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Nuchal Cord

Birth experience–cutting the cord before birth

This mother shares how her son’s umbilical cord was cut before his shoulders were born. After doing her own research, she decides what her care-provider did was not evidence-based.

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When I was pregnant I did everything right to give my baby the best possible chance for a safe, natural birth.

I researched like crazy, hired a doula, changed providers more than once when they showed their true colors, refused induction, let my baby come on his own, labored most of the way at home.

The hospital was wonderful. I had amazing nurses. No one offered me drugs. I had no IV, not even a saline lock, I stayed out of the bed….no AROM.

To give birth, I pushed on my hands and knees and my water broke on it’s own while I was pushing. My natural un-medicated hospital birth was going off without a hitch….UNTIL I pushed my baby’s head out and my provider felt a tight double nuchal cord that she could not unloop.

So she clamped and cut it on the perineum. Thankfully I had another contraction right away and pushed him quickly out. Still, clamping on the perineum almost always necessitates resuscitation…and it did for my baby.

cut nuchal cord babycenter story regina

Thankfully, despite the trauma and premature cord cutting he did end up fine.

His first APGAR was only a 4, but by five minutes it was a 9, which showed his poor condition at birth was caused by the cord cutting, without prior compression making his condition even worse. He did not have to go to the NICU and is now a bright 5 year old in the gifted program :)

This birth experience led me to research nuchal cords like crazy. I found out that what my provider did was not evidence-based. I also found out that there is no danger in having the cord around the neck and there’s no reason that my son could not have been born with it around his neck. There was no need to try to unloop it and certainly no need to clamp it and cut it. There’s no need to even check for a cord.

Hands away from vagina please!!!!!

I’ve had people tell me that a tight cord should be cut because it will get tighter and prevent the baby from being born. But in my readings I have not found any evidence that the umbilical cord gets tighter and tighter, since the fundus pushes everything down at once, including the cord. It’s not as if the cord has the ability to stay up high and stationary while the baby’s body is pushed down. It’s all pushed down together. It’s not a bungee cord.

I’ve done extensive research on nuchal cords and all the studies say the same thing – nuchal cords including tight loops are not associated with any significant adverse outcomes (unless they are cut). I am unable to find one single bit of evidence, research, study that supports the recommendations to cut the cord before delivery of the body in ANY circumstance. Does anyone have real evidence that supports this practice???

The only time that delivery of the body would be prevented by a nuchal cord was if the cord was extremely short and it would have to be EXTREMELY short in that case, not to be able to reach from the placenta next to the baby’s squished up body to the outside of the vagina. However, there is still no evidence or benefit in cutting the cord in this circumstance. And let me say, that a cord this short is unlikely to make it’s way around a head in the first place. In fact, I’ve been unable to find even one case study of this in the literature. Still, if this rare event were to happen, all that needs to be done is to simply hold the baby’s head next to the perineum and allow the body to flip out. This is known as the Somersault Maneuver.

I’ve watched videos on YouTube where an woman having an unassisted birth does this herself, with no one else around. And certainly a MW or OB could do this without any issue. (see diagram below)

To conclude my birth experience I want to finish with a link to this article: Nuchal Cord Management and Nurse-Midwifery Practice- Mercer, Skovgaard, Peareara-Eaves, Bowman 2005. (see the excerpt below)

 

Clamping the Nuchal Cord Before Delivery of the Shoulders

In addition to anaemia, possible neurologic harm from clamping a nuchal cord before birth has been identified.A recent integrated review of the literature on nuchal cord management found reports showing increased risks to the newborn when the cord was clamped before the shoulders are delivered.Leaving the cord intact and using the somersault maneuver is recommended especially if shoulder dystocia is suspected. During the somersault maneuver, the infant’s head is kept near the perineum as the body delivers so that little traction is exerted on the cord (Figure 1).Resuscitation at the perineum allows the infant to regain the blood trapped in the placenta and can be accomplished using all the proper tenets of neonatal resuscitation.

 

somersault image

Somersault maneuver
The somersault maneuver involves holding the infant’s head flexed and guiding it upward or sideways toward the pubic bone or thigh, so the baby does a “somersault,” ending with the infant’s feet toward the mother’s knees and the head still at the perineum.

1, Once the nuchal cord is discovered, the anterior and posterior shoulders are slowly delivered under control without manipulating the cord.

2, As the shoulders are delivered, the head is flexed so that the face of the baby is pushed toward the maternal thigh.

3, The baby’s head is kept next to the perineum while the body is delivered and “somersaults” out.

4, The umbilical cord is then unwrapped, and the usual management ensues. Figure adapted with permission from Mercer et al.

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About Kate Emerson

Kate Emerson, BA (sociology/politics) Kate is a clinical student pursuing her interest in neonatal transitional physiology and clinical cord clamping practices. She produces articles and popular media to increase the level of awareness about delayed cord clamping, for parents, students and interested practitioners. Please visit www.cord-clamping.com to read more.

Discussion

8 thoughts on “Birth experience–cutting the cord before birth

  1. Good article, and I agree. As a former midwife, only once did I cut a nuchal cord on the perineum, and by then it was too late anyway. The cord was so short and tight it tore where it was attached to the placenta during pushing. I later discovered it was about 75% torn, gushing blood by the time the head was slowly born and I could get to it. I cut the cord to lessen the pressure so the baby could be born quickly, since I didn’t yet know if I was dealing with a placental abruption or a cord dehiscence. Either way the baby was no longer benefiting from the cord’s attachment, and could have been losing blood herself.
    So I would agree with the article and say from my experience that only very unusual circumstances would favor cutting the cord on the perineum, and by no means should this be routine management of nuchal cord.
    ps – this baby and mom were fine, though mom needed a transport because we couldn’t get the placenta out. Neither could the docs until they put her under general and dealt with how “stuck” the placenta was to the uterus (accretion) – all in all an unusual and difficult birth, but the little girl is 12 and just fine.

    Posted by Frances Toler | October 30, 2011, 3:07 am
  2. Looking at the somersault maneuvre it just occured to me, when women gave birth in an upright position and reached down and grabbed hold of their babies themselves, they would naturally pull the baby towards them as it birthed. Which would spontanously resolve any potential nuchal cord issues.

    Posted by Kate Evans | June 22, 2013, 3:58 am

Trackbacks/Pingbacks

  1. Pingback: Nuchal Cords: the perfect scapegoat | Midwife Thinking - October 16, 2011

  2. Pingback: Cord around the neck – what parents & practitioners should know « Delayed Cord Clamping - November 4, 2011

  3. Pingback: Cord around the neck – what parents & practitioners should know | Easier Birthing, HypnoBirthing, Birthing Classe, Child Birth Classes, Water Birth, Natural Birth, Doula, Utah, Ogden, Layton, Brigham City, Weber County, Davis County - May 5, 2012

  4. Pingback: Cord around the Neck | {Resources for Moms} » Echo | Photoworks - June 15, 2012

  5. Pingback: Cord around the neck: What Parents and Physicians should know - easierbirthing.com - October 31, 2012

  6. Pingback: CORD AROUND THE NECK – what parents & practitioners should know | THE TRUTHSEEKER'S JOURNAL - July 1, 2013

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