The Problem with Umbilical Cords…

By Lindsey Wimmer, MSN, CPNP

Going through my email today, I had three notes from three different parents sharing their stories of umbilical cord issues.email

The first was a father wanting advice for helping his wife after she had recently delivered their stillborn child at 41 weeks.  The cause was determined to be a cord accident.

The second was a woman asking for prayers for a friend’s newborn child. During delivery, the umbilical cord was compressed and the child suffered hypoxia (lack of oxygen).  The baby is currently in the NICU undergoing body cooling in an attempt to reduce the swelling in his brain.

The third was a woman who recently delivered a baby in Japan.  Ultrasounds were a routine part of every prenatal visit during the third trimester.  At the 36 week visit, they noticed the baby had several umbilical cord wraps around the neck and arm.  Her OB showed her the concern, they did some extra tests to identify if the baby was in any distress, and then a cesarean section was scheduled at 38 weeks of gestation to avoid the baby having complications from the umbilical cord issues during a vaginal delivery.  She said it hadn’t occurred to her that her pregnancy might have been managed differently in the US.

A few major problems stand out to me with these stories.

bean scratching head

Families are told every day that umbilical cord issues don’t cause problems.  Yet, this is also the most common answer families are given when they ask why their child was stillborn.  This hypocritical approach is not acceptable.  If cord issues truly cause birth injuries and death, then that needs to be recognized, accepted, communicated, and addressed.  If they don’t, we need to stop attributing such a large number of poor outcomes to this cause.  It is true that many babies are born healthy despite umbilical cord issues, but this is not the same as saying the cord issues aren’t a cause for concern.

please don't say you cantProviders will often say cord problems are not concerning, but what they actually mean is that they don’t think they should alter the plan or don’t know what to do differently – so they simply offer false reassurance.  In the event of a poor outcome, a cord issue might really be the cause, but “cord accident” may also be the easy answer because it is accepted as something that “nothing” could be done about.

The woman from Japan proves that cord issues can be addressed.  It is impossible for us to guess if she would have had a poor outcome if they had chosen a different approach, but she and her providers chose not to gamble with her child’s health/life and took a route that they believed offered the least amount of risk.  This does not seem that radical to me.  I had similar thoughts and questions during my subsequent pregnancies.  My children all experienced different types of complications that were only identified because I was considered ‘high-risk’ (and that was only because of my previous stillbirth).  Each of these complications were managed and monitored closely.  They were delivered when the risks and benefits of their issues and prematurity flipped so that they had a greater likelihood of survival outside my womb than in it.  And they are all 3 happy, healthy beautiful children today.  Again – no way to know what the outcome would have been otherwise.  I’m eternally grateful for their health, I’m scared when I think about what other outcomes were possible, and I can’t help but wonder if their oldest brother would have survived if he had received the same level of care.

Likewise, we have no way of knowing if recognition of the cord issue could have prevented the stillbirth of the child in the first email.  But these are what-ifs that this family (and many of us) will live with for the rest of their lives.  The providers may be left with the same questions, How many babies MIGHT we be able to save or improve the outcome for if we identify potential problems before the mom or baby is symptomatic?Dr. Seuss don't give up

In the email from Japan, the cord issue was identified because she had a level of care that is not routine in the US and the provider was willing/able to offer a management plan that is not readily accepted in the US.  Americans have insurance companies wanting to reduce the number of tests and procedures, lawyers wanting to eliminate provider liability, and special interest groups pushing their agendas into the medical decision making process of families, providers, and hospitals. The baby in the NICU is a perfect example that everyone involved might have benefitted from knowing in advance about a potential cord issue and management beyond watching and waiting.  The stress, costs, and potential long-term effects for this child/family make some extra tests and a possible c-section seem pretty minor. The family who experienced a stillbirth didn’t know what cord issues could do or that they might be preventable until after their child had died.   The family in Japan was shown the potential issue and allowed to have a discussion with the provider about any risks and benefits of various options.  Together, they developed a plan that they felt comfortable would reduce the risk as much as possible.  Again, this seems rather simple to me.

I routinely hear stories of heath care professionals opting not to look for or to tell families (if they did look) about potential umbilical cord issues.  Their rationale is this – “Why scare the family when I can’t do anything about it?”  This is unbelievable. The family has a right to know regardless of the options.  Most people are understanding and realistic about what medicine is able to provide.  This would not be the first time that families are given information about a diagnosis that doesn’t have easy options.

But the next, obvious question is – why can’t we do anything?

I understand that we may not be able to unwrap a nuchal cord or undo a knot in the cord.  But we can manage the pregnancy differently from that point forward.  We do it every day with many other issues.  Why not this one?  When we see sensational stories on the news about significant anatomical abnormalities that are corrected in utero, it seems unreal that we throw our hands up when it comes to issues like cord and placenta issues.

Medicine is not black and white. 

What works for one person may not be the best solution for another. 

  • frustrated beanI am frustrated by recommendations and policies that assume all situations to be identical.
  • I am frustrated by providers choosing to keep their heads buried in the sand instead of looking for warning signs or risk factors because it makes their job easier or reduces their liability or because the odds are in their favor.
  • I am frustrated by health care professionals not involving families in health care decisions after an honest discussion of all information available.
  • I am frustrated by insurance companies or other parties influencing medical decision making more than the physicians and the families directly impacted.
  • I am frustrated by providers, organizations, and policies that ignore the fact that obstetrics is monitoring the health of TWO patients.

To me – these are some of the real problems with umbilical cords…and too many other causes of miscarriage, stillbirth, birth injury, and neonatal death.

We need more providers who are willing to do what makes sense

for their patients with their patients. 

We need more families to communicate their desires. 

We need more awareness of these issues so that every baby, mom, and family

get the absolute best that medicine can provide.

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  1. March 11, 2014 at 3:48 pm

    Thank you for this post and for articulating so many of my thoughts and frustrations. Everything seems so complicated, yet it really is simple, isn’t it? Treat every mom and baby as individual patients with unique needs. Like I’ve said before, every baby should be treated like a royal baby.

  2. March 11, 2014 at 4:02 pm

    Reblogged this on Job 1:21.

  3. March 11, 2014 at 5:10 pm

    Thank you so much for this! I just wish my providers had cared more about my life and the life of my unborn daughter to help prevent her death at almost 41 weeks. I am forwarding this article to my attorney who is looking into whether we can bring a case against my physician although from his standpoint, the case may not look good because physicians can get away with so much in the area of poor patient care these days. Sigh!

  4. Eileen
    March 11, 2014 at 8:06 pm

    I delivered twins at 37 weeks, my son is fine, my daughter was stillborn due to a knot in her umbilical cord. I did not know there was a problem until the day I delivered. We expected 2 healthy babies. I wish there was more focus on the umbilical cord (the lifeline). Thanks for sharing this post.

  5. Bobbie
    March 11, 2014 at 8:06 pm

    You raise some interesting points and hopefully those in the health care professions read this

  6. Latifa
    March 12, 2014 at 8:44 pm

    Thank you for sharing your thoughts through blog and website. I am truly blessed. There wasn’t a knot in my baby’s cord, but I was told maybe she was laying on it. (Oh okay) during my pregnancy I stayed on the physicians and became very frustrated when they would brush my concerns off. I do agree they need to be upfront on the bad that can happen in a pregnancy. I never heard of half of the bad things until it happened to me. When I would ask questions about the cord, I as always told that an ultrasound cannot visual pick up the location. Then what equipment can? Then I read articles that a lot if ultrasounds are bad for babies. Where I live every doctors office is a group. So each week you see a different doctor. Since they see so many patients in a day, you are just another pregnant woman and barely remembers my name. Whatever happen to “personal attention”. A mother is already worried about the health of her baby, therefore, it adds more stress when I have to do the doctors job too. Great insurance still doesn’t give you great care from doctors. Thanks again for the blog. You are a blessing!

  7. March 13, 2014 at 9:52 am

    I also was told that they would have never seen a cord issue because the ultrasound can’t pick it up. My son’s cord was wrapped tightly around his ankles. I am so thankful that you are focusing on this issue and raising awareness. I now know to ask for more, we are due to have another baby in August. I am very nervous about the last few weeks and will ask for extra ultrasounds to see if they can monitor the cord.

  8. lmz
    March 13, 2014 at 3:16 pm

    I love your details, and agree cord accidents to attribute to quite a few still births. But as a health care professional (25 yrs in OB) should we deliver a baby at 30 wks because there is a knot in the cord, or what we think we see as a knot. Then you have a very premature baby, with other health issues. I don’t want to sound uncaring as I am the grief coordinator at my hosp. as well, and run our support group, yet I wonder where do you draw the line. I can see it both ways, as I delivered lots of alive babies with cords. I guess I feel that sometimes people want doctors to play God, & that is not their role. I don’t think there is a real answer, or a right way.

    • March 14, 2014 at 9:01 am

      Thank you for your comments – and you raise an important point. In no way am I suggesting that a baby should automatically be delivered if a cord issue is identified. I am simply suggesting that 1) cord issues should be looked for, and 2) when identified, cord issues should be considered a high-risk indication. At that point, the pregnancy would then be followed by ‘high-risk’ protocols. The ACOG guidelines generally recommend that a high-risk pregnancy should be followed with weekly to twice-weekly NSTs (some OBs will do daily) and weekly BPPs with delivery considered only when the infant shows significant distress. This part of the equation is something OBs are very familiar with – they do it every day for other high-risk indications (gestational diabetes, HELLP syndrome, hydrops, etc, etc). I believe that pregnancies with identified cord issues should be monitored with this level of care and the decision to deliver is always based on when the risk/benefit balance tips the other direction. If the baby has a better chance of survival outside the womb than in it, we need to have that discussion with the family.

  9. Paula McLaughlin
    May 11, 2016 at 8:08 am

    Thank you Lindsey Wimmer for your many posts that provide us with valuable information. And thank you, moms and families of stillborn babies. Our granddaughter was stillborn on May 29,2014. It was our daughters 1st pregnancy and she was 35 years old at the time. She had a healthy pregnancy and at 2 days short of 37 weeks her doctor was unable to find a heartbeat and 40 hours later she delivered a precious baby girl weighing over 6 pounds. Her death was called a “cord accident”.
    We have 5 grown children and are waiting for the birth of our 9th grandchild this summer. I can honestly say that this was the worst tragedy that our family has ever endured. I worked for over 20 years in clinical trials for major pharmaceutical companies and have a significant background in the industry.
    I am very conflicted over our daughter’s pregnancy outcome. She had an ultrasound at 36 weeks and was told that the baby was posterior. This in itself does not usually pose a problem. My daughter was also told that the baby’s respiration was low. My daughter asked why and was told that it wasn’t abnormally low. Should these two issues have raised a red flag? If they had, would her doctors have done more testing, and perhaps monitored the situation more?
    Because my career was based on research I have spent almost two years researching and reading every article I can find on Stillbirth. Something has to be done to save these babies. The statistics are staggering and people need to be made aware of the numbers.
    I knew very little about the possibilities of a “cord accident” when my grandchildren started being born almost 15 years ago. It wasn’t until we lost our perfect little granddaughter that I started hearing and reading about these losses.
    I support the medical community and all the OBs that take care of the moms. But when there is even the slightest difference in a BP or respiration rate or any test performed, shouldn’t there be some follow-up? If they had taken an additional step to make sure nothing was wrong then maybe our granddaughter would be alive today. There isn’t a days that goes by that I don’t mourn her death. When your daughter losses a baby it is devastating, mostly because there was nothing I could do to ease my daughter’s pain.
    I am retired now and would love the opportunity to become more active in Stillbirth research. There also needs to be more support for families, especially grandparents. I spent months looking for a appropriate support group and found nothing. It would have been comforting to meet other grammas who had experienced this type of loss.
    On a positive note, our daughter gave birth to a beautiful baby girl on June 25,2015. Her doctors paid considerably more attention to her pregnancy and induced her at 37 weeks. We our blessed to have a healthy new granddaughter, but will always miss the baby we lost.

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