"What do you do if the cord is wrapped around the baby's neck? Will they strangle or choke?
Look closely at that beautiful photo (used with permission from the midwifery client pictured) and you will see loops upon loops of umbilical cord around that sweet baby's neck. When I do consultations with people considering home birth, a cord wrapped around baby's neck is one of the perceived emergencies they often bring up. People really worry; they ask, "What do you do if the cord is wrapped around the baby's neck? Will they strangle or choke?"
As a midwife, I really appreciate the opportunity to answer this question. I see it as a chance to clear up one of the huge misconceptions about birth that I believe bring unnecessary fear into the pregnancy and birth process. About 30% of babies are born with a cord wrapped at least once around their neck, referred to as a "nuchal cord". Something so common cannot possibly be an emergency, so why all the fear? Of course parents worry about something they think is dangerous to their baby, so before answering the question about what I, as the midwife, will do - I like to start with some basic fetal physiology about how and when babies breath, and the stuff umbilical cords are made up of.
When babies are in the uterus and in the birth canal, they receive all of their oxygen through the umbilical cord which is attached on one end to their placenta and on the other end to their navel (what will be their belly button). They do not breath through their mouth and nose until after their chest passes through the birth canal and their lungs are able to expand, and even after that babies continue to receive oxygen from the placenta until the cord stops pulsing. Cords are not usually wrapped tightly enough to impede baby's first breaths even after baby is all the way out. Babies can not 'choke' or 'strangle' because their cords are wrapped around their necks.
Umbilical cords are made up of vessels on the inside and this marvelous protective outer tissue termed wharton's jelly. Wharton's jelly is at the same time extremely tough (ask any parent who has had the honors of cutting an umbilical cord) and extremely flexible. The vessels inside are well padded and protected. Cords rarely get into positions or places where they can affect baby's blood flow. The neck is a common place for a cord to hang out and because it is in a groove between the head and the shoulders it is protected from being pinched.
Knowing these facts about how cords work and how babies receive oxygen is enough to calm many parents fears about a cord around the neck, but let's return to what a midwife might do in that situation.
Do nothing. Many times cords do not need to be dealt with at all. Baby's head comes, there happens to be a cord around their neck, and then their body on the next push comes without any assistance. Remember, the large majority of births proceed without us getting our hands in there. Of course, these babies cords are then lovingly and without panic slipped off the neck by midwife or parent. This video shows a mom unwrapping her baby's cord shortly after delivery.
Guide baby's shoulders and body through. If the cord is loose enough, the midwife may help the cord slip back over the shoulders and body as the baby emerges.
Somersault the baby out. There is a pretty neat trick of, after a baby's head is out and a tight cord is discovered, tucking baby's chin towards the parent's thigh and allow the rest of their body to summersault out. Baby ends up with their head closest to the parent and their feet closest to the midwife. A nice end of pregnancy dismount for an already acrobatic baby.
"Reduce" or slip the cord over the baby's head. This is an option if baby cannot be guided through the cord or somersaulted out. Most cords loose enough to be slipped over baby's head can also be slipped over their shoulders which is preferable because handling the cord in this way can cause the vessels to spasm which will affect baby's blood flow and oxygen.
Clamp and cut the cord while after baby's head is out but before the body emerges. The midwife can, if needed, clamp and cut the cord and then have the parent push baby's body out. This is an extreme measure that is used only when all other methods have failed and it is important that baby is quickly born and starts to breath on their own after this as their oxygen supply has been cut.
In the births I have attended, I have seen and dealt with many babies who come with their cords wrapped around their neck (or body, hand, foot) and I have never had to cut a cord before baby was out. In the handful of births where a cord was tight enough to prevent baby's body from being born it has been easily remedied by somersaulting, slipping baby through or reducing the cord. Other midwives I speak to have similar experiences. So the answer to that question, "What do you do if the cord is wrapped around the baby's neck?" is most often little or nothing. Baby will be just fine in the hands of a competent and observant midwife who knows when her hands are needed and when to allow things to unfold.
(By the way, that baby pictured above demonstrates how nuchal cords are not typically emergencies. He had his cord wrapped twice around his neck, once around his body and had tied up it in a true knot. A genuine acrobat. His birth was uncomplicated, he was out and squalling seconds after that photo was shot and he is a happy and healthy toddler as I write this.)