Be aware that the following information describes a rare complication that some readers may find disturbing. You may choose not to read this section.

Treatments for cord prolapse
How does it affect the baby?
What to do if the cord prolapses and you are at home?
What your homebirth caregiver may do

What is a cord prolapse?

A cord prolapse is when a loop of the umbilical cord (which is attached to the baby at one end, and the placenta at the other) falls past the baby, through the woman's open cervix and into her vagina. If this occurs, rather than the baby leading the way down the vagina, the cord does. Occasionally, if the loop of cord is long enough, it can be seen protruding from the woman's vagina. The most common situation for a cord to prolapse is with a gush of amniotic fluid when the waters break during labour (and the woman's cervix is somewhat dilated), with the baby's head (or baby's bottom, if breech), not being engaged. This can leave room for the umbilical cord to 'wash down'.

In extremely rare cases, if the waters break (and the woman is not in labour, therefore her cervix is closed), the cord may fall in front of the baby, but still be inside the uterus. This is referred to as a 'cord presentation'. Occasionally the caregiver can feel a cord presentation during a vaginal examination, before the waters break. Instead of a hard head, a soft 'pulsating' cord may be felt behind the thin membrane, or sac.

Image 5-32 shows a loop of the umbilical cord in front of the baby's head.

A cord prolapse, or cord presentation, is a rare complication (0.2 to 0.4% of pregnancies when the baby's head is down), because normally the baby's head takes up most of the room in the woman's pelvis and adequately covers her cervix, preventing the cord from going down into the vagina. The umbilical cord normally lies beside, or behind, the baby in the uterus.