Skip this if you have had enough of the cord discussion; I haven't yet.
This is a synopsis of some of the discussion on the topic, and I hope at
least some of you find it as intriguing as I do.

First, could someone, preferably Trish Payne, reply to Jette's query, on the
list?
Here is the question Jette posed:
"Trish do I really understand you in the right way? Would a section be
performed after the delivery of the baby's head on the indication
decelerations?"
After Trish had written:
"In about a 1000 births I think I've done it (cut the nuchal cord on the
perineum- rm) once because if it's that tight there will probably be
significant decels and this mom may end up with a caesarean birth."

Marlene Sinclair wrote:
"The risk of having a short cord, wrapped round 3 times or so
(tightly) and leaving it in situ until the woman delivers the rest of
her baby could cause premature shearing of the placenta..."

I am being VERY nitpicky here.  A 'short' cord (defined in Norway as less
than 40 cm or 16 inches) could not get wrapped 3 times around a baby's neck.
I agree that a nuchal cord that impedes labor progress must be dealt with.
In my experience such cords manifest themselves much earlier than the birth
of the head: either no descent, or FHTs that scare the living daylights out
of professional birth attendants in any setting where CTG has any footing at
all, or both.  The nuchal cord that permits spontaneous birth of the head is
almost never a problem, as several posters have mentioned.

I have seen on a couple of occasions cords that have torn at the time of
birth, and this has happened about 15 cm from the baby so it was noticed as
the legs were born.  I was not the primary midwife either time, and I don't
remember whether there was a loop around the baby's neck.  In neither case
was there anything else unusual about the births, nor were there any
complications.

And Robyn Maude wrote:
"However I was the supporting midwife at a birth where the baby took a very
long time to
crown and eventually birth its head, despite good maternal effort.The cord
was very tight around the neck x 3 times. The attending midwife clamped and
cut and unravelled the cord and the baby was pulled out. It was virtually
lifeless and needed extensive resus. I always felt uncomfortable about the
clamping of the cord in this situation. What if the baby had gone on the
have shoulder dystocia?"

In that case, it seems the midwife's judgment was that the cord was
preventing the baby from being born, and it may well have been necessary to
cut the cord in order to allow the baby to emerge.  Shoulder dystocia would
have made matters worse, but what choice did the midwife really have in that
situation?

Then comes Susan James' delightful account, concluding thusly:
"and she was right, the anterior shoulder was there, but the woman could not
budge that baby. And around the neck was the cord three times so tightly it
almost looked and felt
like skin folds. She clamped and cut and the baby flew out. He did need
a little resuscitation but was crying lustily before the woman's partner
had even finished spelling out their name to the 911 dispatcher. We
cancelled the call."
No further comment needed here, except BRAVO for a great 'midwifery tale'.

Cecilia Jevitt, a midwifery educator in Florida, writes:
"I can't imagine a midwife who doesn't check for a nuchal cord. We consider
it an essential hand maneuver for birth."
But you don't need to use your imagination.  You can come see thousands of
us, professional midwives who spend most of our working time catching babies
and hardly ever check for a nuchal cord, unless there is worrisome delay
after the birth of the head.  And if I showed up at my workplace with a US
textbook on midwifery, I would be laughed right out of the room, scornfully.
Don't I think *we* are good enough or something?!  (This is the worn voice
of experience talking now.  The background is the strong, proud -probably
too proud - unbroken tradition of universal midwifery care at birth, by
formally trained midwives, for about 200 years here in Norway.  I am also
among the first to admit that we are far from perfect, but I am not
convinced that adopting routine practice from the US would be our best
strategy to strengthen our role.)

This topic is pointing up some fascinating differences in what midwives
consider essential birth care, and obviously since our outcomes
(midwife-attended births in the UK, N. America, Denmark, Norway, NZ) are not
very different, it is unlikely that our success rates have very much to do
with routine palpation of nuchal cords, or lack thereof.  Maybe we should be
looking somewhere else for the answer about why supporting normal birth (=
practicing midwifery, and if this definition of mine sparks more discussion,
so much the better) seems to be such an effective tactic for good outcomes.
I don't know the folklore of all cultures; where I live, the nuchal cord
enjoys an imposing position in the minds of expectant parents.  I have even
heard parents tell how glad they were that they had their baby in a tertiary
care center, because 'the cord was around his neck, and they didn't find out
until after he was born, and imagine what might have happened if they hadn't
been somewhere with full acute care services, like a smaller hospital or AT
HOME' - and this is after having experienced an entirely spontaneous vaginal
birth with a baby who needed no special care at all, to get out or to get
started breathing.

If you have read this, far you must be interested.  Thanks for your
perseverance and for bearing with me in my ruminations.
Rachel Myr,
Kristiansand, Norway
(US-American woman, Norwegian midwife)