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Nuchal Cord Management and Nurse-Midwifery Practice


  • Judith S. Mercer CNM, DNSc,

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    • Judith S. Mercer, CNM, DNSc, FACNM, is a faculty member of the University of Rhode Island College and Principal Investigator for a randomized controlled trial on delayed cord clamping in preterm infants funded by National Institutes of Health.

  • Rebecca L. Skovgaard CNM, MS,

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    • Rebecca Skovgaard, CNM, MSN, is an assistant professor of clinical obstetrics and gynecology, University of Rochester School of Medicine and Dentistry.

  • Joann Peareara-Eaves CNM, MS,

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    • Joann Peareara-Eaves, CNM, MSN, is a 2004 graduate from the University of Rhode Island.

  • Tracey A. Bowman CNM, MS

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    • Tracey A. Bowman, CNM, MSN, is an expert in the use of water birth; in her own practice, she provides gynecologic care and a homebirth service.

Judith S. Mercer, CNM, DNSc, FACNM, Nurse-Midwifery Program, University of Rhode Island College of Nursing, 2 Heathman Road, Kingston, RI 02881-2021. E-mail:


Nuchal cord, or cord around the neck of an infant at birth, is a common finding that has implications for labor, management at birth, and subsequent neonatal status. A nuchal cord occurs in 20% to 30% of births. All obstetric providers need to learn management techniques to handle the birth of an infant with a nuchal cord. Management of a nuchal cord can vary from clamping the cord immediately after the birth of the head and before the shoulders to not clamping at all, depending on the provider's learned practices. Evidence for specific management techniques is lacking. Cutting the umbilical cord before birth is an intervention that has been associated with hypovolemia, anemia, shock, hypoxic-ischemic encephalopathy, and cerebral palsy. This article proposes use of the somersault maneuver followed by delayed cord clamping for management of nuchal cord at birth and presents a new rationale based on the available current evidence.