When the Umbilical Cord Wraps Around the Baby's Neck

Midwife and husband supporting pregnant woman, giving birth in hospital
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Ever wondered what happens if the baby's cord is around its neck at birth? Parents are often frightened to think about the baby's umbilical cord being around the neck at birth, also called a nuchal cord.

A nuchal chord—when the umbilical cord is wrapped around the baby's neck—is a very common event, occurring in about one-third of all births. The cord becomes wrapped around the neck during pregnancy as the baby moves around. 

The umbilical cord is covered with a thick protective coating known as Wharton's Jelly. This is like gristle in texture and prevents the baby from compressing the arteries and vein that run through the cord. So the cord being wrapped does not usually pose a problem for the baby.

How a Diagnosis of Cord Around the Neck Made

Currently, ultrasound technology is not very useful at determining a nuchal cord. One study showed that there was only a 65% chance of finding the cord around the neck via ultrasound. There was also a 19% false positive rate, meaning that nearly one in five women were told that there was a cord around the baby's neck when there was not. This, as you can imagine, causes much concern. 

At the time of birth, once the baby's head is out, the midwife or doctor will check around the baby's neck for the presence of the umbilical cord. 

What Happens If the Cord Is Around the Neck?

Once the practitioner has determined that there is a cord, they will decide how to best proceed. Typically the cord is wrapped loosely enough for the cord to be slipped over the baby's head. If the cord is wrapped multiple times this may take a while. Typically you will be asked not to push for a minute while this happens.

Sometimes the cord is wrapped too tightly and the cord will be cut before the baby can be born. This is done by your midwife or doctor by placing two cord clamps and cutting between them. This necessitates the baby's birth fairly rapidly since it is no longer getting nutrients from the mother via the placenta.

Occasionally the baby will be born so rapidly that neither of these methods can be employed. A skilled practitioner will hold the baby's head very even and close to the mother's body as the baby's body is born through the cord. This almost looks like the baby flips out as it is born. The cord being around the neck usually requires no additional monitoring of the baby or mother.

Other Umbilical Cord Issues at Birth

There are other issues with the umbilical cord that may cause issues. This includes cord compression and cord prolapse.

Cord compression is where the umbilical cord is pressed, usually between the baby and the pelvis, pressing hard enough to cause some disruption.

Sometimes this is alleviated by having the mother change position, even something as simple as rolling from her right side to her left side. It may also mean other interventions may be needed, like oxygen for the mother, or amnioinfusion. (This is where fluid is put back into the uterus to provide more cushion for the baby and the umbilical cord.) Sometimes if the fluctuations in the baby's heart rate are severe enough or are not responding to treatment, a cesarean birth may be necessary.

A cord prolapse occurs when the umbilical cord comes into the birth canal (vagina) and the baby is behind it. This can cause a very emergent situation because the cord's blood flow can be pinched off by being pressed between the head and body of the baby.

The vast majority of the time, a baby who has a cord prolapse will have an emergency cesarean birth. This may also mean that general anesthesia is required.

Having the cord around the neck is something that is not necessarily going to reoccur in future births. It is also not caused by lifting your arms over your head in pregnancy, as many folklore tellers like to have you believe. If you are concerned, speak to your doctor or midwife about how they handle this at birth.

5 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Bosselmann S, Mielke G. Sonographic Assessment of the Umbilical CordGeburtshilfe Frauenheilkd. 2015;75(8):808-818. doi:10.1055/s-0035-1557819

  2. Peregrine E, O'Brien P, Jauniaux E. Ultrasound detection of nuchal cord prior to labor induction and the risk of Cesarean section. Ultrasound Obstet Gynecol. 2005;25(2):160-164. doi:10.1002/uog.1767

  3. Peesay M. Nuchal cord and its implicationsMatern Health Neonatol Perinatol. 2017;3:28. doi:10.1186/s40748-017-0068-7

  4. Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Nuchal cord is not associated with adverse perinatal outcome. Arch Gynecol Obstet. 2006;274(2):81-83. doi:10.1007/s00404-005-0110-2

  5. Hofmeyr GJ, Lawrie TA. Amnioinfusion for potential or suspected umbilical cord compression in labour. Cochrane Database Syst Rev. 2012;1:CD000013. doi:10.1002/14651858.CD000013.pub2

Additional Reading
  • World Health Organization. Background. Guideline: Delayed Umbilical Cord Clamping for Improved Maternal and Infant Health and Nutrition Outcomes.

By Robin Elise Weiss, PhD, MPH
Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.