So I went in today for my 34 week appointment and follow-up ultrasound. At my 20 week u/s, the baby had "dilated" ureters (tube from kidney to bladder), which is apparently super common (65%) in little boys. Typically they resolve themselves by 3rd tri/birth, but it's something they've been monitoring on him. It's nothing serious, and worst case scenario, he'd need a cath inserted after birth to "straighten" them out. But beyond that, it's nothing major. Okay, so here is the rundown of my u/s:
- Right ureter looks totally normal! Left one is still a little on the large side, but nothing concerning.
- He's head down and facing my spine! Yay!
- Cervix is still measuring long (over 4cm!) and thick! No preterm labor issues this time around.
- Cord is around his neck. (!!!)
I saw my doctor (the one I love!) after my u/s for my regular appointment, and asked her about the cord. She said they were going to do a repeat u/s in 2 weeks to check on it. I then asked her what happens if it WAS still there, to which she replied, "we'll schedule a repeat c-section". Blah, my heart sank. This is the doctor who has been so supportive of my VBAC and not once uttered the word "repeat".
So, now I'm not sure what to do! I've done just a bit of research, and from what I have gathered so far, it doesn't seem like cord around the neck = automatic c/s in most cases. I of course ran across some horror stories of people losing their babies in utero and/or during birth due to cord accidents, so of course now I've got myself scared. I obviously don't want to put his life at risk. This is NOT how I want things to go down! But now I'm totally unsure of what to do and what my options are.
Any words of wisdom?
I think it depends, but a huge number of babies are safely delivered with cords around their necks...and frankly many people don't even have u/s that late in pregnancy. I didn't after 20 weeks. If it was such a huge concern to deliver vaginally with a cord, wouldn't doctors insist on checking that?
I know there are some ladies on here with some much more specific knowledge, but I definitely don't think that should mean automatic c-section given the information you've provided... Good luck and I hope somebody with some great info chimes in and makes you feel better soon
Cord around the neck should not be grounds for automatic c-section. My first 2 boys had the cord around their necks (never knew till they were born) and they were born just fine vaginally, yes it is more likely to cause heart rate decels during the pushing phase and decent into the birth canal then if it didn't have the cord wrapped around the neck but it really isn't that big of a deal. If it did mean that baby "had" to be born c-section due to the cord around the neck then 1 in every 5 babies would be born via c-section.
Not once did they ever check to see if the cord was around the neck. I even had U/S with DS2&3 after 35 weeks and they never checked that. DS2 had the cord around his neck AND chest and was born super easy and fast with very little heart rate decels.
DS1-7/18/08, DS2-2/23/10, DS3 1/18/12
TTC in fall/winter of 2014
Your doctor is trying to scare you into a repeat c-section, and IMHO that is dispicable! Cord around the neck is extremely common and don't usually present any problem during delivery. Here's why: the neck (and the cord around it) is protected during delivery by the head and shoulders. Even *if* the baby's head gets stuck & the cord gets compressed a bit, he's on his way out anyway! If the cord gets compressed during labor enough to affect the baby, then *that* is when you do a c-section, you don't do a c-section JIC. Personally, I'd call that doctor and tell her she's full of bull**** and never go back. If she's pulling this now, imagine what kind of stupid crap she might say when you're in labor? Run away, run away!
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Oh, that is a bummer your OB changed her tune like that. Plenty of people never have an u/s near the end of pregnancy and would never even know if the cord was around the neck. Plus, it is routine practice to check for a cord around the neck (and remove it if there is) AFTER the baby's head is born vaginally. It isn't a big deal. And yeah, why would it be different for you than any other mother, when they would do a c/s only if the cord was actually causing problems during delivery. I am so sick of hearing about doctors coming up with all kinds of bs reasons to push women in to repeat c-sections. It sounds like your dr has been great up until now, and I hope she isn't showing her true colors at the last minute. I'd go in and tell her you've done your research and a cord around the neck doesn't sound like that big of a deal and if it were, wouldn't everyone be sent for a u/s before delivery? And that you still fully expect to be able to try for a VBAC and you hope you still have her support.
I'm a mat nurse and lots of babies are born with the cord around their neck without any trouble. After the head is delivered, we check for a cord, and slip it off over the baby's head. If it is tight, we clamp it early and cut, then deliver the body.
Sometimes cords do cause problems in labor (which is usually speculation because very rarely do we know the location of the cord prior to delivery). A particularly short cord or a baby tangled can cause trouble with descent, and sometimes the cord may get compressed dangerously with contractions, but that is why we keep an eye on baby's heart rate in labor... Cross that bridge when, and more likely if, you come to it.
ITA that this doctor is trying to scare you. There really is no need. I'd say no thank you and quickly choose a different doctor if she presses you further. At least you see the agenda she may have before you are in labor.
~Joy~ DS1-8/5/05, DS2-10/18/10 (VBAC#1), DS3- 4/11/12 (VBAC#2!)
Thanks for the thoughts, everyone!
I think I got myself freaked out because I read all these horror stories of people losing their babies in utero due to cord accidents, but at the same point, I realized that many MANY people don't know the cord location prior to delivery. I had a 31 week BPP with DS with no mention of the cord, and at 36 weeks when I went into labor, he was in distress. His heart rate never dropped, it was just very flat. I think that made my doc (she's no longer with the practice) nervous, and she tried to speed things up. I was progressing fine on my own, but she went ahead and did AROM and an internal monitor and an epi before I was even 5 cm. I know one intervention can lead to another, but I was scared he didn't "look right" on the monitors. When they did a scratch test (scratched his head to scare him and spike his HR), his HR dropped from 150 to 80, then came back up. That was the first and only decel we saw. At that point, I was told it was time for a c/s. When DS was born, he had the cord around his neck three times.
So, I guess I sort of have experience with cord issues, and I guess DS's being around his neck is what ultimately caused my first c/s. I guess I'm just worried of it being pushed again. I honestly can say I truly don't think my doctor yesterday was pushing an agenda on me. She has always been so supportive of my VBAC (even when I complained about another doc trying to play the big baby card, she said not to worry about it), so I'm not sure where her answer came from. I don't see her at my next appointment, but see MY actual doctor. I'm hoping to have an informed discussion with him about this should the cord still be there.
I think what I'm going to do is, if the cord is still around his neck at 36 weeks, tell them I want to go into labor on my own. I think at that point, when I get admitted to the hospital, I will request an u/s to see where the cord is at. If it's not there, then awesome and leave me the F alone. If it is there, then I will consent to continuous (albeit mobile) monitoring and a heplock to keep track of him. If at any point he shows distress, I will go for the c/s. I obviously don't want to play with his life, and will opt for the c/s if at any moment he is in danger.
I think that is a good, proactive course of action. Right?