While you might picture your water breaking as the first sign of your baby's debut, the chances of experiencing premature rupture of the membranes (in other words, your water breaking before you've started getting contractions or are actually in labor) are actually pretty low. If that does happen, however, it's important to follow your doctor's instructions carefully.
Cord prolapse is one very small but potential risk that requires prompt medical treatment to reduce the risk of serious consequences.
What is cord prolapse?
Cord prolapse is when an unborn baby's umbilical cord slips through the cervix and into the vagina after a mother's water breaks and before the baby descends into the birth canal.
During delivery, the prolapsed cord can become compressed by the baby's body. Because the umbilical cord delivers blood from the placenta to the baby, cord prolapse can compromise a baby's oxygen supply.
In the rare event of cord prolapse, quick treatment from a medical professional is essential. The longer the delay, the greater the risk of complications such as placental abruption, excessive bleeding, fetal injuries and stillbirth.
What causes cord prolapse?
A common cause of cord prolapse is premature rupture of the membranes, which is when a mom's water breaks before she's actually in labor and her baby's head has begun to "engage," or settle into, the birth canal.
Other times, obstetric procedures during labor can disengage your baby's head (or the part of his body that's facing down), and the cord can slip past. Obstetric interventions account for approximately 50 percent of cord prolapse cases.
Who is most at risk for cord prolapse?
Some factors associated with cord prolapse include:[1]
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- Your baby's position (breech, transverse, oblique or unstable lie — or his head is unengaged in the pelvis)
- Preterm labor
- Low birth weight
- Having twins or multiples
- Having previous children
- A low-lying placenta
- Atypical placental cord insertions
- Uterine malformations (such as fibroids)
- Polyhydramnios (too much amniotic fluid)
- Having a long umbilical cord
- Prolonged labor
Obstetric interventions associated with cord prolapse include:
- Induction of labor due to cervical ripening with a balloon catheter or artificial rupture of membranes
- Use of forceps or a vacuum
How common is cord prolapse in labor?
Cord prolapse is relatively rare, occurring in about one out of every 300 births.[2]
What are the symptoms of cord prolapse?
The main symptom of cord prolapse is feeling or seeing the prolapsed cord in your vagina or at the vaginal opening after your water has broken. If you think you might have cord prolapse, head to the hospital immediately or call 911. A health care provider will give you a pelvic exam to confirm cord prolapse.
If you're already at the hospital, a doctor may suspect prolapse if your water has broken and fetal monitoring shows your baby's heart rate has slowed to less than 120 beats per minute.
How is cord prolapse treated?
If you think your baby's umbilical cord is prolapsed and you're not already at the maternity ward, call 911 immediately or go to the hospital right away. While you wait, get on your hands and knees with your pelvis up and head down to take pressure off of the cord. On the car ride over, lie down with your hips elevated.
If you're already in the hospital when the cord prolapses, your practitioner may ask you to change positions to make it easier to disengage your baby's head and relieve pressure from the umbilical cord.
Either way, your baby will need to be delivered very quickly, which may require an immediate C-section. Prompt delivery usually prevents the potential risks of cord prolapse (including those caused by lack of oxygen to the baby).
Is there anything you can do to prevent cord prolapse?
There's really no way to know in advance if your baby's cord will prolapse. Although there are risk factors, cord prolapse can occur in low-risk people who are delivering their babies at term.
If you have a complication that increases the risk of cord prolapse, your doctor may schedule a C-section.
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