Month 7: Oh no, unwind me!
If you're worried that your baby will be strangled by having the umbilical cord wrapped around the neck, trust in nature and read on.
It’s an old wives’ tale that you shouldn’t lift your arms above your head to take down curtains, wash walls or hang up the washing while you’re pregnant because this will make the cord go around the baby’s neck. It’s also not necessary to assume that you’ll have a c-section if your doctor says that the cord is around your baby’s neck. It’s estimated a quarter of all babies are born this way, and often this is no problem. Doctors and midwives are trained to check the baby’s neck for a cord as soon as the head pops out. Unless there are anticipated or pregnancy-related problems, if the cord is around the baby’s neck, it’s not difficult to simply slip it over the baby’s head because it’s wet and slippery. If the cord is tight or wound more than twice around the neck, the cord is clamped in two places, cut between the clamps and unwound to release the baby. Compression of the cord during pregnancy, labour and birth could be a problem if it weren’t for a substance called Wharton’s jelly (much like the jelly found in the eye-ball). This milky-coloured congealed gel insulates the blood vessels of the umbilical cord, protecting them and making the cord flexible, slippery and stretchy during pregnancy, labour and birth.
The cord can become compressed during a vaginal breech delivery, or if a long cord slips through the vagina when the waters break.
More problematic than the cord around the neck is a so-called true knot in the cord. Fortunately this is very rare, but it’s dangerous when the baby’s blood supply gets cut off if it gets too tight.
This can be diagnosed during pregnancy when the baby is small-for-dates or not growing, when there is a very slow heartbeat, or when the knot can be seen on a scan. Under these circumstances, even if the baby is premature, there may be no alternative but to deliver the baby early by c-section.
A so-called false knot in the cord is a harmless cluster of blood vessels that may also be identified by scanning.
TOO SHORT TO MOVE
Problems associated with the cord around the neck may be minimal when the cord is average length or longer than usual, but it may be critical when the cord is too short.
A short cord around the baby’s neck may prevent the baby from descending into the pelvis in the first place. The tightening cord may also cut off the blood and oxygen supply from the placenta to the baby.
It must be remembered that a tight cord around the neck does not strangle the baby per se because the baby is not breathing air through the nose, but it does compromise vital oxygen supply, and this situation needs to be swiftly corrected – usually by c-section.
A short cord could also become wrapped around a limb (fortunately this is also very rare), cutting the direct blood supply to the limb, and in this way affecting and interfering with its normal growth and development.
MONITOR DURING LABOUR
When the cord is thought to be around the baby’s neck, complications associated with this diagnosis also depend on whether there are other pregnancy-related problems such as high blood pressure or diabetes. It’s important that a baby’s heartbeat is carefully monitored throughout labour and birth. The baby’s heartbeat usually slows down during contractions when there’s a mild oxygen compromise from the placenta but quickly recovers when the contraction ends. If the baby’s oxygen supply is cut short because the cord is compressed, this can be diagnosed by simply listening to and recording the baby’s heart rhythm before, during and after contractions. If the baby is taking too long to recover after each contraction, and there are other signs of foetal distress (such as green amniotic fluid), the baby will be delivered by c-section without delay. ●