Baby's cord around the neck - emergency?

I have heard it said many times in the past few weeks that, "the baby's cord was around the neck, so it was an emergency and I had to have a caesarean" or something similar. It seems that many people hold the view that it is an emergency situation when the baby's cord is around its neck.

In my practice, I find that this is actually quite common, and seldom an emergency.  In fact, it seems that about a third of all babies are born with the cord around their neck.  Others have the cord wrapped around their bodies.  And some babies have the cord around their neck and body.

Babies are very active in utero.  They move a lot!  This is a very healthy sign and is reassuring for the woman.  However, it does mean that often the baby will move in such a way so that the cord ends up around the neck or body.

But here's the interesting part: the cord is covered by a substance called Wharton's Jelly - and is therefore perfectly designed to be wrapped around a baby's neck or body without causing a problem.  Wharton's Jelly is a thick jelly-like substance that prevents the vessels contained within the cord from becoming too compressed.

Often when a caesarean has been performed, say for fetal distress or slow progress in labour, the doctor will comment that the baby's cord was around the neck, and may imply that this was the reason for the distress or slow progress, however it is more an incidental finding, as about 1/3 babies have the cord around their neck.

So how do we manage a situation where the cord is around the baby's neck at the time of the birth?

We usually wouldn't know that the cord is around the baby's neck until the head is born.  Once the head has been born, the midwife can feel for the cord, and if there is cord around the baby's neck, the midwife can unloop it over the baby's head before the baby is born.  Other times, the baby is simply born through the cord.  Remembering that the cord is covered with jelly and that it has some ability to stretch (it is quite long), it is possible for the baby to be born through the loop in the cord.  For this reason, many midwives do not routinely feel for the cord, as it often makes no difference to the way the birth proceeds.

Occasionally, the cord is tightly around the baby's neck, and in very rare situations, it may need to be clamped and cut before the baby's body is born.  However, this needs to be done with great care because once the cord is clamped and cut, the blood and oxygen supply to the baby is terminated and as the baby is not yet breathing on its own, it is genuinely without oxygen.  There is also the rare possibility that the shoulders may become stuck (as they do with a small minority of births), and in this case, the birth would be delayed even further, leaving the baby without oxygen for even longer.  This makes it more likely that the baby will need to be resuscitated, whereas leaving the cord intact may result in the baby being born in a healthier condition.  Cords are rarely so tight around the neck as to prevent the baby from being born.

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