The nuchal cord at birth: what do midwives think and do?

No good evidence exists to support the practice of routinely checking for the nuchal cord, yet it is a common medical intervention in birth. Some evidence shows damage to the baby because the practice more frequently leads to premature cord-cutting and the vaginal examination, required by such routine checking, may be physically and/or emotionally damaging to the women. Our objective was to learn what training midwives have received and what their current practice is in relation to a possible nuchal cord at birth?

Questions about nuchal cord at birth were posted to two online midwifery discussion forums and responses were invited. Twenty-six midwives from 10 countries responded to questions on nuchal cord practices.

The teaching and practice of routinely checking for the nuchal cord at birth is widespread, according to at least some participants from all 10 countries. Other midwives from the same countries argued that, although they were aware that the procedure is the dominant midwifery practice, many midwives neither teach it nor perform it routinely.

In the absence ofclear evidence, firmly entrenched positions are being argued for and against routine checking. The debate is infused with high emotion. Those arguing for routine checking cite safety for the baby as their main concern. Those arguing against checking cite the need to keep birth normal and the well-being of the baby as their primary concerns. There is a need to reconsider how the possibility of nuchal cord at birth should be conceptualised from a midwifery perspective to ensure woman-centred decision-making.