[I'm going to start another thread concerning knots so that our other members can give their opinions and tell their stories. --Brlnbabies, Moderator]
Wow! That sounds pretty traumatic for all involved including you! Were you there or did you just get to see the baby afterwards? Knots don't usually cause problems but they sometimes can. It sounds like baby was pretty stuck in there if they had to use a vacuum to get him out. Yikes! If the knot was causing a problem like severe decels in the fetal heart rate, then yes, that's a great reason for a section. However, they wouldn't be able to tell that it was a knot until they actually saw it. They could suspect a cord problem, but they wouldn't know it until they saw the knot. Here's what Varney's Midwifery has to say about knots: "Ture knotting must be differentiated from false knotting. False knotting of the cord occurs when the cord appears to be knotted but instead the blood vessels within the cord are kinked. A true knot occurs when the fetus has passed through a loop in the cord and a real knot has been created [then they show a picture]. True knotting is most likely to occur in one of two situations: a. small fetus, long cord, and large amount of amniotic fluid. The higher ratio of amniotic fluid to fetal size in early pregnancy makes this the time of greatest incidence. True knots, although usually benign because the pulsations in the blood vessels may keep the knot from tightening, may be the cause of intrauterine death. [This is where most conventional care providers totally flip out when they see a knot. They immediately think every knot causes death. See my story below.] b. multiple gestation within a single amnion. All sorts of cord entanglements and knots are possible because the fetuses have greater freedom of movement within the fetal sac, thereby increasing both the chance of a knot's forming and the chance of its tightening. Mortality rate is high."
Now, here's what Harry Oxorn has to say: "Occasionally a true knot of the umbilical cord is noted after delivery. This complication can occur when there is a long cord, large amounts of amniotic fluid, a small infant, monoamniotic twins, or an overactive fetus or as a result of external version. In many instances, the knot is formed when a loop of cord is slipped over the infant's head or shoulders during delivery. Rarely is the knot pulled tight enough to cause the death of the fetus from restriction of the circulation in the cord. The umbilical vessels, protected by the thick myxomatous Wharton jelly, are rarely occluded completely. The fetal mortality associated with true knots of the umbilical cord is low. In these cases there is flattening or dissipation of Wharton jelly and venous congestion distal to the knot, as well as partially or completely occlusive vascular thrombi."
Did the doc say that he knew there was a true knot before he did the section?
I've been to several births where a true knot has been found in the cord and there's been no problem whatsoever. I was at one hospital birth and the nurse just about passed out when she saw the knot in the cord and she went on and on about how the woman was "so lucky" and "your baby really shouldn't be here" and on and on until the doc finally said, "You know, knots happen. Get over it. He's fine."
Was your friend's baby still transverse? Was this a scheduled cesarean or did she labor?