What is a Nuchal Cord?

What is a nuchal cord indeed? This question may have popped into your head.

The easy answer is: it is the cord wrapped around a baby's neck as he is being born. Nuchal cord is just the fancy medical term.

We hear from moms all the time who are terrified to birth with a midwife or out of the hospital - whether at a birth center or at home - because "what if the cord is wrapped around my baby's neck?"

Who wants to think about their newborn baby being strangled by her own cord? Of course the answer is no one!

So as not to let fear take over let's look at some facts about your baby's cord.

Nuchal Cord Facts

Here are some important points to remember about a nuchal cord - or a cord around the neck:

So for your baby to have something around her neck is very different than you having something around your neck! Your baby while in utero lives with very different physiological processes than you do.

Your baby has many protective mechanisms in place to protect her. Inside your baby's umbilical cord is something called "Wharton Jelly."

Wharton Jelly is white and very thick.

If you are healthy, your baby's cord will have a lot of that "Jelly" which helps the cord not get too tight. This is another reason why your diet is so important!

Remember that your uterus is right behind your baby pushing her along with you to birth her.

What does this mean?

It means that your baby's placenta and therefore her umbilical cord are following your baby as she is born. It is not like your baby is stretching her cord to be born.

If your baby has a short tight cord, your labor will be a tad "off." For example, your contractions will be spaced farther apart than you would expect - even though they will still be strong enough to dilate your cervix. There could also be some variable decelerations - slowing down - in your baby's heart rate which is typically not an issue.

If there is a tight nuchal cord, your attendant should hold your baby's head close to your body and by doing so this will allow your baby to "somersault out."

Cutting your baby's cord before her body arrives effectively "suffocates" her as it cuts off her oxygen supply. If that cannot be avoided you will be asked to push even without the urge to do so. Your baby may have a difficult transition but even this can be handled by midwives during a homebirth. Remember babies are very resilient.

Checking for a nuchal cord with the birth of the head is often painful for you and quite unnecessary. Unwrapping your baby after her birth is easy to do.

A Nuchal Cord: A Study

Over the course of ten years - 1986 to 1996 - data was kept in order to answer some questions regarding nuchal cords. The questions were as follows:

1) How frequently do nuchal cords occur?

2) Are operative deliveries more common in those pregnancies involving nuchal cords?

3) Does the presence of a nuchal cord cause fetal distress? If so, is neonatal morbidity or mortality increased?

The data for this study was collected from three different sources:

Prenatal records: The data on the mothers was collected from a review of the prenatal records and included age, race, parity (number of pregnancies), pre-pregnancy weight, weight gain during pregnancy and previous personal and obstetric history.

Delivery records: They provided the data for gestational age, method of delivery, presence of meconium in the amniotic fluid, fetal heart rate monitoring that was done routinely, presence of nuchal cord, and any other complications that may have occurred at the time of delivery.

Newborns' records: They were used to collect data for sex, birth weight, Apgar scores, congenital anomalies, and perinatal course.

765 deliveries were looked at and 706 were kept and reviewed. The 59 which were excluded from the study was due to a lack of proper records. Either the maternal or the infant record could not be located.

There were 167 births involving a nuchal cord - 23.65% - or a tad less than 1/4 of the births. Of this 16 births were excluded due to other complications.

Moreover the remaining 523 deliveries in which nuchal cords did not occur served as the control group.

Some Definitions

A nuchal cord was considered to be "loose" when it could easily be uncoiled before delivery of the newborn.

When it needed to be clamped and cut before delivery, the nuchal cord was called "tight."

Fetal distress was defined as the presence of bradycardia or variable or late decelerations in heart rate detected by an electronic fetal heart monitor.

Results

Two coils occurred in 1.7% of the deliveries

Three coils occurred 0.3% of the deliveries

43 - 25.7% - were loose

38 - 22.8% - were tight

In the remaining - 86 - cases no mention of the severity of the nuchal cord were made

There was no statistical difference between the moms from the nuchal cord group and the control group. Also there was no significant difference between the Apgar scores of the two groups even though the babies born with a nuchal cord tended to have lower scores at 1 minute.

Conclusions

The frequency of nuchal cords found in this study is similar to findings in prior studies. A nuchal cord seems to occur between 12.6% to 33.3% of births - therefore we can say it is fairly common.

This study did not find an increase of mechanical deliveries - forceps, vacuum or c-sections - due to a nuchal cord.

It has been determined that nuchal cords do not increase fetal mortality. Coiling of your baby's umbilical cord around her neck is a rare cause of perinatal death. The neonatal death rate is about 1%, regardless of the presence of a nuchal cord or not.

There was one interesting finding in this study however: it is that infants born with nuchal cords weighed less than those in the control group.

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