The first was a father wanting advice for helping his wife after she had recently delivered their stillborn child at 41 weeks. The cause was determined to be a cord accident.
The second was a woman asking for prayers for a friend’s newborn child. During delivery, the umbilical cord was compressed and the child suffered hypoxia (lack of oxygen). The baby is currently in the NICU undergoing body cooling in an attempt to reduce the swelling in his brain.
The third was a woman who recently delivered a baby in Japan. Ultrasounds were a routine part of every prenatal visit during the third trimester. At the 36 week visit, they noticed the baby had several umbilical cord wraps around the neck and arm. Her OB showed her the concern, they did some extra tests to identify if the baby was in any distress, and then a cesarean section was scheduled at 38 weeks of gestation to avoid the baby having complications from the umbilical cord issues during a vaginal delivery. She said it hadn’t occurred to her that her pregnancy might have been managed differently in the US.
A few major problems stand out to me with these stories.
Families are told every day that umbilical cord issues don’t cause problems. Yet, this is also the most common answer families are given when they ask why their child was stillborn. This hypocritical approach is not acceptable. If cord issues truly cause birth injuries and death, then that needs to be recognized, accepted, communicated, and addressed. If they don’t, we need to stop attributing such a large number of poor outcomes to this cause. It is true that many babies are born healthy despite umbilical cord issues, but this is not the same as saying the cord issues aren’t a cause for concern.
Providers will often say cord problems are not concerning, but what they actually mean is that they don’t think they should alter the plan or don’t know what to do differently – so they simply offer false reassurance. In the event of a poor outcome, a cord issue might really be the cause, but “cord accident” may also be the easy answer because it is accepted as something that “nothing” could be done about.
The woman from Japan proves that cord issues can be addressed. It is impossible for us to guess if she would have had a poor outcome if they had chosen a different approach, but she and her providers chose not to gamble with her child’s health/life and took a route that they believed offered the least amount of risk. This does not seem that radical to me. I had similar thoughts and questions during my subsequent pregnancies. My children all experienced different types of complications that were only identified because I was considered ‘high-risk’ (and that was only because of my previous stillbirth). Each of these complications were managed and monitored closely. They were delivered when the risks and benefits of their issues and prematurity flipped so that they had a greater likelihood of survival outside my womb than in it. And they are all 3 happy, healthy beautiful children today. Again – no way to know what the outcome would have been otherwise. I’m eternally grateful for their health, I’m scared when I think about what other outcomes were possible, and I can’t help but wonder if their oldest brother would have survived if he had received the same level of care.
Likewise, we have no way of knowing if recognition of the cord issue could have prevented the stillbirth of the child in the first email. But these are what-ifs that this family (and many of us) will live with for the rest of their lives. The providers may be left with the same questions, How many babies MIGHT we be able to save or improve the outcome for if we identify potential problems before the mom or baby is symptomatic?
In the email from Japan, the cord issue was identified because she had a level of care that is not routine in the US and the provider was willing/able to offer a management plan that is not readily accepted in the US. Americans have insurance companies wanting to reduce the number of tests and procedures, lawyers wanting to eliminate provider liability, and special interest groups pushing their agendas into the medical decision making process of families, providers, and hospitals. The baby in the NICU is a perfect example that everyone involved might have benefitted from knowing in advance about a potential cord issue and management beyond watching and waiting. The stress, costs, and potential long-term effects for this child/family make some extra tests and a possible c-section seem pretty minor. The family who experienced a stillbirth didn’t know what cord issues could do or that they might be preventable until after their child had died. The family in Japan was shown the potential issue and allowed to have a discussion with the provider about any risks and benefits of various options. Together, they developed a plan that they felt comfortable would reduce the risk as much as possible. Again, this seems rather simple to me.
I routinely hear stories of heath care professionals opting not to look for or to tell families (if they did look) about potential umbilical cord issues. Their rationale is this – “Why scare the family when I can’t do anything about it?” This is unbelievable. The family has a right to know regardless of the options. Most people are understanding and realistic about what medicine is able to provide. This would not be the first time that families are given information about a diagnosis that doesn’t have easy options.
But the next, obvious question is – why can’t we do anything?
I understand that we may not be able to unwrap a nuchal cord or undo a knot in the cord. But we can manage the pregnancy differently from that point forward. We do it every day with many other issues. Why not this one? When we see sensational stories on the news about significant anatomical abnormalities that are corrected in utero, it seems unreal that we throw our hands up when it comes to issues like cord and placenta issues.
Medicine is not black and white.
What works for one person may not be the best solution for another.
- I am frustrated by recommendations and policies that assume all situations to be identical.
- I am frustrated by providers choosing to keep their heads buried in the sand instead of looking for warning signs or risk factors because it makes their job easier or reduces their liability or because the odds are in their favor.
- I am frustrated by health care professionals not involving families in health care decisions after an honest discussion of all information available.
- I am frustrated by insurance companies or other parties influencing medical decision making more than the physicians and the families directly impacted.
- I am frustrated by providers, organizations, and policies that ignore the fact that obstetrics is monitoring the health of TWO patients.
To me – these are some of the real problems with umbilical cords…and too many other causes of miscarriage, stillbirth, birth injury, and neonatal death.
We need more providers who are willing to do what makes sense
for their patients with their patients.
We need more families to communicate their desires.
We need more awareness of these issues so that every baby, mom, and family
get the absolute best that medicine can provide.