Giving birth can be a miraculous, joyous experience, but it’s also a worrisome time when a lot can go wrong. When the umbilical cord gets wrapped around a baby’s neck—a circumstance known as “nuchal cord”—any prolonged asphyxia (oxygen deprivation) can result in cerebral palsy or other types of brain damage and intellectual or developmental delays. It can occur even if you’ve had a relatively easy pregnancy.

If you’re a new or soon-to-be parent, you might be concerned about the long-term effects of the umbilical cord wrapped around the neck and how you can advocate for a child affected by a nuchal cord.

How Common Is Nuchal Cord?

Nuchal cord is common during pregnancy and can occur at any point before or during birth. Researchers estimate that the umbilical cord gets wrapped around the baby’s neck 360 degrees in about 20% of healthy pregnancies. In most cases, the baby doesn’t experience permanent medical issues, but serious nuchal cord birth injuries do occur and can pose a significant risk to the baby.

The two types of nuchal cord include:

1. Type A: Also known as an “unlocked” nuchal cord, type A occurs when the end of the cord connected to the placenta crosses over the end connected to the baby. Type A nuchal cords tend to be spontaneous and disentangled with in utero movements.
2. Type B: “Locked” nuchal cords are less likely to disentangle because the end of the cord connected to the placenta crosses under the end connected to the baby.

Nuchal cords can also be wrapped around the neck twice, at which point they pose an even greater risk to the baby.

Doctors are generally vigilant for signs of nuchal cord and will monitor their patients carefully during labor to detect the symptoms of the condition, but they cannot prevent it. Skilled doctors can loosen the cord and slip it over the baby’s head after it crowns. Doctors often have to clamp and cut the cord before the baby’s shoulders deliver to keep the cord from tearing away from the placenta. In severe cases, doctors will deliver babies with nuchal cord via emergency C-section.

Risk Factors for Nuchal Cord

Causes and risk factors associated with nuchal cord include:

• An active fetus that moves around a lot
• Insufficient Wharton’s jelly in the umbilical cord
• A poorly constructed or long umbilical cord
• Twins or multiple babies in the womb
• Too much amniotic fluid around the baby

As a baby’s gestational age increases, so does the likelihood that its umbilical cord will get wrapped around its neck.

Birth Asphyxia from Nuchal Cord

The umbilical cord is the baby’s source of nutrients, oxygen, and blood from the mother. Nuchal cord interrupts this normal exchange, cutting off essential nutrients and blood flow. Perhaps the biggest concern with nuchal cord is it can lead to fetal oxygen deprivation, or birth asphyxia.

Without adequate oxygen, the baby can develop brain damage, seizures, cerebral palsy, or a number of other long-term conditions.

Even if your baby has a nuchal cord before or during delivery, it won’t necessarily cause problems. Birth asphyxia risks depend on how tight the nuchal cord is and how long it is present. The tighter the cord is compressed, the more restricted the oxygen, blood, and nutrient flow to the baby.

Nuchal Cord Birth Injuries

Potential birth injuries or complications resulting from nuchal cord include:

• Stillbirth
• Neurodevelopmental abnormalities
• Umbilical artery acidemia
• Intrauterine growth restriction, causing a baby to be born abnormally small
• Fetal heart rate abnormalities
• Meconium in the amniotic fluid
• Hypoxic-ischemic encephalopathy (HIE), a neonatal brain injury caused by a lack of oxygen that can lead to other disorders such as epilepsy, cerebral palsy, and developmental or intellectual delays

Nuchal Cord Injuries and Cerebral Palsy

According to a study published in Maternal Health, Neonatology and Perinatology, cerebral palsy is associated with tight nuchal cord. Researchers have found that a lack of oxygen during delivery due to nuchal cord or other umbilical cord issues can lead to cerebral palsy. In some cases, medical malpractice is to blame. For instance, a baby may develop cerebral palsy after a physician fails to notice a tight nuchal cord in time to intervene or because the doctor uses the wrong technique to attempt to loosen the umbilical cord.

Cerebral palsy resulting from nuchal-cord-related birth injuries can have lasting financial and emotional impacts on children and their families. If you think your child’s CP is the result of medical malpractice, you may have a case and be eligible for compensation.

Reviewed by:
Claire Surles, RN
Registered Nurse

Claire comes to JJS after a 10-year career as a labor and delivery nurse. She dedicated her hospital efforts to advocating for families, providing the safest birthing environment possible as Newborn Admission Nurse at UMMC St. Joseph Medical Center in Towson, Maryland. Her passion for helping those who experienced losses at any stage of gestation led to her appointment as Coordinator of the hospital’s ROOTS perinatal loss program. READ FULL BIO

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