Compression of the Umbilical Cord During Labor and/or Delivery
There are many causes for compression of the umbilical cord and many babies experience some periodic compression of the cord during labor. Most babies may have some compression of the cord during a normal vaginal delivery as well. The baby can usually tolerate a short duration of umbilical cord compression. Many babies will actually hold and squeeze their own umbilical cord inside the uterus and then they will let go of it without any problem. Many babies will have the umbilical cord wrapped around their neck or body as a result of turning inside the uterus and sometimes this entanglement with the cord does not release. When the mother goes into labor the umbilical cord can be further compressed by the contractions of the uterus and as the baby descends down the birth canal, the umbilical cord can become stretched, especially if it is wrapped around the baby’s neck or body. Such stretching can cause a reduction in blood flow, and thus a decrease in oxygen to the baby’s brain.
The condition of the baby during labor and delivery is usually monitored by a fetal heart rate monitor, which shows the baby’s heart rate in relation to contractions or other changes during labor. Although the American College of Obstetricians and Gynecologists (ACOG) has never confirmed a recommendation for the use of such electronic fetal monitoring, almost all hospitals in the U.S. have used electronic fetal monitors on almost all patients in labor, including the vast majority of normal vaginal deliveries. Most of the time, the monitor is attached to the mother’s abdomen and measures the fetal heart rate through an external doppler or sound device that then records the rate of the baby’s heart beat on a paper strip that can continuously monitor the baby through delivery. Whenever it is indicated by the condition of the fetus or other factors, an internal monitor can be attached to the baby’s scalp, which then directly measures the fetal heart rate and is generally more accurate than an external monitor. Obstetricians and nurses are generally trained in the interpretation of this fetal heart rate monitor strip, and there are certain patterns that show that the baby is in distress and needs to be delivered quickly.
Many medical malpractice and negligence cases involve either a negligent failure to correctly interpret the fetal monitor strip or a delay in notification of the doctor after the nurse becomes aware of a problem.