Umbilical cord prolapse explained: What pregnant women should do if they see or feel the cord

Twenty-five-year-old Anjali, a staff nurse in Kochi, was 39 weeks pregnant and was admitted to hospital in early labour. She was under observation in the ward, not in the labour room, when her waters broke suddenly.

At first, she felt relieved and thought she was going through labour. Moments later, however, she felt something unusual between her legs. The attending doctor confirmed an umbilical cord prolapse, a rare but dangerous complication. Within minutes, an emergency caesarean section was performed. Her baby was born healthy.

Anjali's story ended well because she recognised the warning signs and acted quickly. For many expectant parents, however, the term 'umbilical cord prolapse' is unfamiliar. Yet understanding it could save a baby's life.

Most pregnant women will never experience an umbilical cord prolapse. Yet Anjali's story highlights an important lesson: recognising the warning signs and acting quickly can make all the difference.

The baby's lifeline inside the womb

The umbilical cord is one of nature's most remarkable creations. It connects the baby to the placenta, which supports the baby during pregnancy. Through blood vessels inside the cord, oxygen and nutrients travel from mother to baby, while waste products are carried away.

Throughout pregnancy, this flexible rope-like structure serves as the baby's lifeline. Once the baby is born, the cord is clamped and cut, but until that moment it remains vital for survival and healthy development.

When the cord comes first

Umbilical cord prolapse occurs when the cord slips down through the cervix and into the vagina ahead of the baby after the waters have broken. Instead of the baby's head leading the way through the birth canal, the cord moves into the path first.

This may sound unusual, and fortunately it is. This condition occurs in only about one in every 200 to 1,000 births. Despite its rarity, it is regarded as one of the most urgent emergencies in obstetrics because the baby's oxygen supply may be affected within minutes. Cord prolapse can occur during labour or shortly after the membranes rupture before labour starts.

Why doctors become concerned immediately

To understand the danger, imagine standing on a garden hose carrying water. The flow slows down or stops completely.

A similar problem can happen with a prolapsed umbilical cord. As the baby descends through the birth canal or the womb contracts during labour, pressure can be placed on the cord. This compression reduces blood flow through the cord and may limit the amount of oxygen reaching the baby.

Without adequate oxygen, the baby's heart rate can slow and distress may develop rapidly. If oxygen deprivation continues for too long, there is a risk of permanent injury or even death. This is why health care teams respond so urgently when cord prolapse is suspected.

Can it be predicted before labour?

One of the challenges with cord prolapse is that it cannot usually be predicted. Many expectant parents assume that routine ultrasound scans can identify every potential complication before labour begins. Unfortunately, that is not the case.

The position of both the baby and the cord changes constantly during pregnancy. A scan may show everything appearing normal one day, yet a prolapse could still occur later if circumstances allow the cord to slip below the baby.

Most women who experience cord prolapse receive no advance warning. The condition often appears suddenly after the waters break.

Who is more likely to experience it?

Although cord prolapse can happen in any pregnancy, certain situations increase the risk.

The condition is more likely when the baby is not in a head-down position. Babies presenting feet first, bottom first, or lying sideways leave more room for the cord to slip through. Multiple pregnancies, including twins and triplets, also carry a greater risk.

Other factors include premature rupture of membranes, excess amniotic fluid around the baby, a particularly small baby, or circumstances where the baby's head has not yet settled deeply into the mother's pelvis.

Women with these risk factors should discuss them with their obstetrician or midwife. Occasionally, doctors may recommend hospital observation later in pregnancy so that immediate care is available should labour begin or the waters break unexpectedly.

The warning signs not to ignore

The most important symptom is feeling or seeing the umbilical cord after the waters have broken.

Women often describe feeling a soft, slippery, rope-like structure in the vagina. In some cases, the cord may actually be visible outside the body.

In hospital, doctors and midwives may detect the cord during a vaginal examination. Sometimes the first clue is a sudden slowing of the baby's heart rate shortly after the membranes rupture.

Not every case produces obvious symptoms. Nevertheless, any unusual sensation following rupture of membranes deserves prompt medical attention.

What should you do if it happens at home?

If you think you can feel or see the cord, treat the situation as an emergency.

Seek urgent medical help immediately and inform emergency services that you are pregnant and may have an umbilical cord prolapse. Do not attempt to push the cord back inside and avoid handling it unnecessarily.

Medical professionals may advise getting into a knee-chest position, with your knees on the floor and your chest lowered. This uses gravity to ease pressure on the cord. If that is difficult, lying on your side with pillows supporting your hip may also help.

Avoid eating or drinking while awaiting medical assessment, as emergency surgery may be required.

What happens once you reach hospital?

On arrival, the maternity team focuses on protecting the baby while preparing for delivery.

A doctor may gently lift the baby's presenting part away from the cord during an internal examination. Sometimes a catheter is placed into the bladder and fluid is used to help reduce pressure on the cord.

In most situations, an emergency caesarean section offers the quickest and safest way to deliver the baby. Occasionally, if the cervix is fully dilated and birth is imminent, a rapid assisted vaginal delivery may be possible.

Although the atmosphere may seem intense, every member of the maternity team has a clearly defined role. Communication, preparation and speed are crucial.

What does it mean for the baby and family?

The reassuring news is that the majority of babies affected by cord prolapse do well, especially when the condition is recognised promptly and delivery occurs quickly.

However, a severe interruption to oxygen supply can sometimes cause brain injury. In rare cases, the outcome can be tragic despite the best efforts of healthcare professionals.

The emotional impact should not be underestimated. Parents often describe feelings of fear, shock and helplessness. Speaking with doctors and family members afterwards can help process the experience and provide reassurance about future pregnancies. Importantly, having one cord prolapse does not mean it is likely to happen again. The risk in future pregnancies remains very low.

Umbilical cord prolapse is a rare but serious emergency that occurs when the baby's lifeline slips below the baby after the waters break. The greatest danger is compression of the cord, which can reduce the baby's oxygen supply.

While the condition cannot usually be predicted or prevented, awareness saves lives. Knowing the warning signs, seeking immediate medical help and trusting the expertise of maternity teams can dramatically improve outcomes. For most families, prompt action leads to what every parent hopes for: a healthy baby and a safe birth experience.

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.