A nuchal cord is when the umbilical cord wraps around a baby’s neck. It is a frequent finding during pregnancy and birth. In the vast majority of cases, a nuchal cord does not lead to complications for the baby or the birthing parent.
Understanding a Nuchal Cord
A nuchal cord refers to the umbilical cord encircling the fetus’s neck by at least 360 degrees. The umbilical cord delivers oxygen, blood, and nutrients from the birthing parent to the fetus, and carries away waste products. It is encased in a protective substance called Wharton’s jelly, which helps prevent compression of the blood vessels.
This condition is common, occurring in 10% to 30% of births. A single loop around the neck is most frequent, affecting up to 25% of babies, while multiple loops occur in about 2.4% to 8.3% of births. In many instances, especially when the cord is loosely wrapped, it does not cause any issues.
How a Nuchal Cord Forms
Nuchal cords form due to the natural movements of the fetus within the womb. Babies move in the amniotic fluid, and during these movements, the umbilical cord can inadvertently loop around their neck. Factors that may increase the likelihood of a nuchal cord include an unusually long umbilical cord, which provides more length for entanglement, or excessive amniotic fluid, allowing for more fetal movement.
Nuchal cords are random occurrences and are not caused by anything the birthing parent does. There is no way to prevent them, as they are a consequence of normal fetal activity and the uterine environment. In many cases, a nuchal cord that forms during pregnancy may even resolve itself before birth as the baby continues to move.
Identifying and Managing a Nuchal Cord
Healthcare providers can sometimes identify a nuchal cord during prenatal ultrasounds. However, identifying a nuchal cord via ultrasound does not necessarily indicate a problem, as many are loose and cause no issues. Often, a nuchal cord is first discovered during labor and delivery.
During the birthing process, healthcare providers routinely check for the umbilical cord around the baby’s neck once the head is delivered. If a loose nuchal cord is found, it can often be gently slipped over the baby’s head. If the cord is too tight, alternative techniques are employed.
One common strategy is the “somersault maneuver,” where the baby’s head is gently guided towards the birthing parent’s thigh, allowing the body to be delivered while keeping the cord close and preventing undue tension. In situations where the cord is exceptionally tight and cannot be unwrapped, it may be clamped and cut before the rest of the baby’s body is delivered. This action ensures the baby’s safe passage.
Addressing Concerns About a Nuchal Cord
Serious complications from a nuchal cord are rare. The protective Wharton’s jelly within the umbilical cord helps to cushion the blood vessels, preventing compression. Babies do not breathe air in the womb; they receive oxygen and nutrients directly from the placenta through the umbilical cord, so a nuchal cord does not “strangle” them.
While a tight nuchal cord can, in rare instances, lead to temporary issues like changes in fetal heart rate during labor or mild signs such as facial discoloration after birth, these are typically not severe and resolve quickly. Healthcare teams are well-prepared to monitor for any signs of fetal distress and can intervene promptly if needed. The overwhelming majority of babies born with a nuchal cord have excellent outcomes and experience no lasting health issues.