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By Maria Montoya, MD

Nuchal Cord: Managing Delivery if the Umbilical Cord Wraps Around the Baby’s Neck

Sometimes the umbilical cord wraps around a baby’s neck. A nuchal cord sounds scary, but it is common. Learn what happens if your baby has one.

During pregnancy, the umbilical cord is a baby’s lifeline to its mother. This lifeline, which typically has two arteries and one vein, runs from the baby’s belly to the placenta. Babies receive nutrition, blood and oxygen through the umbilical cord.

One or more loops of the umbilical cord may wrap around a baby’s neck during pregnancy or labor. Your doctor will call this a nuchal, meaning neck, cord and they’re actually quite common, occurring in 20-30% of pregnancies.

Half of all nuchal cords are loose enough to slip off from the baby’s movement, even before delivery. Even if the cord is still wrapped when you go into labor, most babies do not have cord-related complications.

Babies don’t “breathe” in the traditional sense, so a nuchal cord will not hurt them. However, at the time of delivery, your doctor will look for a nuchal cord, and reduce this cord to prevent any injuries to the baby. It is incredibly rare to have any serious implications from a nuchal or neck cord.  In addition, the umbilical cord, which contains two arteries and one vein, has a mucous-filled connective tissue called Wharton’s Jelly, which helps prevent the cord from getting too compressed, even if wrapped multiple times.

Nuchal cords are common, cannot be prevented and can develop due to:

  • Baby’s movement - Babies move around a lot—even while in the womb! That movement is the main cause of a nuchal cord.
  • Excess amniotic fluid - Amniotic fluid is the fluid that surrounds a baby in the uterus to support and cushion the baby. Excess amniotic fluid can also allow extra movement, leading to a nuchal cord.
  • Extra-long umbilical cord - Most umbilical cords are 20-24 inches long. Some babies have an unusually long cord—more than 32 inches long. This may cause a true knot (excessive twisting) or a cord that wraps around the neck multiple times.
  • Twins or multiples – This may happen more often when there is more than one baby sharing space in the womb.

Our doctors and midwives are trained to find nuchal cords and deliver a baby safely if it occurs. To help ease your stress when you go into labor, know the signs of a nuchal cord and what to expect during delivery.

Signs of a Nuchal Cord

You most likely won’t know you have a nuchal cord until a health provider sees it during a routine ultrasound. However, they are most often discovered during delivery. In some cases, patients notice signs such as:

  • Baby moves less than usual. Usually, a baby moves at least five times every 30 minutes.
  • Baby briefly moves a lot, then less. This may be an attempt to free the cord.
  • Baby’s heart rate dips too low during labor. Your doctor will watch for this and keep you informed.

There is currently no way to correct a nuchal cord before delivery. However, your doctor will monitor it for the remainder of pregnancy, and you won’t need to do anything differently. We closely watch the baby’s heart rate throughout delivery to make sure it isn’t putting stress on your baby.

Having an umbilical cord wrapped around your baby’s neck doesn’t usually cause a more challenging delivery or put your baby at risk. It does not directly lead to a cesarean section (C-section) or other birth complications. A 2019 study found that it does not directly cause longer or more difficult labor. According to a 2017 study, nuchal cords don’t usually lead to a higher risk of stillbirth, growth and development issues, or low Apgar scores (color, heart rate, muscle tone, etc.) for a baby.

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What Happens During Delivery

When your baby’s head comes out during delivery, your provider gently feels your baby’s neck for a nuchal cord. If one is present, it is usually loose enough to easily slip over your baby’s head at that time. We may ask you to stop pushing during this time. If the cord is too tight to slip off manually, a doctor or midwife will deliver, then reduce as quickly as possible.

In the rare times a nuchal cord causes an issue, it is because the cord is wrapped so tightly it cuts off the blood supply to the fetus. If a baby’s heart rate falls too low during contractions, stillbirth or other complications could occur. If your baby is in danger, your doctor will do a cesarean section (C-section). Our healthcare team will help you and your baby, even for the most complex pregnancies and deliveries.

If something feels “off” during your pregnancy or you have additional questions or concerns about nuchal cords, talk with your doctor or midwife. We aim to make your pregnancy experience as positive and stress-free as possible.

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Categories: Women's Health