Umbilical cord prolapse: signs, what to do and what happens next

The umbilical cord links the baby's tummy button to the placenta and carries oxygen-rich blood to the baby. In cord prolapse the cord slips down in front of the baby after the waters have broken and can pass through the open cervix. The RCOG says it usually happens during labour, but it can also happen when the waters break before labour starts.

A related term is cord presentation, where a loop of cord lies below the baby's presenting part while the waters are still intact. A Scottish NHS guideline (NHS Greater Glasgow and Clyde) notes that, in practical terms, the urgent management of the two is the same.

The RCOG explains that a prolapsed cord can be compressed by the baby or the womb during a contraction. That reduces blood flow through the cord and therefore the oxygen reaching the baby, which is why the baby may need to be delivered immediately to prevent long-term harm. The RCOG is also clear about reassurance: for most babies there is no long-term harm, although with a severe lack of oxygen some babies can suffer brain damage and, rarely, a baby can die.

When the baby's head or body sits low and fills the pelvis, the cord usually cannot slip past. The chance rises when there is more room around the baby or the baby is not lying head-down. The RCOG lists these situations, and the Scottish guideline lists similar factors, including an unengaged presenting part and a low-lying placenta.

• The baby is not head-first, particularly breech (bottom first) or transverse (lying sideways).

• The waters break, or labour starts, before 37 completed weeks.

• Twins or triplets, or more waters than usual around the baby (polyhydramnios).

• A small baby, or a low-lying placenta.

• The waters are broken by a doctor or midwife (artificial rupture of membranes) while the baby's head is high in the pelvis. The RCOG says staff will usually only do this when the head is low, and may do it in an operating theatre if there is uncertainty.

The RCOG lists four signs: you can feel the cord in the vagina, you can see it coming from the vagina, your midwife or obstetrician sees or feels it on examination, or the baby's heart rate slows soon after the waters break. It adds that in some women there are no signs at all. That is why the heart rate is listened to after waters break in a hospital or birth centre, and why the Scottish guideline says to check for a palpable cord at examinations when risk factors are present.

The RCOG instructions are specific. Phone 999 for an emergency ambulance immediately and say that you are pregnant and think you have a prolapsed cord. Do not try to push the cord back or touch it, and do not eat or drink in case you need an operation. To reduce pressure on the cord, get onto your knees with your elbows and hands on the floor and bend forward, and stay like this until the ambulance or midwife arrives; lying on your side with pillows under your hip is also described.

The ambulance takes you to the nearest consultant-led maternity unit able to provide full care. The Scottish guideline notes the knee-chest position is not suitable for travelling, so in the ambulance you lie on your side with pillows under your hip so the paramedics can fasten the seat belt. An ambulance is called even if birth seems very close, in case the baby is compromised.

The RCOG says that because the baby needs to be born as soon as possible, you may be advised to have an emergency caesarean, although a vaginal birth may be possible. While arrangements are made, a midwife or doctor may place a hand in the vagina to lift the baby's head off the cord, which may continue until the birth. Sometimes a catheter is placed in the bladder and the bladder filled with fluid to help hold the baby's head away from the cord. You may need a drip (cannula) for fluids and medicines.

The RCOG says a general anaesthetic may be used instead of a spinal or epidural because it works more quickly. If the cervix is fully dilated, a normal or assisted (forceps or ventouse) birth may be possible but only if it can happen quickly; vaginal birth is less likely than caesarean. The Scottish guideline adds that caesarean is usually advised when the cervix is not fully dilated, and that a team skilled in newborn resuscitation should attend. A doctor or midwife trained in newborn care is present at the birth.

The RCOG says cord prolapse cannot be prevented, but if you are at higher risk you may be offered admission to hospital so immediate action is possible. It says admission from 37 weeks may be discussed if the baby is lying transverse or changing position often (unstable lie), because labour becomes more likely after that point. The Scottish guideline recommends that women who are not head-first and whose waters break early be advised to have inpatient care.

The RCOG acknowledges that this can be frightening for you, your partner and family, and suggests talking with your midwife, obstetrician or GP about what happened. It also says the chance of having a cord prolapse in your next pregnancy remains very low. Where a baby has come to harm, the baby's doctor should provide full information and details of support groups.