What is an umbilical cord?

The umbilical cord is the vital connection between the fetus and the placenta. Umbilical cord development begins around week 3 with the formation of the connecting stalk (pre-umbilical cord where embryo is connected to what will become the fetal portion of the placenta). By week 7, the umbilical cord has fully formed.

By the end of the first trimester, the umbilical cord is comprised of are two arteries and a vein. It is surrounded by a j gelatinous substance call Wharton’s Jelly. The umbilical vein carries oxygenated blood with nutrients from the placenta to the fetus and the umbilical arteries transporting deoxygenated blood with waste products from the fetus to the placenta.

What does Wharton’s Jelly do?

A thick, gelatinous substance made primarily of collagen, its main job is to provide cushioning and protection for the umbilical cord’s three blood vessels by preventing the cord from becoming compressed or bent. Wharton’s jelly also supports the umbilical vessels’ ability to deliver oxygen, blood sugar, and amino acids to a developing fetus. [Miraclecord News]

What’s does this have to do with an umbilical cord knot?

Occasionally the cord can knot and happens naturally as baby moves around. It can also happen during delivery as baby twists and turns towards the exit. Usually not posing a threat, these knots often unknot on their own. Wharton’s jelly prevents small knots from getting tight.

Sometimes; however, the knot gets very tight, and healthcare providers call this a true knot. Unlike a small knot that loosens easily, a true knot is so tight that it can block oxygen and nutrients from reaching the fetus. It can cause complications during pregnancy and delivery because it deprives the fetus of vital nutrients and oxygen. These true knots comprise less than 1% of all pregnancies.

How to know if I have a true knot?

Its important to monitor movement especially in the last trimester. If baby is moving significantly less, then this is something you want to bring up to you midwife or OB. True knots can be diagnosed through ultrasound. Since you can’t unknot the knot, your health care provider will monitor you and baby much closer and more often. An elective cesarean plan may be brought up if baby is in increasing distress. Labor can also tighten a true knot and can become an emergency if baby is in distress.

Are there risk factors for umbilical knots?

These true knots are rare. Small knots, like the one above, is rarely a cause for concern. The concern comes in when they become tight, potentially cutting off oxygen to the baby. According to the Cleveland Clinic, these are some risk factors:

• The fetus is small for its gestational age.
• The umbilical cord is very long.
• You’re carrying monoamniotic twins (identical twins that share an amniotic sac).
• You have too much amniotic fluid (polyhydramnios).
• You’ve had two or more pregnancies (multiparity).
• You’re older than 35.

To sum up

Know you body and your baby. Heading into the third trimester, if movement of baby has reduced, inform your healthcare provider. Most knots are nothing to be too concerned about and change with baby’s movement. Wharton’s Jelly keeps the cord well lubricated so the knot doesn’t become tight. Enjoy your pregnancy, there will be plenty of skinned knees to worry about later.

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During early labor (she needed to be at the hospital from the beginning), things ere pretty calm with lots of banter between them.

As labor progressed she and her partner rode the wave together until an epidural was needed. Sometimes a momma can get so exhausted that she can’t keep going. An epidural allows so much needed sleep.

Eventually it was indicated that a cesarean was needed. While not something this couple hoped for, it is their story. Their sweet baby was delivered healthy.

Cesareans, when needed, are absolutely life saving interventions. I am not a chest pounding yeller of “no more cesareans!!!” Quite the contrary. We are blessed to live in a time that saving the life of a mother and/or baby is easily accessible. I do have issues with the amount of C-sections our country’s maternal care has not due to emergency situations. Those that I take issues with are ones that are colored over as “necessary”. Like the woman who had one before. She shouldn’t automatically be forced to have another with subsequent children. Or ones where a baby is “measuring too big”, “advanced maternal age”, “labor not progressing” (sometimes, extra time is needed) and if its around a holiday, an OB may need to go out of town and some other reason can be used.

Sorry, I went off on a tangent! I can do that from time to time. Anyhow, a C-section in this case was medically necessary.

As I mentioned earlier, a beautiful healthy baby came into the world. For privacy concerns, the baby is not shown here. To say they were and are over the moon is an understatement. I wish them a lifetime of love. They truly rocked the birth♥

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In April of 2020, I started my journey to understanding on a deeper level and become a doula. As I write this, I am not finished with my education, but I would like to impart some knowledge as I go. In this episode of “What the heck is birth about” I will talk about the physical changes a body goes through while in labor.

What the heck is birth about and what are the Stages of Labor?

Ok, ok, we all know that birth is about pushing a tiny human out of our body so that we can love him and hold him and life will be magical. Maybe you have dreamt of this day forever. Perhaps you have gone into this as a warrior, steadfast in your knowledge. Or maybe you are a bit fearful of any pain. Maybe, like me, you didn’t give it a lot of thought and just waited with baited breath to hold your baby. However you think about birth, knowing the physical changes your body undergoes is hugely important. Why? Well, knowledge is power. When you know what your body is physically doing during the stages of labor, you can mentally prepare and the fear can subside.

The Physical Changes-Prodromal Labor

The first stage of labor-Prodromal Labor- are contractions may begin hours or even days before active labor. They are irregular in length, frequency and intensity. The key word here is irregular. On average they are not longer than a minute and range 7 to 10 minutes apart.

• The cervix is moving from a posterior (back) position to an anterior (forward) position.
• The cervix is softening.
• Effacement or thinning of the cervix is beginning. It may thin anywhere from 0% to 50% during this stage.
• May lose the mucous plug from the cervix.
• The cervix may begin to dilate, opening anywhere from 1 to 4 centimeters.

It’s quite normal to get excited that the moment is finally here, but remember this is just the beginning and to remain calm as this transition can take awhile. The stages of labor are just beginning!

The Physical Changes-Active (Latent Phase) Stage 1

The latent phase is the beginning of active labor and can last anywhere from a few hours to 10 hours or more. The contractions will grow longer, stronger and closer together.

• The cervix continues thinning out (effacement).
• The cervix will dilate to 4 or 5 centimeters.
• You may have a couple of loose bowel movements.
• If it hasn’t happened already. you may lose your mucous plug.
• You may notice a bloody show. Bloody show is thick vaginal discharge that contains mucus and blood from the cervix.

The Physical Changes-Active Labor (Active Phase) Stage 1 continued

The active phase of labor will continue with contractions that grow longer stronger and closer together. At this stage you will find yourself working so hard that everything outside your body almost ceases to exist.

• The cervix continues thinning out (effacement).
• The cervix will dilate to 9 or 9+ centimeters.
• Your body will be working very hard during this stage.
• Your water may break at any point. If it does, you may find contractions are increasing in intensity.
• You may notice a bit more bloody show. Some blood is normal now as her cervix stretches open and some of its tiny blood vessels break.
• It is important to continue to get enough to drink to avoid dehydration.

The Physical Changes-Active Labor (Transition Phase) Stage 1 

Transition marks the period when her body completes its labor and prepares to move into birthing the baby. It is perhaps the most intense part of the labor process, physically and emotionally. It is the shortest phase of labor and pushing will soon begin.

• -The cervix will dilate to 9 or 9+ centimeters.
• -Your body will be working very hard during this stage. Some women will tremble or shake.
• -Some women may be nauseous and/or vomit.
• If your water hasn’t broken yet, it may do so at any time.
• The contractions come closer together, perhaps one to two minutes apart. They will last from one minute to ninety seconds. Some may come in pairs with no rest period between them. These are called camelback contractions. These contractions will be the most intense in strength. They reach their peak quickly and maintain it for most of the contraction.

Birth (Latent Phase) Stage 2

The latent phase of stage 2 is the period that it takes the body to “switch gears” so to speak, moving from the dilating of the cervix to pushing the baby down the birth canal. It begins when the cervix is completely dilated and ends with the urge to push along with the contractions.

• The cervix is completely dilated.
• The uterus is shifting gears from dilating contractions, to pushing contractions.
• Contractions are becoming further apart since the work of dilating the cervix is completed. It is not unusual for there to be five or more minutes between contractions.
• For some women contractions may all but cease.

Birth (Active Phase) Stage 2 continued

The active phase of stage 2 is when the pushing comes.

• The baby’s head is molding to fit through the pubic outlet, stretching the birth canal as it goes.
• You may expel some feces, urine or gas.
• You may feel nauseous.
• Pushing contractions are usually five to ten minutes apart and are accompanied for most women by an intense urge to push. It is not unusual for some women to feel little or no urge to push.
• You may be able to feel the baby’s head moving down the vagina.

Crowning and Birth (Active Phase) Stage 2

As the baby’s head begins to emerge it is referred to as crowning. This is an extremely intense phase emotionally and physically. This is the actual birth of the baby.

• The baby’s head will emerge.
• These pushing contractions may be a bit farther apart if she is especially tired.
• Following a short pause to make sure the umbilical cord is not wrapped around the baby’s neck (this is called a Nuchal Cord and is not usually as dangerous as TV and Movies would like to make you think it is); the doctor/midwife will gently ease the top shoulder out first, then the bottom shoulder. The rest of the baby’s body should slip right out.
• You may feel an intense burning at the vaginal outlet, although many women do not.

Delivery of the Placenta (Afterbirth) Stage 3

Although the baby has been born, you still has some work to do. The stages of labor do not end with the birth of baby. The placenta needs to be expelled. If the placenta is delayed, your doctor, nurse or midwife may encourage its expulsion by ‘kneading’ your belly to get the uterus to contract more effectively. This is called fundal massage. 

• Many women notice no sensation at all until they are asked to bear down “one more time.”   The placenta separates from the uterine wall and is expelled through the vagina.
• You may feel the uterus cramp, especially if the baby begins suckling immediately.
• You may feel an uncomfortable “full” sensation even though the baby is out, until the placenta is delivered.
• Other than a cramping sensation, there will be no more contractions.

To sum it up-Stages of Labor

The changes in your body are pretty amazing. The more knowledge you have about what’s going on, the easier it can be. Knowledge of the stages of labor is power. The more knowledgeable and powerful a woman is, the less fear there is. The less fear there is, the less stress there is. The less stress there is, a more positive experience a woman can have. Some women may forget everything when the chips are down, this is why a doula can really make a difference.

If you are ready to talk about your birth plan, please contact me today. If you need doula support through the stages of labor, I can help. For more information about the stages of labor, the Mayo Clinic site has some interesting pieces of information.

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