Umbilical cord entanglement is a common and manageable part of physiologic birth, especially in water. This lesson explores how to identify, approach, and resolve issues related to nuchal cords, short cords, and the rare occurrence of cord rupture.

We begin by reviewing the difference between long and short cords and why nuchal cords—when the cord is wrapped around the baby’s neck—are not inherently dangerous. In fact, they are often a sign of a longer cord and rarely pose a threat to the baby’s well-being when handled correctly.

Students are taught specific techniques to manage entanglement gently and safely, including delivering the baby with or through the cord, and always avoiding clamping or cutting on the perineum. Special attention is given to preventing cord avulsion (tearing), which can occur if the baby is lifted out of the water too quickly before the cord is assessed.

We highlight the Somersault Maneuver as an essential skill for providers. This 4-step technique—Flex, Fix, Force, Free—can be life-saving in situations where a tight cord limits movement. When done correctly, it allows the baby to be born safely while the cord remains intact and undisturbed.

The lesson also includes powerful visual examples, including a video from Clínica Primivera in Ecuador showing multiple successful births with cord entanglements.

Key takeaway: Nuchal cords are not emergencies. With patience, proper technique, and trust in the process, babies can be born safely—even with multiple cord wraps.