The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Rupture of Membranes Causes Cord Prolapse

One of the nurses tried to insert a catheter. She said, "I feel something--I think its the cord", and it made it difficult for her to get the catheter in. She finally called the doctor in for help. He got the catheter in and said he thought he could feel the cord, too. He said the baby's head was still too high, so he broke my water so the head would come down. After he broke my water, the doctor told me I could start pushing.

I'm no expert. But I'll tell you what I think. I think based on what I see here about the cord being below your son's head before your water even broke was there was no way around your section.

My midwifery partner and I have done labor support training workshops for several years. A few years ago, a nurse attended a workshop. She worked in a large hospital in Indianapolis that served largely indigent and poor people. She repeatedly saw with her own eyes OBs asking a medical students if they had ever seen a cesarean. When the answer was no, the doc would break the water on a mom with a baby with a high head -- bingo -- cesarean for fetal distress. They have a license and I don't.

General rule of thumb for out-of-hospital birth is that you do not break the waters if the head is not engaged. Period. Some would say you do not break the waters . . . period. This wisdom would be well applied in many hospital births.

There are ways of moving the head lower, for example, by putting gentle pressure on the baby's butt or getting the mom into an upright position or squat so the head will fill the pelvis before breaking the waters. Once the waters are broken and a few contractions have helped tighten up the uterus, the head should generally stay in the pelvis.

One of the wonderful things about birth is that it's really a simple mechanical situation, and you can move the parts around.

Even though there are things that wouldn't be appropriate for me to do as a homebirth midwife, I often do thought experiments, as in "What if there were an earthquake and the hospitals were out of commission?"

If you could feel the cord below the head and you needed to break the waters, there are things you could do to try to move the cord. After all, it's just a thick cord in fluid lying alongside the baby. The easiest way to get the cord "above" the head is to get the head below the cord. The reason the cord got below the head in the first place was that it was a long cord, and cords sink in fluid. Naturally, if it happens to get alongside the head and the head isn't filling the pelvis, the cord will "sink" to the bottom of the pelvis.

You can take advantage of gravity by reversing the situation and getting the mom in a knee-chest position so that the cord will again "sink" but this time away from the head. Once the cord is below the head, you can apply gentle pressure to move the baby into the pelvis and keep it there to prevent the cord from sinking again past the head when the mom gets upright. This assumes the head can be moved into the pelvis and will fill it reasonably well, which is almost always the case.

That's the theory. In practice, it's not always easy to know where the parts are or to get them to move the way you want, but it won't happen if you don't try.