I’ve gotten several hits on my blog about this subject, so thought I might as well go in depth with this a bit more.
The umbilical cord is what connects the baby to the mother. Soon after conception, the baby (embryo may be the “correct” term for this stage of development) burrows into the lush uterine lining, and part of the embryo becomes the placenta while the rest of it becomes the baby, inside the amniotic sac. The placenta grows along with the baby, and although the mother’s and baby’s blood never mix, the placenta is where the oxygen and waste exchange happens–the mother’s circulatory system gives the baby oxygen and nutrients while taking away the baby’s carbon dioxide and waste.
Generally, there are no problems with this wonderful system; but occasionally, the placenta does not grow very big, or the umbilical cord can develop a knot, or wrap around the baby. Many home-birthing midwives will testify that maternal nutrition plays a vital role in a well-developed placenta, which only makes sense–”you are what you eat.” Check out The Brewer Diet for more information on a healthful diet. The umbilical cord can develop a knot if the baby moves through a loop in the umbilical cord. This happens very early in pregnancy, when the baby has ample room in the womb for these free movements; later, the baby is much more squished in the confines of the uterus. Most of the time, a knot is not a problem, but a “true knot” can actually be so tight that it compromises blood flow through the umbilical cord to the baby. This is extremely rare, and usually cannot be known before birth.
Probably what most people worry about when it comes to umbilical cords is that they will be wrapped around the baby’s neck. This is called a “nuchal” cord (from the Latin word for “neck”). This is much more common, occurring in up to 20% of all births, but only rarely causes problems. My first son, for example, had the cord wrapped around his neck once, and the midwife couldn’t get it off before his body was fully born, but the cord was kept intact and my baby had no problems whatsoever. In fact, I did not even know it had happened until a few years later when I was looking through my copy of the birth records. What might cause problems is if the cord is wrapped around the baby’s neck and cuts off or diminishes circulation to the baby’s brain either in utero or as the baby is being born. But again, this is rare.
The typical response to a nuchal cord is to unloop it from the baby’s neck after the head is born and prior to full birth if at all possible; and if it’s too tight, to cut the cord and unwind it. (The cord will be clamped in two places, and the cut will be made between, to minimize blood loss to the baby, and mess on the floor from the placenta side of the cord.) Some birth attendants will instead “somersault” the baby out of the birth canal, keeping the baby’s head close to the mother’s body. This allows the baby to be born while still keeping the cord intact (occasionally, a nuchal cord might prevent the baby from coming out because it makes the cord too short). With the baby fully out, the cord can then be unwound from the baby’s neck or body, thus allowing the full amount of oxygen that sustained the baby inside to keep coming to the baby on the outside, while he makes his transition to breathing.
It may be possible to identify a nuchal cord with ultrasound, but there are some considerations you should have. First, most nuchal cords do not cause problems. There are fetal tests that can be done if a nuchal cord is suspected or known that can reassure you as to fetal well-being (including you doing “kick-counts” to make sure your baby is moving adequately). Second, ultrasound is not 100% reliable, and you have to judge the benefits vs. risks of this or any other procedure. And finally is a story one of my online friends shared with me (she is a doula at a birth center, as well as childbirth educator). A couple discovered via ultrasound that their baby had a nuchal cord (after the woman was at term, but prior to onset of labor). The woman was terrified of the baby strangling herself, so she decided to have a C-section right then. The birth center offered to keep her overnight and continue to monitor the baby, and let her see that the baby was just fine, but she was too scared to accept. Within a couple of hours, she had had the C-section, and the doctor said there was no nuchal cord. Babies move in utero; they twist and turn. It is easily understandable that the baby could wrap herself up in the cord, and then unwrap herself just as easily.
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Filed under: umbilical cord | Tagged: baby, birth choices, childbirth, childbirth education, labor and birth, pregnancy, umbilical cord
Thank you for this umbilical cord primer!! I wish more mothers would read this. I have to tell you… I recently attended a birth where the doctor made me really, really angry. Baby emerged with a tight nuchal cord, which as you say is rarely a problem. But the doc looked at me (the nursery RN) and right in FRONT of the parents said, “I’m going to need you to take the baby straight to the warmer because she’ll need to be resuscitated.” Ohhh… I got so angry. Not only did she say this in front of the parents, but she also deprived this mother of having her infant placed directly on her abdomen. And of course the baby was fine and let out a nice holler right away. Shaking my head…
Thanks for your comment on my first entry! I feel a lot less bewildered now that I’ve been able to spill the beans to a few people. I’m still oscillating between giddiness and total non-excitement. I’ve browsed through a few of your entries here, and I like what I see. I think I’ll keep looking.
We had a UC with 2 true knots – they didn’t even tighten into recognizable knots until after the baby was born. (our babies tend to have very long umbelical cords) – just to throw out there a personal example of true knots being nothing more than a conversation piece as part of a normal labor.
I just found out today that at 34 weeks, my baby has the cord wrapped around her neck. They couldn’t determine if it was twice or three times. I’m trying to take it all in stride. A fan of internet know-how, I’ve been searching for info and found this blog to be the most comforting and seemingly informative. My doc simply told me to keep monitoring the kicks and getting my twice weekly ultrasounds (because I’m AMA… Advanced Maternal Age) and to get an amnio test scheduled to see how developed the lungs were, then maybe induce. Me? I’m crossing my fingers (and meditating) that she’s just accessorizing early and will soon be tired of her new necklace and therefor unwrap herself by the next ultrasound. Oh and I’m drinking tons of water to increase the fluids around her so she’ll have more room to unwrap. That’s my own reasoning on that one. Nothing scientific. I will say, be wary of what you may read online. I’m sticking w/the actual medical studies done on the subject and avoiding any Henny Penny posts telling people to flip out and go in for a c-sect immediately.
Hi, we just found out that our baby (around 4 months in pregnancy) has a non-coiled
umbilical cord. Dr. told us that we have returned to do ultrasounds every month and
kept to monitor baby’s growth (or not). I tried my best to look for information about
this issue but little was found. I really appreciate what you may help us.
Hi, my name is Silvana and i lost my baby at 32 weeks 3 months ago. Her umbilical cord was straight. Everything was normal during the pregnancy. I´m from Argentina and here doctors don´t consider riskes about straight cords (they didn´t tell me anything that the cord was uncoiled). I would like to know if you have more information about this and if with a doppler can doctors see the cord twist in future.
than you
Silvana
I was not familiar with this condition, so had to look it up. Here are some things I found. This study showed a higher risk of fetal anomalies and stillbirth when the fetus had a non-coiled umbilical cord; however, the majority of babies were perfectly fine. The causes of a straight umbilical cord are not well understood — it is believed that coiling is caused at least in part by fetal activity, so a baby who doesn’t move as much will have a straight cord. Even though blood flow through the cord does not seem to be compromised with external pressures (such as what happens during labor) in either straight or coiled umbilical cords, since fetal distress is more common in babies with a straight cord, it may be advisable to have continuous monitoring during labor, to be able to take steps quickly should the baby become distressed. It seems that avoiding an induction of labor and/or augmenting labor may also help avoid fetal distress, since these agents can cause fetal distress in normal babies. You may want to ask your doctor if there have been any safety studies done on these medicines with babies that have straight cords.
This webpage has some pictures as well as information on “abnormal cord coiling” and says that the cord coiling index is “virtually impossible to assess [prenatally], so most of the following data have been collected retrospectively.” This may be a large part of the reason why there is little information — the data is hard to collect prenatally. (Below this information are some pictures of cords that have a lot of coils on them — hyper-coiled cords — which provides a sharp contrast to the pictures of the straight cords.)
This website has a good synopsis of this condition. Among other things, it says that a straight cord may become coiled later in pregnancy, so it may be a good idea to check the state of the baby’s umbilical cord in any future ultrasound you have, to see if your baby’s cord becomes coiled. Several things have also said that maternal health seems to play a role in this — higher rates of non-coiled umbilical cords have been noted with maternal conditions such as preeclampsia and gestational diabetes.
Your doctor is recommending monthly ultrasounds to monitor the baby’s growth; this is because IUGR (intrauterine growth restriction) is more common in babies with straight cords. However, I will point out this study, which demonstrated that frequent ultrasounds led to higher rates of IUGR. Although the study’s authors said it was possibly due to chance, “it is also plausible that frequent exposure to ultrasound may have influenced fetal growth.” What I would do in this case would be to ask the doctor what information he hopes to gain from frequent ultrasounds, and what differences that information would make in my care. Also, I would ask if there are any other ways he could get this information without these tests. For example, will measuring the uterus from the pubic bone to the fundus demonstrate that the baby is still growing? If the baby isn’t growing from 4-5 months or from 5-6 months, what will he do? If there is something that can be done to help the baby at that point, then knowing this information will be valuable. If, however, there is nothing that can improve the rate of baby’s growth (and ultrasounds may possibly hurt it), and the doctor wouldn’t suggest an early birth until 7 or 8 months along, then how can it help to know the estimated fetal weight at 5 or 6 months? There may be something your doctor can do, so these are not just rhetorical questions.
One of the above-mentioned websites suggested testing the baby’s lungs for maturity at 37 weeks. This is because of the higher rate of fetal demise, with the obvious implication of inducing labor or having a C-section if the baby’s lungs are mature, to avoid the higher risk of stillbirth that happens with babies with straight cords.
While this information may be unsettling, to know that babies with straight umbilical cords are at higher risk for certain problems, I like to look on the positive side of things, and focus on the fact that most babies with straight cords are perfectly fine. While there are some known risk factors and reasons for babies to have straight cords, the majority of the cases are of unknown reasons.
sir my wife went for check up and scanning
detected for unblicical cord around the neck
36 week, baby is healthy
suggestion needed from you sir
iam from india chennai
Current research shows that 20% of all babies have cords around their necks at birth. Most of the time this is no problem; sometimes it can be a problem. Right now, ultrasounds cannot tell when it is or is not a problem. If the baby is fine, then I would suggest watchful waiting. If you or your wife are concerned, you can have more ultrasounds to make sure everything is still good with the baby.
Your wife can also count the baby’s kicks to make sure the baby continues to be active. While babies tend to decrease in movement leading up to the birth, they should still kick frequently. Not enough fetal movement can be an indication of something being wrong. I don’t want to scare you, but friends of mine lost their baby before birth because the umbilical cord was wrapped too tightly around the baby’s neck. She noticed less movement from the baby but was not concerned. Again, most of the time nuchal cords (umbilical cords around the neck) are not a concern, but it would be wise to make sure the baby is active and possibly to have another ultrasound to see if it might be a problem. If it seems to be a problem (the baby isn’t moving enough, or the heartbeat is too slow or something), then it might be better to induce or have a C-section — your doctor will advise you on that.
-Kathy
hi everyone .My name jane .My baby was stillbirth last year .I find out from the report ,my cord was too short ,that time about 9 month ,the baby less moving ,I was not concerned .I want to say when you prengcy after 5,6 month ,you have to count baby moving ,make sure the baby is fine .
hi ,If someone prengcy after 5 or 6 month ,doctor can find out the cord is too long or too short by ultrasound ?thank you help me .
I did find one article that said it is possible to find out by ultrasound that the cord is short; but most studies that look at the incidence of the cord being short are done after the baby is born. It is probably one of those things the doctor will have to specifically look for, and not something that he will just notice. A short cord is usually not a problem, but babies with short cords are more likely to have various problems. The idea is that the more active the baby is, the longer the cord becomes; and babies with certain problems (including genetic defects) are less active, which leads to the cord being short.
-Kathy
Thanks for the information. Just for another example, my second son was born healthy and happy at a birth center with the cord wrapped around his neck four times. That was the first all of the attendants had seen with so many, but the cord was long enough to compensate. My labor was slow going (20 hours at 8cm), so we checked the baby’s heartbeat often. He took his time, but never waivered and it all worked out great.
I have a question though – I am now 15 weeks pregnant with my third. I only feel movement on my left side and I was wondering if the umbilical cord could be to short for the baby to be getting to the other side. Does the cord grow throughout pregnancy?
My understanding is that the cord does continue to lengthen as the baby gets bigger — just as the baby and placenta grow from near-microscopic to weigh several pounds at birth, so the umbilical cord gets bigger and longer too. It may be that you are just a little more sensitive on one side than the other. Fifteen weeks is pretty early for you to feel movement, so if you didn’t feel movement at all, that would be pretty normal (most first-timers don’t feel it until around 18-20 weeks, although women who have had more than one do tend to feel “quickening” earlier). I don’t think it’s a reason for concern that you can only feel it in one spot.
hi… i’ve just experienced to lose my 8 month pregnancy baby two weeks ago.. for having a “true knot” that caused to cut/prevent the blood and oxygen to reach the baby … i was visiting the doctor for the regular check the night before and “i” noticed a slow heartbeat for my baby and told the doctor about it but he said its normal after hearing it! he just asked if the movement is fine and i told him yes (as i got used to his movements) but after leaving i was very concerned and watched carefully if the movement is really fine.. but it wasn’t!..the next morning there was no movement and went to have the ultrasound when i found that there is no heartbeat!!!… i had the c-section with my born still baby!!… it was very hard for me.. the dr. showed me the “true knot” on his camera after that! it was the same as the one in the picture here on this site..
i wanted to ask if it was the doctors mistake or me??! he didn’t see this true knot in the ultrasound when i first visited him.. should he see it before that or not? and he could have done something when i heard the slow heartbeats??… or is it me who should have noticed the less movements of my baby??? but the last check before this one everything was just fine and the baby was moving very well… i don’t know does this happen through this 3 weeks .. could the knot get tighten through this short period???
please reply… thanx
I’m so sorry for your loss!
It is *possible* sometimes to see a knot in the umbilical cord by ultrasound, but there may be many factors that would make it difficult or impossible to see. First, I would think that the doctor would have to look for one along the entire length of the umbilical cord, and it may not be possible to see the whole thing — for instance, if the cord is wrapped around the baby’s body, and the knot is behind him; or it may be that the picture is just not clear enough to see. Many times it is not known until birth that there was a knot in the cord. Also, not all knots are dangerous — I’ve heard several stories of babies born with true knots that were not problematic — but if a cord was visible by ultrasound, I would want to pay close attention to it. (Here is a link to a study which talks about how difficult a prenatal diagnosis of umbilical cord knots are: http://www.ncbi.nlm.nih.gov/pubmed/7719859)
In general, for the cord to get tied in a knot or for the cord to get wrapped around the baby’s neck or something, it has to happen early in pregnancy, when there is still enough room in the uterus for the baby to move freely. Basically, in its early stages, the baby sometimes makes a loop with its umbilical cord and goes completely through it (which sets the stage for a knot), or goes partially through it (which makes for a cord around the neck or body). It is possible for a loop to form early in pregnancy, and then for the baby’s movements (including playing with the cord) tighten the loop into a knot later in pregnancy. However, many times it is not visible by ultrasound, or it can easily be mistaken for just a looped umbilical cord. It’s possible that newer technology and more powerful imaging devices will be able to accurately diagnose a true knot, so that they can keep close check on the baby during the end of pregnancy and during labor, but that may still be some years in the future.
Many times women “just know” that there is something wrong — if you think there is a problem, listen to your gut instincts. It may be that your baby’s heartbeat was still within the range of normal, even if it was lower than normal for your baby. However, the bigger the baby gets, the lower the heartrate is; so a slower heartbeat is not necessarily a sign that something is wrong (the fetal heart-rate increases every week in early pregnancy and then decreases from the 11th week onward). Decreased fetal movement is a good indicator that something may be wrong, which is why midwives and doctors will many times have women do “kick counts” where they keep track of how often the baby is moving, as an early indicator if something is wrong. Yes, the cord can tighten and cut off the oxygen supply in a matter of weeks. At the time, you thought that the baby was moving well enough, which was an indicator to the doctor that everything was still fine, even if the heartbeat was lower than it had been. When oxygen levels get low, fetal movement slows down — to conserve oxygen and energy, to make sure the brain and other vital organs get as much oxygen as possible.
You can’t go back in time, so I don’t want what I say to add to the grief you must be feeling; but just to know for the future (although it’s unlikely this would happen again), here is an example of a kick-count chart to keep track of fetal movements (http://www.americanpregnancy.org/duringpregnancy/kickcounts.htm). Since ultrasound is not always completely accurate nor completely clear, fetal movement is probably a better indicator of fetal well-being in cases like these. Babies tend to slow down in movement later in pregnancy, but it still should be within “normal” parameters.
My heart goes out to you,
My son was born 7 years ago with 4 nuchal cords. Shortly before his birth, I notice tremendous movement. The only way to describe it was it was as if my baby was panicing and flailing the same way someone who was suffocating/drowning would flail and fight for air. I met with my ObGyn and she told me the baby was fine, heartrate was normal. I was a new, first time mom close to my due date and probably just anxious. But I knew something was wrong. Her solution was for me to come back in two days in stead of the customary week, which I did. Thankfully, I met with another Doctor in the practice and she took the time to monitor my son’s heartrate. She listened to my odd complains about strange itching sensations under my skin (was later told this was a sign of liver distress) and my belief that I was further along than they had calculated. After an hour of making me lie in several different positions and giving me food and liquids to raise my sons heartrate, my sons heartrate continued diving low. She told me this would be normal during a contraction, but I wasn’t having any. I was sent to the hospital for induction but when my son’s heartrate dove below 40 bpm, I was rushed into surgery. Every doctor/nurse I spoke with the next few days told me that had never seen 4 nuchal cords and that, considering the situation, they were amazed he was born alive. My son scored well on his Apgar, 9-9 but we have seen some effects we believe are related to possible oxygen deprevation inutero. He is currently being evaluated for Asperger’s (Autism) and has some neurological anomalies, symptoms of ADHD. The doctor providing the assessment believes that there is a strong correlation between the nuchal cords and some of his current problems. Who knows? The whole point I wanted to make was, if at any time, something strikes your gut as not being right, persue it. I felt something was wrong when I originally met with my doctor and felt she wasn’t really hearing my concern, but my belief that she was knowledgable overrode my gut reaction. I still feel guilty over not having insisted she check my baby more thoroughly, especiallt after hearing the nuchal cords could have caused his problems. If I could do I over again, I would rather have her think I was a neurotic pain in the neck rather that have my son suffer the possible life long consequences of my reticence.
Hi all,
This is Rekha Singh from India. At present I am in my 38th week of my very first pregnancy and today itself , my Doc after going throgh my USG test reports told me that the Nuchal cord is noticed and there may arise a need to go for C-Section.
I am really worried as I understand that once you have got yourself operated with such C-Section then throughout your life you have to compromise with so many things like you will not be able to have a cold bath or move in sun etc. etc.
Now as I have gone through the articles placed here on this web page I am feeling a bit relaxed.
But frankly speaking I am still very nervous and worried about my baby’s health.
It is normal to be nervous and worried about your baby’s health. But it is possible that the cord may be around the baby’s neck today and then gone tomorrow; and it may be loosely around his neck. Most nuchal cords do not pose a problem to the mother or baby. Something *may* happen to necessitate a C-section, but you probably won’t need one just because of the nuchal cord. Your doctor will probably monitor your baby during labor, and if it appears that the baby is having problems, will give you a C-section.
I’ve heard that India has a very high C-section rate in hospitals, most of which are unnecessary; and depending on your particular doctor and hospital, you may be likely to have a C-section even if there is no problem. I have not heard about those things you said a woman couldn’t do after a C-section; but I have heard that many women have a nagging pain or itching at their incision site, and it’s possible that a cold bath or moving in the sun may make it worse.
Before you get a C-section just because the baby may have a nuchal cord, I would suggest another ultrasound to make sure the cord is still around the baby’s neck, and to see if they can judge whether the cord is tight or loose. And definitely pay attention to your baby’s movements — if you notice a decrease in movements, that may indicate that there is a problem and you then may need a C-section in order to safely get your baby out.
My husband and I were getting ready to try having another child. He came home from work and told me that a friend’s wife just found out that her baby had died from the cord wrapping around her neck. She was 39 weeks and had been to the doctor two days ago. They were getting ready to deliver this week. This news really made me sad and useless. More than that, it scared me to death. Looking at my son, who will be two in July, I couldn’t imagine going on with my life without him. I wanted to find more information about my friend’s loss. Reading this information made me feel better, but I also learned things I didn’t know during my first pregnancy. I plan to take this information and use if wisely. I’m hoping that y’all might pray for our friend and his wife.
Thanks,
C.
I most certainly will pray for them — it is truly a devastating experience! My husband’s best friend and his wife had a similar occurrence, three and a half years ago, losing their baby on their due date, and she had been unwilling to try to have another baby, out of fear of the same thing happening again.
There is an organization called SANDS — Stillbirth and Neonatal Death Society — which will be of far more value than anything I can say, because these people have lived through this nightmare, and will know best what to say. Perhaps you can get some information from them to help your friend, or share the organization’s name with her so she can look into it herself.
Our third son was born still at 22w1d. At his 20 week u/s, we found that he was only measuring 18 weeks, had echogenic bowel, and low amniotic fluid. We had multiple u/s, but I was concerned about Will’s movement and went in for a paranoia check, only to find that his little heart was no longer beating. At his birth, we found that the last inch or so of his umbilical cord (to where it attached to his belly button) decreased in diameter to about a quarter of its previous diameter. I was again researching info about this and came across a very similar post that defined this as hypercoiled umbilical cord. We did request an autopsy but have not yet received he final results. What causes hypercoiling? Was it something I did? I went down a waterslide with my 3 yr old at 12 weeks…did that cause it? Will it happen again? Could Will have survived it we had made it to 24 weeks and gotten him out? Thanks!
Jen,
I’m so sorry for your loss!
It sounds like your son had issues that were related to the umbilical cord, and/or possibly some underlying factors. I’m glad you’ve chosen an autopsy — that will likely answer a lot of your questions. The cause of stillbirth is unknown in about half of all cases, but many parents do not choose an autopsy, so the cause of death may be knowable in more cases.
Unfortunately, many rare conditions, including hypercoiling and other umbilical or placental issues, are not well studied, since they are so rare, so often there are only “educated guesses” and medical reasoning to go on, rather than straight facts. Many cases have no known risk factors, and just appear to be “one of those things.” I cannot imagine that going down a water slide could have caused this to happen to your son, because of the cushioning and protection of the uterus. Sometimes women are told that things they do cause problems with their babies, but these may be false “old wives’ tales.” Please don’t torment yourself by thinking that you caused the problem; and don’t let anyone else make you feel guilty.
The rates of survival for premature infants vary based on their gestational age at birth — at 24 weeks, about half of all babies survive; at 22 weeks, the rate is somewhere around 10-15%. An otherwise healthy baby has a better chance of living than a compromised baby. Considering his smaller size at the 20 week u/s, it sounds like he may have had some underlying problem that may not have allowed him to live if he was born alive at 24 weeks.
Sometimes it is difficult to ascertain whether something was a cause or an effect — was his small size due to the umbilical cord constriction? or was the umbilical cord constriction somehow due to his small size, or another underlying factor? In many cases, doctors only know that there is an association between a hypercoiled umbilical cord and intrauterine fetal demise, without knowing why the umbilical cord sometimes coils or constricts. There are some guesses, such as that babies that move more in utero may cause extra coiling of the cord, or knowing that this condition is associated with certain genetic problems, but the problem is not common enough to have a lot of good, solid research into it. Due to the rarity of the situation, you may need to consult with a specialist into this problem for better answers.
It is unlikely to happen again — just as it didn’t happen with either of your other two children.
I am 8 months Pregnant and my umbilical cord started hurting a few hours ago i just want to know if its normal
It is pretty common as your belly expands around your growing baby to have your own navel become more sensitive. Many women actually have it poking out, and it then can become more irritated as clothes rub across it. Perhaps you can put some sort of bandage over it, to help protect it from the friction.
I’m just about 9 months pregnant with a VERY active baby. One day she’s vertex and the next day she’s breech. Does this put her at increased risk to develop a nuchal cord or even a true knot?
Thank you!
Possibly — it depends on if she is wrapping herself up in her umbilical cord or not with her motions. Most knots and nuchal cords are set up in early pregnancy, when the baby typically has more room to move around in the uterus, being small (a pound or two, as opposed to 7-9 pounds), and more able to get tangled in the cord. Let me stress that nuchal cords and even true knots are usually not a problem, but they *might* become problematic. Keep track of her movements, because that’s usually the first indication that there is a problem — *if* it becomes a problem (which it typically won’t). Do kick counts, and if you notice a decrease in movements, notify your care-giver. An ultrasound can usually detect if there really is a problem or not.
I have a 3 yr old son with cerebral palsy and am now 33 wks preg. with my second. My 1st delivery was was very long with and ended with failure to prgress and a c-section. I have asked my doctor if there was any reason why i could not vaginally deliver and they said that sometimes things just dont all go the way they should and that he was on the big side 8.7lbs. For this pregnancy i decided to switch doctors and therefore requested my original ob records. I was suprised to find the placenta report attached that stated that my sons ambilical cord was only 10cm long. They even noted that 32cm was concidered necessary for a normal vaginal delivery and went on to list some complication that went along with a short cord. With that said i am very upset that no one told me about this after such a non suggsesfull delivery.
isnt this something they should have been able to tell me at least after the fact and is this something they could have or should have sceen before i delivered. Everyone said i never dropped and when they broke my water my son went back up high and they even called in the ultra sound tech to check where he had gone. This was after about 13 hrs of labor. my water did contain some maconium and yet i still labored for another 16 hrs with 3.5 of those pushing with no progress. My new doctor stated that they can not tell the cord length by ultra sound. I am tring to avoid a c-section and wonder if i should push for an ultrasound in hopes that they might be able to determain it is long enough of it to be able to go forward with natural delivery?
Thanks
A short umbilical cord is unusual, so is unlikely to recur (it may be that a short cord is one of those things that is more likely to happen a second time, if it happens a first time, but is still pretty rare — I don’t know the real figures, but let’s say that the likelihood of any baby having a short cord is 1/10,000, and if you are now at an increased risk for it [which I think unlikely, but I just don't know], it may be 2/10,000 or 3/10,000 — higher risk, but still very low risk of recurrence).
According to this study ((458)Durand A, Descamps P, Vieyres P, Menigault E, Gregoire JM, Pourcelot D et al. In utero measurement of the umbilical cord in full term pregnancy. J Gynecol Obstet Biol Reprod 1996;25:78-86), you can tell umbilical cord length by ultrasound. It may be that your particular doctor, his equipment, or your baby’s position, make it difficult or impossible to see the full cord in your case right now, but in general, it *is* possible to determine that. You can ask our doctor to try again, or perhaps seek a second opinion.
It may be possible that your doctor is playing on your fears to try to get you to have an elective C-section, and saying, “Hmmm, we don’t know and can’t tell if this baby is going to have another short cord, just like your first baby did.. so it’ll be better to just have another C-section before you have such a long labor again.”
Fetal movement seems to be correlated with cord length — is this baby moving more than your first baby? It seems that the more your baby moves (particularly in early and mid pregnancy), the longer the cord gets, perhaps by some sort of playing with and stretching.
Since short cord is unusual, it’s not something that is normally screened for (although it might be possible to just “happen” to see it on an ultrasound). It’s also not something that might be assumed or perhaps even thought of as a reasonable explanation for a long labor during labor (although as you found out, it is something that can be determined with accuracy after the birth). So, yes, it’s technically something that they could have screened for (although sometimes it’s not easy seeing the whole length of the umbilical cord), but I don’t think that it’s something they “should have” done.
In my opinion, the first doctor should have told you about your son’s short umbilical cord. Perhaps they felt like it didn’t really matter, since it’s unlikely to be repeated, but I think it’s important for women to know as much as possible about why their labors and births turned out as they did, particularly for a planned vaginal birth that ended in a Cesarean. It seems pretty obvious that your baby just couldn’t descend enough to be born, which was ultimately the reason for your C-section; but if you didn’t know that, you might assume that it was due to his size, which is not necessarily the case.
I’m 26 weeks pregnant and just had an ultrasound on thursday. My doctor called me yesterday to talk to me about the results and some kind of referal. She got off of the phone very quickly and told me to call her back five minutes later. My phone died and I wasn’t able to talk to her. My baby is already in a frank breech position and she says that the cord is wrapped around his neck. She also said they needed to take a look at the placenta and the cord insertion. The baby has been moving less often, and I told the person who was doing the ultrasound and she just laughed and said it was normal. His heart rate is usually around 147-152 and it was 130. I’m not sure if I need to be worried, I would assume she would have called me back if she thought there was an immediate problem but I really didn’t get a chance to tell her everythign
I’m 26 weeks pregnant and just had an ultrasound on thursday. My doctor called me yesterday to talk to me about the results and some kind of referal. She got off of the phone very quickly and told me to call her back five minutes later. My phone died and I wasn’t able to talk to her. My baby is already in a frank breech position and she says that the cord is wrapped around his neck. She also said they needed to take a look at the placenta and the cord insertion. The baby has been moving less often, and I told the person who was doing the ultrasound and she just laughed and said it was normal. His heart rate is usually around 147-152 and it was 130. I’m not sure if I need to be worried, I would assume she would have called me back if she thought there was an immediate problem but I really didn’t get a chance to tell her everything I have been feeling lately. I can’t get ahold of her until monday and i’m not sure i can wait that long. any advice on what to do?
This is understandably nerve-wracking! A nuchal cord (wrapped around his neck) is not necessarily an indication of something wrong — something like 20-30% of babies have nuchal cords at birth (including my firstborn son), and it is only rarely associated with a negative outcome. Many nuchal cords identified by u/s resolve themselves before birth. It’s possible that the nuchal cord is making it difficult or impossible for him to turn to a head-down position; but something like 25% of babies are still breech at 30 weeks, but only about 3-4% are not head-down by the time labor commences, so your baby has plenty of time to turn.
The fetal heart-rate increases with activity, so if your baby happened to be kicking or moving when his heartrate was checked before, and/or he was asleep the last time it was checked, that may be the reason it’s lower now. I checked my prenatal records for my first pregnancy, and my baby’s heartrate ranged between 148-160 most of the time, but at 33w4d, it was 136, and the midwife didn’t bring it to my attention in any worrisome way. Here’s a graph showing different heart-rates for the two sexes and at different weeks of gestation, which may put your mind at ease.
It would be nice to say, “Oh, since your doctor didn’t call you back, then it must be nothing,” but I can’t say that, because there could be other reasons (including forgetfulness, dialing a wrong number, or expecting you to be the one to call back) why she didn’t call back.
If you’d rather not wait until Monday, and you can’t get in touch with her or anyone else at that office until then (a message service?), you may be able to go to the hospital and get an ultrasound for reassurance. They may not be able to do the more detailed one that will look at the placenta and cord insertion, but they can check the fetal heartrate (could do that w/o an ultrasound, too — just with an EFM, Doppler, or fetoscope), which might be reassuring to you. You could also see if a crisis pregnancy center with an ultrasound machine could check you out. I know it’s not exactly what they’re there for, but I would think they’d be sympathetic enough to do that, unless they are somehow prevented by legislation or internal guidelines from doing that. You could also look to see if there are some of those “keepsake” ultrasound places around. While I’m not a big fan of u/s, and the FDA has come out against unnecessary u/s, particularly those done at non-licensed facilities that go by cutesy names like “Womb with a View” and whatnot, you might find it worth the price of your peace.
Another avenue, which you can undertake immediately, is to do kick counts. It’s not entirely unusual for babies to move more or less often from time to time; but if there is a sudden and marked change, that may indicate a problem. It’s not always a definite indication of something wrong — sometimes the positioning of the baby makes it harder for the mother to feel the movement (and some mothers go through pregnancy without even knowing they’re pregnant!). My SIL one time got really concerned about one of her babies — she hadn’t felt her move in several hours, and even after my SIL drank juice or a Coke (something sweet which tends to make fetuses a bit hyper), poked her belly, and bounced around a bit, there was still no movement. So, she went to the hospital to get checked out, and just as they were starting the u/s, the baby started kicking. {shrug} But a friend of mine noticed that her son at 34 weeks had a marked decrease in movement, so she went to get checked out, and sure enough, there was a problem, and she had a necessary emergency C-section that day which saved his life. Some years later, a friend of hers remarked that *her* baby wasn’t moving very much, and my friend didn’t want to worry her, so said nothing about her own experienced, and this other woman’s baby did end up dying, with the decrease in movement being the first indication that something was wrong. “Less movement” as long as it is *enough* movement is okay; but compromised babies move less, to conserve their energy, so that’s why it’s often the first sign of a problem. And mothers can do kick counts every day, while it’s not feasible to go to the doctor or hospital every day “just to check.” Many mothers who had stillborn babies noted that the babies had less movement leading up to the loss; this is why kick counts are so important.
But do the kick count (pick a time when the baby is usually active), and if that doesn’t reassure you, then you may feel better about going for a check at the hospital. Poking your baby, and seeing if he’ll kick back may reassure you as well. Look at it as a “bonding experience”, a form of communication just between the two of you.