To ask if any Midwives here have experienced/dealt with a cord prolapse.

[Chorusforpoormortals]

and, could you explain/share your experiences, and maybe explain your procedures etc (especially regarding induction/breaking water,examinations) But I also have a few questions and any answers would be greatly appreciated.

Q1) Is it hard to diagnose due to fact it is rare?
Q2) How many internal examinations would you need to do to diagnose?
Q3) How would you reassure your 'patient'?
Q4) What is your role once 'patient' is in theatre/surrounded by obgynae peeps?

Also if anyone clicks and is not a midwife but has experienced this I am all ears for the sharing.

imip, so sorry to hear your experience, it is truly awful.

OP, I used to be a midwife and in the 15 years I worked I can only recall one episode of cord prolapse. On that occasion it was obvious as the cord was prolapsed outside of the birth canal and visible. The Mum was no due for several weeks and her baby was born by caesarean section.

In the event of a cord prolapse there are few options available apart from emergency delivery of the baby. Internal examinations are a very inexact science....like mining in the dark. You have to be able to visualize what you are feeling if that makes sense. It isn't always clear cut either when you are not feeling usual stuff. In my time I have felt placenta due to an undiagnosed placenta praevia (it wasn't clear what I was feeling but I knew it was not the baby's head), bottom (undiagnosed breech), and a foot (footling breech).

Because cord prolapse is so rare I have never experienced finding this on internal examinaton but I do know that if I was in any doubt I would err on the side of caution. I am also curious to know if anyone else did an internal to confirm cord prolapse or if they took the word of the midwife in question?

Whatever happened, it sounds as though it was very traumatic for you and at the very least you need someone to go through your labour and delivery records and answer any questions you might have. You have a live baby and that's great but the birth trauma can impact upon what should be a very happy time for you (if exhausting) and as such you need to have any nagging lingering questions resolved so you can get on and enjoy your baby.

To answer your questions..

1, It is hard to diagnose if not obvious and a lot would depend on the experience and skill of the midwife involved. It is rare so if a midwife feels "something" unusual on internal examination then it can be open to her interpretation of what that is. If what she is feeling is pulsating....is it the edge of a lower lying placenta, is it a cord, is it something else?

2.You might only need one internal examination to diagnose if it is obvious, I was always taught that once you have identified a cord prolapse you get the Mum into a position which reduces pressure on the cord. If it isn't obvious/the midwife is unsure then they could ask someone to check...as long as there are no obvious signs of fetal distress. If I was unsure but there were signs of fetal distress then I would always err on the side of caution.

1. Reassure the Mum by explanation....not sure you can reassure someone adequately in this situation as it is a real emergency but I would always explain exactly what I could feel and what needed to happen.

1. In theatre the role of the midwife would really be to support the Mum unless of course there is short staffing and the midwife is needed to play another role. I have lost count of the times I was asked to go and scrub to assist the surgeon...meaning my support of the Mum was taken over by someone else. Not god continuity but that's how it is sometimes.

Hope that helps a bit....it's been 10 years since I was a midwife so some things may have changed. Hopefully someone with ore recent experience will come along.

So sorry imp

My waters had broken early, 31 weeks so they kept me in hospital due to risk of cord prolapse as ds3 was lying transverse. I was having mild period pains during the night on the ward, they did a trace, baby was fine. Actually they were so mild that I went to sleep for a few hours, dp rang which woke me up, I went for a wee and there was the cord.

I was very very lucky, if id been at home or if he hadn't been lying transverse and so high up (so not pushing down compressing the cord too much) he could very easily have died.

However I still felt incredably shocked and traumatised in the begining. It took quite a while to make sense of it all.

It might be an idea for you to phone the hospital and make an appointment to go in and speak to someone who can go over your notes with you

Ex post with jake

They also got me straight onto my hands and knees, I think to take pressure off the cord and the midwife said it was the first one she had delt with in 20 years.

Havana, my circumstances were the same as yours, however, cord prolapse was never outlined as a risk.

Yep it was mentioned more than once by the consultant, I still don't understand why the mw didnt check for it when I went into labour, or phone down to labour ward. We knew I would be having a csection due to how he was lying. It was 4 hours after I told her I was having mild contractions that the cord prolapsed.

I was a midwife for 15 years and only dealt with 2 cord prolapses. An internal exam, especially in the earlier stages, can be tricky. I remember feeling a face presentation and after expecting to feel the usual landmarks of the head had to really use my imagination to work out i had my fingers in his nose! (The registrar who confirmed it initially thought it was a cord). Few births follow the text books (oh that they would!) so a midwife has to do the best she can and err on the side of caution. If the outcome is a healthy baby and mother then that is a success.

The irony of my experience was also that my mother had a cord prolapse, and my brother died... Given the midwives' experience here, that is pretty shitty odds....

Btw how do you know it wasn't cord prolapse? It may have been a case of cord presentation rather than prolapse. Either way a emcs would have been the right course of action.

imip I am so so sorry for your loss. I can't imagine what that must have been like

Chorus, I think imp has sadly explained what I meant when I described an emcs as the safer option.

Imp

Imip rather. Apologies

Cord prolapse is one of the most serious, scariest emergencies a midwife can face. If not dealt with immediately, the baby has minutes to live. As others have explained, sometimes the prolapse is obvious, as a sizeable length of the cord "falls through" the cervix and can be seen. However, other times the cord is held at the front/side of the baby's head and will not be easy to feel. If the midwife was even 50% sure it was a cord, I am not surprised she requested an emergency c-section. The way we deal with cord prolapses where I am finishing my midwifery studies is to put the woman on hands-and-knees with her bum up in the ear, and the midwife pushing on the baby's head with her fingers... there is really no time to ask for other practitioner's opinion, and yes, the obstetric team would act on her findings alone.

I understand it will be very frustrating to have gone through a scary emergency c-section just to be told there was no cord prolapse to start with. However, I am unsure how they were so sure there was no prolapse. During the process of the c-section and extracting the baby from the uterus the cord would have moved anyway. Also, during a prolapse it is not a given that the cord will be compressed and the baby will be distressed, especially if the prolapse happened early in pregnancy. A fast c-section may as well have resolved the prolapse and saved the baby from later distress.

But even if it is true, and the midwife made a mistake, I fully believe she made that decision to her best professional practice. It would be very unfair if she was disciplined for acting promptly in her findings and organize an efficient emergency response that resulted in your baby's safe delivery.

It's hard to make sense of your post but if I'm right the midwife did a couple of internals thinking she had found a prolapse, it turned out not to be (someone else checked?) and you went on to labour but ended with an EMCS for other reasons?

There are three ways to find a cord prolapse... See it, hear it, feel it. You might see the cord hanging down, you might hear a sudden prolonged deceleration (which will prompt you to VE), or you will feel it with your fingers on VE. Feeling a cord on VE is very very obvious ONCE YOUVE FELT ONE which most midwives will not have done. What happens before then is you feel random lumpy bits of cervix, or head wrinkles, or fingers, or whatever and might think it's a cord. How it's then treated will depend on baby's FH, if it's fine then we will fill the bladder and possibly get a second opinion. If it's crashing then it will be to theatre.

Sounds like she thought she felt a cord, but didn't. Of course that's very common, to have a second thought and re examine to check your findings.

I was admitted to hospital at 36 weeks with my daughter due to her unstable lie. It was considered high risk for cord prolapse because of her position, my slightly open cervix (three babies already) and a history of really long cords. DS3's cord was well over 1.5m and had a full knot, luckily not tight. As I was given a bed on the ward the midwife mentioned getting gloves in all sizes ready beside the bed - I asked why. I was told that if my waters broke I would get a VE and be wheeled straight to theatre on my hands and knees, backside in the air with a midwife's gloved hand suitably inserted. Thankfully, this did not happen but it was obvious how serious the risk was taken. I am very much of the "better safe than sorry" camp.

*seriously

imip. Me too. my experience was the same as yours. with the difference that I had no risk factors before I went into labour and no earthly idea what had happened before I got to hospital after several hours of labour. by which time it was too late.

OP - I understand why you're asking, and I'm sorry you had a traumatic delivery. But the safe delivery of your baby really is the overwhelming priority.

I was taken to labour suite to have my waters broken and induction at 41+6 weeks with ds1. It was decided that, as his head wasn't engaged, there was a risk of cord prolapse if they went ahead and ds was delivered by c section the next morning without further intervention. The midwife who was looking after me had lost a baby a couple of years before following a placental abruption and felt we shouldn't take any chances.

On my previous post, "especially if the prolapse happened early in pregnancy" should have read "early in labour".

Had cord prolapse.. rushed to theatre with mw on trolley holding I think baby off cord. prepped for cs just in case but baby born with forceps v quickly. baby fine, had 4th degree tear . All in space of under hour.

One thing I'd say to u is I kept on going over it in my head but it did fade. you're v short time after birth, experience will fade and baby being fine sx main thing.