The caregiver will normally discover a prolapsed cord, during an internal vaginal examination. Some caregivers will routinely do a vaginal examination after the waters have broken, especially if they are aware you could be at an increased risk of this happening (for example your baby is premature, breech, in a transverse lie or you are having twins). Usually, though, the baby's heart rate is listened to soon after the waters break, and if this is normal, it is unlikely the cord has prolapsed. If the cord is felt, the caregiver will usually call for help, and organise for an emergency Caesarean to be prepared for immediately.
If the cord prolapses to the extent that it can be seen outside the woman's vagina, it would need to be gently replaced (just inside the vagina) to keep it warm and moist, and prevent the blood vessels from going into 'spasm', (which can impede the blood flow to the baby more rapidly). In an effort to relieve the pressure on the baby's cord, the caregiver will normally keep their fingers inside the vagina, aimed at pushing on the baby's head (or bottom) to keep it off the cord. To help with this they will usually instruct the woman to assume a position with her buttocks elevated. This would be either a 'knee-chest' position (on all fours) or lying on her side with her bottom elevated, (using a large pillow under her hip). Often the woman is given oxygen through a mask, and the baby's heart rate may be listened to, if there is time (and an extra set of hands helping).
The woman is usually taken straight to the operating theatre, where an emergency Caesarean is performed. Emergency Caesareans are usually carried out under a
general anaesthetic, (unless an epidural is already in place). A Caesarean can normally be performed within 5-7 minutes, from the time the woman arrives in the operating theatre, to when her baby is born. You may wish to read more on Caesarean births in
class 9.