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Umbilical Knots

Last post 07-12-2009 6:09 AM by Colleen Nelson. 8 replies.
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  • 06-12-2009 12:39 PM

    Umbilical Knots

    In light of the recent posts over in the VBAC/Cesarean Prevention area, here are some questions for our birth attendants.

    In your experience:

    • When do you suspect a knot in a cord? Do you ever suspect a true knot during a prenatal exam?
    • Do you use ultrasound or refer your clients for doppler studies if you suspect a cord problem? (see http://www.thefetus.net/page.php?id=2623)
    • About how many true knots do you see every year or how many have you seen out of X number of clients?
    • Out of those clients who have had true knots, how many of them were problems or resulted in the death of a baby?

    Thanks!

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 06-12-2009 1:28 PM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: Umbilical Knots

    I may suspect a cord problem in labor with decels/slow return to baseline in certain positions.  My mind really never goes to 'true knot' just, 'a cord problem'.  Really never have thought about it prenatally.

    I employ watchful behavior if cord problems are suspected.

    I have seen a handful of true knots in my practice of  +/-  25yrs.

    All cords with true knots that I encountered  were from babes born at home, alive and well.

    Love that line, "knots happen, get over it", gonna use that.

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 06-18-2009 1:42 PM In reply to

    Re: Umbilical Knots

    I've been a doula for 8 years and have seen 3 true knots... all three babies were born in the hospital, but completely unmedicated with mom mobile throughout the labor.  Non of the babies showed any distress before or after birth.

    On another note, I have a friend that was induced just before Christmas about 14 years ago and her baby went into severe distress under pitocin and an epidural.  She had an emergency cesarean, a true knot was found and her baby was left with severe CP.  From her point of view, she is thankful that she had an induction so she was able to get to the OR fast to save her baby's life.... however, the induction along with the knot is probably what caused the CP.... not just the knot.  I have a profound respect for a woman's body to protect the baby.... and although it's not perfect, it is near perfect.  I have seen some amazing things done by a laboring body when it is left alone that are usually disasters during a typical high intervention hospital birth.

  • 07-05-2009 2:43 PM In reply to

    • ZoeysMom
    • Top 25 Contributor
    • Joined on 02-04-2009
    • Lincoln, NE
    • Posts 63

    Re: Umbilical Knots

    I just attended my first birth as a doula... and was AMAZED to see a true knot in the cord!  What a doozy :)  Sounds like it can be pretty rare. 

    Mandi
  • 07-08-2009 9:55 PM In reply to

    Re: Umbilical Knots

     I've not seen very many, but never kept a count, maybe three over 30 years. I've had more velamentous than knotted cords. Most cause no problem and none were dxed before delivery. One stillborn baby had a true knot. But the mom was not all that healthy in general, on the verge of being risked out for a homebirth. Day before labor, heart rate was fine. In labor, at 1st assessment, there was no heartbeat, so we transported and delivered soon after, in the ER, then brought the baby home for burial. looked like the baby dropping into the birth canal pulled the knot tight.

  • 07-09-2009 5:00 AM In reply to

    Re: Umbilical Knots

     Out of over 500 births, I've seen approximately 3 true knots, no problems with the babies.  My favorite knot story comes from my days as an OB nurse.  I cared for a lady who had 5 losses (stillborn, miscarriages, tubal pregnancy) and finally took this baby to term.  I was her labor nurse and I remember clearly how she liked to watch the baby's heartbeat on the moniter throughout her whole labor.  She had her whole church praying for her during this pregnancy.  When the baby was born, he cried the moment he was born and there were 3 knots in his cord, 2 so tight, they almost were the size of the diameter of the cord and the 3rd was a loose knot.  I then believed in miracles.  Joyce

  • 07-10-2009 7:50 PM In reply to

    Re: Umbilical Knots

     I've seen about a dozen true knots, none have been in babies with any problems.  They have mostly been picked up while I'm checking out the placenta, just one of those things. 

    Velamentous insertions however, now they make me nervous.  Had a scary one years ago when the mum rang to say her waters had broken and they were green.  Got her to come straight into the facility I was already in , fetal heart in it's boots, straight off the theatre.  The cord was a true velamentous insertion with loops of cord on the fetal side, just hanging loose in the fluid.  Absolute miracle that baby didn't catch one while moving around. Still gives me the willies, but a true knot, phef, not such a big deal.

    I agree with the poster who commented that funky fetal heart would make me think cord involovement/compression, but not true knot.

    Have had a mum lose a baby due to chrionic bands wrapping around the cord and all but cutting it.  Rather like band amputations of fingers and limbs.  poor wee bub

  • 07-12-2009 6:09 AM In reply to

    Re: Umbilical Knots

     Had a few true knots, no issues with baby, but it's still one of those things that make you go "whew!" and say a quick prayer of thanks! Had a vasa previa once, felt the pulsing vessels in the membranes right in front of the baby's head, took my fingers out REAL QUICK, and talked to mama about transport. She decided to go to hospital, but her waters spontaneously released (clear! no blood) while she was putting on her shoes and she started pushing immediately after. Baby was born fine, after a few scary minutes when he must have been compressing those vessels as his head came through the pelvis, but again, one of those things that make you go "whew!" and say a prayer of thanks. And be very, very grateful that she didn't go to hospital and have her membranes artificially ruptured! Imagine snagging that with an amnihook? Sheesh.

     

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