Umbilical Cord Breaks During Delivery: Understanding Umbilical Cord Issues in Childbirth

The umbilical cord is a vital connection between mother and child in the womb.

Understanding umbilical cord complications is crucial during pregnancy. Problems with the umbilical cord are relatively rare but not unheard of. Routine ultrasound testing during pregnancy reveals many more common umbilical cord issues. Suppose your unborn baby is diagnosed with an umbilical cord abnormality, such as umbilical cord avulsion. Umbilical cord avulsion occurs when the umbilical cord tears, ruptures, or is compressed during labor. Your doctor should take steps to consider risk factors, monitor the baby, and diagnose the problem in a timely manner. Immediate action, including emergency surgery, is essential to prevent birth injuries and even death.

Before we talk about problems that can develop with the umbilical cord, let’s take a quick look at a baby’s support system in the womb.

The Fetal Support System

As a fetus grows in a mother’s uterus, a fluid-filled sac (the amniotic sac) forms around it. A jelly-filled tube with three blood vessels (the umbilical cord) connects the fetus to an organ that forms on the wall of the uterus (the placenta).

How do these special structures work together to support a growing baby?

• Placenta: The placenta is a round, flat organ full of blood vessels that forms during pregnancy and attaches to the uterine wall. Nutrients and oxygen from the mother are exchanged with waste and carbon dioxide from the fetus in the placenta.
• Umbilical cord: The umbilical cord is a tube, usually about 50 cm long, that runs from a baby’s abdomen to the placenta. Within the tube, there is a vein and two arteries. The vein brings nutrients and oxygen from the mother to the baby; the arteries carry away waste and carbon dioxide. A gelatinous substance called Wharton’s jelly inside the tube protects the blood vessels.
• Amniotic sac: The amniotic sac is a fluid-filled bubble surrounding the fetus. Within the amniotic sac, a baby is free to move around, allowing its muscles to begin to develop. The amniotic fluid acts as a buffer between the baby and the outside world, protecting it from jerking and jarring. The common phrase “my water broke” refers to the amniotic sac breaking before a mother goes into labor.

Common Umbilical Cord Problems

Although umbilical cord issues are relatively rare, a few problems commonly occur when issues arise.

• Velamentous insertion is when the umbilical cord attaches to the placenta outside the amniotic sac and the Wharton’s jelly does not protect the umbilical blood vessels. It can often be detected by ultrasound.
• Vasa previa is when umbilical blood vessels run close to the cervix, at the entrance to the birth canal. Compression of the umbilical blood vessels during labor and delivery can cause them to clot or break, often resulting in death or brain damage. Fortunately, most cases of vasa previa can be diagnosed during pregnancy by ultrasound or a doctor’s examination.
• Occasionally the umbilical cord develops with a single umbilical artery instead of the usual two arteries. This condition is usually diagnosed by ultrasound during pregnancy.
• A nuchal cord—the most common umbilical cord complication—is when the umbilical cord is wrapped around a baby’s neck. It usually doesn’t present a threat to the baby.
• Knots can develop in the umbilical cord as a baby moves around in the amniotic sac. Umbilical knots put babies at risk of brain damage or death from cord compression. 
• Cord prolapse is when the umbilical cord comes through the birth canal before the baby. The biggest risk factor for cord prolapse is a breech presentation, when the baby enters the birth canal feet first.
• Cord avulsion or compression is when the umbilical cord tears, ruptures, or is squeezed by a knot or pressure during labor. Conditions like vasa previa, umbilical cord knots, and cord prolapse greatly increase the risk of cord avulsion or compression.

What Happens if the Umbilical Cord Breaks During Birth?

A full or partial break in the umbilical cord—also known as an umbilical cord avulsion or a ruptured umbilical cord—is a rare but severe complication of childbirth.

Cord avulsions most often occur because of the following:

• Compression of the umbilical cord due to vasa previa or a prolapse
• Weakening of the umbilical cord due to an infection

Almost all umbilical cord ruptures occur during the process of childbirth, not while a baby is developing in the mother’s uterus.

If a condition like vasa previa or a prolapsed umbilical cord exists, a doctor might opt to deliver a baby via c-section rather than risk a cord avulsion during delivery.

The most common sign of a break in the umbilical cord while a mother is in labor is vaginal bleeding. An obstetrician should immediately perform an examination to determine the source of the bleeding—mother or child. A small volume of blood may represent a minor loss for a mother but could be life-threatening or cause brain damage in the child. The best treatment is likely to be immediate delivery of the baby via c-section.

Birth Injuries From Umbilical Cord Problems

Infant death is one tragic but possible result of umbilical cord issues during labor and delivery. Bleeding is the most common cause of umbilical cord–related mortality during delivery. For example, according to Marie Helen Beall, MD Clinical Professor of Obstetrics and Gynecology, there is a “50%–75% mortality rate” in cases where umbilical cord blood vessels rupture due to vasa previa.

The blood supply transported by the umbilical cord provides oxygen to a developing fetus, acting as a substitute for lung function until the baby can breathe independently. The brain is extremely sensitive to a lack of oxygen. Suppose the umbilical cord is compressed, torn, or completely severed during the birth process. The flow of blood and, consequently, the oxygen supply to a baby’s brain is cut off. This can result in varying degrees of brain damage or even death.

This type of brain damage is known as hypoxic-ischemic encephalopathy (HIE).

• Hypoxic refers to a lack of oxygen.
• Ischemic refers to a deficient supply of blood.
• Encephalopathy refers to damage to the brain.

Because the brain is the body’s center of operations, damage to the brain can have a wide range of effects. HIE can cause:

• Cerebral palsy—symptoms include problems with movement, coordination, posture, and balance; deficiencies in gross and fine motor skills; and speech difficulties.
• Epilepsy
• Developmental delays
• Intellectual disabilities

HIE and cerebral palsy are not diseases or progressive conditions. Rather, they involve one-time, permanent damage to the brain. Treatments are not aimed at repairing the damage but at supporting an affected child. Care may include:

• Physical and occupational therapy
• Devices that assist with movement, such as wheelchairs, leg braces, or crutches
• Medications to relax stiff muscles or stop muscle spasms

When Are Umbilical Cord Birth Injuries Considered Malpractice?

Unfortunately, many birth injuries are unavoidable. But in some cases, they result from a health care practitioner’s negligence. In medicine, negligence is the failure to provide what Indiana law (844 IAC 5-2-5) calls “reasonable care.”

Reasonable care is the care that another doctor of the same or similar background would have provided in the same or similar circumstances. Suppose a doctor’s actions don’t live up to the standard of reasonable care, and your baby has a birth injury as a result. In that case, you may be able to receive compensation through a medical malpractice claim.

If you suspect that your baby’s death or brain damage resulted from your doctor’s negligence, we strongly encourage you to speak to an experienced birth injury attorney about your case.

When a baby has an umbilical cord issue that results in a birth injury, here are a few things that might be considered medical malpractice:

• Failing to diagnose a condition like vasa previa through ultrasound
• Not following up on the diagnosis of an umbilical cord issue with appropriate tests
• Not properly monitoring a baby’s heartbeat during labor and delivery
• Not investigating the source of bleeding during labor and delivery
• Failing to order a c-section when natural birth is a threat to the baby’s life

You can learn more about medical malpractice by reading our medical malpractice FAQ.

Experienced Birth Injury Lawyers

If you believe your infant was injured or died due to a healthcare practitioner’s negligence, the Indianapolis birth injury lawyers of Wilson Kehoe Winingham can provide guidance regarding your case. Contact us today for a free, no-obligation consultation.

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