A nuchal cord — or a cord around the neck — is one of many things mothers-to-be fear about childbirth.
The thought of your baby being ‘strangled’ by the umbilical cord can cause so much worry.
Fortunately, a normal, healthy umbilical cord is protected from blood vessel compression.
Babies receive nutrients and oxygen via the umbilical cord, not by breathing through their nose or mouth.
They don’t actually breathe until after the birth, when they take in that first breath of oxygen into their lungs.
This is one of the many reasons why it’s important to leave a baby’s umbilical cord intact (uncut) for at least 2 minutes after the birth.
The cord will continue to provide oxygen, and is the life support system for the baby, until his head is born and oxygen hits his nose.
Read more about why it’s important to delay cord clamping.
It’s the very same reason why babies don’t drown during a water birth, because they have an oxygen supply already attached. They don’t take their first breath until they are stimulated by air.
But what about when the cord is around baby’s neck?
Nuchal cord facts
Here are some interesting facts about a nuchal cord, including some great information from Doctor and Midwife Rachel Reed, who studied nuchal cords for her PhD:
#1: Around one-third of babies are born with a nuchal cord
It’s common to hear stories of babies being born with the cord wrapped around their neck.
The reason for this is because… nuchal cords are very common.
Some doctors and midwives don’t even mention it during childbirth, because they simply loop the cord over the baby’s head when he or she is crowning.
It’s usually no big deal. Unless it’s a dire emergency, the cord should be left alone during the birth, to prevent further compression or complications.
Studies report figures of up to one-third of babies being born with a cord around their neck – that’s 1 in 3 babies.
This is the same number of babies being born by c-section in Australia and the United States. Hardly a rare event.
Cords come in a range of lengths. In this study, cord length ranged from 19 to 133 centimetres.
The average umbilical cord length is around 50-60 centimetres long.
The above study states: “In this study, the long umbilical cords seemed to be associated with the increased rate of multiple nuchal cords and true umbilical knots… however long umbilical cords did not contribute to adverse perinatal outcomes by themselves. In theory, fetal movement produces tension on the cord that creates ample free length for delivery plus the length of the wrapped cord. Although an entangled cord may be at risk for intermittent or partial occlusion [blockage] of umbilical blood flow as previously reported, the excessively long cord may have self-protective effects to protect the fetuses from the risk of decreasing umbilical blood flow.”
“All 3 of my babies had the cord wrapped around their necks — even wrapped twice around 2 of them.” — Jessica, BellyBelly Fan
#2: A healthy umbilical cord is protected by a slippery, soft coating
The human body is ever surprising with its clever design.
Our bodies have been built to ensure our survival as a species.
Even the umbilical cord has it’s own set of party tricks.
A normal, healthy umbilical cord is filled with Wharton’s jelly, a soft, gelatinous substance which protects the blood vessels inside the cord.
This substance helps to protect the cord against compression as well as true knots (which can occur in around 1% of births) as a result of the baby’s normal movements.
If a medical condition was impacting the amount of Wharton’s jelly in the cord, or if the cord was not in good condition, then perhaps there may be complications.
However, the umbilical cord is carefully designed for uterine life. For the vast majority of babies, the cord is well protected.
Although this is not a nuchal cord, look at the impressive cord bundle a set of twin girls managed – and are happy and healthy today.
Cords like this are protected thanks to the simple yet magnificent Wharton’s jelly.
To see more knots and nuchal cords at birth, click here.
“My first baby had the cord around her neck, her waist and her ankle. The midwife didn’t remember the last time she saw a cord that long!” — Anna, BellyBelly Fan
#3: A nuchal cord does not get tighter as labour progresses
Doctor Rachel Reed is an Australian midwife, researcher and lecturer, who studied nuchal cords for her PhD.
To put her commitment and knowledge on this topic into perspective, a PhD is 6 years part-time or 4 years full time.
Doctor Reed reviewed all of the available studies and published a literature review. In her well-researched article, she explains:
“The baby is not ‘held up’ by the cord because the whole package — fundus (top of the uterus), placenta and cord are all moving down together. The uterus ‘shrinks’ down (contracts) moving the baby downwards, along with their attached placenta and cord. It’s not until the baby’s head moves into the vagina, that a few extra centimetres of additional length are required. However, when a c-section is done for ‘fetal distress’ or ‘lack of progress’ during labour, the presence of a nuchal cord is often used as the reason… “ah ha, look ” your baby was stressed because the cord was around his neck” or “…the cord was stopping her from moving down”. The cord is unlikely to have had anything to do with the stress or lack of progress.”
Some women say their baby’s heart rate was dropping when they were pushing. Studies have proven this is normal behaviour for a baby experiencing pressure around the head.
One study concluded:
“There was a very high incidence of abnormal FHR [fetal heart rate] during the second stage of labor, however, the most cases were response to parasympathetic stimulation due to umbilical cord or fetal head compression by mothers over push and descent of fetal head, or temporal diminishing of uterine placenta blood flow. It suggests that it is unnecessary to interfere immediately, unless truly fetal distress.”
Giving birth in an upright position can help, whereas being on your back can make it worse — and more painful. Induction of labour with medications like synthetic oxytocin (Syntocinon or Pitocin) can also increase the likelihood of fetal distress.
#4: A nuchal cord is not often associated with adverse outcomes
This may be hard to believe or hear, especially if you’ve lost a baby and his or her cord happened to be wrapped around the neck.
Since one out of three babies is born with a nuchal cord, it makes it quite likely that a nuchal cord will also be present in babies born with complications too.
However, several studies have reported that a cord around the neck is unlikely to be the main cause of adverse outcomes.
One study concluded:
“Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary.”
Another study came to the same conclusion.
Many other conditions (including unknown complications) can cause adverse outcomes, making it very easy to blame the visible cord around the neck.
Stillbirth and loss is still an area of much needed research.
Doctors and researchers themselves can’t be certain what causes 100% of cases.
But hopefully, we’ll continue to make key discoveries over time.
Something parents can do if they are worried about their baby is to keep an eye on baby kicks.
#5: Even with a ‘tight’ nuchal cord, there isn’t an increased risk of cord accidents
Even a tight nuchal cord isn’t uncommon.
A recent study found a tight nuchal cord occurred in 6.6% of over 200,000 consecutive live births, where they classed ‘tight’ as being unable to manually unloop the cord over the baby’s head.
In their findings, they state:
“Those with a tight nuchal cord were not more likely to have dopamine administered or blood hemoglobin measured on the first day, nor were they more likely to receive a transfusion or to die.”
“My baby boy has it wrapped around his neck 2 times. I freaked at first when my doctor told us, but I fed off his calmness, which helped me settle down. Figured if he wasn’t panicked I shouldn’t be.” — Robin, BellyBelly Fan
#6: A nuchal cord is not an indication for a c-section
The College Of Obstetricians and Gynaecologists in the United Kingdom advise that there is no reason to perform a c-section section due to a nuchal cord.
They state, “No studies were identified of the effectiveness of caesarean section in the presence of umbilical cord around the fetal neck.”
Doctor Reed agrees that there is no reason to perform a c-section ‘just in case’ due to a nuchal cord. “They very rarely cause a problem. Why not wait and do a c-section if/when a problem occurs? If you really want to avoid complications relating to cords, then don’t rupture the membranes [break the waters] to avoid cord compression — a much greater risk than a nuchal cord. Incidentally, when the cord is around the neck, it is often protected from compression.”
She continues, “Women need to bear in mind that obstetric training provides graduates with medical and surgery training. The graduates will not be trained in research, nor be required to continue to do any research. They’ve learned medicine in a medicalised system, with content often sponsored by pharmaceutical and technology companies. They are not researchers, and they have very little, if any experience or knowledge about physiological birth.”
“My first baby had her cord around her neck, it must have been around it for quite some time as I had to have an extra scan at 32 weeks because they couldn’t get a clear view of her left hand. She was born with her hand wrapped up in the cord too. Protecting herself before she was even born!” — Shauna, BellyBelly Fan
#7: Nuchal cord accidents are very low
Unfortunately, in a small percentage of births, a range of cord accidents do happen – and not all of them are due to a nuchal cord.
According to a recent report from the Australian Institute of Health and Welfare, 1 out of every 135 (0.74%) babies born in Australia is stillborn.
In the United States, it’s 1 in 160 births.
While the classification of stillbirth varies around the world, in Australia, a stillbirth is classed as ‘the birth of a baby who shows no signs of life, after a pregnancy of at least 20 weeks gestation or weighing 400g or more’.
A study in the Journal of the American Medical Association found that placental issues (for example placental abruption) were the leading cause of stillbirth at 26%, which was similar to a study in Sweden.
A further 14-19% of stillbirths were due to infection.
As for cord abnormalities, 10% of stillbirths were due to — or assumed to be due to — cord problems.
The range of cord problems included vasa previa, cord entrapment, evidence of occlusion [blocked], fetal hypoxia and prolapse.
“Nuchal cord alone was not considered a cause of death. This important cause of stillbirth has been somewhat overlooked in prior studies because of the difficulty in differentiating between harmless nuchal cords and cord conditions associated with pathophysiology leading to stillbirth.”
When you do the maths, the likelihood of a genuine cord accident due to being wrapped around the baby’s neck, cutting off oxygen, is very small. In fact, it may not even be the underlying problem at all.
There may be a visible nuchal cord, leaving everyone thinking it’s a no-brainer as to the cause of death.
But without an autopsy (which parents may or may not feel comfortable having done), other reasons may be completely overlooked.
“My son had the cord wrapped around his neck when he was born at home in water September 2013. No big deal and I unwrapped it myself! I was also wrapped at birth and so were my brothers. It’s normal” — Guðrún, BellyBelly Fan
#8: Even multiple loops aren’t more harmful
The number of loops is not important. Remembering from above, the uterus, placenta and cord all move down with the baby during labour.
Doctor Reed says: “… as long as the cord is long enough to get the baby’s head out (i.e. the length of the vagina — which is not long when stretched into a baby’s head shape) then the rest of the baby can come out. It’s extremely rare — but possible — that the cord is too short to allow descent of the baby. Then you would get a lack of progress and eventual fetal distress… often these babies get into a breech position before labour.”
A study found the number of nuchal loops varied from 1 to 4, and the presence of 2 or more loops of cord around the neck was reported to affect between 2.5% to 8.3% of all pregnancies. They stated, “0.1% of babies have 4 or more loops of nuchal cords and the maximum reported number was 9”.
The study also mentioned most babies in the study had Apgar scores of 7-10 (where 10 is the best score) after one minute, and only eight babies had an Apgar score of less than 7 after five minutes (5.20%), suggesting that any possible effect is only transient.
“My baby had his cord around his neck and under his arm. Absolutely no complications and it wasn’t scary for us. It can be okay!” — Ashley, BellyBelly Fan
#9: It’s usually another intervention which causes fetal distress
Inductions of labour, especially with synthetic oxytocin (Syntocinon in Australia or Pitocin in the US) can cause fetal distress. Once you’re hooked up to the drip, it will remain on until after the birth. Many mothers-to-be accept an epidural after these inductions, because synthetic oxytocin can make the uterus work very hard. Artificial oxytocin doesn’t work the same as natural oxytocin (doesn’t cross the blood-brain barrier) nor are the contractions like natural labour contractions.
With an epidural in place, the mother-to-be can’t feel a thing, but her baby is still under the effect of the strong, constant contractions due to the synthetic oxytocin. The uterus works harder and faster, meaning the blood and oxygen supply can easily become compressed — not just from the induction, but also because the mother is now immobilised, flat on her back. This can lead to the baby becoming distressed, requiring an emergency c-section. Then everyone thanks to the doctor for saving the baby.
This is called the cascade of interventions — you start one intervention (the induction), then more are required. It can quite easily snowball into an emergency c-section. However, if there happens to be a cord around the neck at the same time, this may be used as the reason for the c-section, with no further investigation performed.
Take a look at the clip below from the must watch documentary, The Business of Being Born. It explains how an induction with pitocin/syntocinon can result in fetal distress and emergency c-section.
How to reduce your risk of a stressful situation at birth
The best things to do if you want to avoid extra stress and complications when your baby is being born is to avoid an unnecessary induction of labour. Ask for evidence or proof that the baby needs to be born right away, not just because you’ve reached your estimated due date. Seek actual test results or signs that something is not working well.
Being on your back during labour and birth can cause problems too. Being stuck in bed is inevitable if you have an epidural, which is the usual next step if you have an induction with synthetic oxytocin.
Because a labouring woman will be stuck in bed and can’t move her pelvis with an epidural, her baby doesn’t have help to move down into the most optimal position. This may result in difficulties being born, requiring forceps or vacuum, or worst case, emergency c-section.
Getting informed with quality, evidenced-based information, and not just what you hear from friends or family, is crucial to set yourself up for the best outcome. We research our major purchases before we buy them; we need to research major life events too. Having a doula can reduce the incidence of many interventions.
Remember: Sometimes, doctors and midwives just don’t know
It may be the last thing you want to hear (and the last thing care providers want to say), but sometimes, doctors just don’t know why complications have occurred. It can be especially hard when it looks to be as obvious as a nuchal cord, and parents are understandably emotional and desperate for answers. Yes, a cord accident can sometimes occur, but there are lots of things we still don’t understand about childbirth.
Conception is a magical, mysterious thing. It’s complicated yet simple at the same time – and the same goes with birth. All we can do is trust the process. While life sometimes throws some distressing events our way, where things just don’t work out as we hoped and dreamed, sometimes there is no-one or nothing to blame. Remember: Mother Nature works beautifully the vast majority of the time – the population of the planet is proof of that. It’s not your fault if something goes wrong. And it’s very likely there was nothing you could do to have prevented it.
A cord around the neck is a very common occurrence, and needn’t be feared. However, if you have any concerns or feel that something isn’t right, count your baby’s kicks and always speak to your care provider for reassurance or diagnosis.