The Umbilical Cord II

What happens when we have a birth with the umbilical cord around the baby’s neck? How does the baby manage to get free from this challenge without any harm?

Let’s remember that between 30-40% of the births are produced with some kind of compression of the cord forming a circle or a loop around the neck. It could be a circle or one loop, as it can be two or three loops. It can be loose or tighten. Those of us who accompany the mother during labor can see the loop in the moment of child birth or in the moment the head of the baby girl or baby boy appears. We can easily tell how many are there? and if they are tighten or not.

Normally if it’s only one loop and it’s not tight the birth of the shoulders will continue and the cord will slip slowly around the body as a “bandoleer”. If it’s more than one loop or only one loop is tight, we ask the mother to breathe with her mouth opened, to gasp so that she can give us time to cut the cord, unwind it and then let the shoulders and the rest of the body out. With a couple of simple instructions the mother can easily understand what she has to do and they always do it very well!!

At the moment of showing his head for the first time if the child comes in contact with the air around, he immediately starts with his first breathings. They aren’t deep because the thorax is still in the birth canal but it’s immediate as a reflex answer. If the loop of the cord is tight we have an extra difficulty. Frequently he turns a little pale and loses some body tone. The opportune maneuvers of drying that we perform and in occasions providing some oxygen throughout a mask, helps the baby overcome the difficulty quickly.

When the birth is performed in the water the situation is different. If it’s more than one loop of the cord around the neck we cut it and take the baby out of the water so that we can dry him up and help him. If it’s only one loop then we slide the cord through his body. When the body is completely out, we observe the newborn under water without putting him yet in direct contact with the air. This way we can avoid for a few seconds that he makes this effort and also give time for the cord, that is no longer compressed and its loosen to allow the baby to receive all the oxygen the mother is sending him through it.

Let’s remember that immediately after the compression of the cord when it ends a compensatory tachycardia is produced allowing the girl or boy to restore the oxygen he or she needs by increasing its cardiac frequency. We see how they brighten up underneath the water and recover their body tone their color and movements. Then we take them out of the water and give them to their mother.

The cord remains intact until slowly its pulsations start decreasing and are almost imperceptible mean while the breathing of the baby replaces completely its function and then and only then we cut it. This process generally lasts a few minutes.

Usually during the controls the mother has during her pregnancy we talk to the future mother about this and other situations that are normal in any birth. We analyze every aspect in detail and that makes it easy to solve any surprise that any childbirth has.

It is wonderful to confirm every day how the mother does everything so naturally and efficiently.

Dr. Rodrigo Aybar
Dra. Graciela A. de Aybar