1. Umbilical cord around the neck. Parents often worry that the umbilical cord will end up wrapped around their baby's neck (also known as a nuchal cord), choking the infant. This is, in fact, a very common place for the cord to be found, because the cramped quarters of the uterus allow for only so many places where the cord can go.
   
   It's often helpful to remember that the baby does not get its oxygen through the mouth and nose, as we do, but that the mother does the breathing for the two of them. Furthermore, umbilical cords have mechanisms in place to help them keep functioning even when stretched.
   
   The truth is, most babies who are born with the cord around their neck require only an extra moment at birth for the practitioner to unwind it, and then go on to be perfectly healthy.



2. Pressure on the umbilical cord during labor. If the umbilical cord becomes overly stretched or compressed during labor, it usually will cause the baby's heart rate to slow down temporarily. This is the baby's reflexive response to less blood flowing back to his heart. These brief "variable heart rate decelerations" are not harmful. Any practitioner who delivers babies is trained to recognize heart-rate patterns that are potentially problematic, and he may recommend further evaluation if there is a concern.
   
   If the baby's heart rate slows to below 100 beats per minute and does not return to normal (120 to 160 for most babies) within a few minutes, measures will be taken to relieve the presumed cord compression. This includes giving oxygen and fluid to the mother or having her change position. Medication may be given to slow down the contractions. If there is still concern about pressure on the umbilical cord, a cesarean delivery may be arranged.



3. Prolapsed cord. On very rare occasions after the bag of waters has broken, the umbilical cord may precede the baby into the birth canal. This is slightly more common if the baby has not yet descended into the mother's pelvis or is not coming headfirst. This can cause serious trouble, because the cord can become compressed.
   
   Any time an umbilical cord has prolapsed into the vagina, it is considered an emergency requiring immediate medical attention. In the event of a prolapsed cord, the baby will be delivered by cesarean section to prevent further compression of the cord during childbirth.



4. Knot in the cord. Sometimes a baby will be born with a true knot in the cord; other times the blood vessels within the cord will be so curvy that they look like a knot. In extremely rare situations, a knot found in the cord of a baby who was stillborn will be presumed responsible for the baby's demise, as it may have tightened enough to stop blood flow through the umbilical cord. Unfortunately, there's no way to tell if a knot has formed before delivery. However, it may be reassuring to know that most cords have safeguards to keep this from happening.
   
   Often, true knots don't form until the time of delivery, when a baby happens to be delivered through a loop in the cord. And, of course, once the baby has been delivered and is breathing air, the knot no longer presents a danger.

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