• Unassisted birth and cord prolapse

    Date: 2011.04.07 | Category: Unassisted Childbirth | Tags: ,,

    Cord prolapse is an urgent emergency during childbirth during which the baby’s umbilical cord either presents first, before the baby does (overt prolapse), or presents alongside the relevant part of the baby (occult prolapse). Because the baby relies on its umbilical cord for oxygen before birth, and cord prolapse results in its compression, it is a situation that can easily be fatal. How do you handle a cord prolapse during an unassisted birth? What are the risk factors? And how should cord prolapse factor into your decision making while planning a freebirth?

    A cord prolapse is one of those few emergencies that should scare the cr*p out of any laboring mother or birth attendant. With an overt cord prolapse, fetal hypoxia, brain damage, and death can occur within an extremely short period of time. In a hospital setting, a cord prolapse usually results in a crash c-section. It is important for unassisted birthers to be aware that a cord presenting before the baby is an immediate danger. Should this happen to you, there are two things you can do. Neither option is ideal, and neither gets your baby out of the danger zone. Let’s take a look at both possibilities:

    What to do in case of cord prolapse

    1. Move into a bum-up position right away. Have someone insert their hand in the birth canal and hold the baby away from the cord to prevent its weight from cutting off oxygen supply, and call 911 immediately. The same position, illustrated below (credit: Global library of women’s medicine), should be maintained until you reach the hospital – that is, you should ride in the ambulance in this position.

    2. If your baby’s birth is truly imminent, and you are sure that you will be able to get him or her out in a matter of minutes, PUSH with all your might. Whether you choose option one or option two is literally a split-second decision. Both options are extremely dangerous – that is, once cord prolapse occurred, there are no favorable options. If you decide to get your baby out immediately rather than calling an ambulance, waiting for it to arrive, and waiting the time it takes to get to the hospital and the OR, realize that the cord will be compressed as the baby passes it. Babies can be born healthily in both situations, but the risk is huge.

    Cord prolapse risk factors

    Cord prolapse occurs in one to six births per 1,000. Risk factors include but are not limited to waters breaking early in labor, having a premature baby, polyhydramnios (an excess of amniotic fluid) and a long umbilical cord. What is also extremely interesting is that the risk of cord prolapse significantly increases for breech babies. Let’s take a look at the statistics (source: patient.co.uk):

    • 0.5% cephalic and frank breech presentations.
    • 5% complete breech.
    • 15% footling breech.

    This, I think, tells you that women planning an unassisted birth should be extremely aware of their baby’s position at all times, and factor in the additional risks abnormal presentations involve. See fetal position and unassisted homebirth for information on how to go about this. In addition to fetal palpation, a late ultrasound is another option to determine position. Many babies change their positions extremely late in pregnancy, and even during labor. It is, therefore, useful to know to palpate your uterus to find out your baby’s position.

    A transverse lie, in which the baby is positioned sideways, is another risk factor for cord prolapse. BUT since transverse babies cannot be delivered vaginally anyway, you should already be having a c-section if your baby is transverse.

    A real story of cord prolapse

    Rixa Freeze published the story of a family who suffered a cord prolapse at home and then transferred to hospital on her fantastic birth blog. This family and their baby Apollo were, above all, very lucky. Knowing what a cord prolapse can look like in a real situation might be informative. Note that this mom’s waters broke before her labor started; one of the risk factors for cord prolapse.