Myth-conceptions: cord wrapped around baby's neck

Hello, readers. Thanks for your patience with my spotty attendance. It's back-to-school time in our household of 4 kids age 7 and under, and that means homeschooling first and second grades simultaneously while attempting to throw a few Pre-K activities for my busy 4 y.o. son and nursing my toddler daughter as she wants up on my lap, then down, then back up again, and repeat. I've also spent a lot of time trying to secure a regular venue for my Well Rounded Birth Prep classes.

I would like to start a blog series called Myth-conceptions, addressing common myths regarding pregnancy, birth, and breastfeeding. I have so many things I'd like to address in this series that I don't know where to start. It's actually a bit daunting.

I've heard and read hundreds of birth stories over the years, and it didn't take long to begin to see patterns. Research has established the cause-and-effect relationship between routine birth interventions and potentially preventable complications.

Since I have to start somewhere, why not this one: "The cord was wrapped around his neck--twice!!!--and if we hadn't been in the hospital, we both would have died!" True cord emergencies are extremely rare. In God's perfect design for the umbilical cord, the two arteries and one vein that make up the cord are covered with a rubbery substance called Wharton's jelly that helps protect the cord from kinks. The normal blood pressure through the arteries and vein in the cord help put positive pressure outward on the cord to help keep it from kinking as well. Even in the event of a true knot in the cord, Wharton's jelly usually prevents problems for the infant by keeping the cord from compressing. A knot in the cord isn't typically discovered until after the birth anyway, which means that nothing could have been done to have foreseen or prevented any true cord issues.

I once read a comment in response to a friend's informative post about homebirths, stating something to this effect, "I'm glad that worked for you, but my wife and son would have both died had she not been in the hospital. The cord was wrapped around his neck 3 times, and it even had a knot in it. Then there were heart decels while she was pushing and the doctor had to perform an episiotomy to get him out faster."

Let's take a look at this scenario piece by piece, shall we? First off and foremost, having the cord around the neck (in and of itself) at birth is not an emergency. In fact, it occurs in about 30% of all births. OBs and midwives will check around the neck to see whether the cord is wrapped around the neck after the head has been born. If the cord is wrapped around the neck, they will gently slide the cord over the neck without any problem. If the cord is wrapped multiple times, they will attempt to slide the first loop over the baby's head and sometimes this gives enough slack to the rest of the loop that the body is delivered with no complication at that point. If there isn't enough slack for that, a midwife will hold the baby's head near mother's leg and allow the body to be delivered in a maneuver resembling a somersault (pictured below), which doesn't put extra strain on the cord around the neck. (Most doctors will not do this, as they have not been trained to do so.) In a rare, true wrapped-tight-cord situation, the birth attendant will clamp the cord twice and cut in between, then help the mother to deliver the baby quickly as his/her oxygen supply (cord) as been severed.

As for the knot in the cord, in this particular birth story, nothing was done about it during that birth (nor could anything have been done about it) and there was no indication that the knot caused any problems. When and how did this dad think that knot got there, anyway? True knots can only occur early on in pregnancy when baby has enough room in the uterus to flip and spin freely to do a loop-the-loop and create the knot. This knot had been present for months.

As for the fetal distress during delivery, it's hard to say, since no details were given in this man's account of his wife's birth. However, it is well established that fetal distress can be an indicator that the baby is not tolerating mother's position well. The first thing a midwife will suggest if baby's heartrate is dipping, is to switch positions to see whether baby's heartbeat responds in a more favorable way. Sometimes it's something as simple as baby's cord getting slightly compressed due to the mother's positioning. Changing positions to help baby's heart rate would be difficult if the mother had an epidural, which has issues all its own that I will address in a moment.

It's also well established that the lithotomy position (a.k.a. "stranded beetle" position, lying flat on her back: the most common position for pushing in America) can cause fetal distress. Remember how expecting moms are cautioned never to lie on their backs for extended periods of time beyond the 5th month of gestation, since sleeping or lying on their backs (for more than a few minutes) can cause the weight of the uterus to compress the main artery providing blood flow to the lower half of the body (including baby)? What makes anyone think this would suddenly be a good idea during labor and delivery????

Epidurals are sometimes responsible for fetal distress. I wonder how many women are told this before they get an epidural: blood pressure drop is a common epidural side effect. They try to combat this by giving IV fluids or medications, but it doesn't always work, which sometimes causes fetal distress. Directed pushing (a.k.a. "purple pushing" = "hold your breath and push as hard as you can while we count to 10") is also associated with higher incidence of fetal distress.

Was the mother on Pitocin (synthetic oxytocin, a drug given to speed up labor)? Pitocin can also cause fetal distress. Insiders from our local hospitals have told me that the overwhelming majority of labors they have attended are induced or augmented with Pitocin.

So, were there other factors with this particular fetal distress? I don't know. I'm just pointing out some common situations so that readers can have an understanding that "fetal distress" doesn't often happen out of the blue, and it's even more rare that it would happen "without any apparent reason." (Yes, I'm aware that it *can* happen that way. I'd just like to reassure readers that those are the rare exception, not the rule.) And as for that poor woman's episiotomy, was it truly medically necessary? Perhaps. They are medically indicated approximately 5% of the time. Sometimes true fetal distress means that an episiotomy would save 5-10 minutes of pushing time; if changing pushing positions and giving mother oxygen to help fetal oxygenation doesn't help, then the episiotomy can help. Most of the time, however, episiotomies are entirely preventable and amount to nothing more than genital mutilation.

I think this episode of Myth-conceptions has melded into many posts at once. I'll try to delve into the other topics in greater detail in future posts.

To sum it up, this guy's argument was that his wife and child would have died had they given birth anywhere but in the hospital. I totally respect their right to give birth anywhere they want, and that's their personal decision, but nothing he said indicated any care provided by hospital staff that would not have been available at a birth center or a homebirth (namely, episiotomy, which is available at either a birth center or homebirth but rarely performed since most midwives understand the true indicators for an episiotomies and do not perform them routinely).

I'll close by sharing a birth story that a local doula shared with me. One baby whose birth she attended at an independent birth center had his umbilical cord wrapped all around his body *five times* in different ways: around the neck, around the chest, above and under the arms, etc. The baby was fine. When the cord is wrapped multiple times like that, it is usually long enough to compensate.

The bottom line is that true cord issues are rare and unpreventable. There's no need to fear them. A skilled birth attendant (whether OB or midwife) knows to look for a cord around the neck, and knows what to do if it occurs. There's no need to panic, people. It's only birth.

See also : Doula'ing my nephew's gorgeous home waterbirth! My nephew was born with his cord wrapped twice around his neck.