Nuchal Cord – What You Should Know

The way your baby is growing inside your body is nothing short of a miracle. 

The umbilical cord and placenta are your baby’s lifeline – they bring in nutrients and oxygen and take away waste products. 

The umbilical cord is a much underrated part of pregnancy and is quickly forgotten once a baby is born.

One of the fears mamas-to-be worry about is the cord being wrapped around their baby’s neck. This is called a nuchal cord and is actually very common. 

Let’s take a look at nuchal cords and what this means if your baby has one. 

What is a nuchal cord?

The umbilical cord is the long tube connecting your baby to you during pregnancy. It contains three blood vessels:

• One carries food and oxygen from the placenta to baby
• Two carry waste from baby back to the placenta.

A healthy umbilical cord is filled with a special substance called Wharton’s jelly. This soft, gelatinous goo protects the veins inside the cord against compression and prevents them from kinking. 

As your baby grows, so does the umbilical cord. According to research on the topic, cords can be anything from 19 to 133 centimetres at birth. 

With all that cord, it’s no wonder babies end up getting tangled up in them sometimes! While there’s plenty of space and fluid for the baby to move around in, the cord tends to slip off easily. Babies even play with their umbilical cords and get their hands and feet wrapped up. 

As they get bigger and there’s less room, the cord doesn’t move as easily. So it’s not uncommon for it to be wrapped around their body or neck. When a baby is born with the cord around their neck, this is called a nuchal cord. 

Nuchal cords happen in up to 30% or 1 in 3 births, so they’re not uncommon. The cord is rarely wrapped more than once around the neck. 

What causes nuchal cord?

Mums who have been pregnant before or are in their third trimester will know just how much babies move around! Baby movement is a good sign of their wellbeing and pregnant women are encouraged to get to know their baby’s movement patterns.

So it won’t surprise you to know baby movement is one of the main causes of why they can be born with a nuchal cord. 

But there are some other causes of nuchal cords, such as:

• Insufficient Wharton’s jelly 
• Being pregnant with twins or more babies
• The cord is very long
• You have excessive amniotic fluid, known as polyhydramnios.

How is nuchal cord diagnosed?

You might be surprised to know many nuchal cords aren’t diagnosed before birth. A nuchal cord can be picked up on ultrasound during one of your regular scans. But it’s important to remember the cord can untangle, especially if you’re still in early pregnancy. 

If a nuchal cord is diagnosed before birth, this will be noted in case your health care providers want to monitor baby during labour. 

What are the risks?

Complications happening with nuchal cords are extremely rare. Research into this area actually shows 

The main concern with nuchal cords is compression during labour. However, it’s important to remember that compression of the umbilical cord happens naturally during contractions. 

Babies usually cope incredibly well with this temporary lack of oxygen but any signs of distress will show up in their heart rate during monitoring. Your midwife will check your baby’s heart rate during labour to watch for this and make sure it’s not impacting on your baby’s well being. 

It’s a normal part of labour for a baby’s heart rate to drop during contractions, then recover. Research has shown this is often due to baby’s head or cord being compressed during a contraction or when mothers are pushing.

Studies also show a cord around the neck is unlikely to be the main reason for adverse outcomes. It’s likely those events happen in babies born with other complications as well. 

Is normal birth possible with nuchal cord?

It’s absolutely possible to have a normal labour and birth with a nuchal cord. Your care providers may suggest more frequent monitoring to ensure your baby is coping fine. To avoid increasing the chances of fetal distress, you can ask to have monitoring while you’re upright, such as sitting on a birth ball or standing. 

C-sections as a ‘just in case’ measure aren’t recommended by leading maternity care experts such as the UK’s College Of Obstetricians and Gynaecologists.

Instead, care providers should support women to give birth with as few interventions as possible, to reduce any small risk of complications with nuchal cords. 

How do I prevent complications?

Unless you have had a late ultrasound just before giving birth, there’s no way to know if your baby has a nuchal cord. Which is why it’s so important for pregnant women to be informed about how to achieve a positive birth experience with as few interventions as possible.

Interventions are often suggested to women without them understanding the ripple effect of those procedures. From breaking the bag of waters to the more invasive induction of labour, these interventions have the increased risk of causing a complication that was very unlikely to happen without it.

Even though nuchal cords rarely cause any complications, no woman wishes to put her baby in danger if there was something she could do to avoid it. 

Supporting women to have a normal, active birth is the first and most important step we can take to reduce complications and interventions that might lead to further issues.

This starts with women being informed and aware of what normal birth is. From there, offering pregnancy and birth care that supports women in achieving a normal birth, without rushing the process that must unfold for birth without complications. 

Finally, respecting a woman’s right to choose what is right for her and her baby. Care providers work in a system that encourages intervention as action. Instead, women should be informed about the way an intervention can create more problems. 

Can a nuchal cord be prevented? 

Nuchal cords are very much a normal occurrence of birth. There is an extremely small risk of anything going wrong but nuchal cords can’t be prevented. Being told your baby has a nuchal cord can cause a lot of anxiety and stress, but it isn’t anything you have or haven’t done. 

The best thing you can do to avoid complications is to work towards having a normal birth. You’re aiming for an active, upright labour, with the type of support and environment that promotes oxytocin. Caring, supportive birth team who will actively help you to achieve your birth wishes. 

Things to think about:

• Avoid induction: this increases the strength of contractions which can increase the risk of fetal distress
• Avoid having an epidural: these are common with inductions and tend to mean you are confined to the bed, lying down
• Don’t have your membranes ruptured as this can increase cord compression which is more of a risk than nuchal cord
• Monitoring should be done only as necessary and avoid being trapped lying down on a bed for long periods. 

Is nuchal cord an emergency?

Remember, your baby is getting oxygen through the cord and placenta while in labour and even in the first minutes after birth – which is why delayed cord clamping is SO important. You can read more about that in Delayed Cord Clamping And The Umbilical Cord. 

If your healthcare provider is not seeing signs of distress, then a nuchal cord is not an emergency. 

Nurtured Birth can support you to become informed about your birth choices and choose the right care provider for you. Please contact us to discuss how we can nurture you through this incredible journey.