Umbilical Cord Complications: Prolapse, Compression & Birth Injuries

The umbilical cord serves as your baby’s lifeline during pregnancy, delivering oxygen and nutrients necessary for healthy development. When complications like cord prolapse, compression, or entanglement occur during labor and delivery, your baby can suffer oxygen deprivation that leads to serious birth injuries including brain damage and cerebral palsy. Many umbilical cord emergencies require immediate medical intervention to prevent permanent harm.

If your child experienced a birth injury following umbilical cord complications, you may have questions about whether proper medical care was provided. When healthcare providers fail to recognize warning signs, delay necessary interventions, or mismanage cord emergencies, their negligence can result in devastating consequences for your family. Understanding what happened during your child’s birth is the first step toward getting answers—and getting your family the support you deserve.

If you believe medical negligence during an umbilical cord emergency caused your child’s birth injury, you may have legal options. A birth injury attorney can review your case at no cost and help you understand whether malpractice occurred. Because statute of limitations deadlines apply, it’s important to get answers sooner rather than later. Contact a birth injury lawyer today for a free, confidential case evaluation.

On this page:

• Understanding the umbilical cord’s role
• Types of umbilical cord complications
• Cord prolapse emergencies
• Cord compression and nuchal cord
• How cord complications cause birth injuries
• Warning signs medical teams should recognize
• When cord complications become medical malpractice
• Diagnosis and monitoring during labor
• Treatment and emergency interventions
• Long-term effects on your child
• Filing a birth injury lawsuit
• Finding a birth injury lawyer
• Frequently asked questions

Understanding the Umbilical Cord’s Role in Pregnancy

The umbilical cord connects your baby to the placenta throughout pregnancy. This remarkable structure typically measures 20 to 24 inches long and contains three blood vessels: two arteries and one vein. The umbilical vein carries oxygen-rich blood and nutrients from the placenta to your baby, while the two arteries return deoxygenated blood and waste products back to the placenta for removal.

When the umbilical cord functions properly, your baby receives a consistent supply of oxygen and nutrition needed for healthy growth and development. The cord floats freely in the amniotic fluid, allowing your baby to move and develop without restriction. A protective substance called Wharton’s jelly surrounds the blood vessels, providing cushioning and preventing the vessels from becoming compressed under normal circumstances.

Any disruption to blood flow through the umbilical cord can quickly become dangerous. Because your baby depends entirely on the cord for oxygen, even brief interruptions in blood flow can lead to oxygen deprivation. During labor and delivery, when stress on your baby naturally increases, umbilical cord complications require immediate recognition and response from your medical team.

Types of Umbilical Cord Complications

Several different umbilical cord problems can occur during pregnancy and childbirth. Each type presents unique risks and requires specific monitoring and management approaches.

Umbilical cord prolapse occurs when the cord slips through the cervix ahead of your baby, typically after your water breaks. This emergency situation can cause the cord to become compressed between your baby and the birth canal, cutting off oxygen supply. Cord prolapse is one of the most dangerous umbilical cord complications and requires immediate delivery, usually by emergency cesarean section.

Cord compression happens when pressure on the umbilical cord restricts blood flow. This can occur when your baby lies on the cord, when the cord becomes trapped during delivery, or during contractions. While brief compression during labor is common and usually harmless, sustained or severe compression can cause oxygen deprivation leading to birth asphyxia and brain damage.

Nuchal cord refers to the umbilical cord wrapping around your baby’s neck one or more times. Despite common fears, nuchal cord is relatively common—occurring in about 25-30% of deliveries—and usually does not cause problems. However, a tightly wrapped cord or multiple loops can compress blood vessels and restrict oxygen flow, particularly during delivery when the cord may tighten.

Umbilical cord knots can form when your baby moves through loops in the cord during pregnancy. True knots occur in approximately 1% of pregnancies. While loose knots typically don’t cause issues, tight knots can restrict blood flow and lead to complications, especially during labor when tension on the cord increases.

Short umbilical cord (less than 16 inches) can create problems during delivery by limiting your baby’s movement through the birth canal or causing the cord to tear. Conversely, an excessively long cord (more than 39 inches) increases the risk of cord prolapse, entanglement, and knots.

Vasa previa is a rare but serious condition where fetal blood vessels run through the membranes covering the cervix. When membranes rupture, these unprotected vessels can tear, causing rapid fetal blood loss. This condition requires diagnosis before labor and delivery by scheduled cesarean section before membrane rupture.

If you’re concerned about how umbilical cord problems affected your child’s birth, a birth injury attorney can help you understand whether proper monitoring and intervention occurred.

Umbilical Cord Prolapse: A Medical Emergency

Umbilical cord prolapse represents one of the most critical obstetric emergencies. When the cord drops through the cervix before your baby, each contraction can compress the cord against your baby’s body or the walls of the birth canal, cutting off oxygen supply. Without immediate intervention, cord prolapse can quickly lead to profound oxygen deprivation, brain damage, or death.

Cord prolapse occurs in approximately 1 in 300 deliveries. Certain risk factors increase the likelihood of this complication, including breech presentation, transverse lie, prematurity, polyhydramnios (excess amniotic fluid), multiple gestation, and artificially rupturing membranes when the baby’s head is not engaged in the pelvis.

Medical teams can sometimes identify “occult” cord prolapse through abnormal fetal heart rate patterns on the monitor, even when the cord cannot be felt during examination. An “overt” prolapse occurs when the cord can be seen or felt in the vagina or has descended past the presenting part of the baby.

When cord prolapse occurs, minutes matter. The standard of care requires immediate measures to relieve pressure on the cord and emergency delivery—typically within minutes. Your healthcare provider should manually elevate the presenting part of your baby to reduce cord compression while preparing for emergency cesarean section. Other interventions may include filling the bladder to lift the baby, positioning you in Trendelenburg or knee-chest position, and administering medications to stop contractions.

Delays in recognizing cord prolapse, failure to take immediate action to relieve cord compression, or postponing emergency delivery can constitute medical negligence when these delays result in preventable birth injuries.

Cord Compression and Nuchal Cord During Delivery

While cord compression can occur at any point during labor, it becomes particularly concerning during the pushing stage of delivery. As your baby descends through the birth canal, the cord may become trapped between your baby’s body and your pelvis, or wrapped tightly around the neck or body.

Fetal heart rate monitoring provides the primary means of detecting cord compression during labor. Variable decelerations—sudden drops in your baby’s heart rate—often indicate cord compression. These decelerations typically occur during contractions when pressure increases. While occasional variable decelerations are common and may not harm your baby, severe, prolonged, or progressively worsening patterns signal significant oxygen deprivation requiring intervention.

Nuchal cord—when the umbilical cord wraps around your baby’s neck—deserves careful monitoring but doesn’t always require intervention. Many babies with a nuchal cord are born healthy without complications. The critical factor is whether the cord is loose or tight, and whether it affects blood flow and oxygen delivery.

Your medical team should recognize warning signs that nuchal cord or cord compression is affecting your baby, including persistent or worsening variable decelerations, bradycardia (sustained low heart rate), absent variability in the heart rate pattern, and lack of accelerations. When monitoring indicates your baby is not tolerating labor due to cord compression, interventions may include changing your position, administering oxygen, providing intravenous fluids, amnioinfusion (infusing fluid into the uterus to cushion the cord), and expediting delivery when conservative measures fail.

Understanding the connection between umbilical cord complications and conditions like hypoxic-ischemic encephalopathy can help you evaluate whether your medical team provided appropriate care.

How Umbilical Cord Complications Cause Birth Injuries

The mechanism by which umbilical cord problems lead to birth injuries relates directly to oxygen deprivation. When blood flow through the umbilical cord becomes restricted or cut off, your baby’s brain and organs no longer receive the oxygen they need to function.

Brief interruptions in oxygen supply may be tolerated without permanent harm, particularly when they resolve quickly. However, sustained or severe oxygen deprivation triggers a cascade of cellular damage. Brain cells are particularly vulnerable to oxygen deprivation. Without oxygen, brain cells cannot produce the energy needed to maintain their structure and function. As cellular energy stores deplete, toxic substances accumulate and cell membranes break down.

This initial injury phase continues as long as oxygen deprivation persists. Following restoration of blood flow and oxygen, a secondary injury phase begins hours later, involving inflammation, additional cell death, and the development of seizures. The extent of brain damage depends on the severity and duration of oxygen deprivation, as well as how quickly therapeutic interventions are provided.

Hypoxic-ischemic encephalopathy (HIE) represents one of the most serious outcomes of umbilical cord complications. HIE occurs when oxygen deprivation causes brain damage around the time of birth. Babies with HIE may develop cerebral palsy, intellectual disabilities, seizure disorders, vision and hearing impairments, and other neurological problems.

Other birth injuries that can result from cord complications include cerebral palsy affecting movement and muscle control, developmental delays impacting cognitive and motor skills, periventricular leukomalacia (brain white matter damage), neonatal seizures in the first days of life, and in the most severe cases, death.

The likelihood of permanent injury increases when medical teams fail to recognize fetal distress caused by cord complications or delay necessary interventions. Early recognition and rapid response can sometimes prevent brain injury even when cord complications occur.

Warning Signs Medical Teams Should Recognize

Healthcare providers have a responsibility to monitor your baby continuously during labor using electronic fetal monitoring. This technology tracks your baby’s heart rate and identifies patterns that suggest distress or oxygen deprivation.

Specific fetal heart rate patterns indicate possible umbilical cord compression. Variable decelerations appear as sudden, sharp drops in heart rate that typically coincide with contractions but may occur between contractions. While mild variable decelerations are common, severe variables (heart rate dropping below 70 beats per minute or lasting longer than 60 seconds) or repetitive variables that worsen over time require intervention.

Prolonged decelerations—heart rate drops lasting 2-10 minutes—may indicate cord compression or prolapse and demand immediate evaluation and action. Bradycardia, when your baby’s heart rate falls below 110 beats per minute for an extended period, can signal severe cord compression or prolapse.

Additional warning signs include absent or minimal heart rate variability (the normal fluctuations in heart rate that indicate a healthy, responsive nervous system), failure of the heart rate to return to baseline between decelerations, and the presence of late decelerations (indicating the placenta isn’t providing enough oxygen) in combination with variable decelerations.

Physical examination findings can also alert providers to cord problems. When membranes rupture, your healthcare provider should perform a vaginal examination to check for cord prolapse, particularly when risk factors are present. Palpating the cord during examination or visualizing the cord at the vaginal opening requires immediate emergency response.

Your medical team should also recognize when risk factors for cord complications are present and adjust monitoring accordingly. High-risk situations include artificial rupture of membranes when the baby’s head is not engaged, breech or transverse presentations, premature labor, polyhydramnios, and multiples.

When warning signs appear, your healthcare providers must respond appropriately. Failure to recognize these signs, dismissing concerning patterns as normal, or delaying intervention when monitoring indicates fetal distress can constitute negligence.

If you believe your medical team missed warning signs or failed to act appropriately when your baby showed signs of distress, speak with a birth injury attorney. A free case review can help you understand whether the care provided met accepted medical standards.

When Umbilical Cord Complications Become Medical Malpractice

Not all umbilical cord complications constitute medical malpractice. Many cord problems occur unpredictably and cannot be prevented. However, when healthcare providers fail to properly monitor your baby, recognize warning signs of cord compromise, or respond appropriately to a cord emergency, their negligence may give rise to a valid malpractice claim.

Medical malpractice occurs when a healthcare provider deviates from the accepted standard of care and that deviation causes injury to the patient. In birth injury cases involving umbilical cord complications, potential acts of negligence include failure to adequately monitor fetal heart rate during labor, misinterpreting or ignoring concerning fetal heart rate patterns that indicate cord compression, failing to recognize or respond appropriately to cord prolapse, delaying necessary interventions when monitoring shows fetal distress, and failing to perform a timely emergency cesarean section when indicated.

Additional examples of negligence include artificially rupturing membranes without proper precautions when risk factors for cord prolapse exist, failing to identify high-risk situations that warrant increased monitoring, allowing labor to continue despite persistent signs of fetal compromise, and inadequate communication among medical team members during an emergency.

Proving medical malpractice in cases involving umbilical cord complications requires demonstrating that competent healthcare providers would have acted differently in the same circumstances and that the provider’s failure caused your child’s injuries. This typically requires expert testimony from obstetricians, maternal-fetal medicine specialists, and other medical professionals.

Medical records provide critical evidence in these cases. Fetal heart rate monitoring strips show exactly how your baby tolerated labor and when concerning patterns developed. Labor and delivery notes document what interventions were attempted and when. Operative reports describe what providers found at the time of delivery. Your baby’s newborn records, including Apgar scores, resuscitation efforts, and early test results, help establish the severity of oxygen deprivation and resulting injuries.

Proving causation—that the provider’s negligence caused your child’s specific injuries rather than unavoidable complications—often presents the most challenging aspect of birth injury cases. Medical experts must analyze the timing of events, the severity and duration of oxygen deprivation, and other potential causes of injury.

An experienced birth injury attorney can help you obtain and review medical records, identify potential departures from the standard of care, and connect you with qualified medical experts who can evaluate your case.

Diagnosis and Monitoring During Labor

Continuous electronic fetal monitoring represents the primary tool for detecting umbilical cord complications during labor. This technology uses external sensors on your abdomen or an internal electrode attached to your baby’s scalp to track heart rate patterns continuously throughout labor.

Normal fetal heart rate monitoring shows a baseline heart rate between 110 and 160 beats per minute with moderate variability (fluctuations indicating a healthy, responsive nervous system) and accelerations (temporary increases in heart rate associated with fetal movement or contractions). These reassuring patterns suggest your baby is tolerating labor well and receiving adequate oxygen.

When the monitor shows variable decelerations, your medical team should evaluate the pattern’s severity and frequency. Mild variable decelerations that resolve quickly may simply require continued monitoring and position changes. However, severe or worsening patterns demand more aggressive intervention.

Your provider may perform additional assessments when concerning patterns appear, including vaginal examination to check for cord prolapse or rapid cervical change, checking your position and changing it to relieve potential cord compression, fetal scalp stimulation to assess your baby’s ability to respond, and sometimes fetal scalp pH testing or lactate testing to measure your baby’s oxygen status directly.

Ultrasound can sometimes identify umbilical cord issues before or during labor. Prenatal ultrasound may detect abnormal cord insertion, vasa previa, a short cord, or true knots. During labor, ultrasound can confirm cord prolapse or visualize nuchal cord, though these findings must be interpreted alongside clinical symptoms and fetal heart rate monitoring.

When umbilical cord complications are suspected or confirmed, your medical team should increase monitoring intensity and prepare for the possibility of emergency delivery. Delays in ordering appropriate tests, failing to perform vaginal examination when cord prolapse is suspected, or continuing to rely on external monitoring when internal monitoring would provide better information may constitute substandard care.

Proper monitoring gives healthcare providers the information they need to recognize problems and intervene before your baby suffers permanent injury. When monitoring is inadequate or findings are misinterpreted, opportunities to prevent infant brain damage may be lost.

Treatment and Emergency Interventions

Treatment for umbilical cord complications depends on the specific problem, its severity, and how your baby is responding. Conservative measures may resolve mild cord compression, while severe complications require immediate delivery.

For cord compression indicated by variable decelerations, initial interventions typically include changing your position (to left side, right side, hands and knees, or Trendelenburg), providing oxygen through a face mask to increase oxygen available to your baby, administering intravenous fluids to improve placental blood flow, and reducing or stopping Pitocin if labor is being augmented or induced.

Amnioinfusion—infusing sterile saline into the uterus through an intrauterine catheter—can cushion the umbilical cord and relieve compression. This intervention is particularly effective for variable decelerations caused by low amniotic fluid (oligohydramnios). Studies show amnioinfusion can reduce the rate of cesarean deliveries performed for fetal heart rate abnormalities.

When these conservative measures fail to resolve concerning fetal heart rate patterns or when monitoring indicates your baby is deteriorating, expedited delivery becomes necessary. The method of delivery depends on how close you are to delivering vaginally. If you’re fully dilated and your baby is low in the birth canal, operative vaginal delivery using forceps or vacuum extractor may be the fastest option. Otherwise, an emergency cesarean section is usually required.

Umbilical cord prolapse demands immediate emergency delivery in nearly all cases. While providers work to prepare for emergency cesarean, they must take immediate steps to relieve pressure on the cord. A provider should insert a hand into the vagina to manually elevate the presenting part of your baby, lifting your baby off the compressed cord. This intervention continues until delivery. Additional measures include placing you in a steep Trendelenburg (head down) or knee-chest position to use gravity to reduce pressure, filling your bladder with sterile fluid to lift your baby, and administering tocolytic medications to stop contractions.

The standard of care requires delivery as quickly as possible when cord prolapse occurs, typically within minutes. The often-cited “decision-to-incision” time of 30 minutes for emergency cesarean section applies to urgent situations; for stat emergencies like cord prolapse with severe bradycardia, delivery should occur much faster when possible.

Following birth, babies who experienced significant cord complications and oxygen deprivation require immediate evaluation and potentially intensive treatment. Resuscitation, therapeutic hypothermia (brain cooling) for HIE, seizure management, and monitoring for organ dysfunction represent critical interventions in the immediate newborn period.

Delays in implementing appropriate interventions when cord complications are identified, failure to proceed with emergency delivery when conservative measures are ineffective, and inadequate preparation for neonatal resuscitation when birth asphyxia is anticipated can constitute negligence when these failures result in preventable injuries.

Your family deserves answers if your medical team failed to provide timely, appropriate treatment for a cord emergency. Contact a birth injury attorney to discuss your specific situation and whether you may have grounds for a medical malpractice claim.

Long-Term Effects on Your Child

The long-term impact of umbilical cord complications depends on whether oxygen deprivation occurred, how severe and prolonged it was, and what interventions were provided. Many babies who experience cord complications during delivery are born healthy and develop normally without any lasting effects.

However, when cord complications cause significant oxygen deprivation leading to HIE or other forms of brain injury, your child may face lifelong challenges. The severity of long-term effects typically correlates with the severity of the initial brain injury.

Mild HIE may result in learning disabilities, attention difficulties, fine motor coordination problems, and behavioral challenges that become apparent as your child grows. Moderate to severe HIE can cause cerebral palsy affecting movement and muscle tone, intellectual disabilities ranging from mild to profound, epilepsy or seizure disorders requiring ongoing management, vision impairments including cortical visual impairment, hearing loss, and feeding difficulties requiring specialized support.

Cerebral palsy represents one of the most common long-term outcomes of birth asphyxia caused by cord complications. This condition affects muscle tone, movement, and posture. The type and severity of cerebral palsy varies widely. Some children have mild symptoms affecting only one limb, while others experience severe spasticity or movement disorders affecting their entire body and limiting independence.

Children who experienced oxygen deprivation may also develop developmental delays affecting motor skills, speech and language, social-emotional development, and cognitive abilities. Early intervention services including physical therapy, occupational therapy, speech therapy, and developmental support can help maximize your child’s potential.

Medical care for children with birth injuries often continues throughout life. Your child may require multiple therapies, assistive devices and mobility equipment, medications for seizures or muscle tone, orthopedic surgeries, feeding support including gastrostomy tubes, and special education services.

The emotional and financial impact on families raising children with birth injuries can be overwhelming. Medical expenses, therapy costs, home modifications, specialized equipment, and lost parental income create significant financial strain. Many families also face emotional challenges including grief, stress, and concerns about their child’s future.

Understanding the connection between the umbilical cord complications during birth and your child’s current condition is important for several reasons. It helps you understand what happened and why, allows you to make informed decisions about your child’s care, and helps you determine whether medical negligence played a role in your child’s injuries.

If your child was diagnosed with cerebral palsy, developmental delays, or other conditions following umbilical cord complications during birth, a birth injury attorney can help you investigate whether these outcomes could have been prevented with appropriate medical care.

Filing a Birth Injury Lawsuit for Umbilical Cord Complications

When medical negligence during an umbilical cord emergency causes your child’s birth injuries, you may be entitled to compensation through a medical malpractice lawsuit. These legal claims can help your family recover damages for your child’s medical expenses, therapy and rehabilitation costs, assistive devices and equipment, home and vehicle modifications, special education needs, lost future earning capacity, pain and suffering, and decreased quality of life.

Birth injury lawsuits also compensate parents for their own losses, including lost wages from caring for your injured child, emotional distress, and loss of the parent-child relationship you expected.

The process of pursuing a birth injury lawsuit typically begins with a free consultation with an experienced birth injury attorney. During this initial meeting, you’ll discuss what happened during labor and delivery, your child’s diagnosis and current condition, and whether the care provided appears to have departed from accepted medical standards.

 

If your attorney believes you may have a valid claim, the next step involves obtaining and thoroughly reviewing your complete medical records from pregnancy, labor, delivery, and your child’s newborn period. These records will be evaluated by medical experts—typically obstetricians, maternal-fetal medicine specialists, neonatologists, and neurologists—who can identify whether the standard of care was met and whether negligence caused your child’s injuries.

Medical malpractice cases require expert testimony. These qualified medical professionals review the evidence and provide opinions about what should have been done differently and how those failures led to preventable harm. Your attorney will work with these experts throughout the case.

Once the investigation supports a claim of malpractice, your attorney will file a formal complaint in court. The defendants—which may include your obstetrician, hospital, nurses, and other healthcare providers—will file answers and the discovery process begins. Discovery involves exchanging information, taking depositions (recorded testimony under oath), and gathering additional evidence.

Many birth injury cases settle during the litigation process. Settlement negotiations allow both sides to resolve the case without going to trial. Your attorney will negotiate on your behalf to seek compensation that fairly addresses your child’s needs. However, if a fair settlement cannot be reached, your case may proceed to trial where a jury will determine liability and damages.

Birth injury litigation is complex and time-consuming, often taking two to four years to reach resolution. However, the compensation recovered can make a significant difference in your child’s life by ensuring access to necessary medical care, therapies, and support services.

Time limits apply to filing medical malpractice lawsuits. Each state has statutes of limitations that set deadlines for bringing legal claims. For birth injuries, many states provide extended time periods or toll (pause) the statute of limitations until a child reaches a certain age, but exceptions and special rules apply. Because these deadlines can be complicated and missing them can permanently bar your claim, it’s important to consult with an attorney as soon as possible.

Many families worry about the cost of legal representation. Most birth injury attorneys work on contingency, meaning you pay no upfront fees and the attorney only receives payment if they recover compensation for you. The attorney’s fee comes as a percentage of the settlement or verdict, so legal representation is accessible regardless of your financial situation.

Finding a Birth Injury Lawyer

Choosing the right attorney to represent your family in a birth injury case is an important decision. Birth injury litigation requires specific medical and legal knowledge, significant resources, and experience handling complex cases.

When evaluating potential attorneys, consider their experience specifically with birth injury cases. While general medical malpractice experience is valuable, birth injury cases involve unique medical issues related to obstetrics, neonatology, and pediatric neurology. Ask how many birth injury cases the attorney has handled and what outcomes they achieved.

Resources matter in these cases. Successful birth injury litigation requires working with multiple medical experts, obtaining medical literature and research, creating demonstrative evidence for trial, and investing substantial time in case preparation. Choose a law firm with the financial resources and infrastructure to fully pursue your case.

Medical malpractice cases, particularly those involving birth injuries, are often vigorously defended by insurance companies and healthcare institutions. Your attorney should have trial experience and a track record of success in the courtroom, not just with settlement negotiations. Defendants are more likely to make fair settlement offers when they know your attorney is prepared and capable of trying the case.

Communication is also critical. You should feel comfortable with your attorney and confident that they will keep you informed throughout the process. During your initial consultation, assess whether the attorney listens to your concerns, explains legal concepts clearly, and treats you with compassion and respect.

Questions to ask during your consultation include: How many birth injury cases have you handled? What results have you achieved for families in situations similar to ours? Which medical experts would review our case? How long do birth injury cases typically take? What expenses should we expect and how are they paid? How will you communicate with us throughout the process? And what makes you believe our case has merit?

Most importantly, trust your instincts. The attorney-client relationship in a birth injury case often lasts several years. Choose someone you trust to advocate for your child and your family throughout this challenging process.

Don’t let statute of limitations deadlines expire while you’re considering your options. Contact a qualified birth injury attorney today for a free case evaluation. Understanding your legal rights costs nothing and can provide valuable information about your family’s options moving forward.

Frequently Asked Questions About Umbilical Cord Complications