Cord round neck - Elective C-section or VBAC??

[Loubicheeza]

Hi, I'm 38 weeks with 2nd baba. 1st delivery was a nightmare, 20hrs of induction followed by emergency c-section because baby had turned and failure to progress (had dilated about 3cms.) This time round I initially plumped for a Vbac; however as the due date draws nearer I am petrified of a repeat performance and having another emergency c-section. We found out last week that the cord is round the baby's neck, which apparently means the baby could show signs of distress with larger contractions - which we were told means being whipped into theatre for an emergency c-section straight away! I'm thinking I should just choose to have an elective now, rather than risk having an emergency cesar. Has anybody else experienced this? Any advice?

Hi

I had my DS 5 weeks ago (1st baby) and had to have an EMCS after I failed to progress (I think I got to 4cms after 12 hours of labour) and he was having serious heart decelerations with the bigger contractions. He had a clip placed on his head and also blood taken from his head which showed that the oxygen level in his blood was dropping hence the EMCS. When they went in to get him he had the cord round his neck twice which was apparently the cause of his distress. He was also back to back and chin up (brow presentation) which is why I wasn't dilating.

So, in my (limited) experience the cord being round the neck did contribute to the need to have an EMCS but there were other factors as well. I've already pretty much decided on an ELCS if I have a second baby because, like you, I don't want to risk going through all that again and would like to feel more in control. But the experience is still very fresh in my mind and it may be that a couple of years down the line I will consider VBAC. I am wondering whether the fact that I would have another child to look after might impact on the decision to try a VBAC because the c-section has taken (is still taking) me a long time to recover from. But I guess at least if you elect a c-section it gives you time to make proper arrangements which of course an EMCS doesn't.

Not sure how helpful any of that is so sorry if it's not at all but didn't want to leave your post unanswered. I hope all goes well for you whatever you decide to do.

for my part I would go with your instinct....which seems to be a planned c-section. You've already had one heart stoppingly adrenaline fuelled birth and after one CS they are always watching the scar anyway...and now you have a cord to worry about too. For what it's worth my first was a complete nightmare birth with 48 hour induced labour resulting in very poorly SCBU baby, HOWEVER baby no 2 was a breeze...vaginal delivery in less than one hour...so it can happen......but you need to feel OK with what you decide, and happy to go with the flow if you choose a VBAC, (births 3 and 4 were equally ok...so I've only had a drama with no.1) GOOD LUCK with whatever you decide.

Lots and lots of babies have cords round the neck without any problems or concerns, it is a normal thing to happen. It can't strangle the baby cos it doesn't need to breathe until it comes out. I don't know why they even bothered to mention it to you, as it can only worry you, even though it shouldn't!

If you go into spontaneous labour you will probably have a normal delivery, you are an ideal candidate for a vbac as long as you don't need to be induced. Good luck with your decision and the birth.

Planned sections are very different than emergency. Much calmer for starters. I loved mine and felt good about them in a way inhadnt with the first emergency one

I agree, a planned section is completely different. I had an ELCS with DS2 just over 9 weeks ago, and what a difference it was from my EMCS.

Thanks for all your points - it's very useful to get different opinions/first-hand experiences.

Sloathy - my 1st had the cord twice round his neck, and I too am sure it contributed to his distress

One reason I didn't go for a VBAC is that I didn't want to risk an EMCS. No regrets whatsoever, the ELCS was great.

maxbear - obviously they don't need to breathe, the issue is about cord compression, not the neck. Also, interesting that you can diagnose her to be an "ideal candidate for VBAC" just by one post over the internet

Worth reading through this to understand a bit better about nuchal cords, and be a bit more informed about it midwifethinking.com/2010/07/29/nuchal-cords/.

My impression from maxbear's post (and experience in real life) is that doctors throw around scary terms like "cord wrapped around its neck" without fully explaining what it means or how it works. The best decision you can make comes from fully understanding the risks on either side. Informed is forearmed!

WidowWadman - you are quite right I actually thought that just after I had posted it what I should have written was you may be an ideal candidate, in other words a failed induction of labour isn't going to be a recurring problem if someone goes in to spontaneous labour. Of course I don't know anything else about the OP, she may not be an ideal candidate at all, I apologise for posting quickly without thinking properly!

Cord compression is usually not a problem if the cord is round the neck, even if the cord is fairly tight, it is often not a problem in normal spontaneous labour, it is more likely to cause problems if labour is induced or augmented. Many people do believe that a fetus needs to breathe and that it will be strangled if the cord is around the neck which is why I was pointing out that that wouldn't happen.

loobicheeza how is your decision making going? Hope you are feeling ok about it, have you talked to your midwife, many hospitals now have specialist vbac/elective section midwives.

Personally, I'd go for ELCS in your shoes.

Me too, i'd opt for the ELCS, had one it was great. I would be too worried to relax and go for a natural birth. Good luck

The sonographer did say that as it stands,the cord probably wouldn't distress the baby during labour. However if it was to coil round twice or more between now and then, the likelihood of an EMCS will be increased. The foetus could become distressed with the larger contractions. Last midwife I spoke to suggested I go for a ELCS. I have a consultant appointment on Monday, so will speak to them about it and make a decision.

Yes, I spoke to a specialist Vbac midwife a while ago. I must say though, rather than than tell me the virtues of having a Vbac, she proceeded to list all the dangers of having a c-section and things that could go wrong! It didn't help!

My ds had the cord round his neck. Lots of babies do. They just slip it over the head as the baby is born. Unless it is extremely short it shouldn't present any problems to the birth.

Starlight - this happened with DS too, MW asked me to stop pushing after the head was out while she looped the cord over.