The umbilical cord is the lifeline between mother and baby. Connecting your baby to the placenta, the cord has three vessels – two arteries carrying blood from the baby to the placenta, and one vein that carries blood to the baby.
The arteries contain waste products such as carbon dioxide, and the vein provides nutrients and oxygenated blood to the baby.
During labour, the umbilical cord can be compressed for short periods, during contractions; this is normal and babies have adapted to withstand it.
If the cord is compressed for too long, however, it becomes a medical emergency.
What Is A Cord Prolapse?
During labour, the umbilical cord is usually above the baby’s head, which presents first into the cervix, the opening of the uterus. If the cord prolapses, it comes through the cervix and into the birth canal before the baby.
This is a life-threatening emergency as the umbilical cord can become squashed or compressed and cut off the flow of blood and oxygen to the baby.
Who Is At Risk of Cord Prolapse?
Fortunately, cord prolapse isn’t common and occurs in approximately 1 in every 300 births.
There are certain pregnancy complications which increase the risk of prolapse:
- Polyhydramnios: too much amniotic fluid can cause the baby to float above the cervical rim, allowing the cord to slip below the baby’s head.
- Malpositioning of baby: the optimal position for birth is head down, ensuring the baby’s head covers the cervix. Side lie (transverse) or breech lie (head up and bottom down) can allow the cord to come through the cervix first.
- Premature rupture of waters: if the baby is not engaged and membranes rupture before labour, there is a chance that the cord will be swept out before the baby’s head.
- Twins or multiples: due to the different positions of each baby, there is a risk one will have a low-lying cord.
- Induction when baby is not engaged: if the baby’s head is not well into the cervix there is a risk the cord will prolapse. If induction is medically urgent, a c-section might be a safer option.
What Are The Signs Of A Cord Prolapse?
If the umbilical cord slips below the baby’s head, there is a risk of compression, and the fetal monitor will indicate the baby is showing signs of distress. Signs include variations in heart rate, especially a noticeable drop, effects on blood pressure, and lowered oxygen levels.
If the cord slips down through the cervix during labour, you may actually be able to feel or see the cord. Your care provider will place her fingers inside your vagina, and gently push the baby’s head off the cord. To reduce pressure, you will be moved into a position that elevates your bottom, and be given oxygen. Your baby needs to be born very quickly. If the baby is low enough, your care provider might use either forceps or a vacuum extractor to deliver the baby; otherwise you will need an emergency c-section.
If you are not in hospital and your cord has prolapsed, it is important to call an ambulance immediately.
- Move into a knee-to-chest position on the floor, with your bottom higher than your shoulders, to take the baby’s weight off your cervix. Stay in this position until the ambulance arrives.
- If the cord is protruding out of your vagina, gently push it back in. This helps keep the cord warm and moist, which prevents the blood vessels from spasming.
- It is not recommended that anyone uses fingers to keep the baby’s head off the cord, unless it is a health professional who knows how to deal with this emergency.
What Are The Effects Of Cord Prolapse?
How severely a cord prolapse will affect the baby will depend on how much pressure was on the cord, and the length of time the cord was compressed.
If the cord was partially compressed then it is likely the baby will be born without any problems. Full compression reduces blood flow and oxygen to the baby, and if not detected in time can lead to severe brain damage or death.
How To Avoid A Cord Prolapse?
Fortunately cord prolapse is rare. There are certain things you can do to reduce the risk of the umbilical cord being compressed by your baby’s head:
- Avoid having your waters broken, especially if you’re not in labour and your baby’s head is not fully engaged. Babies can pop out of the pelvis even when they are engaged, so it is best to wait until nature determines when labour should begin.
- Avoid cervical checks during pregnancy, because of the risk of accidental rupture of membranes.
- If your baby needs to be born early, discuss with your care provider the risks of prolapse associated with any induction methods suggested. An elective c-section might be a safer option.
- Be aware of optimal fetal positioning to ensure your baby is in a perfect position for birth. Spinning Babies is a fantastic resource for this.
- Understand that certain conditions, such as excessive amniotic fluid, come with a higher risk of cord prolapse, and be prepared.
Cord prolapse is a rare medical emergency and one which requires immediate action from care providers. Being aware of the risks and ways to avoid a prolapse will help you feel more confident about what to do if you are at risk of umbilical cord prolapse.