Here is what you need to know - nuchal cords are surprisingly common and unlikely to cause problems during pregnancy or at birth. Reports tell us that almost 20 to 30 percent of all deliveries involve a nuchal cord. In recent global Obstetrics and Gynecology, it has been found that most babies do just fine when one is present.

Be assured: nuchal chords are surprisingly common and unlikely to cause problems during pregnancy or at birth. 

Around 1 in 2,000 births will have a true knot in the chord, in which case there are some associated risks. Even in these cases, it’s rare for the chord to tighten enough to become dangerous.  

Most babies with a nuchal cord had just a single loop around the neck. Fortunately, there was no increased risk for growth problems, stillbirth, or lower Apgar scores.

What is a nuchal chord? Is it a cause for worry?

An umbilical chord that is wrapped around a baby's neck in the womb is called a nuchal chord. 

We all know that the umbilical chord is a lifeline for a baby. Running from the baby's abdomen to the placenta, the umbilical chord usually contains three blood vessels It provides oxygen, blood, and nutrients to the developing foetus. It is about 21 inches long.

What causes nuchal chord?

It is truly random. The baby moves around quite a bit and that may end up in the chord wrapping around its neck. 

You may also be more likely to get a nuchal chord if:

1. you’re having twins or multiples
2. you have excessive amniotic fluid
3. the chord is especially long

10 Facts to Know About Nuchal chords:

Fact 1: There are three ways of classifying nuchal chords:

Firstly, it is based on how many times the chord is wrapped around the foetal neck which leads to the terms single nuchal chord, double nuchal chord, etc.

Secondly, it is determined whether it is wrapped loosely or tightly. A “tight” nuchal chord is defined as one that cannot be slipped over the baby’s head during delivery, and may compress the fetal neck.

Thirdly, the nuchal chord can be Type A or Type B:

A Type A nuchal chord is “unlocked.” The umbilical end goes under the placental end, and fetal movement can easily undo it.

A Type B nuchal chord is “locked.” The placental end of the chord goes under the umbilical end of the chord, potentially leading to another type of umbilical chord complication known as a “true knot.” This will not likely be resolved by foetal movement.

Fact 2 : Nuchal chords are common. Doctors watch them closely during birth and change the birth plan based on whether they are loose or wound tightly, wrapped more than once around the neck, or “locked.”

Fact 3: The chord is not easily pressed or damaged. A normal, healthy umbilical cord is filled with Wharton’s jelly, a soft, gelatinous substance which protects the blood vessels inside the cord. This substance helps to protect the cord against compression as well as true knots as a result of the baby’s normal movements. While doing your visualization exercises, do imagine the chord as a strong entity in which the blood vessels are safe.

Fact 4: A nuchal cord does not get tighter as labour progresses. It’s not like the baby is descending down during labour and the chord remains up there. It also moves with the baby from the fundus (top of the uterus), so does the placenta. When the mum is having contractions, it means that the uterus is  ‘shrinking’ down (contracting) moving the baby downwards, along with their attached placenta and chord. 

It’s not until the baby’s head moves into the vagina, that a few extra centimetres of additional length are required. But, truly, nuchal chord causing a disruption is quite unlikely. Some women say their baby’s heart rate was dropping when they were pushing. This is quite normal behaviour for a baby experiencing pressure around the head and the chord is not the reason.

Did you know that giving birth in an upright position can help to reduce the pressure on baby's head?

Fact 5: To see a nuchal chord, your doctor will take many ultrasound images from multiple angles. Otherwise, a nuchal chord may be misdiagnosed as foetal skin folds, amniotic fluid pockets, posterior cystic neck mass, or even a chord that is simply near the foetal neck but not encircling it. Color Doppler imaging is also more accurate at detecting nuchal chords than grey-scale ultrasounds.

Fact 6: Just because there is a nuchal chord early in pregnancy does not mean that it will still be there at-term. Nuchal chords may form, become undone, form again, etc. If the nuchal chord is “locked,” however, it will not become undone.

Fact 7: As you approach your delivery date, your doctor will study the loops and tightness of the nuchal chord to take next steps. So, do let your doctor make the right decision and don’t google worst-case scenarios.

In a study of 2530 women 23.5% had a nuchal chord and of those only 1.9% had a tight nuchal chord.If a nuchal chord is loose and the foetus is not showing signs of distress (an abnormal heart rate, lack of movement, etc.), doctor routinely slip the chord over the head during delivery. 

Sometimes, doctors move the chord down over the shoulders and deliver the baby through the loop. 

If the head has already been delivered and the chord is too tight to slip over the head or shoulders, doctors may attempt a “somersault delivery.” They push the baby’s head toward the mother’s thigh (as opposed to pulling the baby straight down). This allows the shoulders and the rest of the body to be born in a somersault, and keeps the neck near the birth canal so that the nuchal chord is not stretched and further tightened. They can then unwrap the nuchal chord.

In cases where a tight nuchal chord is diagnosed prior to delivery, especially if there are accompanying signs of foetal distress, your doctor will recommend a c-section.

Fact 8: Nuchal chords can disrupt the flow of oxygenated blood to the baby but with proper management at birth, any damage or deficits can be avoided. In a study, it was found that babies with with a tight nuchal chord had lower APGAR scores at 1 minute, that by the 5 minute APGAR score their results had improved significantly and the nuchal chord had no bearing on these results which suggests that the effects of a nuchal chord on a baby's health are transient and not long lasting.

Fact 9: Even if a baby sustains some damage because of a tight nuchal chord, it is still possible to minimize brain damage. A treatment known as therapeutic hypothermia, also sometimes called “cooling therapy,” can allow infant brains to recover after an oxygen-depriving injury. Although hypothermia therapy is not a complete cure, it has been shown to significantly reduce the extent of brain damage that infants suffer after birth injuries.  

Fact 10: Delayed chord clamping is a good idea 

If a baby has in 'foetal distress' during labour or who had a tight nuchal cord during birth, the doctors can choose to let clamp their chord after a delay Leaving the baby attached to their placenta after birth allows them to receive all of the blood from the placenta, and in this blood is increased oxygen. So whilst your baby may already be taking breaths, the benefits of your baby receiving their full placental blood and stem cells is almost immeasurable  

Mums, thankfully, as more research is done into nuchal cords, and as more babies are delivered safely and without complication with nuchal cords being present, babies and mums don’t have to worry.

‍

Stressed about nuchal chord diagnosis? Here’s help!

Mum, while the reason for your stress might not go away, there are some things that you can do to manage your stress quite effectively. Here are some suggestions: 

Relaxation & Yoga Nidra for Pregnancy -

• Try side shavasan and get support from bolsters.
• While in Shavasan, do a 10-15 minute body scan with breath awareness.
• Listen to a short yoga nidra of ten minutes or a full length yoga nidra of 30 minutes. 

Mantra Chanting -

• Try any holy chant/verse or hymn. 
• It creates positive, calming vibrations, improves focus and concentration, removes stress and tension and creates a positive environment.
• Chanting will help to withdraw all your distracted senses, internalising the mind very quickly.

Breath awareness -

This simple form of meditation is a good preparatory technique and can be used before other forms of meditation. It can also be practised alone as a meditation for as long as is comfortable. 

• Sit in a comfortable position. Keep your body stable, shoulders relaxed, chest  open and eyes gently closed. 
• Play some calming music.
• Become aware of the breath. Notice if it is shallow or deep. Notice what part of the body is moving, the abdomen or the chest. 
• Notice if there is any sound with the breath. 
• Try to focus only on the breath. Try to become aware of the temperature of the breath.
• When the air is inhaled, it is a little cool, when it is exhaled it is a little warmer. Notice the difference.
• Notice if the breath is becoming smoother and deeper. Notice if there is any strain. Be aware only of the breath.
• Follow the breath with the inhalation and exhalation. Try to focus only on the breath. Continue with this practice for as long as is comfortable. 

Nature awareness & nature walking-

• Nature walking is a meditative technique that has powerful properties to calm.
• Even just looking at a tree, a leaf, a flower, a bird, noticing how perfect nature makes each and everything in this world. It can bring great peace and happiness. Instead of nature walking you might prefer to sit for meditation on a rock or under a tree, sing songs or just observe life.

iMumz is here to comfort you at every stage. Remember, the calmer you are, the healthier your baby will be.

The iMumz Womb Care Program offers daily yoga, lifestyle tips, and expert-led classes for making your womb a better place for your baby. It comes with a panel of coaches to be by your side and make your journey amazing.