"All that is necessary for the triumph of evil is for good men to do nothing" Edmund Burke, 18th century Philospher.

"A long habit of not thinking a thing wrong gives it a superficial appearance of it being right." Thomas Paine

"The welfare of humanity is always the alibi of tyrants." Albert Camus

"Choice is the essence of ethics: if there were no choice there would be no ethics, no good, no evil; good and evil have meaning only insofar as man is free to choose." Margaret Thatcher, March 14, 1977

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.” ― Upton Sinclair

Explaining the Cause

I am a practicing obstetrician who is a strong supporter of patients rights to informed consent and refusal. I believe a patient has the right to choose her own path given true and not skewed informed consent. Following that tenet, just as a woman should be able to choose to have an elective c/section she should be able to choose not to have one, as well. The American system of hospital based obstetric practice has been eroding those choices for women for quite some time. Due to concerns of economics, expediency and fears of litigation women are being coerced to make choices that may not be in their best interest.

I have had a long relationship collaborating with midwives and find the midwifery model of care to be evidenced based and successful. I was well trained at Cedars-Sinai Medical Center in the mid 80's to perform breech deliveries, twin deliveries, operative vaginal deliveries and VBACs, and despite evidence supporting their continued value, hospitals are "banning" these options. Organized medicine is also doing its best to restrict the availability of access to midwives.

Home birthing is not for everyone but informed choice is. Medical ethics dictates that doctors have a responsibility and a fiduciary duty to their patients to provide true, not skewed, informed consent and to respect patient autonomy in decision making. Countries with the best outcomes in birthing have collaboration between doctors and midwives. This is not what has been happening in the hospitals of America. Its time for a change and the return of common sense.

The midwifery model of care supports pregnancy as a normal function of the female body and gives a legitimate and reasonable alternative to the over-medicalized model of birth that dominates our culture. Through this blog I hope to do my part to illuminate what is wrong with our maternity care system and what is right with it. I do not expect all to agree and that is OK. We must all understand that given honest data it is not always reasonable to expect two people to come to the same conclusion. Our differences should be respected.

Wednesday, September 16, 2009

Dispelling a Myth About the Umbilical Cord

The umbilical cord around the fetus’ neck cannot strangle your baby! There, I said it. Now, let’s discuss the logic behind this truth. Nature has devised a system to nourish the developing baby inside the womb of all mammals. The placenta and umbilical cord are an amazing creation of both form and function. The placenta acts as a factory for hormones to support the pregnancy, a filter that among a myriad of tasks acts to bring in good things and remove waste and provides a reserve of blood and oxygen to support the baby through labor. The umbilical cord is the conduit by which nutrients such as sugar and oxygen help feed the baby via its two veins while through its one artery passes the waste by-products of growth.
Understanding how a baby gets its oxygen allows us to understand why a baby cannot strangle or “choke” on its cord. In order to choke, one must be using its trachea to breath air. Clearly, there is no air in the uterus, the baby does not breathe through its throat and, therefore, cannot choke. When an ultrasound reveals the cord around the neck it is a normal human response to anthropormorphasize the intrauterine baby to our extrauterine experience. But this is not the case and there is no reason to have fear. So, let’s dispel once and for all the rumor that a cord around the neck (nuchal cord) is more dangerous than any other situation. About 35-40% of normal term babies are born with the cord around the neck at least once. It can also be wrapped around the body or legs or even at times have a true knot. None of which are usually significant as the cord is designed to deal with this.
Cord compression can occur anytime during pregnancy. The cord is well equipped to handle temporary squeezing as the 3 vessels are cushioned by a matrix called Wharton’s jelly and the surrounding amniotic fluid. In labor, sometimes after the bag of waters breaks and fluid leaks out, the cord can be repeatedly compressed with contractions. This is not uncommon and is not, by itself, a sign of distress. Your practitioner or nurse can listen to or interpret the fetal heart rate pattern to know whether any intervention is necessary. And the compression of the cord almost never is an emergency or a cause for the tragic death of a baby inside the womb. When that tragedy occurs we all want to know why and often, mistakenly, we are told it was a “cord accident”. Compared to the number of times I have heard this mentioned by patients or news stories the real truth is that this is a very rare event.
Please be reassured that your baby will not strangle on its cord because it is not breathing through its neck like you and I. If you hear someone repeat this rumor you would be doing a great service to pregnant women everywhere by logically explaining to them the reasons why.


  1. Wow, that's amazing and........ it's actually common sense! I hope that next time I hear someone talk about this subject I'm able to remember all of this, or at least the link, to share with them!

  2. Ok...so that explains the O2 issue...so why was my son's ENTIRE head PURPLE and almost black from lack of blood flow...didn't think of or address that one...did you?

  3. I agree with most of what you said, however blood still needs to get to the baby's brain, through the carotid arteries in the neck, which can be compressed with a very tight cord. It is unlikely, yes, but it does sometimes happen. And is what killed my friend's baby three years ago on her due date.

    *Most* nuchal cords and body entanglements are absolutely no problem -- my first son was born with a nuchal cord that couldn't be reduced on the perineum, but I didn't even know about that until a few years later when I read through the midwife's birth notes. It was absolutely no problem. But sometimes it can be a problem.


  4. I had a baby with a tightly compressed cord around her neck. No heart beat as she was crowning. Are you saying that it is unlikely that this her lack of heart beat and breathing actually had to do with the cord?

  5. "Your practitioner or nurse can listen to or interpret the fetal heart rate pattern to know whether any intervention is necessary."

    I think what he is getting at here is that just because your baby has a cord around the neck, does not mean that it is a bad thing. I think the key here is what he said above. Of course if your baby does not have a heart beat or is showing distress, you should do something.

    It would be tragic, though, if a mom where to get a c-section just because the ob felt like there might be danger simply from the fact that the baby has a cord around it's neck. What if you had a c-section for that, hemorrhaged and died.

    I would agree with the fact that most nuchal cords are not a problem, but we much always watch out, because sometimes (rarely they are).

    I have also wondered, if our automatic breaking the bag of waters at the onset of labor might have an impact on how bad a cord accident could be. It makes sense to me that if you have the bag of waters to cushion the cord and allow it to move around more freely, then it should prevent some of the problems that arise with the cord. Of course I have no research on that, just my own thoughts.

  6. I SO agree! I had a breech birth EASILY (in a tub in my kitchen) and had a HECK of a time finding someone trained to do it now. It's just not done any more. This cord thing has been a BIG EXCUSE doctors say to persuade a c-section, where they make more money. I'm so glad to KNOW about this blog that I totally agree with.

  7. To Jesse and Cathy, There is a big difference from what happens when a baby is crowning and the cord is compressed and what I was saying. Of course a cord can be compressed and the heart rate drop dramatically. This a vagal nerve reaction, normal and generally transient. If prolonged then the baby needs assistance to be delivered if delivery is not imminent. Also, as in Jesse's case, a tight nuchal cord can cause ecchymosis (black and blueness) and hyperemia from compression of the jugular veins more than the carotid arteries. But to cut off blood flow to the brain completely unnoticed inside the uterus is a very rare event. The point of my article was to dispel the idea that babies can choke simply because the cord is around the neck in utero and that should be used for a reason to instill unnecessary fear which can lead to an unnecessary c/section as Kathryn implies. There will always be exceptions to any rule but I believe it is wrong to counsel all women with a really rare, fear-based, worse case scenario mentality.

  8. I have a question about attempting a version with the chord wrapped around the baby's neck. My baby is breech and they were going to attempt a version today, but when they saw the chord around the neck, they said the baby might "choke". Is that incorrect? I am scheduled for a c-section this friday(in 3 days) and I really DO NOT want to have one. Is it really dangerous to do a version if the cord is wrapped around the baby's neck? If anyone has info on this, could you please let me know ASAP!