A midwife’s responsibility is to ensure families are educated and have access to unbiased and evidence-based knowledge to support their journey into parenthood. This not only allows parents to make informed and educated decisions, but it also empowers families to feel confident and have an understanding about situations that may arise during pregnancy, birth and postnatally.
During my antenatal classes, when I talk about the anatomy of the mother and baby, I receive many curious questions from expectant parents about the placenta and the umbilical cord. Most questions are related to delayed clamping and cutting of the umbilical cord (I will write about this in a future blog) but the question that plagues people mostly is “how does the cord not wrap around my baby when my baby is constantly moving, turning and tumbling?”. Let’s break it down to understand the umbilical cord.
The umbilical cord connects the baby to the placenta, which is attached to the mother. All nutrients, oxygen and waste products travel between the mother and baby via the umbilical cord which houses the important life supporting blood vessels. The coiled-like umbilical cord is approximately 60cm long, although every pregnancy and woman is different. As a midwife birthing babies, I have seen cords twice that length as well as ones that are a little shorter. Your midwife will observe the length and presentation of the cord as baby is born and placed skin to skin. Other assessments conducted include evaluating the thickness of the cord, the three blood vessels and the colour, which represents the blood flow in the cord.
The precious blood vessels of the umbilical cord are protected by Wharton’s Jelly, a substance that provides an armour designed to ensure the blood flow between mother and baby is less likely to become compromised. Most babies are born with the cord around them and is not generally alarming as the midwife gently unravels the cord as the baby is born. A comprehensive study (Peesay, 2017) identified that 10-29% of babies have a nuchal cord (the umbilical cord wrapped around the baby’s neck) at birth, but most are not associated with adverse complications. As midwives, we are trained to manage a nuchal cord when it fails to naturally unravel itself and management is associated with the observations made by the midwife during the labour and birthing process. The anatomy of the umbilical cord is naturally designed to handle the twists and turns of the baby.
On rare occasions a true knot (an entwined section of the umbilical cord) may be detected. Research (Ikechebelu et.al, 2014) has reported an incidence of 0.3% to 2% of true knots in umbilical cords. The prevalence of a true knot is increased in earlier gestations when there is more amniotic fluid present in comparison to baby’s size. The most important advice for mothers is to ensure continued regular antenatal visits to discuss any complications that may arise with a true knot. The photo below demonstrates a true knot and highlights the blood flow still evident. However, during the birthing process this may become tighter and compromise the blood flow to the baby. A detected true knot may indicate that baby requires close monitoring during the birthing process.
Most nuchal cords and true knots are detected during ultrasounds. The red and blue flowing flashes on the ultrasound screen represents the blood flow through the umbilical cord and assists your health professional to determine the effectiveness of the umbilical cord to nourish and nurture the growth of your baby. This with many other factors, such as the size of your baby in relevance to your gestation, is the evidence health professionals need to support pregnancy assessments. Antenatal appointments, midwifery education and obstetric visits are crucial to ensure families are informed and provided with information to reduce apprehension by providing additional support and advice when needed.
Be Prepared. Be Confident. Be Empowered. By Midwives.
BirthHQ Midwife, Nurse, Educator & Mum of three
Peesay, M., 2017. Nuchal cord and its implications. Maternal Health, Neonatology and Perinatology, 3(1).
Ikechebelu, J., Eleje, G. and Ofojebe, C., 2014. True umbilical cord knot leading to fetal demise. Annals of Medical and Health Sciences Research, 4 (8), p. 155.