Month nine

When baby’s life­line is around the neck

Your Pregnancy - - Contents -

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.

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