Month nine
When baby’s lifeline is around the neck
BELIEVE IT OR NOT, a cord around the neck of a baby occurs in about one third of all pregnancies. As your baby moves around inside you, his cord may become wrapped around his neck or other parts of his body. The umbilical cord connects the baby to the placenta and is responsible for the baby’s oxygen supply while in the uterus. A thick jelly-like substance called Wharton’s jelly surrounds and protects these blood vessels. While the bag of membranes is intact, the cord floats around inside the uterus and ensures baby receives adequate oxygen and nutrients, and the Wharton’s jelly prevents the baby from compressing the cord. What most people don’t realise is that the blood vessels in the cord are convoluted within the jelly and many times longer than the cord in which they’re contained. This means that even if the cord is stretched, the vessels within will not be compromised. Much more of a concern is compression of a baby’s head on the cord once the waters have released. This can cause foetal death in a few minutes and is an obstetric emergency.
WILL I NEED A C-SECTION?
During pregnancy, the cord being around the neck is usually not a problem for the baby. Remember your baby is “breathing” through his cord and not through his trachea while in the womb. The average cord length is between 50-60cm long, but some cords can be much longer – up to 133cm. A short cord (around 19cm) may indeed pose a problem in that it may prevent the baby from moving down once in the vagina. This may be diagnosed only once foetal distress becomes a problem, a C-section is performed, and the placental unit is examined. Most practitioners have no problem delivering a baby that has been diagnosed on scan as having a nuchal cord. However, if the cord is wrapped twice or even three times around the neck, some caregivers may decide to perform a C-section. There has been much research on this subject over years and the College of Obstetricians and Gynaecologists in the UK feel there’s no reason to do a C-section because of a nuchal cord. A baby won’t be held back by a cord, because as labour progresses, the entire unit of uterus, placenta, cord and baby move down as one. The uterus contracts and shrinks to allow the cervix to open and moves the baby with his entire support system towards the vagina. Yes, cord and placenta are in tow! Only once the baby’s head enters the vagina will there be a need for a few centimetres of cord slack.
WHAT COULD HAPPEN AT BIRTH?
If at delivery, the practitioner finds a cord around the neck, there are two ways to deal with it. If the cord is wrapped loosely enough (even with multiple cord loops), the practitioner will slip the cord over the baby’s head. This may take longer if there are multiple loops. You’ll be asked to withhold from bearing down. If the cord is wrapped too tightly to be slipped over, the practitioner will clamp the cord in two places, and then proceed to cut the cord and unloop it, so the baby can be born as normal. Most of the time, your doctor or midwife won’t even mention this to you, unless you had requested delayed cord clamping. Your baby’s Apgar test will be done and your baby will be placed under observation should the Apgar be low. Every attempt should be made to place the baby skin-to-skin on the mother, as this will help your baby breathe better and settle and be infused with oxygen. Nuchal cord or cord around the neck at birth does not have to be complicated and is seldom as life-threatening as you may be led to believe, and the birth can be a normal one ending in a safe delivery of your baby if adequate care is taken at the proper time. Don’t let the news of your baby having a nuchal loop cause you to stress. Speak to your caregiver about how he or she would handle a situation like this, so that you are not surprised or shocked at the time of delivery.