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Updated July 10, 2015.

Question: What happens if the cord is around the baby's neck at birth?

Answer: Parents are often frightened to think about the baby's umbilical cord being around the neck at birth, also called a nuchal cord. The truth is that this is a very common event, occurring in about one third of all births. The cord becomes wrapped around the neck during pregnancy as the baby moves around. 

Currently ultrasound technology is not very useful at determining a nuchal cord.


One study showed that there was only a 65% chance of finding the cord. There was also a 19% false positive rate, meaning that nearly one in five women were told that there was a cord around the baby's neck when there was not.

The umbilical cord is covered with a thick protective coating known as Wharton's Jelly. This is like gristle in texture and prevents the baby from compressing the arteries and vein that run through the cord. So the cord being wrapped does not usually pose a problem for baby.

At the time of birth, once the baby's head is out, the midwife or doctor will check around the baby's neck for the presence of the umbilical cord. Typically the cord is wrapped loosely enough for the cord to be slipped over the baby's head. If the cord is wrapped multiple times this may take awhile. Typically you will be asked not to push for a minute while this happens.

Sometimes the cord is wrapped too tightly and the cord will be cut before the baby can be born. This is done by your midwife or doctor by placing two cord clamps and cutting between them.

This necessitates the baby's birth fairly rapidly since it is no longer getting nutrients from the mother via the placenta.

Occasionally the baby will be born so rapidly that neither of these methods can be employed. A skilled practitioner will hold the baby's head very even and close to the mother's body as the baby's body is born through the cord. This almost looks like the baby flips out as it is born. The cord being around the neck usually requires no additional monitoring of the baby or mother.

There are other issues with the umbilical cord that may cause issues. This includes cord compression and cord prolapse. Cord compression is where the umbilical cord is pressed, usually between the baby and the pelvis, pressing hard enough to cause some disruption. Sometimes this is alleviated by having the mother change position, even something as simple as rolling from her right side to her left side. It may also mean other interventions may be needed, like oxygen for the mother, or amnioinfusion. (This is where fluid is put back into the uterus to provide more cushion for the baby and the umbilical cord.) Sometimes if the fluctuations in the baby's heart rate are severe enough or are not responding to treatment, a cesarean birth may be necessary.

A cord prolapse occurs when the umbilical cord comes into the birth canal (vagina) and the baby is behind it. This can cause a very emergent situation because the cord's blood flow can be pinched off by being pressed between the head and body of the baby. The vast majority of the time, a baby who has a cord prolapse will have an emergency cesarean birth. This may also mean that general anesthesia is required.

 

Sources:

Hofmeyr GJ, Lawrie TA. Amnioinfusion for potential or suspected umbilical cord compression in labour. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD000013. DOI: 10.1002/14651858.CD000013.pub2.

Peregrine E. O’Brien P. Jauniaux E. Ultrasound detection of nuchal cord prior to labor induction and the risk of Caesarean section. Ultrasound Obstet Gynecol 2005; 25:160-4.

Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet. 2006 May;274(2):81-3. Epub 2005 Dec 23.

Wilson B. Sonography of the Placenta and Umbilical Cord. Radiologic Technology. 2008;79 (March/April):333S.