George

“Oh, looka there.”

These were the words of a nurse at about 5:31 on Thursday, October 27. My wife Katherine had just delivered our daughter, Ella Aminah, 11 minutes before. She had just been taken to the warming table, and I had done what every parent has done for millenia, counted fingers and toes (for my family this is actually important; my daughter Naomi was born with 6 fingers on each hand), looked for anything that would show there was something we should be concerned with. No, Ella was perfect from the tips of her really long fingers, her very pointed toes, to the top of her squalling but otherwise healthy head.

“Oh, looka there.”

I was recording these moments in the room as they took her to the warming table, proud of my wife for enduring three days and two nights of induction, poking and prodding constant nurse visits in the middle of the night, the seemingly harmless but painful struggle to find a vein for her IV the first night we were there, the very necessary and helpful but painful epidural process. The doctor was doing what he needed to do for her post delivery. I was recording my daughter’s first breaths and movements outside the womb.

The nurse saw what none of us had seen immediately after delivery, what couldn’t be seen without special equipment and a bit of previous knowledge, and often can’t be known unless there is a terrible moment during pregnancy. She saw what is known as a “true knot” in Ella’s umbilical cord. You can see the knot in the picture just above her left hand. The website associated with the ubiquitous pregnancy book “What to Expect When You’re Expecting” has this to say about umbilical cord knots:

What it is: A cord knot is exactly what the term sounds like — a knot in the baby’s umbilical cord. Some knots form during pregnancy as the baby flips and turns in his or her amniotic sac; other knots form during delivery.
 
How common is it?  Umbilical cord knots occur in about one in every hundred pregnancies, but only one in 2,000 deliveries will have a true tight knot that could present problems for the baby. (More common than knots are nuchal loops, the technical term for when the cord wraps around a baby’s neck. Nuchal loops — also known as nuchal cords — occur in as many as a quarter of all pregnancies but rarely pose risks to the baby).
 
Who is most at risk? Babies with long cords and those who are large-for-gestational age are at greater risk for developing true knots. Researchers also speculate that nutritional deficiencies that affect the structure and protective barrier of the cord, or other risk factors such as smoking or drug use, carrying multiples, or having hydramnios may make a woman more prone to having a pregnancy with a cord knot.

Katherine doesn’t drink, doesn’t smoke, doesn’t use drugs, never has had a multiple pregnancy. When we asked the doctors and nurses that day what might have caused it, the repsonse was simple: “Swimming.” That is, Ella did a lot of moving around early in pregnancy and caused the loop that eventually became a knot. And she was big: at the 39 week mark when she was delivered, Ella clocked in at 8 pounds, 10 ounces.

Cutting to the chase, here’s what you can do:

What you can do: There is nothing you can do to prevent a knotted umbilical cord.

I’ll spare the descriptions of what can happen in the case of a tight true knot.

Katherine and I have talked about this only briefly, because the alternative was far too terrible. She had only seen it from the distance of the birthing bed to the warming table that day until I showed her the picture above, when she was finally ready to see it. She said “Wow. I do believe that should be one for the baby book – from day 1 a persistent, strong little soul.”

This always reminds me of how close to the razor’s edge every single birth of a child really is. It was not that long ago (1950) that 30 of every 1,000 births in this country ended in the worst way possible (currenly, just over 7 end this way in the US. That still only ranks us 34th in the world, well behind Japan, Spain, France, the U.K., and many others). Right now in Afghanistan, the birth mortality rate is an appalling 143 per 1,000. Maternal mortality in the US is 11 per 100,000 live births. Much smaller, but still sobering.

Our sleep deprived nights for the next few months are well underway. Ella is into the “reflex smile” stage, when she smiles without context, and many times when she is still asleep. Her brothers and sisters have all held her, felt her squirm when she gets hunger or is in the process of excercising that brand new digestive system. Wallace, our Rhodesian Ridgeback, is getting over the nervousness of having a new baby in the house, but still comes quickly to see what’s going on when she cries. And as I hold her, this my third daughter, I still am amazed at her persistent, strong little soul. Even when that soul decides it’s time to poop again when I JUST CHANGED THAT diaper.

I would be remiss if I didn’t mention the voice artists, Twitter followers, and great people and friends who sent Ella a wonderful stuffed animal and Amazon gift cards. They are:

Erica Risberg, Mike Wong, Derek Chappell, Liz De Nesnera, Fran McLellan, Lisa Rice, Natalie Cooper, Emma Gable, Dave Courvoisier, Hélène Janover , Karen Souer, Bob Souer, Tim Keenan, Anne Ganguzza, Xe Sands, Gini Martinez, Pamela Vanderway, Bob Ball, and Lauren McCullough. Thank you everyone for your unbelieveable kindness and thoughfulness.

She is our gift, our persistent soul, and we’re glad to have her.