-lying and said I might need a C section if it didn't move up enough. Eventually, he decided that it had moved up enough that I could deliver naturally. There were no signs of distress on the fetal monitor.

When the baby's head came out and the cord wad discovered around the neck, the doc quickly cut and removed it. My son was grey and lethargic but the nurse eventually got him stimulated enough to take a good breath and his color improved. Six hours later, he began having seizures and was rushed to the NICU, only to discover that he had had a stroke for "unknown reasons probably shortly before, during or after birth".

He is now 3, has extremely mild cerebral palsy, but still requires physical therapy weekly. He falls often, can't kick a ball or jump like other boys his age. We've been extremely blessed that his case is not worse than it is. However, when it was discovered that I had a full placenta previa with my fourth pregnancy and would require a C section last year, I didn't complain. Even though my daughter was a low-birth-weight preemie (due to insufficient nutrition and oxygen flow because of the placement of the placenta) she has been far healthier than my son, who had the cord wrapped around his neck.

Long story short - whatever discomfort and inconvenience I had to experience by the C was worth the outcome of a healthy baby. That's the whole goal of childbirth anyway, isn't it? If I knew then what I know now, I would have told the doc to go ahead and do the C with my son, too, so he would not have to struggle with CP today.

Ellie and Alex's Mom said...

In 2009, I had a low-lying placenta with my 3rd pregnancy but my doc decided it was high enough to go ahead with a natural delivery. He was full-term and the pregnancy was uncomplicated. The delivery was quick, easy and required no pain meds or induction.

Then, last year, with my 4th, I had a full placenta previa and had to have a c section. She was six wks early and weighed only 3 lbs 4 oz. Even so, she is much healthier today than my son is. Why? Because he was born with the cord around his neck, which caused him to have a stroke during the delivery. He now lives with cerebral palsy.

Whatever discomfort and inconvenience that I suffered because of a c section was well worth the outcome of a healthy baby. Because that's what childbirth is all about, right? Bringing a healthy baby into this world. If I knew then what I know now, I would have told my doc to be MORE cautious and go ahead with a c section for my son. It would have been worth him not having to live with CP today.

Emily said...

Ellie and Alex's mom - Thank you for your comment, and I appreciate your taking the time to read the article. There is a growing body of evidence that indicates CP occurs during pregnancy, not during labor. I will see if I can gather some studies for you and bring that back. However, cord around the neck has never been associated with CP or any other long-term condition, nor with mortality. If it were, you'd see a higher incidence of CP, since a full quarter of the world's population is born with a cord around the neck.

I'm also glad to hear your son is doing so well. My cousin was born with CP as well (no cord around her neck), and is perfectly able to function in life. It sounds like your son also has a great prognosis.

Anonymous said...

Here in India where middle class is opting for a single child, hospitals go for the mullah as that is there only chance to make money from a couple. Most cases in private hospitals end up as c-sections.

Anonymous said...

Though I think this post has some good information, you lost me at breathing thru the neck. No one breathes thru their neck, adult or infant. We breath thru our nose and mouth. The anatomy of the infant IS different than that of an adult in that the trachea is more anterior than an adults, also the carotid artery is not deep in the neck, it is on either side of the trachea, slightly posterior. When the head of an infant comes out of the vagina that is the moment when they take their first breath. It is important to suction the mouth and nose for this reason. If there is a cord around the neck they can not pass that oxygen into the tissues. Yes, they do receive oxygen from the cord and placenta but birth is that all important moment of transition from being dependent on mother to sustaining life independently. A cord around the neck is a traumatic birth. My son was born vaginally and had the cord around the neck which made for a very complex labor. What saved me from a c-section was a very competent doctor, midwife and experienced nurses. That is not always the case and babies do die from having a cord around the neck. I think your intentions are good but I suspect you are not an experienced medical professional.

Emily said...

Anonymous, thank you for your comment. No, I'm not a medical professional, but I can read, and everything I've ever read said there is no statistical correlation whatsoever between nuchal cord and infant mortality. The big difference between a researcher and a medical professional is that researchers have more time to actually read and research. Medical professionals tend to just rely on anecdotal evidence and correlation myths. If you can find something different, I'd be glad to read it.

And as far as the transition goes, you are a little off on that. A baby can go even a few minutes after being born without taking a first breath. If babies took their first breath upon exiting the birth canal, water births would be illegal, because they'd all die. Also, what about babies who are born in the amniotic sac? FYI, suctioning the mouth and nose of an infant is also not necessary. I think there are millions of women who had their babies at home who can testify to each of the things I just stated. Again, if you can find evidence to the contrary, I am interested to read it.

Anonymous said...

Once they are "out" the airway is cleared, I don't need to site research. All medical professionals, regardless of their scope of practice, are taught the basics of life support. Airway, breathing and circulation. If any of those are compromised it is an emergency situation. Nuchial cord is a compromise of all three. I recommend you study anatomy and physiology to support your research.

Emily said...

Anonymous - your comment presumes birth is an emergency situation. Birth is not an emergency. My baby came out just fine with no assistance from any professionals.

Anonymous said...

As a medical professional I find your smugness alarming. All medical professionals rely on their education of how the body works, not anecdotal evidence or correlation myths. As a mother of a son born with nuchal cord and a medical professional I can say with confidence you are wrong. Your lack of knowledge on how the human body works coupled with a lack of knowledge in the education and training of any medical professional renders your post baseless and false. You can read? Read some anatomy and physiology. Get some experience treating patients. You are not qualified to write about anything medical. I'm so sorry for the women who have lost children due to nuchal cord who read this uneducated piece and I hope you will reconsider your lack of education before you write any thing else. The Hippocratic Oath is a promise to do no harm. A piece such as this is harmful.

Anonymous said...

I lost my baby just last week, due to a nuchal cord. It was wrapped around his neck FOUR times. I sat up in the hospital bed and watched my Dr unwind the cord. The first three wraps weren't tight at all. But the fourth one,closest to my babies neck, was so tight, it had started cutting into his skin. So you cannot sit here and tell me a nuchal cord doesn't cause deaths in unborn babies. Unfortunately my little boy is proof that it DOES happen. I really think you should know what you are talking about before starting a blog like this!

Emily said...

Anonymous - This woman had a home birth with a baby with a cord also wrapped four times around the neck:

http://wellroundedbirthprep.blogspot.com/2010/10/guest-post-christines-homebirth-w-cord.html


I'm truly sorry for your loss, but nuchal cord just isn't a death sentence.

Anonymous said...

This lady was just blessed to have her child born unhurt. I have sent your blog to my ob and my Maternal Fetal Medicine specialist and not to my surprise, they both called you an uneducated idiot that needs to be reported for giving false information. The specialist has had many autopsies done on babies that were born sleeping (with nuchal cord)and the results were that the babies were perfectly healthy but oxygen was cut off DUE TO NUCHAL CORD. I have had two other children born with nuchal cord and they are alive and well today. So I know babies are not always in fetal demise due to nuchal cord. But my last baby wasn't so lucky. I just wanted to pass this info along to you and to the poor mothers who have out their precious babies due to nuchal cord.

Anonymous said...

Last year we lost our baby due to nuchal chord. My wife was in her 37th week and we has a sonogram just a week before it. Everything was so good and suddenly when we went for last sonogram doctor found that the heart has stopped. We were shocked. Doctors were also surprised and told that chord could be tight but we need to check.
At delivery time, doctors told that the cord around the neck and it was very tight that doctor could not easily put fingers between his neck and cord.

Now we are blessed with another baby but can not ever forget this incident.

Anonymous said...

Not a problem? Tell that to my niece whose baby (9lbs 6 oz) died at birth two days ago from cord around around neck in Canandaigua NY 02/28/2013

Emhyr said...

Im 36 weeks along with my pregnancy and just today I was informed about nuchal cord x2. My doctor said it was normal to see babies with the cord wrapped even a total of SIX times. So now I have weekly monitoring.

Obviously as we have a wealth of information about a sundry of subjects at our fingertips, I wanted to know more, and this article as well as the studies posted have given me confidence that this is not as dangerous as most people in the internet seem to put it. This blog has been an informative and positive outlook into my son's future birth especially after reading the embellished stories of a few mothers who scared the living shit out me because of this.

I think most people just trust too much in the medical pros simply because they have the paper to prove they are professionals. No one is perfect and NO ONE knows everything that there is to know about these situations. I think it is harder for a person that spent a number of years earning a degree to admit they are wrong even more so than someone such as Emily that has spent much time researching and trying to find the facts. So far not even the people that claim to be pro's have proven her assumptions wrong. AND I would also like to point out that NO WHERE does it say in this blog that Emily is a medical professional, so the mere fact that some mothers who lost their children come in here to badger her and tell her that the information in this blog is hurting people is blatantly WRONG and nothing but misguided anger.

Everyone has the right to search and inform themselves on the different sides of the issue, and just because you dont like the proof so far doesn't mean that you should go around pointing fingers and calling people idiots followed by the story of such and such loosing their child. I was under the impression that this site was created for you to ask questions and to seek the truth and so far I dont think ANYONE (especially the angry ones) knows how to read, they post the same thing over and over and they all resort to the insults to get their way as well as resorting to guilt trips making others feel like shit just because.

For one none of you are experts and rely on what doctor says is the golden truth, the few pro's that claim this is bullshit have not even proven anything either.. so who do we trust? I think this is a matter of fate as well as other factors that contribute to the fatalities but I have reason to think its mostly due to the fact that most medical facilities do not have the time to deal with labor and they always try to rush everything, as it was the case with my first baby. Nurses and staff where rather pissed at me because I refused to induce, and refused to take the edge off and refused to get the epidural done as soon as I got to my room... not to mention they broke my water without my consent while they checked if I was dilating ok and they made me push so hard I nearly tore in half... so yeah I have my doubts about trusting in the professionals just because they want to punch a god damn clock. I want to thank Emily for sticking to her guns and dealing the barrage of insults and rudeness just because she has posted information about things a mother should question instead of going along with the sheep mentality. Thank You for this.

Anonymous said...

My daughter died almost 2 years ago due to a nuchal cord accident. They did not find any other reason than that. It was 3 times type A around her neck and once around her body. I was in early labor with her and when they did an ultrasound they didn't see that the cord was around her neck. Of course after this happened when I asked my Dr for my medical records they "lost" the copy of her last ultra sound. Why would a Dr destroy the last ultrasound if he didn't feel like his office failed to see the cord around her neck. Since I was not dialated they sent me home over the weekend and told me if I didn't go into full labor to come in on Monday. On Sunday she went hyperactive. I phoned my doula who told me "she was just excited by the labor" and told me to go to the Dr the next morning. I video taped her death on my phone. You can clearly see that she is struggling and kicking wildly but since it was my first (and only) birth I didn't know any better and did what my negligent doula told me to do. (i hired her because she had delivered 150 babies before mine and she came from a reputable agency) She was not present and had no right to tell me my baby was just excited by the birth. Even the owner of the doula agency called to tell me that she had made a terrible mistake in saying that. When I went to the office the next morning I was in labor and couldn't tell that my baby had stopped moving which the contractions masked. When they did the ultrasound clearly she had no heartbeat. It took a day to deliver her and another Dr. basically had to elbow her out of me. When she finally came out the cord was so tight around her neck it was difficult for him to remove it. Now how can you say that the cord was not the cause of death. She was struggling and kicking me because it was killing her. Having done all the research a baby loss parent does I know that the cord is often around babies necks and most of them do not die in utero like mine did but when it does happen to you blogs like yours become semantics. You are arguing for nothing and your position will eventually be disproven. The fact that it hasn't yet is because dr's and the medical insurance community and the NIH don't want to take responsibility for infant loss due to cord accidents. It is all driven by money. SO all your blog does is help their case to keep the old adage going "that it just happens sometimes". I would not want to be standing on the shaky ground you currently stand on with the conviction that you do. It is not acceptable that you are so vehemently opposed to try to put the effort into balancing your debate by helping those of us that have lost our children to this horrible excuse. Clearly you are very bright and passionate.. what good you could do if you just opened your heart and mind to actually help those of us who have suffered this horrible crime. I don't need your empathy but want you to try to be more balanced and helpful in the world. Your current position is too myopic. Maybe you are getting money from insurance companies? It seems like you are being paid off. Just calling out what no one has yet to say. If you aren't willing to help then maybe you might want to see if you can get paid since what else would be your motivation?

Anonymous said...

I have to agree with Emily "cord around the neck is not an emergency". I have had 3 vaginal hospital births.

My first baby boy had the cord around the neck ONE time, came out perfectly fine.
My second baby (girl) had the cord wrapped around her neck TWO times; came out perfectly fine. Had all natural birth with her, no epidurals or any kind of interventions.
My third baby (girl) had the cord around her neck THREE times; she came out healthy as can be; no complications.
The only thing with my third baby- I hated the hospital; they had me laboring helplessly on my back (because they were doing the fetal monitoring to make sure baby is doing ok) for my two hour labor, and I got an epidural less than 1 minute before the baby started to come out while I was being held upright for the epidural, and I stayed upright because of my urge to push.

It depends who your doctor is, and what hospital you're giving birth at.
Some hospitals love doing a whole bunch of unnecessary interventions, so they could make more money- like epidurals at 10 cm, etc.
Some doctors love doing C-sections because they get paid more for less time wasted with a laboring woman.

Anonymous said...

RE: I have to agree with Emily "cord around the neck is not an emergency". I have had 3 vaginal hospital births. .......................

I forgot to add: My DH told me the doctors just slid the cord off (over the head) the babies neck right away, when the head just came out; before I even started to push the rest of the body out.

RE: I have to agree with Emily "cord around the neck is not an emergency". I have had 3 vaginal hospital births.

My first baby boy had the cord around the neck ONE time, came out perfectly fine.
My second baby (girl) had the cord wrapped around her neck TWO times; came out perfectly fine. Had all natural birth with her, no epidurals or any kind of interventions.
My third baby (girl) had the cord around her neck THREE times; she came out healthy as can be; no complications.
The only thing with my third baby- I hated the hospital; they had me laboring helplessly on my back (because they were doing the fetal monitoring to make sure baby is doing ok) for my two hour labor, and I got an epidural less than 1 minute before the baby started to come out while I was being held upright for the epidural, and I stayed upright because of my urge to push.

It depends who your doctor is, and what hospital you're giving birth at.
Some hospitals love doing a whole bunch of unnecessary interventions, so they could make more money- like epidurals at 10 cm, etc.
Some doctors love doing C-sections because they get paid more for less time wasted with a laboring woman.

Anonymous said...

Wowzer Emily. Your blog says you aren't perfect but you live "gently and respect others". I'm amazed at your arrogance and insensitivity. We lost a baby due to cord accident, the second was almost lost due to the same. You can have whatever study statistic and scientific 'evidence' you friken well like but until you are able to put your head in there during a birth and actually see what killed our baby, shut the fuck up you insensitive bitch. Our babies died, wrapped in their life line. And you don't even have the humility to accept that there might be a chance you are wrong about this? Crazy stuff. Scientific evidence changes on a daily basis....we choose what to believe ourselves. Mothers intuition doesn't eveR change. I knew my baby was dying and no one believed me. You would have been another plank in the room who stood behind the decision to wait and see. The line of blind faith you have in scientific research is worrying. You should become a catholic or something.....no need to think or reason on anything, just read, believe and obey....what a daft twat........

Anonymous said...

You have no idea what you are talking about. All you are doing is diminishing peoples ' loss by citing BS facts. You are disrespecting families who have lost babies and have no answers. You are NOT a doctor. How dare you use this as a forum to feed your ego! Believing in home birth etc.. Is one thing but undermining real tragedy by trying to argue your point is disgusting. Good job Emily. I'm sure all of the families who have lost babies feel much better now that they know the truth thanks to you.

Elizabeth E. said...

I found this article during my research:The Umbilical Cord
Val A. Catanzarite, M.D., Ph.D.
Director of Perinatal Imaging
San Diego Perinatal Center
8010 Frost Street, Suite 300
San Diego, CA 92123
I was curious since my son was born with a double nuchal cord; it was frightening but he's never had any issues (he's nearly two now). I didn't realize how common nuchal cords are; my first child was born via c-section. The aforementioned article documents conditions related to the umbilical cord itself and corresponding health issues of the baby and typical outcomes. Seems the researchers found that nuchal cords are extremely common, but not a statistically significant indicator of fetal demise or long term complications.