When I was in high school, I was obsessed with the movie Household Saints. In it, Tracey Ullman becomes pregnant and her mother-in-law tells her not to lift her arms too high or the baby's cord will wrap around its neck. That idea never left me. But if you've had an ultrasound or two, you might have already heard that the cord is wrapped around your little one. It's not like there's a lot of room in there, you know? So should you worry about the cord being wrapped around your baby's neck?
When the cord is wrapped around the neck of a fetus, it's referred to as a "nuchal cord." While it sounds positively terrifying, it's actually quite common. According to the Journal of Midwifery and Women's Health, a nuchal cord is present at between 20 and 30 percent of all births, wherein the cord wraps itself around the neck of the infant at least one time. While the single loop nuchal cord is most common, there are cases where the cord has wrapped itself around the baby's neck up to nine times. Yep, you read that right — nine times. According to Ultrasound in Obstetrics and Gynecology, there "appears to be a linear increase over gestation in the presence of both single and multiple loops," meaning that the further along the baby is, the more likely you are to detect the presence of a nuchal cord in-utero. Thankfully, the article also pointed out that 25 to 50 percent of these cases self-resolve and require no additional intervention. Also, there's nothing a mother can do to prevent them. The most common reason that a cord would entangle itself around the baby's neck is due to the morphology of the cord — it has nothing to do with lifting your arms over your head.
I spoke with family nurse practitioner Ellie McGregor to learn more about the cord and when you should worry about it wrapping around your baby. "You'll probably never know if it happens," she says. "Most of the time, if there's not any other symptoms present, your midwife or doctor won't tell you about it because it's so common and not usually dangerous." She adds that it's also often undiagnosed. Doctors don't perform routine ultrasounds late in pregnancy, so unless you've noticed decreased fetal movement or your doctor is thinking about inducing you or concerned with birth presentation, he or she probably won't know if your baby has a nuchal cord or not.
McGregor says that once you get to the hospital and set up on a cardiotocography (CTG) fetal monitor, there are measurements that your doctor will look for in the readouts that would indicated a compressed cord, but again, not all nuchal cords are compressed. "We look for something in the readout called shouldering." It's just what it sounds like. It's the abrupt decrease in fetal heart rate (FHR) in a pattern and the readout looks like shoulders. McGregor says they are also looking at other disruptions in the typical intrapartum FHR.
"If that's the case, that's when we worry. If your doctor mentions a nuchal cord that's presented itself during your pregnancy, he or she may tell you to keep a closer eye on fetal movements. But without the CTG, it's difficult to truly measure what's happening, and since they're not typically associated with infant morbidity and mortality, there isn't a proscribed clinical response," McGregor notes.
Sometimes, it feels as though most of pregnancy takes a "wait and see" approach, and it's very frustrating. Yes, the risks of a compressed cord are scary, but not all nuchal cords are wrapped tightly enough to be concerning, thank heavens. Chances are, you won't even be aware of the situation until after the fact, so maybe any worry is all for naught. (Even if panic seems to go hand-in-hand with pregnancy.)
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