Ep 209: The Umbilical Cord -What Is It, What Does It Do and What Problems Can Occur

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The umbilical cord is truly your baby’s lifeline. It provides a pathway for the exchange of nutrients, oxygen, and waste. After birth the cord is cut and the fetal circulation ends, leaving behind a small stump. And when that stump falls away it makes the belly button, a permanent reminder of the physical connection between you and your baby.

In this episode you’re going to learn about what potential problems can happen with the umbilical cord including those diagnosed during pregnancy (marginal cord insertion, velamentous cord insertion, vasa previa, 2 vessel cord), and those that can occur during birth (cord compression, cord prolapse, nuchal cord, cord knots). Now, even though I go over a lot of cord-related issues in this episode, the chances of a true emergency are unlikely. I want you to be informed and aware of the potential risks but mostly I want you to come away from this episode feeling amazed and appreciative of what your body can do.

In this Episode, You’ll Learn About:

  • What the umbilical cord delivers to your baby and how it works
  • Which cord-related issues can be diagnosed during routine ultrasound exams
  • What cord complications can happen during the course of labor
  • What delayed cord clamping is and what the benefits are
  • What umbilical cord blood banking means
  • What the types of cord blood banking are and which might be right for you
  • How different cultures around the world commemorate the umbilical cord

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Transcript

Dr.Nicole (00:00): In this episode, you are going to learn all about the umbilical cord. Welcome to the All About Pregnancy and birth podcast. I'm Dr. Nicole Calloway, Rankins, a board certified OBGYN, who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident and empowered to have a beautiful pregnancy in birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

(00:49): Hello there. Welcome to another episode of the podcast. This is episode number 209. Whether you are a new listener or a returning listener, I'm so glad you're spending some of your time with me today. So in this episode, you're going to learn about the umbilical cords. So we're going to go into what is the umbilical cord. You'll learn some issues that are or can potentially be diagnosed during pregnancy, including marginal cord insertion, valentas cord insertion, visa previa, and then a two vessel umbilical cord, also known as a single umbilical artery. And then we'll talk about some of the things that can happen during the course of labor or that are discovered during the course of labor, and that is umbilical cord prolapse, umbilical cord compression, nucle cord, and then knots in the umbilical cord. And then we'll end with delayed cord clamping and then umbilical cord blood banking, as well as some traditions around the world of what other folks do with the umbilical cord.

(01:50): Just a little bit of fun information at the end there. Now the umbilical cord connects to the placenta, and if you want to learn all about the placenta, then check out episode 180 of the podcast where I go through what the placenta is and potential issues that can happen with the placenta. That's dr nicole rankins.com/episode 180. And if you want to learn how to get calm, confident and empowered for your birth and check out the birth preparation course, the birth preparation course is my signature online childbirth education class that will get you calm, confident and empowered to have a beautiful birth. Thousands of folks have gone through the course at this point and I would love to serve you inside of the course as well. So head to dr nicole rankins.com/enroll and check out all the details there. All right, let's get into it about the umbilical cord.

(02:44): So first off, what is the umbilical cord? Well, the umbilical cord is a flexible tubular structure that connects your developing baby to the placenta and the placenta is attached to the wall of the uterus. It does all of the exchange of nutrients and waste and all of that, and it's composed of two arteries. In one vein, the arteries carry blood away from the baby towards the placenta, and the vein carries blood from the placenta to the baby. Now, those two arteries in one vein aren't encased in a gelatinous substance called Wharton's jelly. The closest that I can think of that it feels like is kind of like a gummy bear. It's a bit softer than a gummy bear, squishier than a gummy bear, but it's kind of a squishy sub substance. And then the umbilical cord is roughly 20 on, I should say on average 20 to 24 inches long and a little less than an inch wide in diameter.

(03:48): Now, the umbilical cord is the lifeline between your baby and the placenta. It provides a pathway for the exchange of nutrients, oxygen waste products between you and your developing baby. It also contains stem cells. Stem cells can be used in medical treatments for certain diseases and conditions, and I'll talk about the collection of those in umbilical core blood banking towards the end. Now, as we know during birth or right after birth, the umbilical cord is clamped and cut that separates your baby from the placenta that ends the fetal circulation and that little stump falls off within a few days leaving behind the belly button or umbilicus is the medical term. And most people have an people have an Audi, but that is a reminder of your baby's physical connection to you or all of our physical connection to our mothers that were happening during pregnancy.

(04:50): Okay, now let's get into some of the issues that can happen with the umbilical cord. We're going to start with marginal cord insertion. So marginal cord insertion is when the attachment of the umbilical cord to the placenta is at the edge or margin of the placenta instead of at the center of the placenta. So typically the umbilical cord attaches to the placenta around in the center when it's on the edge instead, that is a marginal cord insertion. And the reason that it attaches in the center is that it allows for kind of equal distribution of blood flow and nutrients to the baby. So it starts in the center and kind of equally distributes out. Now, when the umbilical cord attaches towards the edge, it can potentially impact the blood flow and nutrients that are delivered to the baby. Now, thankfully, it's not very common on the high end, I saw that it can happen in about up to 6% of pregnancies.

(05:58): So again, it's not very common and it actually usually does not cause any complications. It may be associated with an increased risk of restricted blood flow to the baby, which can then affect the baby's growth where the baby's not growing as well as we would expect. It can also be associated with some placenta abnormalities like placenta previa. And if those issues occur and cause problems during labor, then that can lead to an increased risk of cesarean birth. But in general, marginal cord insertion does not lead to any problems. Typically, if marginal cord insertion is recognized, and I should say these issues can be recognized at that middle of pregnancy ultrasound. So the anatomy ultrasound, which happens in about 18 to 20 weeks, that is when these issues can be discovered. At that ultrasound, we look at all of the structures including the umbilical cord, and if those things are noted, then typically we just do closer monitoring during the pregnancy with ultrasounds every four weeks roughly, and maybe testing towards the end of pregnancy where we place you on the monitor, do testing twice a week, but even that may be considered overkill.

(07:14): Mostly we're going to look at cereal ultrasounds to make sure the baby's growing well and there are no issues. That's for all of these umbilical cord problems. Okay, next one is valentas cord insertion. So valentas cord insertion is when the umbilical cord attaches to the placenta in an abnormal manner. So this is, I'm going to try and describe it as best I can, but this is something that would, is kind of helpful visually to see. But basically, usually the cord inserts directly into the placenta tissue, all right, and it's surrounded by placenta tissue. So in a development cord insertion, the cord attaches to the fetal membranes that are outside of the placenta, and that means the blood vessels actually go through the membranes before they reach the placenta. And because the membranes are very thin, that leaves those blood vessels unprotected. So the placenta itself is like chunky it. The closest I can think of is liver. All right? So if the blood vessels are going directly into that, they're protected. But with veis cord insertion, they're going through the membranes, which are very thin as you might imagine the membrane to be, and then those unprotected blood vessels and the membranes are at risk of compression, at risk of being injured, and that can lead to complications.

(08:52): Now, one of the big things that veis cord insertion can be associated with its vaa previa, and I'm going to talk more about vaa previa in a minute. That's when the blood vessels in the umbilical cord cross or lie near the cervix. That can be dangerous during labor, but it's also associated veis cord insertion With growth restriction, sometimes the compromised blood flow and nutrient supply can affect the baby's growth. It is linked to an increased risk of preterm labor and birth. And of course, preterm birth can cause challenges for baby depending on how baby the early is, how early the baby is born. So as far as what we do when there is veis cord insertion, again, similar to what I talked about before, we closely monitor the baby's growth, typically doing ultrasounds every three to four weeks. And the reason we do ultrasounds with that frequency is that that is the amount of time that is needed to accurately assess whether or not there's a change in growth.

(09:59): If you do ultrasounds sooner than every three to four weeks, then it's not accurate in terms of looking at whether or not the baby's growing well. So that's why we don't do ultrasounds like every week or anything like that to look for growth because we need some time to actually assess the growth. And some things we also look at on ultrasound are the blood flow, is the blood flow through the umbilical cord using something called doppler, which basically uses sound waves, looks at the flow through the cord, and we looked at whether or not the flow through the cord is restricted. That's kind of a simplified way of looking at it, and depending on how that blood flow is going, there are different degrees of how that relates to fetal wellbeing.

(10:47): We look in particular, it's something called diastolic flow, and I'm not going to get into all of the details of that, but essentially, if there's reverse in diastolic flow or absent in diastolic flow, then those are indications that there's a problem and that the baby may need to be delivered. So typically, again with veis cord insertion, we just monitor things. There aren't typically problems, but we do have to be careful. Now, the big thing that veis cord insertion can be associated with that is a big problem is VEA previa. And as I said before, that is when the umbilical cord vessels cross or lie near the cervix within the fetal membranes, this leads to the vessels being at risk of tearing or rupturing when the cervix begins to dilate during labor. And if that happens, that can result in pretty significant blood loss for the baby and it can happen pretty quickly.

(11:57): Remember, these little babies don't have a ton of blood volume. They're little tiny humans, and it doesn't take long for them to lose a significant amount of their blood volume, even though it may not look like a lot of blood, but it's substantial because they don't have a lot of blood to begin with. So just like all of the other things, vaso previa is typically diagnosed during routine prenatal ultrasound exams, and you can see it on ultrasound if you see that the blood vessels are crossing the cervix. Or if we do color doppler to look for blood flow, you can see that there's some color flow near the cervix. There are two types of AZA previa. One is when the vessels are kind of free floating, and type two is when the vessels are within that veis cord insertion type one. As you might imagine, when vessels are just kind of free floating out there, carries a higher risk of fetal harm because of the vessels potentially tearing.

(13:00): This is the one condition where cesarean birth is appropriate in order to minimize the risk of vessel injury during labor. Because remember again, as that cervix opens, if those blood vessels rupture, it can lead to rapid fetal blood loss that can put the baby at risk for severe anemia, suffering from a lack of oxygen, even fetal death. So we really have to be careful about monitoring vaso previa, closely monitoring the pregnancy, no vaginal exams, and then really hospitalization often during the end of pregnancy, and then a planned cesarean birth well before we believe labor starts in order to minimize the risk of those vessels being injured in the event labor happens.

(13:57): And the last thing that can be diagnosed during pregnancy during routine ultrasound examination is a two vessel cord or a single umbilical artery. As I mentioned at the top of the show, the umbilical cord usually has two arteries and one vein. However, sometimes there's a condition where the umbilical cord only contains two vessels, and usually it's just one artery and one vein. Okay, so in the case of a two vessel umbilical cord, one of the arteries is absent. This is not very common, happens in maybe like 2% of pregnancies. It's actually generally considered a variation of normal anatomy. However, we do have to be mindful because it can be associated with some other things. There's a slightly higher association between a two vessel umbilical cord and some chromosome abnormalities. So if we see a two vessel, two vessel umbilical cord on ultrasound, we will probably offer you genetic testing if you haven't already had it done.

(15:06): A two vessel umbilical cord can in rare circumstances also be associated with fetal growth issues, and it can also be associated with other anomalies like kidney anomalies or heart anomalies. So when we see that, then we have to do a very careful look and make sure everything else looks okay. Again, do that frequent testing and monitoring just to make sure that the baby is growing well. We don't have to do anything different in terms of delivery, unlike the visa previous situation. We just have to monitor things closely. Most of the time, this does not end up being anything of any consequences. It doesn't require any specific changes to the delivery plan. Okay.

(15:55): Okay, so that's it for the big things that are diagnosed during ultrasound examination during pregnancy, that's marginal cord insertion development, cord insertion, VAs previa, that's the most serious one, and then that two vessel cord. Now let's talk about things that can happen during the course of labor with the umbilical cord. First up is umbilical cord prolapse. So umbilical cord prolapse is a potentially very serious emergency that can occur when the umbilical cord slips through the cervix and is in front of the baby. So instead of the head coming first, the umbilical cord comes first, and the circumstances under which that happens are when the head is not really engaged in the pelvis and it's not like nice and well applied to the cervix and there's some space around the head and that allows the cord to slip down. It's pretty rare happens in less than 1% of pregnancies at two forms that'll happen.

(16:56): Sometimes it's a cult where it's hidden, you can't see it or you can't feel it necessarily. Like it may not be apparent until you see fetal heart rate tracing abnormalities, and then you feel or look closer with ultrasound and see it there. And then overt is when it is straight like hanging out of the vagina. That is very urgent because it can be compressed or occluded and that can cut off blood supply and oxygen supply to the baby. I have seen this a handful of times in my career once in fact where a woman walked in and she said, something's hanging out of my vagina, and it was indeed the umbilical cord. That baby thankfully ended up being well, but it does happen most often. It's going to happen if your water gets broken early. So if we break your water too soon before the head is nice and well applied to the cervix, then that increases the risk of the umbilical core prolapse when I've seen it happen outside of that instance.

(18:05): And there's one other instance I can think of where I saw it happen, it's going to be because we broke your water and made it happen. So that's one of the situations where we have to be careful about making sure we're not breaking your water before it's safe to do so. Some other things that increase the risk or if the head is not the first presenting part. So if the baby's breach, especially if the baby is footling breach, those feet are tiny, and that leaves a lot of space around the feet for if you start dilating for the cord to come through, or if the baby is in a transverse presentation, meaning going across in your uterus, and that leaves some space for the cord to come through. If there's extra amniotic, so there's lots of space for the baby to move around, then that increases the chances that the cord can come through first.

(18:54): Now, oftentimes you hear people say like they had an emergency cesarean birth, and what they mean is more that it was urgent, like if you have 20 or 30 minutes in between the time they said you had a C-section and when you had the C-section, that is not an emergency. However, umbilical cord prolapse, this is a true emergency cesarean birth, and by emergency, what I mean is we are ripping the cords out of the wall. Somebody has their hand in your vagina trying to hold up the head and keep that pressure off of the cord because again, when that cord comes down, and if the head settles down on top of it, it can compress the cord and lead to the baby not getting blood flow and oxygen, and that can be catastrophic. So someone is going to be hands in your vagina trying to elevate the head.

(19:48): So it is, or whatever is the presenting part, if it happens to be the butt or whatever, to keep it off of the cord, we are running to the or. And that is a true, true stat emergency cesarean section. It requires truly immediate medical attention and intervention in order to make sure that the baby has a good outcome. And I will say most often babies do have a good outcome as long as it's recognized and addressed quickly. But this is a true, true emergency cesarean birth inappropriately. So, okay, moving on. Umbilical cord compression. Umbilical cord compression is as it sounds, it's when the umbilical cord is compressed or squeezed, and that can occur during the course of labor is when most often we'll see it. There are some characteristic changes in the fetal heart rate tracing that make us suspicious that the umbilical cord is being compressed, and if it's continually compressed, that can potentially lead to the baby being in fetal distress.

(20:50): So it can happen for a variety of reasons. Sometimes the baby's positioning the baby just rolls over onto the cord and the cord gets compressed. Okay, the baby's body are limbs pressed against the cord and that instance. That's why when we see these characteristic deceleration or drops in the baby's heart rate, one of the first things we're going to do is try to move you in different ways, because if the baby's on the cord, then we want to get the baby off of the cord. Low levels of amniotic fluid, oligohydramnios oligo means low hy drosis fluid can increase the likelihood of umbilical cord comp compression because there's less fluid to cushion and protect the cord. Okay? Also, nucle cord, which I'll talk about in a minute, is when the cord is wrapped around the baby's neck, that can sometimes lead to compression during labor if the cord becomes really tight, if the core becomes really, really tight.

(21:45): Okay? Now, some signs and symptoms, as I mentioned of a lic cord compression are specific changes or drops in the fetal heart rate. They're called variable deceleration. A lot of times people want to look at the baby's heart rate and say, well, what does that mean? What does that mean? Honestly, that is what the nurses and physicians midwives, that is what we all go to school for in order to interpret those fetal heart rate tracing. So please don't think that you're going to be able to understand exactly what all of those things mean. But there are some characteristic things that we look for in the fetal heart rate tracing, and again, because it can reduce the blood flow to the baby, we just try and move you around to move the baby off of the cord. Sometimes if it's because the fluid is low or the water has been broken artificially or even naturally, sometimes we do something called an amnio infusion where we actually add fluid back into the uterus in order to try to create some space and try to relieve that compression.

(22:45): Most often these things resolve any issues with umbilical corp compression with position changes or in that instance of, or amnio infusion like I talked about. So this typically does not end up being a major issue. If it does, then unfortunately our only recourse is cesarean birth. If the typical measures don't work, then cesarean birth is the right thing because obviously you can't keep having your baby have an oxygen getting cut off. That's not going to be good. Okay, next up is cord is when the umbilical cord is wrapped around the baby's neck, nucl refers to the neck, okay? It's when the umbilical cord is wrapped around the neck. This is so common, happens in up to about a third of pregnancies very, very, very, very common. Most often, the court is loosely wrapped around the baby's neck. It can also be draped around the body.

(23:38): It does not cause any complications or harm to the baby. You can actually see it sometimes on prenatal ultrasound. I think most often these days we actually don't mention it because it gives people an unnecessary sense of panic because it does not cause any problems. Or we can notice it during monitoring and labor like, oh, we're having some drops in the heart rate here and there. Maybe there's a cord wrapped around the baby's neck. It's generally considered pretty harmless. Now, there are some suspicions that it can be an issue if it becomes wrapped really tight around the baby's neck, and you can understand why that might be a problem, if that's going to restrict the blood flow of oxygen and nutrients through the umbilical cord. If it's wrapped really tight, that can lead to fetal distress and we'll see more severe changes in the fetal heart rate monitoring.

(24:29): But most often it is not an issue, and it can be wrapped around multiple times. I think the most I've seen a cord wrapped around is four times wrapped around a baby's neck. So it can definitely be wrapped around multiple times. There's not a lot that we can do to unwrap the nucle cord. The baby may unwrap themselves from the nucle cord, so there's not anything that we can specifically do to change that. But again, it does not typically pose a risk to baby. The vast majority of babies are born healthy despite having AAL cord. And then last thing I'll say, ISAL cord is more likely to occur, as you might imagine, if the cord is particularly long, there's more of the cord there for the baby to get twisted up in or if there's more fluid. So the baby has more space to kind of wrap around in the cord.

(25:25): Okay, and then last thing that is seen potentially during labor or birth is umbilical cord knots. So knots in the umbilical cord are when the cord literally forms a loop and it looks like a knot in the cord, okay? And we believe that these develop as the baby moves around in the womb, the baby just twists and forms loops in the umbilical cord. True knots happen in the umbilical cord when it is truly an actual knot. It looks like a knot. They are pretty rare happening in one to 2% of pregnancies. This is another time where the cord being longer is going to increase the risk. If the cord is longer than average, that's going to increase the risk of true knots in the cord. And then false knots are more like kinks or twists. They kind of look like a knot. They're more caused by the presence of blood vessels that branch off from the main cord, and then, excuse me, rejoin the cord, and it looks like a loop like structure.

(26:34): So those are false knots, but true knots are literally true knots. They're actually kind of cool to see because when you think about the gymnastics of what to happen in order for the baby to loop itself through the cord like that, it really literally looks like a knot. Now, depending on how tight the knot is, it can increase the risk to the baby, okay? If the knot becomes too tight, as you can imagine, we're going to be cutting off or interfering with the blood flow of oxygen and nutrients through the core. That's going to lead to distress and complication. They are usually discovered through labor. So we're usually going to have a suspicion that there's an umbilical cord not during labor because of changes in the baby's heart rate when those contractions are squeezing the baby, putting the baby under distress if there's a knot in the cord and that adds additional distress, we may see that not all cord knots lead to any complications, though many, many, many, many times I've been at birth where there was a true knot noted in the cord and there was no suspicion of anything going on whatsoever.

(27:44): So really, we just manage it based on what the fetal heart rate tracing looks like. If there's some suspicion that the baby's in distress, then we may need to do a C-section or trial was caught. Intrauterine resuscitative measure measures in order to perk the baby up while still inside of your uterus. But most often this is something that we don't see until after the birth and then after delivery, and we see, oh, here's the knot. Either it's a surprise or it's like, oh, this is the reason why we were seeing those changes in the heartbeat.

(28:18): Now, last couple things about the umbilical cord that can happen during labor or in the hospital that you want to consider or maybe want to know more information about are delayed cord clamping and umbilical cord blood banking. And let's talk about delayed cord clamping. Delayed cord clamping is the practice of waiting to cut the umbilical cord. It needs to be for at least 30 to 60 seconds, or it can be up until the cord stops pulsating, which is going to be about three to four minutes, maybe a little bit longer. Back in the day, we used to immediately clamp the cord within like 15 or 20 seconds of birth. But now evidence has pretty convincingly shown that TLE core clamping is beneficial both to term babies and preterm babies. That extra blood flow that's coming through the placenta while we're waiting for the placenta to detach from the wall of the uterus, it contains iron.

(29:07): It contains stem cells that can boost the baby's health, boost the baby's immune system. It can increase the iron stores and the baby's blood, which will reduce the risk of anemia. There's even some evidence that it may help improve brain development. So really delay cord clamping should be routinely done at every birth. As long as the baby comes out looking well and doesn't need any resuscitation, then delayed coral clamping should be done. It is recommended by a World Health Organization, American College of Obstetricians and Gynecologists, the American Academy Pediatrics. It should be routine both in term and preterm babies and at vaginal birth and cesarean birth. Delayed cord clamping can still be done at cesarean birth. And then the final thing I'm going to talk about is umbilical cord blood banking. Umbilical cord blood banking is when you collect and store blood from the umbilical cord immediately after the baby's birth.

(30:07): The umbilical cord contains cells that are very important or powerful. They're called hematopoetic stem cells. They have the potential to develop into various types of blood cells in the body, and they can be used for potential medical use. There's some cancers and things that stem cells can be used to treat. Now, there are two types of core blood banking, private core blood banking, and public core blood banking. So public core blood banks collect and store donated core blood units, and they are made available for public use. Okay? It can be used for transplantation and individuals who need a stem cell transplant and do not have a suitable match with their family. These are at no cost to donors. There's not a lot of indications that we can use core blood, but we're finding more and more indications for its use. And with public core blood banking, you give it to the bank and it's given, and you don't have any say over what happens to it after that, similar to if you donated blood at a regular blood bank.

(31:19): Okay? Now the other option is private core blood banking and private core blood banking. You choose to store your baby's cord blood, any a private cord blood bank for your family's exclusive use, they charge a fee for collection for processing, for storing the core blood, and it's reserved solely for the use of the baby or potentially compatible family members. Now, a couple things with private core blood banking, the chances are very low that a child or a family member will develop a condition where the blood can be used. It's less than one in a thousand, okay? There are also instances where people cannot use their own core blood cells. So for example, if you are diagnosed with certain types of blood disorders, then they're not going to use your core blood cells in order to try and treat the disorder because your own core blood cells may contain the disorder in the cord blood cells, and then often there's not enough blood collected from the umbilical cord in order to be used as a unit by itself.

(32:28): So the amount of blood that is collected is not enough for transplantation. Only eight to 12% of units that are collected at are like by themselves enough. In order to be enough for transplantation, you have to combine it with other people's cord blood in order to get enough for transplantation. Also, umbilical cord blood banking. If you do delay cord clamping, then you're going to have less blood at the umbi that's going to be collected for the umbilical cord blood bank because that blood is going into the baby. So there's going to be less blood collected if you do delay cord clamping, or if you want to try and collect more blood for umbilical cord blood banking, then you're going to not have the benefits of delay cord clamping. And then the final thing I'll say is that private core blood banking is expensive, especially upfront.

(33:24): So they know that people are going to over time be like, you know what? I don't really n maybe need to keep paying for the storage fees. So they're really charged like a big fee up front in order to get recoup a big amount of money in the beginning because they know a lot of folks are not going to maintain storage. This is my 2 cents. I don't know that private core blood banking is worth it financially unless you know, have a family history of some blood disorders and conditions because it's just not likely that it's going to be used or that you're going to need to use it. I do think if you have the option of public core blood banking, that's a lovely way to help someone else, is to have those cord blood cells collected to be used in a public bank. You do not need to change your thoughts about delayed cord clamping, you know, still do delayed cord clamping. And then whatever is left is left can be potentially donated to a public cord blood bank. They're not a lot of hospitals that have public core blood banks, so that's something that you're interested in. Typically, they bring it up in the hospital. Is this something you want to be interested in or in your prenatal care? But you can always ask at the hospital if that is an option.

(34:44): Okay. And then the final thing I want to end with is just some of the traditions around the umbilical cord around the world and things that we do with the umbilical cord. We know that cutting the cord has various traditions and rituals because it's associated with being separated from your mother. So we know in the US typically we do a pretty simple cord clamping and cutting soon after birth. Often the partner does it. It doesn't have to be the partner, it can be whoever. It can be the mother if she wants to do it. Some dads do not want to cut the cord, and that is totally fine. It's usually done with sterile scissors right there with mom on baby's belly. You can ask if you want. Definitely ask the nurses if they can take a picture of the cor being cut if that's something that is important to you, but that is the act that will symbolize the actual physical separation of you from your baby.

(35:43): Now, in other cultures, they do things like umbilical cord burning and some cultures the cord is dried and burned as a way to symbolize the separation between the mother and her baby. The rituals are believed to promote healing, also believed to protect the child from certain illnesses and some Native American traditions. The court is dried and burned in the sacred fire to honor the connection between the baby, their ancestors, and the earth. And some Malaysian and Indonesian traditions. The umbilical cord is buried under a plant, typically a rice plant, and that plant is later used to make a special dish. And that ritual is believed to bring good fortune and health to the child. In some central American cultures, particularly among the Mayan people, the umbilical cord is dried and burned in a ceremonial fire, and then the ashes are scattered and a sacred place as a symbolic way to protect the child's spirit and ensure their wellbeing. And then the Masai people of East Africa, which I had the privilege of seeing when I was in college. And when I was in college, I studied abroad for a year in Kenya, and the Masai people are in that portion of East Africa, Kenya, Tanzania. They have a tradition where the umbilical cord is dried. It's wrapped in a package made of animal hide and spaced and placed in a special tree. And the belief is that this ritual will ensure the child's connection to their homeland and to ancestral spirits.

(37:33): Some other cultures also bury the umbilical cord in a special location in order to symbolize the connection between the child and their roots. So in Chinese culture, the umbilical cord can be dried, wrapped in a piece of red cloth and chosen in a specific location that is based on cultural beliefs or family customs. It may be near the family home, it may be under a tree, and it's seen as a way to, again, symbolically connect the child to their ancestral land and promote good health and good fortune. In the Philippines, it's common to bury the umbilical cord. It's wrapped in a piece of cloth, placed in a container, buried in a location that is chosen to be significant and meaningful by the family. And that burial is supposed to foster a strong connection for the child to their birthplace and to their family's roots. And then in some Scandinavian countries like Sweden and Norway, there's a tradition of bearing the umbilical cord in a special place, again, often in the family garden or near a tree, in order to help the child develop a strong connection to nature and the environment.

(38:51): Okay, so just to recap, the umbilical cord is what connects your baby to the placenta. It's the lifeline that does all the transport of nutrients of waste, everything while your baby is developing. Some issues that may occur or be diagnosed during pregnancy are marginal cord insertion, where the cord inserts as the edge valentas cord insertion, where the vessels are exposed. Vaso previa, which is the most serious one, and requires cesarean birth. That's when the vessels are near the cervix. And then two vessel umbilical cord or single umbilical artery during labor. The things we have to be careful for or watch out for our umbilical cord prolapse, umbilical corp compression. Also, we often see, or yeah, I would say often see nuco cord during labor. Sometimes you can see knots in the cord. Typically, neither of those cause any issues at all. And then delayed cord clamping should be routinely done in all births, both vaginal and cesan births.

(39:52): And then umbilical cord blanking. Banking is really a personal choice, although it can be expensive and you're not likely to use it later on. There are public options where you can give two public cord blanks at banks as well. All right, so there you have it. Do me a solid, if you like this episode. If you like this podcast, share it with three friends who may find it useful, whether they're pregnant, thinking about getting pregnant work in the birth space. Sharing is caring. I'm on a mission to reach and serve as many people as I can, and I would appreciate your help in doing so. Share this podcast, hit that share button wherever you're listening to me right now. Also, subscribe to the podcast wherever you're listening to me right now. Leave me an honest review in Apple Podcast or shoot me a dm. I love to hear what you think about the show. I love to hear ideas and topics for the show. Actually had a few people reach out and ask about umbilical cord things. So that kind of prompted me to do this episode. So I'm on Instagram at Dr. Nicole Rankins. Shoot me a DM there, let me know what you think. So that is it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.