Nuchal Cord (Cord Around the Neck)

I often hear stories from people about how they or a woman they knew had a cesarean and “the cord was wrapped around the baby’s neck two (or three) times!”

Having the cord wrapped around the neck is called a “nuchal cord” and is present in about 30% of all births. In most cases, it is not associated with a significant increase in the rate of adverse fetal/neonatal outcomes.

The most common “complication” of nuchal cord is variable deceleration in the baby’s heart rate during labor.  Cesareans are often performed on the basis of variations in the baby’s heart rate during labor, and then when the baby is born vigorous and well, the only thing reason they can give is that the cord was wrapped around the baby’s neck.

Nuchal cord can cause more serious problems and has even been implicated in stillbirths, but causality is often difficult to prove in these cases.  Another possible complication is that the wrapping of the cord around the baby’s neck shortens the cord and makes it difficult for the body to be born normally.  This also tightens the cord and can reduce the blood flow through it which can cause a temporary lack of oxygen for the baby. The options in this instance are clamping and cutting the cord after the delivery of the baby’s head (this is an emergency procedure and effectively cuts off the baby’s supply of oxygen at this point), or delivering the baby with a somersault maneuver which keeps the head close to the mother while the body “somersaults” out.  The blood flow thru the cord then returns after the birth and while the baby is resuscitated, if necessary.

During labor, I check the baby’s heart rate frequently and if we hear frequent mild decelerations, we know that there may be a nuchal cord.  Most of the time, even if baby is later discovered to have the cord wrapped, the heart rate is steady and strong without marked drops during contractions.  I usually gently check for a nuchal cord after the head is born, and if it seems tight, I use the somersault maneuver for delivery of the body and simply unwrap the cord afterward.  It is extremely important to leave the cord intact when possible.  This is the baby’s lifeline until they take that first breath.  When the cord is loose around the neck, I simply leave it alone and allow the birth to proceed, then unwrap it afterward.

Having the cord around the baby’s neck is fairly common, but is not generally a dangerous situation.  Midwives like to say, “It’s a necklace, not a noose!”