Umbilical cord prolapse is rare but can happen to anyone during any pregnancy, whether it’s your first or your fifth. However, it only occurs in about 1 to 6 deliveries out of every 1,000 births. The odds are in your favor! But this emergency means ensuring you have a qualified and experienced person helping with your delivery.²

The umbilical cord is your baby’s lifeline. It gives them nutrients and oxygen while they’re still in your womb. When the umbilical cord prolapses or falls through the cervix into the vagina or birth canal before the baby, this can cause the baby’s oxygen and nutrients to decrease, which could lead to severe complications such as fetal distress, fetal demise, hypoxia, cerebral palsy, or stillbirth.^1,3

What Is Umbilical Cord Prolapse?

Umbilical cord prolapse happens after your water breaks, typically right before or during delivery. The umbilical cord slips out of the uterus, through the cervix, and falls into the vagina or birth canal ahead of the baby during labor or delivery. This life-threatening event requires immediate medical attention, as it can create severe complications for the baby, such as compromised blood flow and oxygen supply.¹

What Causes Umbilical Cord Prolapse?

We can’t predict who will have a prolapsed umbilical cord with their delivery, but several factors can increase your risk of a prolapsed cord, including:^1,2

• Premature rupture of membranes: When your water breaks before the baby’s head engages in the birth canal, the cord will have more space to slip through.
• Malpresentation: If baby is in a breech position (when any other part of your baby comes out first instead of the buttocks), it can increase the chances of a prolapse.
• Multiparity: You’re at a slightly higher risk if you’ve had multiple pregnancies and deliveries (usually five or more).
• Polyhydramnios: When there’s excessive amniotic fluid in the uterus, it can increase the chances of cord prolapse.
• Preterm labor: Preterm births are more prone to umbilical cord prolapse.

According to the Cleveland Clinic, the following conditions may also increase the chances of a prolapse:^1,2

• Fetal congenital disorders
• Placenta previa (its position blocks all or part of the cervical opening)
• An irregularly shaped umbilical cord
• Assisted vaginal delivery (using a vacuum device or forceps during delivery)⁴
• Low birth weight (baby weighs less than 5 pounds, 8 ounces, or 2.5 kilograms at birth)⁵
• Macrosomia (baby is larger than average)⁷
• Being pregnant with twins, triplets, or more
• Velamentous cord insertion⁶
• High fetal station (baby’s position relative to your pelvis during labor)
• Procedures like amniotomy (provider breaks your water for you) or inserting a balloon to ripen your cervix⁸

However, umbilical cord prolapse can happen without these risk factors.¹

How Is It Diagnosed?

Your provider and staff are trained to watch for this condition during labor and delivery. They will look for common signs and symptoms of cord prolapse, which may include the following:^1,2

• Visible or palpable umbilical cord protruding from the vagina
• Fetal heart rate changes, such as decelerations or bradycardia (when baby’s heart rate slows down too much)⁹
• Sudden and severe fetal distress
• A prolapsed cord can be felt during a vaginal examination when they check your cervix’s dilation progress

How Will Your Provider Manage a Prolapsed Cord?

If your provider suspects umbilical cord prolapse, they will quickly relieve the pressure on the prolapsed umbilical cord to make sure the baby receives adequate oxygen and blood supply.¹ This may involve changing the mother’s position, elevating her hips, or using the Trendelenburg position or the knee-chest position.^1,10

Your provider could also insert a gloved hand into the vagina to manually move the baby’s head off the cord. They will aim to deliver the baby quickly to prevent any life-threatening results. In most cases, the provider will perform an emergency cesarean section to expedite delivery and minimize the risk to the baby. A fetal monitor will continuously show the baby’s heart rate, which will help the provider decide what plan to follow.^1,2

Can You Prevent it?

Unfortunately, you can’t prevent a prolapsed umbilical cord. The Cleveland Clinic explains that it’s difficult to detect because of the frequent movements of the baby and the cord.¹ Some risk factors for a prolapsed cord can be noted as part of the mother’s birthing plan so the parents and medical providers know the possibility of it. But it comes down to your provider acting quickly.¹

Can Babies Survive a Prolapsed Umbilical Cord?

Thankfully, most babies do survive a prolapsed umbilical cord, the Cleveland Clinic notes. In hospitals, the number of babies who die from a prolapsed umbilical cord is about 3%.¹ However, a study in the Journal of Perinatal Medicine found the rate to be about 7%.¹¹ The Cleveland Clinic also states that when a baby is born outside of a hospital setting, the infant death rate is almost 20 times higher.¹

We hope this article gave you a better idea of what can cause umbilical cord prolapse. If you’re feeling worried about it, remember that this condition is very rare! While you can’t really avoid it, it’s helpful to understand the risk factors and treatment so you can be aware of this condition and know what to expect from your healthcare provider if it does happen.