Cord traction is a procedure performed during childbirth to assist in the delivery of the placenta, the organ that provides nutrients and oxygen to the baby during pregnancy. This intervention helps to expedite the third stage of labor, the period after the baby is born until the placenta is fully expelled.
What is Cord Traction?
Cord traction refers to the controlled pulling of the umbilical cord to facilitate the expulsion of the placenta from the uterus. During this stage, some blood loss naturally occurs as the placenta separates from the uterine wall.
The purpose of controlled cord traction is to reduce the risk of postpartum hemorrhage (PPH), which is significant blood loss after childbirth. PPH is a serious complication. This technique is often a component of “active management of the third stage of labor” (AMTSL), a set of interventions designed to prevent excessive bleeding. AMTSL includes administering a uterotonic drug, such as oxytocin, early cord clamping, and uterine massage, in addition to controlled cord traction.
How Cord Traction is Performed
The procedure of controlled cord traction requires specific training and is performed by skilled medical professionals. It begins once the uterus shows signs of contraction, typically two to three minutes after a uterotonic drug has been administered. The umbilical cord is clamped near the perineum, and the practitioner holds the clamped cord.
With the other hand, the practitioner places their palm on the lower abdomen, just above the woman’s pubic bone, to apply counter-pressure to the uterus. This counter-pressure is important to stabilize the uterus and prevent it from turning inside out. As a strong uterine contraction occurs, the practitioner gently pulls downward on the cord while maintaining the upward counter-pressure on the uterus. This simultaneous action helps to guide the placenta out through the birth canal. Gentle twisting of the placenta as it delivers helps to ensure the membranes come out intact.
Potential Risks and When It’s Avoided
While controlled cord traction is a widely used procedure, it carries potential risks if not performed correctly or if certain conditions are present. One serious but rare complication is uterine inversion, where the uterus turns inside out. This can occur if too much traction is applied to the cord without adequate counter-pressure on the uterus, or if the uterus is not sufficiently contracted.
Another potential complication is cord avulsion, where the umbilical cord tears away from the placenta while the placenta remains inside the uterus. This can happen if the cord has an anatomical anomaly, such as a velamentous insertion. If the placenta is not fully separated from the uterine wall, pulling on the cord can lead to this tearing.
The procedure is avoided or approached with caution in specific circumstances. If there are no clear signs of placental separation, such as a gush of blood or lengthening of the cord, applying traction can increase the risk of complications. Conditions like suspected placenta accreta, where the placenta is abnormally attached to the uterine wall, are contraindications for cord traction. In such cases, attempting cord traction could lead to severe hemorrhage or uterine damage. Clinical judgment and continuous monitoring of the mother’s condition are essential in determining the appropriateness of this intervention.