If there is one thing to know about pregnancy and childbirth, it is that nothing is a smooth road. There are some bumps in the road that expectant moms ought to see coming, such as a delayed delivery date or even premature birth. These are things that are rather likely. Something that is less likely, but still a major bump to be aware of, is the umbilical cord being in danger during labor and delivery.
Of course, this seems like a worst case scenario thing to think about, but it is something that does happen. About 1 in 10 births will have some sort of issue with the umbilical cord when the baby is trying to find its way through the birthing canal.
Most of the time, these are minor dangers that won’t be life-threatening or too problematic. There are more severe cases where umbilical cord problems can lead to acquired brain injury at birth. That is not something anyone wants or deserves!
Thankfully, doctors and midwives know what they are doing to get the baby from womb to world. There are many strategies in place throughout a standard delivery where the umbilical cord is monitored closely and carefully. Therefore, if danger does occur to the umbilical cord, the doctor is basically one step ahead.
Here are some things that the doctor will do if the umbilical cord is in danger, and more likely than not get that baby out of the womb feeling healthy and happy.
15 Assess For Compression
Umbilical cord compression is basically when there is additional pressure put on the baby’s cord. There is always a small amount of pressure, whether from a tight stomach after mom ate too much food, or the baby wriggling around and pulling on the cord. However, compression is when the pressure is too high and it is preventing the flow of blood and oxygen to the baby.
Doctors assess umbilical cord compression during prenatal visits and pay particular attention to it in the final trimester, especially in the lead up to the anticipated due date. The majority of compression issues happen as labor really kicks into gear and the baby is moving more than the cord can keep up. Doctors will be assessing this throughout each contraction.
14 Check Things Out With An Ultrasound
While the baby is still in the womb and the cord is still attached to the placenta, the human eye can’t exactly see what’s going on. Therefore, doctors use an ultrasound throughout labor and delivery to see the cord’s position if they sense something is going wrong.
An ultrasound will mostly be used after general assessment of the umbilical cord. Since most periodic compressions that happen during labor, thanks to the contractions, are harmless to the baby, an ultrasound might not always be used. However, if the doctor thinks that a compression is lasting too long on the cord and can have serious effects, they will use an ultrasound to see just where the cord is and how the baby’s position is. This is a good preventative measure.
13 Give An Amnioinfusion
If the umbilical cord compression is becoming too serious and reducing the flow of blood and oxygen, or lowering the baby’s heart rate, doctors will intervene with more than assessment and ultrasounds. The most common treatment of cord compression is something called an amnioinfusion.
This is when a saline solution is introduced to the scene. This is a basically a salt-based mixture kept at room temperature that is injected into the uterus during labor. It relieves a lot of pressure around the uterine wall lining and the umbilical cord. If there are concerns before labor happens, an amnioinfusion might be inserted as a prevention, or it can be reactively used during labor.
12 Increase Mom’s Oxygen
The umbilical cord is basically the baby’s gateway to oxygen. Compression of the umbilical cord, even minor, can mean that less oxygen is flowing from mom to baby. The less oxygen that is flowing through the umbilical cord also means the less blood that is reaching the baby. Given the strenuous nature of labor and delivery, it is a time when oxygen and blood are totally needed.
So, a treatment for minor compression is to increase the supply of oxygen that mom is getting. This is done through a simple and easy oxygen mask and is useful in helping mom breath throughout the contractions and pushing of labor. This helps to increase the amount of oxygen being breathed in and support a more regular flow of blood around mom’s body, which ultimately reaches the baby.
11 Emergency C-Section In Extreme Cases
If the umbilical cord compression is turning from minor to major, there should be courses of action in place. One of the best options that doctors have during extreme cases of cord compression is to perform an emergency C-section. This isn’t something desirable, but in the case of life or death, it is good to know the doctors have this procedure up their sleeves.
An emergency C-section might need to be performed if cord compression is lowering the baby’s heart rate too much. There might be signs of distress from inside the womb, and the baby’s heart rate might show sudden signs of short drops in heart rhythms. In these cases, a C-section will be performed to save the baby’s life.
10 Change Mom’s Position
The umbilical cord is very much dependent on positioning. This can mean the position of both mom and baby. As the baby wriggles and turns with each contraction of labor, the umbilical cord also moves around and some pressure can be applied.
The same goes for the position that mom is in. If you are constantly moving during labor and changing your position, the umbilical cord might not be able to handle the pressure from both you moving and the baby moving. Therefore, sometimes doctors might recommend you to stay still on one side or move you from standing to lying position to alleviate any pressure gathering on the umbilical cord. This can also help to get the baby to stay still and move towards the position of crowning.
9 Slip Their Fingers In To Unknot It
In some cases, pressure can be gaining on the umbilical cord because of a knot or tie that has occurred. In extreme cases, this knot can be around the baby’s neck which has only terrifying prospects. In lesser cases, the umbilical cord might have knotted around a finger, or a toe, or even itself. These cases are much easier for doctors to handle.
If there is a simple knotting problem that is leading to compression of the cord, doctors can simply untie it. This is much more glamorous than it sounds, as untying the knot does involve the doctor slipping their fingers into the dilated vagina and getting the cord loose again. Thankfully, you won’t even realize what’s going on down there thanks to all the pain of contractions distracting you!
8 Stop Contractions If Necessary
With each contraction leading to another push of labor over, the baby moves more and more. This is great news unless there are issues happening with the umbilical cord. Uterine contractions during labor and delivery are totally necessary, but if there are risk factors involved with the cord it can be problematic.
Some risk factors include an extra long umbilical cord, too much amniotic fluid, carrying twins, or a breech birth. In cases like these, one course of action that doctors might decide to take is stopping contractions altogether. To stop contractions, doctors use a medication called terbutaline. It is injected in the body and stops or slows the uterus from contracting, allowing time for the umbilical cord to recover from pressure.
7 Monitor The Baby’s Heart Rate
One of the major symptoms of umbilical cord compression is the heart rate of the baby. Therefore, monitoring the fetal heart rate will be a top priority for the doctors, regardless of the risk of cord compression. If the heart rate declines to less than 100 beats per minutes, the doctors won’t hesitate to act and alleviate any umbilical cord compression.
Throughout labor and delivery, the doctor will be assessing and watching the heart rate of the baby, and if anything goes wrong or looks odd with it, they will have ways to act. If there have been known fetal heart abnormalities detected in prenatal doctor visits, the doctor might even recommend a C-section to avoid the risk of cord compression.
6 Clamp The Cord Before The Shoulders Are Out
Generally speaking, the umbilical cord will be cut at least two minutes after birth. This allows time for the newborn’s lungs to take their first breath. Prior to this, the baby’s lungs have been developing, but inactive, as oxygen has been delivered through the umbilical cord.
If there are compression issues with the cord or other signs of danger, the doctor might make the decision to clamp the cord before the baby’s shoulders have fully passed through the birthing canal. This means that the baby can still take a deep breath with the lungs. The main consequence of this is that the baby might need additional oxygen once the shoulders and rest of the body are out, which is simple enough.
5 They Won’t Tell You About It (For Good Reason!)
Now, labor and delivery is a stressful time for any expectant mom. The body has to maneuver itself and deal with new levels of pain that are totally unprecedented. It is one of the main jobs of the doctor and midwife (aside from getting the baby out happy and healthy) to keep mom calm and assured that things are going well.
So if something like cord compression strikes, naturally mom is going to get a bit anxious about what that means. Compound this with stress, hormones, and painful contractions, and it's no surprise that the anxiety levels would rise. Therefore, if cord compression is an easy fix at the doctor’s end, they might not even mention it to mom. It is a real case of ignorance is bliss at your end!
4 Use Forceps Or A Vacuum
If the baby is taking his or her time to get out of the womb and there are issues happening around the umbilical cord, doctors might need to speed up the process. Sometimes, it can get to a point too late in labor and delivery to do an emergency C-section. Yet, there still needs to be something telling the baby to hurry up and get out of there.
In this type of case, doctors might use forceps or a vacuum to get the baby out at a faster rate. This is important to alleviate any pressure of problems happening around the cord and get the baby out safely and breathing well. Forceps and vacuums are pretty simple procedures and rarely leave your baby with a funny shaped head!
3 Trust The Wharton’s Jelly
Nature has plenty of time to get the birthing process just right. This is kind of why the umbilical cord exists in the first place. There are a lot of things that nature and biology have in place that we can and should trust. When it comes to the umbilical cord, nature already has a preventative measure there.
The umbilical cord is coated in a slippery, soft substance called Wharton’s Jelly. This coating ultimately protects the blood vessels and nerve endings inside the cord. It also protects against compression knots as it keeps the cord from tightening on itself as the baby moves. Often, doctors won’t intervene with the umbilical cord (unless the fetal heart rate indicates it is needed) because biology is already taking care of it.
2 Use Other Methods To Reduce Mom’s Stress
As pressure builds in labor and delivery, the position of mom and baby can have an impact on the cord. If the umbilical cord gets caught up in the stress and tension of labor and delivery, this is when problems might occur.
Rather than injections and interventions, simply relieving stress can help mom to relax and the baby to relax in turn, therefore removing any pressure on the cord and risking more problems arising. Stress relief looks different for everyone, so it is worth discussing with your doctor in prenatal visits how you relieve stress. For some, it is stress ball to squeeze and others it might be calming music. Having these interventions in place can make labor easier and reduce the risk of any umbilical cord dangers.
1 Might Not Act At All
When a baby’s cord is wrapped around the neck, it is called a nuchal birth. In many cases, babies make it out of the womb with their cord in this nuchal position, becoming just another baby in a list of numbers to have a nuchal birth. This is because, in some cases, there is nothing going wrong with the cord being in this position.
If the baby’s heart rate is fine, the position is good, the contractions are fine, and full dilation has occurred, the doctors might just leave the cord where it is. Around 1 out 3 babies are born with the cord around their neck. Doctors might just be able to slip the cord off as the head crowns without any problem. In these cases, the cord doesn’t tighten with contractions and doesn’t get a pressure build up at all.
Sources: Americanpregnancy.org, Birthinjuryguide.org, Bellybelly.com.au, Babycentre.co.uk