# Cord accidents



## Breathless Wonder (Jan 25, 2004)

It was my understanding that, a cord wrapped around a baby's neck was "no big deal", and generally, easy to deal with during labor.

And yet, more than once here on MDC I have read about a mama that lost her baby to a cord accident- a twist in the cord, or the cord wrapped around the baby's neck.

How big a deal is it really, and why do some babies die, or have problems from cord issues, and others it just involves "pulling it over their head" and they are fine?

Is there anything that can be done to prevent cord accidents? I've never put any stock in the old wive's tales regarding cords, but perhaps, is there some truth to them?


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## captain crunchy (Mar 29, 2005)

Having had a wonderful pregnancy thusfar without any complications or worries about the baby (thank God) .. this is the last of my big worries...

I am hoping some experienced people can shed some light... or is it something that just *happens*...?


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## Patchfire (Dec 11, 2001)

I think it does depend, somewhat, on the overall length of the cord. I don't know. To put some fears to rest (hopefully!), my dd was born with a nuchal cord that was easily handled. Ds was born with the cord around his neck TWICE and it was easily handled. No problems whatsoever with either of them. (In fact, ds was crying when it was just his head out!) Dd's cord was normal length, and the midwife commented that ds' cord was 'really long.' Other than that, I don't know what could make the difference (except, of course, possibly management of the issue?)


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## OnTheFence (Feb 15, 2003)

Breathless, I was wondering that too. I think we must have read coleslaws very tragic and sad news about her baby this morning.









I will have to say that *I* personally in the last 15-16 years that I have been literally "obsessed" with obstetrics, births, and women's birthstories, I've heard more stories about babies being born with cord injuries than anything else. Yet, I read time and time again that some babies are easily born with the cord wrapped around their necks and with knots and are perfectly fine. Is it the luck of the draw? I don't know. I know that when I was really militant natural birth supporter, that this was the one issue that didn't seem to bother me when people had medicated births or cesareans -- I just knew to many, read about too many who had lost their babies that way (some before they were ever born).

Two babies, one of them being my husband's youngest brother, in my husbands family have died from cord injury -- prolapse cord and then one had it wrapped tightly around the neck twice and around the arm tightly. Recently a friend of mines cousin lost her baby to cord injury. Baby was breech, cord was really long, and some how strangled herself on the cord. It was wrapped weirdly all around her body and constricting her neck. My neighbor's MIL was/is a mountain woman and worked with a midwife for years (she is also a LPN) and said they had more complications with babies with cord issues than anything else, including breeches.

I have to say that cord injury scares the bejezus out of me, especially since I carry my babies breech or transverse, because it just seems to be the luck of the draw. At the OB office I go too, they now do ultrasounds at 35-36 weeks to check position of baby and to look at where the cord is. They have the new GE Volusion machine that actually color codes the cord that shows how many vessels it has and where the cord is. I know some probably think this is awful and just another intervention to interfere with normal birth -- and to some extent I agree, but I have to say I am interested in seeing how things look with my breech baby in 3-4 weeks and her cord.

One of the reasons I personally am against ECV is risk of cord injury, but I am firmly in the belief that if a baby is breech and they can't be turned by low intervention techniques like Websters, tilts, or accupuncture, then there is a reason they are that way.


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## Breathless Wonder (Jan 25, 2004)

The thing is, 3 of my children have had cords around their necks at birth.

Only one was in distress, and I attributed it later to the doctor's interventions (AROM, Pitocin, Narcotic pain relief, IFM, lithotomy position, no food, etc.). The baby was "saved" by the episiotomy they cut, and the fact that they had me stop pushing once the head was out, and cut the cord.

Was I just lucky?


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## Clarity (Nov 19, 2001)

Another issue is that many unknown stillbirths are called cord accident for lack if a better explanation. Some parents feel better to have an explanation, some doctors feel it might protect them from liability. But it is sort of a catch-all description for deaths that might be a variety of causes.


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## liseux (Jul 3, 2004)

Some cord accidents happen in utero when the baby grows with the cord a certain way, like around the whole torso or neck, and the cord strangles the baby as they get bigger. Its very rare. Most of these no big deal cord things are just the way the baby comes out, there`s probably plenty of room with certain cords and they are not cutting off air at all, they just come down with a cord around the neck that slips off easily. Its like shoulder dystocia, many babies have a sticky shoulder moment and are fine, but some get stuck very badly and die.


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## Moon Faerie (Aug 2, 2004)

I don't know what causes the difference.My ds was born with the cord around his neck, but it was easily slipped off. My dd had the cord wrapped 3 times around her neck, and the midwife said she'd never seen a nuchal cord that tight. Lauren's heartrate was in the 40s and not recovering, and she needed oxygen after birth for a few minutes.


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## girlndocs (Mar 12, 2004)

Quote:


Originally Posted by *Clarity*
Another issue is that many unknown stillbirths are called cord accident for lack if a better explanation. Some parents feel better to have an explanation, some doctors feel it might protect them from liability. But it is sort of a catch-all description for deaths that might be a variety of causes.









I was going to say that. I wonder in how many of these deaths the cord wrapping around the neck, or having a knot, is coincidental and not actually the cause of death?

Correlation does not guarantee causation.


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## pamamidwife (May 7, 2003)

I agree with Clarity and Kristin. Many times we have no solid explanation for stillbirths. Yet, everyone needs a reason, so sometimes there are guesses.

Some babies have very little wharton's jelly (the white gel that surrounds the vessels) and this can cause issues with knots or really short cords. This is very, very rare. There is no way to determine by u/s (despite a new trend wanting to do so) which babies are more at risk.

Ultimately, we cannot control all injuries and/or deaths. Whether it's before birth, during birth, or afterwards - or even with our eight year olds. We are not in control of our fates - yet there seems to be a drive to believe so.


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## pamamidwife (May 7, 2003)

oh, and nuchal cords are very common. I wish providers would stop looking for them with the birth of the head. This is not only very uncomfortable, but it puts the baby at risk by handling the cord and exposing it to air. If the cord is so short that it needs to be cut (again, very rare, but many providers think that if they cannot loop it over the head it should be cut), the baby is suddenly being suffocated without an oxygen source until it is born and hopefully breathes on its own.

I read one story where a midwife thought it was a short nuchal cord that was holding the head up, so she cut the cord before the head was completely born. The baby actually had a shoulder dystocia and it took an additional five minutes for the baby to be born. It had severe brain damage from the insult.

I just think that we need to leave things be more often. Nuchal cords are not an issue the vast majority of the time. If they were, you'd hear it during labor with heart tones and even then, those babies stay high and seem to dive right down at the right time to birth rather quickly.


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## stafl (Jul 1, 2002)

My second DD was born with the cord wrapped around her neck, twice, very tightly. Midwife didn't unwrap it until after her entire body came out. She was not in distress and had great apgar scores.

I was _told_, after DD1 was delivered via cesarean, that her decels were probably caused by the cord being wrapped around her shoulder, or maybe she was grabbing hold of it too tightly. Because there were absolutely no signs of distress and she had PERFECT apgar scores! I believed this story, too, until I got a copy of my records and did a little more research, and now I think it was because of the Cytotec they gave me (without my informed consent). Of course, no doctor is going to tell you that the problems you had during childbirth were caused by things he did!


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## Artisan (Aug 24, 2002)

Quote:


Originally Posted by *OnTheFence*

I have to say that cord injury scares the bejezus out of me, especially since I carry my babies breech or transverse, because it just seems to be the luck of the draw. At the OB office I go too, they now do ultrasounds at 35-36 weeks to check position of baby and to look at where the cord is. They have the new GE Volusion machine that actually color codes the cord that shows how many vessels it has and where the cord is. I know some probably think this is awful and just another intervention to interfere with normal birth -- and to some extent I agree, but I have to say I am interested in seeing how things look with my breech baby in 3-4 weeks and her cord.

Maybe I am missing something here... but the cord is floating in water. How would seeing it on an u/s 3 weeks before birth tell you much about the position of the cord before the birth (or the next day, even). Doesn't the cord move around and change position as the baby changes position?


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## wendy1221 (Feb 9, 2004)

Quote:


Originally Posted by *reader*
Maybe I am missing something here... but the cord is floating in water. How would seeing it on an u/s 3 weeks before birth tell you much about the position of the cord before the birth (or the next day, even). Doesn't the cord move around and change position as the baby changes position?


I wouldn't say anything is floating in water that late. It's pretty tight in there at the end. kwim?

But I agree w/ you 100%. If there are no signs of distress then, how does looking at it 3 weeks ahead of time, when there's plenty of time for the baby to roll a few more times, show that there will be distress later? Makes no sense to me.

My brother was born w/ the cord around his neck a few times. I think 3. He was fine. There is an old wive's tale that babies born that way can't die from drowning. My brother drowned in a bucket of water (the phone rang and my mom put the bucket in the bathtub before answering it!) but my mom knew cpr and he was perfectly fine.


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## Artisan (Aug 24, 2002)

Yeah, it's definitely tight in there, but there is still generally a layer of fluid cushioning the baby. And the cord will still be at least be partially floating, as there is always the insertion point into the placenta itself that would be sticking out. Even if baby was laying on it, one roll and it would be in a totally different position.

Theoretically, a baby could be fine during an u/s, and have a cord accident later that day. I agree with Pam that we just can't control these things. They're not meant for us to control. If we were meant to control the baby's cord, there would be something we could do about it.


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## NB Mom (Jul 7, 2004)

My DH had his cord wrapped around his legs, well, it had actually grown into his legs, and it had to be cut out. The doc told his mom that he would never walk because of it. But my dh started walking at 18 months. He still has the scars in his legs from where the cord was, though.
My ds had his cord wrapped around his arm a couple of times, but he was fine.


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## coleslaw (Nov 11, 2002)

Hi ladies, it's me. I sincerely want to thank BW for starting this thread. As you can imagine (since I think I'm the reason this thread got started), I have many questions about this myself. I have learned a lot from all of your comments, particularly pamamidwife. I have dabbled in the angry phase of grief today and was ready to march into my midwives' pratice and demand some answers on how they could have missed this and what else they could have done. I do have questions, but they have become more rationale and focused thanks to some of the information I have read here. Like some of you said, it may not have been the cord. We thought it was because of what my dh saw when Grace was born - it appeared to him like it played a role, but hasn't given me details and I haven't asked. The doctor (long story why it wasn't a midwife) said that it may be the case too. I didn't see anything until they put her in my arms wrapped up in blankets (which was fine with me). They are doing tests on her placenta and her and did bloodwork on me. Maybe we will find something out then.

Please continue the discussion if there is more to be said and know that you are helping a greiving mom get through one of the hardest moments of her life. I thank you for that with all my heart.


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## Ms. Mom (Nov 18, 2001)

This is a very interesting topic. My first child Amanda died because the placenta abrupted, but, there were also several hemerages in the cord.

My son was born with the cord around his neck and shoulder. The cord again, had several hemerages and the placenta was torn. He came out screaming and healthy. The doctor later said he was amazed that ds was so healthy.

In the 10 years since my daughter was stillborn, I've done a lot of searching for answers. One thing I've come to believe is that life and pregnancy are a very delicate balance. Most stillbirths do seem to be from cord or placenta accidents, but there is little that can be done to detect a problum.

Coleslaw, I am so very sorry for your loss - I wish I had some answers for you - all I have are cyber hugs







Please know your in my thoughts as yoj move through this.


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *reader*
Maybe I am missing something here... but the cord is floating in water. How would seeing it on an u/s 3 weeks before birth tell you much about the position of the cord before the birth (or the next day, even). Doesn't the cord move around and change position as the baby changes position?

I have no idea but I will be sure to ask. My babies don't really move after a certain time period. I've had a breech baby now for sometime and she can't move due to the septum. (she seems quite ticked at times too because of this)


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## TCMoulton (Oct 30, 2003)

My daughter had her cord wrapped around her neck FOUR times and she was still born vaginally, albeit with assistance from forcepts. The nurses were amazed as none of them had ever seen a cord x 4 and this is a fairly large hospital with 2500 + births a year. My doctor (a wonderful woman) did everything she could to get my daugher to come out, since due to repeated decels I had only one or two more pushes left until a c section. While she spent 3 days in the NICU, more due to the fact that no one knew if she should be closely monitored or not, in the end I was grateful to have a beautifil healthy baby to take home. A skillful Dr. or midwife, I believe, can handle most situations without problem, but it is the rare occurrence that will take a baby's life that skill or experience can do nothing to prevent that is so frightening!
Take care Mama and don't worry!
Colleen


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## pamamidwife (May 7, 2003)

Hugs to Coleslaw and MsMom. I'm so sorry for both of your losses. Even those words seem so trite. My heart aches for you.

Colleen, one of my clients in December had a four time (or it could have been five, we're not sure) wrap. Baby had some decels when active labor kicked in, but we didn't hear anything after they resolved. Baby was born in the water and my assistant/apprentice caught her, unwrapped the long cord and everything was fine.

It is interesting, though, that "what if the cord is around the neck?" is one of the most popular questions from people on the fence about homebirth.


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## mwherbs (Oct 24, 2004)

I think that in the face of still birth and the numbers are high as to no know cause incidental findings like nuchal cord get reported and/or blamed , what else does an expert say to a mom who has experienced a loss.
Other things that are rare cord accidents that would have to do with still birth like not enough wartons jelly to protect it , or a cord that is falling apart and detaches before birth or a true knot that tightens before birth-- I have seen true knots in live well babies but this could be a cause for still birth--- there are some issues with cords, placentas and pregnancies that have identical twins/triplets/quads...
as you can see these are very rare things and you may have never heard of any of them. One more common dangerous cord accident is a prolapse where the cord is born long before the baby is born-- happens more often in preterm birth before 36 weeks, the younger/smaller the baby the greater the danger - early rupture of membranes and baby is not enguaged or the baby is enguaged but so small in mom's pelvis that cord can fit too and certain presentations like footling breech , because the feet are smaller than a head and the cord will deliver before the head.
a while back this subject came up and I did some research-- there were some findings on more than 3 wraps with very long cords relative to long term outcomes not deaths... but who knows what this means could be managment, or that babies with certain problems move around more and make longer cords that equal more wraps....

--------------------------
as far as cord being wrapped around the neck- think about this - the baby is not using its throat and neck for breathing in air until after the chest is born... also think about how tightly you are going to be able to coil a pressurized hose can you coil it around something that will stop its pressure and flow? how hard do you have to push, press to accomplish this? how tightly can you wrap it around a something rounded about the size of your wrist--- the devitalized cords we see after birth are not the full lively things they are prebirth


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## doctorjen (May 29, 2003)

I think I'm going to start keeping track in my own practice, because it seems that I almost have more babies with a wrap of cord around the neck than not. I do think that they are just so common, that they are likely to be incidental findings in a stillbirth. In order for a cord wrap to cause a baby to die, it has to be tight enough to cut off blood supply to the baby. As mwherbs pointed out, babies don't breathe prior to birth, so they don't get strangled, as in unable to breathe due to a tight cord prior to birth.
Unfortunately, and frustratingly, most stillbirths are not found to have a definite cause. Makes it so much harder to find closure, and then move on and possibly consider another baby.
coleslaw, I'm so, so sorry about your daughter. Wishing you love and support in this time of grief.


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## doctorjen (May 29, 2003)

Wanted to add, I'm not sure what good doing an ultrasound at near term for cord position is. What are you going to do with that information?
In January, I had 5 births, all with nuchal cords. This morning, I attended a lovely birth, with a tight nuchal cord. All 6 babies perfectly fine at birth. If I'd known the cord was around the neck to start, would we offer cesarean to all these women? And when? Just monitor close during labor? But shouldn't we do that anyway?


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## homemademomma (Apr 1, 2004)

Quote:


Originally Posted by *pamamidwife*
oh, and nuchal cords are very common. I wish providers would stop looking for them with the birth of the head. This is not only very uncomfortable, but it puts the baby at risk by handling the cord and exposing it to air. If the cord is so short that it needs to be cut (again, very rare, but many providers think that if they cannot loop it over the head it should be cut), the baby is suddenly being suffocated without an oxygen source until it is born and hopefully breathes on its own.


THANK YOU for saying that pam!!!! both my preceptors are also RNs at the local tertiary hospital, and i can really feel their fear around birth, regarding this issue and many other issues. every time i've caught a baby thats come out too fast to have her cord manipulated (looped over head, loosened over shoulders, or cut), the cord has been plenty long enough to allow the baby to be born.


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## ~Megan~ (Nov 7, 2002)

Quote:

as far as cord being wrapped around the neck- think about this - the baby is not using its throat and neck for breathing in air until after the chest is born... also think about how tightly you are going to be able to coil a pressurized hose can you coil it around something that will stop its pressure and flow? how hard do you have to push, press to accomplish this? how tightly can you wrap it around a something rounded about the size of your wrist--- the devitalized cords we see after birth are not the full lively things they are prebirth
The first part is something that I had considered before. I think that we are afraid because we forget about that.

Now the second part is really interesting. I didn't consider that its pressurized, that makes a lot more sense.


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## Greaseball (Feb 1, 2002)

I looked at the original thread...







So sorry for your loss! It does sound like one of those things where the cord is merely incidental.

If the cord has to be tight enough to cut off blood supply, I suppose there is no way to prevent that. But during labor, if heart tones are monitored, wouldn't a serious cord issue cause some fetal distress? Then the mother could transfer to the hospital and have a cesarean, rather than simply scheduling one because of a questionable cord position in late pregnancy.

Ultrasounds show many false positives that lead to moms scheduling c-sections because they have been led to believe they will have 10-lb babies, or even having abortions in early pgcy because the u/s showed some defect that was later not found in the aborted fetus. I think if c-sections are scheduled for every woman who has a "questionable" cord, the rate will rise much higher.

DD2 had a loose cord around the neck, no big deal. My midwives said that most babies in their practice have the cord around the neck at least once. But doctors think it's a really big deal - when we took her to see the ped, the first thing she said was "The cord wasn't around the neck, was it?"


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## kavamamakava (Aug 25, 2004)

My mom had me unassisted (well, with two friends and a toddler present) and she tells me that my cord was around my neck three times and in such a clump that it came out funny and she ended up with a tear. She slipped the cord off me after I was born and said I did take a little while to pink up. But I'm fine and I'm pretty sure I didn't suffer any brain damage.


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## MinnieMouse (Nov 19, 2001)

I was transferred from our birth center to the hospital across the street for serious heartrate decels from dd during the pushing stage. I was only in labor for a total of 4 hrs, showed up at the birth center at 2:45 at 8cm, 10cm by 3:00, heart decels detected by 3:10. After 3-4 of them were they plummeted w/ each push and stayed down the decision was made to transfer.

I got an IV (not routine at the birth center but was at the hospital) at 3:31 and was placed int he ambulance. Dd was born at 4:04 in an LDR room. Episiotomy w/ forceps assisted birth.

They discovered after she was born that the cord was wrapped twice around her neck (tightly) and it was short. Between the two it was surmised that with each push it was tightening more, causing the decels.

Dd was wisked across the room with the fear that she would be in major distress but was fine. Her APGARs were excellent. They actually rushed her there so quickly that noone mentioned to dh or I exactly what her sex was... I had to ask!









While I'm not thrilled w/ the ambulance transport and the hospital birth, I am happy that dd was okay. In speaking w/ my midwives afterwards they suspect that dd was okay because of how quickly my labor went... that she may not have been w/ a typical drawn out first time mom labor. I also am VERY grateful that the midwife insisted on putting me in an LDR room and not the OR which is where they were going to take me. I was told that they had the OR all ready and waiting for me to be sectioned...and I'm convinced I would have been if my midwife hadn't been attending me.

We are now pregnant w/ our second child and have already had our first appt w/ the birth center. The midwife and I went over a lot of dd's birth and they are pretty confident that we will actually be able to stay at the birth center this time around. They are way more concerned about my 4hr labor and making sure that I get there on time... I'm not really into having my child on the PA Turnpike!


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## crazy_eights (Nov 22, 2001)

FWIW - 5 out of my 6 kids have had nuchal cords. My first dswas born totally wrapped in his cord (over the shoulder, between the legs, etc.). He did have some variables in labor, but luckily I was giving birth in Israel with midwives who took it all in stride. Apparently the house physician was not so calm about it. I have seen more c/sec's for the same type of variable decels here in the US than I care to count. DS was born with APGARS of 9/10, so obviously didn't hurt him.

I wanted to add that in addition to cord around the neck often being an incidental finding, there is some speculation that clotting disorders (MTHFR, Factor V Leiden, etc) might play a role in some of these still births that have no apparent cause (clot in the cord, in the placental bed, or perhaps one that traveled to the baby?). Awareness of these disorders is rising and these women are at greater risk for still birth and 'late' miscarriage.


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## crazy_eights (Nov 22, 2001)

Quote:


Originally Posted by *MinnieMouse*
They are way more concerned about my 4hr labor and making sure that I get there on time... I'm not really into having my child on the PA Turnpike!

Sounds like me exactly! I had a 4 hour labor with my first, but a 5 hour labor with my second. It took me until my 5th to have one 'unattended' b/c the mw didn't make it on time. (#3 was 2 hours, #4 was 1 1/2 and #5 was 50 minutes).


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## girlndocs (Mar 12, 2004)

One of the most memorable birth stories I ever read was Carla Emery's (she's the author of The Encyclopedia of Country Living). She was checked and found to be 5 cm, but as soon as the nurse walked away she felt like she had to push! Her DH ran after the nurse while she started pushing. The doctor ran in just in time to catch her son as he shot out in only 2 pushes -- from halfway-dilated to birth in exactly 12 minutes









Turns out her son *was* one of the babies with a very tight nuchal cord around his chest and neck. She says he was dark blue like ink. If he'd spent longer in the birth canal than he did, he might have been in trouble -- her body saved the day, apparently. She asks, what if she had had anesthetic and couldn't feel the urge to push? What if she hadn't trusted her body and resisted pushing because the nurse said she wasn't complete?

So for me, giving birth naturally with attendants who trust my body is one big way I will choose to minimize the risks of cord injury, should I have another baby.


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## liseux (Jul 3, 2004)

We all know that babies don`t breathe in utero, yet if a cord is really compressed, either by being in a true knot or malformed or too tight like the last poster described, it cuts off air to the baby from the cord.

I disagree that cord accident is a term just loosely thrown around by doctors to explain stillbirths that are unexplainable. Does anyone have evidence of this happening often? At the infant loss support group I attended there were 4 unexplained stillbirths and all of the parents there understood that even after autopsies that they couldn`t explain their babies deaths. Also, in a group of 20 women only 2 of the deaths would I consider to be caused by intervention, the rest just happened.


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## crazy_eights (Nov 22, 2001)

Quote:


Originally Posted by *liseux*
Does anyone have evidence of this happening often? .

Yes. I work L&D and the OB's will admit as much. Often a stillborn baby will have a cord around the neck, true knot or whatever and they will tell the parents 'we may never know what happend, but the only thing that was apparent at birth was (cord around neck, around the arm, true knot)'. However, the cord might not have been tight and it is hard to evaluate knots after blood is no longer pumping through the cord (with the fetal death, not the birth). We all know that many babies are born with tight cords, true knots (I've seen women that gave birth to live babies with multiple true knots), etc. Anyway - it's often hard to know what is a incidental finding and what is causitive.


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## liseux (Jul 3, 2004)

"Often a stillborn baby will have a cord around the neck, true knot or whatever and they will tell the parents 'we may never know what happend, but the only thing that was apparent at birth was (cord around neck, around the arm, true knot)'. "
This makes sense to me only in that it would be weird if the doctor or mw didn`t mention everything that was observed. What the parents choose to infer from that is up to them. I agree that there is no way in really knowing, even an ultrasound can`t tell you very much about the cord and what will change about it before birth.


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## mwherbs (Oct 24, 2004)

sometimes it is parents inferring but it is just as often that I will hear a doctor say with some conviction that there was a cord around the neck... also other hospital staff will say things like it was some sort of cord accident... and if you get the facts no known cause-- even in what I would consider uneventful births there will be alot of "drama" around nuchal cords. It is not just parents on their own making these mistakes.


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## liseux (Jul 3, 2004)

"It is not just parents on their own making these mistakes." Of course not. A professional can always put things into your head about went wrong that might not be true. It happened to me. But since we all agree that cord accidents can happen, then chances are its not always a mistake, right? Sometimes its really a cord accident. Luckily, most of the time cord issues are minor or non-existent because the cord is long enough not to be an issue.


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## Benji'sMom (Sep 14, 2004)

I had a natural labor all day but was not dialating much and not effacing at all. So then I ended up having a section that night. When they took DS out, the doctor said the cord was wrapped around his neck twice. His head was slightly molded from the birth canal, and the cord was stretched VERY THIN, so basically the cord was holding him in and was too short for him to come out. I guess I'll never really know if I "needed" a c/s or not, but anyway that's what ended up happening. (But he was never "in distress", heart rate and everything was normal.)


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## cottonwood (Nov 20, 2001)

mwherbs wrote: "One more common dangerous cord accident is a prolapse where the cord is born long before the baby is born [...] and certain presentations like footling breech , because the feet are smaller than a head and the cord will deliver before the head."

Cord prolapse is *common*? How many have you seen in your practice?

Anyway... another thing to consider about cord accidents, as far as prolapse with a small head/breech goes, is that the cord is lighter than the baby, so if the mother is standing when the water breaks, the baby will move down first. Which is one reason AROM is not that great an idea, the mother has to be on her back so that gravity cannot assist in pulling the baby down before the cord, and in the fact the lighter weight of the cord will make it more likely for it to be pulled toward the vaginal opening with the flow of water.


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## mwherbs (Oct 24, 2004)

so as problems in pregnancy and birth go cord prolapse is a very small number but is most common cord accident--- keeping with the topic- and my statement included "preterm" as a risk factor for prolapse

Int J Gynaecol Obstet. 2004 Feb;84(2):127-32.
Umbilical cord prolapse and perinatal outcomes.

Kahana B, Sheiner E, Levy A, Lazer S, Mazor M.

Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

OBJECTIVES: To determine obstetric risk factors and perinatal outcomes of pregnancies complicated by umbilical cord prolapse. METHODS: A population-based study was performed comparing all deliveries complicated by cord prolapse to deliveries without this complication. Statistical analysis was performed using multiple logistic regression models. RESULTS: Prolapse of the umbilical cord complicated 0.4% (n=456) of all deliveries included in the study (n=121,227). Independent risk factors for cord prolapse identified by a backward, stepwise multivariate logistic regression model were: malpresentation (OR=5.1; 95% CI 4.1-6.3), hydramnios (OR=3.0; 95% CI 2.3-3.9), true knot of the umbilical cord (OR=3.0; 95% CI 1.8-5.1), preterm delivery (OR=2.1; 95% CI 1.6-2.8), induction of labor (OR=2.2; 95% CI 1.7-2.8), grandmultiparity (>five deliveries, OR=1.9; 95% CI 1.5-2.3), lack of prenatal care (OR=1.4; 95% CI 1.02-1.8), and male gender (OR=1.3; 95% CI 1.1-1.6). Newborns delivered after umbilical cord prolapse graded lower Apgar scores, less than 7, at 5 min (OR=11.9, 95% CI 7.9-17.9), and had longer hospitalizations (mean 5.4+/-3.5 days vs. 2.9+/-2.1 days; P<0.001). Moreover, higher rates of perinatal mortality were noted in the cord prolapse group vs. the control group (OR=6.4, 95% CI 4.5-9.0). Using a multiple logistic regression model controlling for possible confounders, such as preterm delivery, hydramnios, etc., umbilical cord prolapse was found to be an independent contributing factor to perinatal mortality. CONCLUSIONS: Prolapse of the umbilical cord is an independent risk factor for perinatal mortality.
---------------------------------------------------------------------------

Eur J Obstet Gynecol Reprod Biol. 1983 Apr;15(1):17-23.
Neonatal mortality and morbidity associated with preterm breech presentation.

van Eyk EA, Huisjes HJ.

A retrospective study was performed on 88 live-born preterm infants with breech presentation. The neonatal mortality (NNM) was 18.2%, and 13.3% after correction for congenital malformations incompatible with life. 62.5% were delivered vaginally, and 37.5% by cesarean section (CS). In spite of the fact that most CSs were done for indications associated with increased fetal and neonatal morbidity and mortality, overall morbidity was comparable in the two groups. Mortality was higher in the vaginal group. Entrapment of the fetal head (7.3% of vaginal deliveries) and prolapse of the cord (4.5%) were major complications of preterm breech delivery. They resulted in two cases of neonatal death (NND) and three cases of neonatal asphyxia. Prolapse of the cord was in all cases associated with footling presentation. The authors consider these results in favor of routine CS in preterm breech presentation

-----------------------------------------------------------------------------

now I think that after their statement of one maternal incident!!!!!!!! I don't exactly agree with their conclusion of c-sectioning breeches

J Obstet Gynaecol. 2004 Apr;24(3):254-8.
Related Articles, Links

*
Correlation of fetal outcome with mode of delivery for breech presentation.

Bassaw B, Rampersad N, Roopnarinesingh S, Sirjusingh A.

Department of Obstetrics and Gynaecology, University of the West Indies, Trinidad. [email protected]

The objective of this retrospective analysis of 344 singleton pregnancies of gestational ages greater than 24 weeks conducted at a tertiary hospital was to determine the fetal outcome in relation to the mode of delivery of the fetus with a breech presentation. Caesarean section was performed in 157 mothers, and 187 babies were delivered vaginally. There was no statistical difference in the perinatal outcome for breech fetuses delivered either abdominally or vaginally. Cord prolapse and arrest of the after-coming head were responsible for five fetal losses, four of which were delivered vaginally. Neonatal morbidity comprising nerve injury, birth asphyxia and seizures occurred in 11 newborns, nine of whom were delivered vaginally. One mother sustained a massive intra-operative haemorrhage during a caesarean section which necessitated an emergency hysterectomy. We conclude that a policy of planned vaginal birth for selected breech fetuses with a low threshold to proceed to caesarean section may be in the best interests of both mother and child.


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## Greaseball (Feb 1, 2002)

Prolapse is not always the huge emergency, either. My midwife delivered a baby at home after the cord prolapsed. She offered the mother the choice of going to the hospital, and the decision was made to continue at home. A happy outcome for all.


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## mwherbs (Oct 24, 2004)

here is an address with quite a bit of info including % of incidence of the various cord problems

http://www.emedicine.com/med/topic3276.htm


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## crazy_eights (Nov 22, 2001)

Quote:


Originally Posted by *mwherbs*
We conclude that a policy of planned vaginal birth for selected breech fetuses with a low threshold to proceed to caesarean section may be in the best interests of both mother and child.

OT here - I don't know that much about studies done on the subject, but I spoke with a perinatologist who DOES vag. breech deliveries (and his wife has homebirths, fwiw, including one that was breech) and he told me this: the problem with preterm breech deliveries is that until 36 (or was it 34? I think it was 36) weeks gestation, the breech presenting part is smaller than the head. He claimed that there was a greater risk of the breech delivering through an incompletely dilated cervix and then having head entrapment from the larger head not fitting through. This seems to be part of what is shown by the study here.


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## doctorjen (May 29, 2003)

Quote:


Originally Posted by *Greaseball*
Prolapse is not always the huge emergency, either. My midwife delivered a baby at home after the cord prolapsed. She offered the mother the choice of going to the hospital, and the decision was made to continue at home. A happy outcome for all.

I don't know about the specifics of this case, but in general cord prolapse is one of the true real emergencies in obstetrics. If the cord truly presents before the baby, cord compression is almost certain, and unless that compression can be alleviated, or the baby delivered quickly, injury due to lack of oxygen can happen pretty quickly.


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## applejuice (Oct 8, 2002)

From my readings on the subject, I have come to the conclusion that a cord wrapped around the neck in a cephalic presentation is more of a natural prevention against a cord prolapse.

If a baby's blood and oxygen supply are not compromised by obstetrical drugs in the mother's system or by laying on her back, there should be enough oxygen to get to the baby unless the cord

is too short,
or too long,
or in a knot,
or some other birth defect exists.

The cord was around all of my children's necks, all births planned, begun, and completed at home, and my Father said the cords were wrapped around all of our necks also, all but one, at home...


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## applejuice (Oct 8, 2002)

Quote:


Originally Posted by *Mom2six*
OT here - I don't know that much about studies done on the subject, but I spoke with a perinatologist who DOES vag. breech deliveries (and his wife has homebirths, fwiw, including one that was breech) and he told me this: the problem with preterm breech deliveries is that until 36 (or was it 34? I think it was 36) weeks gestation, the breech presenting part is smaller than the head. He claimed that there was a greater risk of the breech delivering through an incompletely dilated cervix and then having head entrapment from the larger head not fitting through. This seems to be part of what is shown by the study here.

ITA!

I have said it before on these forums...the problem with breeches is not the breech itself, but other factors as prematurity.

Excellent post, Mom2SIX!!!


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## AngelBee (Sep 8, 2004)

I found a site www.missinggrace.org that may have more info on cord accidents and stillbirth.


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## crazy_eights (Nov 22, 2001)

Quote:


Originally Posted by *AngelBee*
I found a site www.missinggrace.org that may have more info on cord accidents and stillbirth.

I was just poking around reading at this site and some of it really doesn't sit well with me. They want bereaved parents to arrange for this OB to come speak at local hospitals to teach about monitoring for cord issues. But in it, it mentions that in ONE WEEK he had 3 women that he was monitoring b/c cord issues seen on u/s and delivered them early - and they say these babies probably wouldn't have made it without his intervention. I have worked OB in 2 hospitals with a fairly lg. numbers of deliveries (4,500/year and 7,000/year) and 3 term demises in a MONTH would be huge. And they want you to arrange to bring this guy in to train residents to be monitoring ALL pregnant women by u/s for those at high risk for cord accidents. The whole thing just doesn't sit well with me. Sounds like just another invitation to intervention and c/sec.

ETA - another thing from this site, from a list of things that you should go to L&D for monitoring: "Obvious uterine contractions less than 10 minutes apart for one hour, you need to be monitored. Continual Brackston-Hicks, or false labor, can be hard on the baby and can cause fetal stress."

HUH?


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## AngelBee (Sep 8, 2004)

Quote:


Originally Posted by *Mom2six*
I was just poking around reading at this site and some of it really doesn't sit well with me. They want bereaved parents to arrange for this OB to come speak at local hospitals to teach about monitoring for cord issues. But in it, it mentions that in ONE WEEK he had 3 women that he was monitoring b/c cord issues seen on u/s and delivered them early - and they say these babies probably wouldn't have made it without his intervention. I have worked OB in 2 hospitals with a fairly lg. numbers of deliveries (4,500/year and 7,000/year) and 3 term demises in a MONTH would be huge. And they want you to arrange to bring this guy in to train residents to be monitoring by u/s for women at high risk for cord accidents. The whole thing just doesn't sit well with me. Sounds like just another invitation to intervention and c/sec.

Sorry...I have not checked out the site. I heard info about it on talk radio anfd have been meaning to check it out. It was started by a mother who lost her daughter, Grace, due to a cord issue.


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## gossamer (Feb 28, 2002)

Something that mom2six touched on is the issue of blood clots etc. Having a baby die due to a cord accident or such doesn't necessarily mean an external visual anamoly (can't spell that word). More and more in the fight against pre-eclampsia, doctors are finding out and testing for blood clotting disorders that only present themselves during pregnancy like factor V Leiden, factor II, thrombophilia etc. Death from a cord accident doesn't always mean something like it was knotted or too tight around the neck, it could mean there were several blood clots that restricted the flow of nutrients to the babe. Just some more food for thought.
Gossamer


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## mwherbs (Oct 24, 2004)

Quote:


Originally Posted by *gossamer*
Something that mom2six touched on is the issue of blood clots etc. Having a baby die due to a cord accident or such doesn't necessarily mean an external visual anamoly (can't spell that word). More and more in the fight against pre-eclampsia, doctors are finding out and testing for blood clotting disorders that only present themselves during pregnancy like factor V Leiden, factor II, thrombophilia etc. Death from a cord accident doesn't always mean something like it was knotted or too tight around the neck, it could mean there were several blood clots that restricted the flow of nutrients to the babe. Just some more food for thought.
Gossamer

yes I agree with this, and for some moms if this is known or found there are treatments that can help prevent this from repeating. This is one reason for moms who have had losses- to be tested for auto-immune diseases and clotting disorders there is a battery of tests that are done via blood work . (many are tested by physicians if they have had more than 2 miscarriages)


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## ~*~MamaJava~*~ (Mar 7, 2004)

This thread is just so interesting for me...my DS2 (born in hospital, vaginal birth, 10 days over due) had the cord around his neck 6 times, under his arm once, and it had 2 true knots in it.

The nuchal cording was tight when he came out, he was purplish but not blue.

His apgars were good, and his oxygen saturation was perfect. The cord was quite short between him and the placenta (I guess since so much of it was wrapped around him).

Now, my doctor (and the nurses) told me it's a miracle that he lived, and that he appears to have no brain damage. They attributed his smallish size (6lbs 3oz) to the knots.

I had a ultrasound a few days before he was born and nothing was detected, but due to the amount of cording etc the Dr says he was probably like that for quite some time (whole last trimester). He was very quiet in utero as well, which makes me think she was right.

Additionally - the pushing phase with him lasted only 10 mintues (as opposed to 1 1/2 hrs with #1) since I got up and squatted to push him out quick (even though we had no idea he had this problem).
I thank God for MDC and the mamas here posting about natural birth, because I'm quite sure had I been lying there on my back, drugged up, Lucas would not be in my arms today. Can you just imagine if I had an epidural and it slowed it all down? Maybe some of you who are expert in these matters could tell me for sure, but I would think he wouldn't have made it.
I'm crying just thinking about it.








to you mamas whose babies are with God.


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## homemademomma (Apr 1, 2004)

Quote:


Originally Posted by *doctorjen*
I don't know about the specifics of this case, but in general cord prolapse is one of the true real emergencies in obstetrics. If the cord truly presents before the baby, cord compression is almost certain, and unless that compression can be alleviated, or the baby delivered quickly, injury due to lack of oxygen can happen pretty quickly.


yup


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## ~*~MamaJava~*~ (Mar 7, 2004)

applejuice said:


> the problem with breeches is not the breech itself, but other factors as prematurity.
> QUOTE]
> 
> Hey - that's interesting. Really?


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## pamamidwife (May 7, 2003)

totally. when people talk about the head getting stuck in a breech, it's related to either a small footling breech or a preterm baby (whose heads are larger than their torso).

term babies have heads that are equal to, or a little smaller, than their torsos. If you imagine a frank breech (but first with the feet by the head) coming, the width of the hips, torso and legs together are bigger than the head.


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## sugarmoon (Feb 18, 2003)

Okay, Totally OT, but....

Congratulations Gossamer! I didn't know you were pg!!!!

I will think of you, everyday, from now until you are holding your sweet baby in your arms!

I'm getting all teary


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## applejuice (Oct 8, 2002)

Quote:


Originally Posted by *~*~MamaJava~*~*

Quote:


Originally Posted by *applejuice*
the problem with breeches is not the breech itself, but other factors as prematurity.

Hey - that's interesting. Really?

Yes, other problems that make a breech a problem for vaginal delivery are cord problems, hydrocephalus, placenta previa (maginal, complete) previous surgery to the uterus, odd shaped uterus that prefers the head up and may not contract well, a pelvis that prefers the sacral position, and incoordinate contractions.


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## MoonStarFalling (Nov 4, 2004)

Hi all, this is an interesting thread thanks for the info and the great discussion.

Addressing the issue of cord accident being thrown around as a cause for stillbirth. I just wanted to add my .02. BTW, my daughters were momo twins who were stillborn due to cord entanglement, I'm involved with several stillbirth groups and have written an article on stillbirth, it's causes and in paticular cord accident management. More than half of all stillbirths are classified as SADS (Sudden Antenatal Death Syndrome). In my experience, doctors are most likely to *not* give a reason for the death even if they suspect one. It's just plain *easier* to use "SADS" instead of running the many many tests and procedures required to find the true cause of death. Secondly, there is no standard protocol for stillbirth autopsies. Every office does them differently and not everyone is an expert on placentas and looking for evidence of cord injury. Even if a family requests an autopsy (I requested one but was denied), the information simply goes in the trash. There is no central repository for stillbirth research or statistics so we have no way of knowing exactly how many babies die of what and what evidence was used to come to that conclusion.

I'd like to address some fears mothers may have. From reading the thread, I feel like most of us are concentrating on accidents that happen at birth or during labor. It's in my experience that most fatal cord accidents happen in the last month of pregnancy, but before labor. There are warning signs you can be aware of, as was mentioned by the pp. I experienced most of these the day my daughters died (and yes mom2six, continual Bx hicks was a sign for me, they felt different from regular bx hicks though, it was more of an all day tightness which was sometimes painful):

Excessive hiccups (baby), hyperactivity (baby), decreased movement (please do kick counts every day!), fetal heart rate under 100 or more than 150 bpm, fetal shuttering or quivering, localized pain in the uterus (usually happens at night, it will be a sharp pain towards your side and will happen a few times in a row), frequent contractions (The Pregnancy Institute http://www.preginst.com/)

If you're truly concerned about cord accidents, please read Dr. Collin's research at http://www.preginst.com/. Like the pp mentioned however, he is *very* pro c/section. I don't agree with his belief that all pregnant women must have weekly or daily u/s to look for cord issues. However, I do agree that if you're experiencing the above symptoms, you should get a NST.


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## coleslaw (Nov 11, 2002)

twinangels04, I am so sorry for your tragic losses. What a terrible thing to go through - to lose two babies. My heart goes out to you.

I need for you to know that the information you presented has me reeling. In the week before Grace's (in utero) death (she was 37 weeks gestation), I experienced most of the symptoms you describe. I mentioned them to the only midwife I saw the week symptoms started up until the day before her death. She never did anything about them and attributed them to Grace suddenly turning breech. Even before reading your post, I have been putting the story together and thinking she missed something that she shouldn't have. I am convinced now (for more reasons than just the info you presented) that if a NST was done on the Monday before her death, they would have seen distress, done a c-section and she would be OK. I am going to document everything and present it to the head midwife on Monday when I go for my check-up to see what happens. I am also sending it to a friend who is an OB/GYN for more opinions. Needless-to-say, I am devestated at the idea that it's possible my daughter's death could have been prevented. I'm at a loss and need to get my thoughts together. Thank you for the information.


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## Greaseball (Feb 1, 2002)

Why in the world were you denied an autopsy?!


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## pamamidwife (May 7, 2003)

Keri, do you mean that frequent hiccups, strong and long BH contractions and frequent movement should all signal a NST?

I don't really know how something like that could be necessarily prevented. Unless, of course, we're doing cesareans on every woman at 35 weeks.

Not to get hostile, please don't take it that way. Was just wondering why that website makes sense to anyone. I think that it gives false hope to people.


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## coleslaw (Nov 11, 2002)

No, I mean that I had unusual movement for my pregnancy, for my baby. I've been pg before and I know what was typical and not typical for my pregnancy. There is more to my specific story than what I wrote. I was just thanking her for giving me some information because it seemed to have fit what my instincts have been telling me on what killed my baby. I am also feeling very raw, so I don't think I should go any further with this post.


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## pamamidwife (May 7, 2003)

, Keri. I didn't mean to insinuate anything.

and now, not related to you.....

(please don't read)

That website really disgusts me. It symbolizes everything that is wrong with modern childbirth. I really feel physically ill after reading it.


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## Full Heart (Apr 27, 2004)

Quote:


Originally Posted by *twinangels04*
Excessive hiccups (baby), hyperactivity (baby), decreased movement (please do kick counts every day!), fetal heart rate under 100 or more than 150 bpm, fetal shuttering or quivering, localized pain in the uterus (usually happens at night, it will be a sharp pain towards your side and will happen a few times in a row), frequent contractions (The Pregnancy Institute http://www.preginst.com/)

So would these be a sign if there weren't present before in the pg? Like Excessive hiccups and hyperactivity? Because I have had babies who have had hiccups several times a day every day. Like the baby I am carrying now. This pg I also have a very hyperactive baby. One night it felt like someone was inside me doin the jig. I have never experienced that before. I have also had a very very quiet baby who never moved much. In all my pg I have felt the baby quivering or shuttering. And have heard other women mention the same thing. No one seemed to know what it was from. My midwife suggested it couldbe the baby practicing its breathing. I can imagine those symptoms would send women to the drs constantly for nst and u/s.

Also I had a u/s a week before I had ds, no one mentioned anything about his cord. He had it wrapped around his arm, torso and leg. It was so tight he had bruises on his leg and arm for what seemed like forever. Probably only a few weeks, but in nbs that seems like forever. Especially when the normal bruising from birth went away in a few days.

Anyhow, DIdn't read the websites but those symptoms seem more like a normal pg to me than warning signs. Unless its is sudden and unusual.

Michelle


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## pfamilygal (Feb 28, 2005)

I've seen 4 or 5 true "cord accidents" (that caused stillbirth) in my 6 years as a nurse. Most of the time it is obvious. Once I saw the cord wrapped like a sling around the child and one half of the body was purple and the other half was pale. Other times there is an obvious kink or knot in the cord. The cord is fat and healthy from the kink down and shriveled from the kink up. A dear friend lost her son this way. She noticed at 38 weeks that she was feeling no movement. She had polyhydramnios, so she had difficulty feeling movement at all.

That said, all three of my kids had nuchal cords. My first had it times 3. I was induced for severe PIH and pulmonary edema. When he was beginning to crown his sats dropped very low. The OB cut a huge episiotomy and pulled him out with forceps. She had a a hard time getting the cord untangled even after his head was out. He was black as coal, floppy and not moving or breathing. After a few minutes (the longest of my life!) of resuscitation efforts he started crying. He was fine.

My second only had a nuchal cord x 1. I pushed her head out, the doc slipped it over her head, and out she came. No biggie.

My third was a c/s due to transverse lie after SROM. When they cut me open the doc had a hard time getting her turned to come out because the cord was around her neck twice and around one leg. He said it was a very short cord. I feel like maybe the reason God allowed her to turn was so I'd have the c/s.

I think cords can be a big deal or no big deal at all. Just depends.


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## crazy_eights (Nov 22, 2001)

Quote:


Originally Posted by *twinangels04*
(and yes mom2six, continual Bx hicks was a sign for me, they felt different from regular bx hicks though, it was more of an all day tightness which was sometimes painful):.

I want to start by saying I'm really sorry for your loss. Such a horrible, horrible thing.

In this area, standard care for mono/mono twins is hospitalization at 26 weeks with continuous monitoring until delivery (some will only do it until 34 weeks as the risk of entanglement decreases after that), but that is relatively new. In just this past year I saw one 'crash' c/sec with mono/mono twins that got entangled and luckily the huge decel experienced by one twin was caught on the monitor. This is one case where all that high-risk care really pays off.

That being said, the website said 'BH contractions less than every 10 minutes'. That fits just about all women as they near term. I honestly can't believe that every woman in her 9th month of pregnancy needs daily NST's for B'H ctx. What you decribed as 'contant B'H', does not seem to be what they were describing. They seemed to indicate the frequent B'H ctx. were a risk in and of themselves to the baby, not that it was necessarily an indication of a problem. I've seen women on continuous monitoring, esp. those pregnant with twins that will contract every few minutes for days to weeks with no apparent harm to their baby.


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## mwherbs (Oct 24, 2004)

Quote:


Originally Posted by *pamamidwife*







, Keri. I didn't mean to insinuate anything.

and now, not related to you.....

(please don't read)

That website really disgusts me. It symbolizes everything that is wrong with modern childbirth. I really feel physically ill after reading it.

I agree with you pam, a few years ago we saw this web site and wrote and complained to no avail. Where is the art in this kind of care? every woman in pregnancy may experience one or more of the things he suggests including the heart rate-- he gives too little information and too broad a swipe at what might be dangerous-- as he would have it all women would be under constant monitior and NSTs and I have certainly seen a trent toward this in the local hospitals- docs no longer have a mom come to the office for anything, they go to the in-hopsital testing area/triage and are given NSTs or what ever other testing....
to note that Sister Angela had instuted using kick counts starting at 28 weeks in her high risk population and that she decreased her still birth rate to 0 by using them- the change she used was in reduced movement noted by mom she did an in office NST where she listened and felt for movement with a fetal scope and charted it by hand if still questionable she would send a mom in for an ultrasound or further testing--


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## MoonStarFalling (Nov 4, 2004)

Greaseball - I suspect I was denied an autopsy because I was on Medicaid and because the hospital was afraid they would be found at fault. Even though I offered to pay for it myself, I was blown off. I believe they were scared because I sat in the ER in preterm labor for 4 hours before they agreed to check me. When they finally checked me they got a hb (mine) and told me all was well I could go home. I demanded an u/s, which I finally got, that revealed our daughters had died.

To everyone else who has mentioned that these particular "symptoms" are present in any pregnancy: It's all about instinct as you mentioned coleslaw. My instincts told me something was wrong, thus is why I went to the ER. When they talk about hiccups being abnormal, they're talking about the baby having hiccups for hours. When they talk about BH, well it's just unmistakable. The BH I had were constant and didn't feel normal to me, I new something was wrong. The hyperactivity/inactivity mentioned is in reference to a baby that is normally docile but suddenly becomes frantic or an active baby that suddenly cannot be motivated to move.

Mom2six, that is the standard of care for momo twins here also. However, since I declined the routine u/s we had no idea we were having momo twins. Even daily NSTs or constant EFM doesn't guarantee a live baby in some cases. I definitely don't agree with everything Dr. Collins recommends. However, his research is an asset because he is one of only a few researching stillbirth. I don't think NSTs are the absolute answer. I think the mother's instinct is most important. In my circle, I know too many mothers (myself included) that knew something was wrong but were denied monitoring. Too many times we're treated as nothing more than an overly nervous pregnant woman. That's why I believe UP and midwife care is so essential. It's important to be connected to your baby not just relying on a machine to tell you everything is okay.


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## mwherbs (Oct 24, 2004)

twinangels04 I am sorry for your losses and agree that if you felt something wasn't right you should have been listened to.
I also think that there are many docs and researchers out there looking at stillbirth- I recommend looking at and searching web sites like Pub Med that will net you many abstracts reflecting published articles from around the world.
there are also some very specific web sites out there that deal with momo twin issues- and cord entanglement is a big problem for these babies as is twin-to-twin transfusion syndrome , because these babies share the same bag and the same placenta-- the estimates are 40-70% will have a problem but the frequency of momo twins is pretty small 1 in 25,000 to 1 in 60,000 pregnancies. I agree that these pregnancies should be closely monitored and followed ----


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## mandalamama (Sep 1, 2004)

i was going for natural childbirth with my daughter, even though we were in a hospital things were going really well (having 2 doulas and a pro-natural labor nurse helped of course). we needed a c-birth because i kept going in and out of transition, the baby never dropped below -3 yet i'd be nearly fully dilated and then go back down to 6cm, 4cm, confusing! turned out she has a *short* cord wrapped twice around her neck. i had no labor interventions, except at 26 hours *i* requested AROM to see if i could help the baby move downwards by getting on my hands and knees, or squatting and rocking. we went for "slow" AROM with careful positioning to avoid prolapse. the baby didn't move down any further.

total, i labored for 30 hours, and i have no idea if she was already wrapped up when i went into labor, or if something i did during labor caused her to wrap







i was moving around a LOT, getting comfy in any position i could, it didn't feel like she was twisting but who knows. her head was dipping down and dilating my cervix during contractions but then bouncing back up again. we are very, very, very lucky she didn't drop past -3, because that short cord could have become an issue, i believe.

another weird thing ... she started showing major signs of distress at 29 hours and my fluid began to show a LOT of meconium (that's when we rushed to surgery) ... yet when born, she didn't have a drop of it in her lungs! the dr. and my labor/surgical nurse both said they think the cord prevented her from swallowing meconium in utero. *shrug* i'm just really glad i had the chance to labor normally, but also had the option to go for the surgery when things went wrong so quickly. i still feel sad i didn't get the vaginal birth i wanted, and especially sad we didn't get to leave the cord attached as long as possible (which the hospital had agreed to, if it had been a normal birth).


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## MoonStarFalling (Nov 4, 2004)

Quote:


Originally Posted by *mwherbs*
I also think that there are many docs and researchers out there looking at stillbirth- I recommend looking at and searching web sites like Pub Med that will net you many abstracts reflecting published articles from around the world.
----

As I stated before, I've written several articles and done hundreds of hours of research on stillbirth and it's causes. Occasionally a survery will be put out for parents, looking at stillbirth experiences. However, there just plain isn't any real scientific research! That's what's so astounding. Everyone just assumes there's research being done. But it's not.

Quote:


Originally Posted by *mwherbs*
there are also some very specific web sites out there that deal with momo twin issues- and cord entanglement is a big problem for these babies as is twin-to-twin transfusion syndrome , because these babies share the same bag and the same placenta-- the estimates are 40-70% will have a problem but the frequency of momo twins is pretty small 1 in 25,000 to 1 in 60,000 pregnancies. I agree that these pregnancies should be closely monitored and followed----

Yes, one of those websites is mine.

Quote:


Originally Posted by *mwherbs*
I agree that these pregnancies should be closely monitored and followed
----

I chose not to and would do the same again.


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## Galatea (Jun 28, 2004)

I know this is late but I just saw the thread.

Ds had a true knot that we didn't know about until I delivered the placenta. Ds was fine and had no decels so I guess he had enough jelly to keep it flowing.

My sister's 1st son didn't move hardly at all in the last trimester. He was always high up on the right side. She went into labor at 41+ weeks and never progressed very far. The baby simply wouldn't descend. They did a section and discovered his cord was nuchal x 4 and there was no slack for him to descend. He had aspirated a lot of meconium by this time and was in the NICU for awhile. He is fine now. He truly would have died without the section.


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## mwherbs (Oct 24, 2004)

Quote:


Originally Posted by *twinangels04*
As I stated before, I've written several articles and done hundreds of hours of research on stillbirth and it's causes. Occasionally a survery will be put out for parents, looking at stillbirth experiences. However, there just plain isn't any real scientific research! That's what's so astounding. Everyone just assumes there's research being done. But it's not.


So the web site you recommend the doc doesn't do much research himself he collects info written by other care providers and has written his own interpretation of that research that is why the paper has about 600 references-- I say read the references--- and come to your own conclusions... I haven't read all of them but much of the info I have read and come to different conclusions.


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## eilonwy (Apr 3, 2003)

My daughter was born by emergency c-section for cord prolapse; she turned breech at 39 weeks, broke the water and the cord slid down first, followed by her feet. It was all very sudden; I wasn't having any contractions at all, hadn't had a particularly stressful day, nothing extraordinary happened at all until she turned. My waters don't break in the usual way, they seem to just dribble out a teensy bit at a time until there's nothing much left. I think that may have played a role in the cord staying where it had dropped, but there was nothing I could have done about that. It was just a freak accident, there was no way to know in advance that it might happen, and there was nothing that anyone could have done to prevent it. She's fine today, and I have reasons to believe that she might not be fine if I hadn't had the section when I did.

I had an *extremely* long cord when I was born (about 8 feet). It was wrapped around my neck twice, and around my body several times. I shot out like a watermelon seed and was caught by a terrified third-year medical student by one foot. :LOL No brain damage (I don't think so, anyway) but I did have blue extremities. My mom says that it was because the room was freezing and she was ravenously hungry at the time (lunchtime). The nuchal cord wasn't a big deal, because it was freakishly long and I was born very quickly.


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## CarrieMF (Mar 7, 2004)

My youngest dd just about died due to a knot in the cord. I don't know when it all started. I had the routine US at 18weeks and they talked about doing another one later because they suspected IUGR(caused by the knot???). She was measuring 2 weeks behind my dates(had bt's at the beginning of the pregnancy) I fell at 30weeks due to my stupidity, though I wonder now if it was my subconscious. I went into preterm labour, they did a NST, and an US(again measuring 2 weeks behind), all seemed fine. She went from normal movement to frantic movement. At 34 1/2weeks we had sex(wasn't supposed to until 35weeks) and I immediatly started bleeding and she stopped moving. I did my usual things to get her to move and nothing worked, convinced I'd killed her(I'm normally not a paranoid person) we went to the hospital. They never found a cause for the bleeding, she seemed fine and I started NST's twice a week. They were still talking about doing another US later. Her movements went from frantic to barely there. At my 36week NST I purposely went after I had finished my big shopping day because I knew I'd have the most contractions and after weeks of this I wanted someone to take notice that this wasn't normal. As soon as I was hooked up and had the first contraction her heartrate went down to 80. Same thing with the next one and then it seemed to correct itself. The nurse came in and left me on for longer because they(late decels) were still there just not as noticeable. The dr scheduled a biophysical for in 3 days. At this US she was now measuring 3 weeks behind. To pass that the tech had me move from side to side for 15minutes to get enough movement out of her. Because I passed that they stopped the NSTs. AT 40weeks(in reality I was 42weeks but that's a different issue) my water broke, in spite of all my contractions I didn't go into labour but the decels were there with every contractions. The next day they hooked me up to pit to augment and the first 2 contractions the hr went down to 50. They called a surgeon in but he wanted to leave it for a while. At 3 I was finally kicked into labour. At 3:50 I felt like I was in transition but there was no change. They turned everything off and called the surgeon back to do a c-section, while they were gone her heartrate went down to 13. At 4:30 he arrived I was 2-3cm, 60% effaced and he could push her head out of my cervix. She was born at 4:47 vaginally. I was laying there while they were shaving me and the nurse handed me a drink for the anesthesia, I waved it off because I had a contraction. I breathed the gas in and started pushing. I didn't know I had to push. She ended up getting stuck adn the dr pulled her out with his hands, then left with her. My dr had never done that before. When I started pushing I had convinced myself she was dead, it took me 3 weeks to accept she was alive. Her apgars were 5 & 9, she was on O2 and monitoring for the first 24hours. I have pics fo the knot around here somewhere.

The drs said her cord was long and that's probably was caused the knot(twisting and such) but also what saved her. Had it been shorter it would have pulled tighter.

There was nothing I could have done to prevent it and with the technology available here there was no way to see it on any of the US's I had.

The drs and nurses in the room at delivery all said "Lucky Baby, Lucky Parents". IMO they should have added "Lucky Dr", even though they couldn't have predicted the knot according to tests done at the beginning of the pregnancy I was 2 weeks further along than they thought. when I went into preterm labour the 2nd time they put me on bedrest to stop it because they don't deliver here before 35 weeks, in reality I was 36 1/2weeks. All the little things alone didn't suggest any problems, but together I knew there was something wrong. I believe even dh could tell, he didn't want anyone knowing I was pg until I was over 20weeks.

She was 6lbs 5oz & 19.25" at what was really 42weeks. She is 3 now and is 27lbs, 32". She has had developmental delays her entire life, she had an immature intestinal tract and is now waiting testing for possible behaviour issues. She is OCD and most likely has some SID, she probably has Speech Apraxia too. She does some very weird things. I finally have someone who thinks that her lack of O2 in utero and during labour is probably the cause of her issues.


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## mandib50 (Oct 26, 2004)

first to the mamas who lost their precious babies, i am so so sorry!!

secondly, wow, i'm surprised. i never even really considered cords to be an issue unless it was prolapsed. one of my son's (homebirth) had a cord around his neck and was fine. my other son was born with the cord wrapped around his body and he did have some decels during pushing but nothing i felt intuitively concerned about. i just wanted to pull him close to me as soon as he was born but couldn't until he was unwrapped from his cord.
thanks for the food for thought.
mandi


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## crazy_eights (Nov 22, 2001)

One of my neighbors has a similar story - her son had a true knot, but all they could see was the IUGR. She was admitted to the hospital and monitored daily. At some point they decided the baby was not growing at all and delivered him. I believe he weighed 3 lbs. at 35 weeks or so? Tiny. They found 2 tight true knots at delivery. Anyway, he is 8 today and about the size of a 4 or 5 year old and is being treated with growth hormones.


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