Category Archives: Delayed cord clamping

Journey to birth Coco Milou – an epic masterpiece … stunning!

This is absolutely gorgeous … thank you to Jane McCrae Photography for her beautiful fusion of photos & video to create something so magical … some gorgeous honouring elements … be prepared to cry … and the baby was born in the caul … how auspicious …

Link    http://www.janemccraephotography.com/birth-photography/journey-to-birth-coco-milou-our-epic-masterpiece/

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Nuchal Cords – the scapegoat?

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Umbilical cords around the neck.

Why and how babies end up wearing their cord around their neck

The presence of a nuchal cord is a very common occurrence during birth. Around a third of all babies are born with the umbilical cord around their neck. How and when it ends up there will be different for individual babies. Interestingly, it is more common with boy babies – perhaps because they are more likely to have longer cords. It also becomes more common with increasing gestation – I suppose there is more time to get wrapped the cord. If a nuchal cord does not occur in pregnancy it can occur during labour. As the baby moves through the pelvis he/she rotates and can spin the cord around their neck. See this post to see how rotation works.

Risks associated with clamping and cutting a tight nuchal cord

Once the cord is clamped, blood flow between the baby and placenta ceases, reducing the baby’s blood volume and oxygen supply. This makes resuscitation more necessary and difficult once the baby is born. Any delay in the birth of the baby (eg. shoulder dystocia) will further increase the risk of hypoxia. While waiting to be born the baby now has NO blood supply rather than a limited one. There have been successful malpractice actions against obstetricians in the US who cut nuchal cords prior to shoulder dystocia.

One study (Sadan et al. 2007) found that neither cutting nor leaving a nuchal cord adversely affected the outcome for babies. However, they did not look at tight nuchal cords, and the cords were cut after the anterior shoulder had birthed.

For a baby with a tight nuchal cord the worst thing you can do is clamp and cut!

Risks associated with pulling and looping a loose nuchal cord

A far more common practice is pulling and looping a loose nuchal cord. Most care providers do this and I was taught to do this when I trained. However, handling the cord stimulates the umbilical arteries to vasoconstrict, reducing blood flow. Loosening the cord will usually involve some traction which can risk tearing the cord and subsequent bleeding (from the baby), or partial detachment of the placenta. As a student midwife I snapped a cord while looping it over the baby’s head. Luckily my mentor clamped the ends quickly but not before I got blood sprayed in my eyes! I later discovered that babies can be born with the cord around their neck. They either birth through the loop, or they come out with it still wrapped.

Checking for a nuchal cord

So, if you are not going to cut or loop a nuchal cord what’s the point in digging about to see if it is there? Checking for a cord interferes with the physiological process of birth. It also reinforces the notion that this is a birth complication that endangers the baby, rather than a common situation. Telling the woman to stop pushing and putting your fingers into her vagina can be disempowering and painful. There are also consent issues – how many care providers gain consent before this procedure?

Suggestions

  • Talk to parents before birth about the possibility and normalcy of a nuchal cord.
  • During birth DO NOTHING.
  • IF the cord is preventing the baby descending once the head is born (extremely rare) use the ‘somersault technique’ (Schorn & Blanco 1991) – see below.
  • Once the baby is born, unwrap the cord (the mother/family can do this).
  • If the baby is compromised at birth encourage the parents to talk to their baby whilst the placental circulation re-establishes the normal blood volume and oxygen for the baby. if the baby requires further resuscitation do it with the cord intact.

The somersault manoeuvre 

I have only had to use this twice in hundreds of births.