The umbilical cord is looped around the neck of the foetus; this may cause foetal distress and halt the progress of birth after delivery of the head.
Nuchal cord does not become visible until after the head is delivered.
If the loop is loose, slip it over the neonate's head.
If the loop is tight and/or has several turns, clamp the cord with 2 Kocher forceps and cut between the 2 forceps (Figure 5.14). Unwind the cord, complete the delivery and perform neonatal resuscitation, if necessary.
Note: the possibility of a nuchal cord is the reason why 2 Kocher forceps and a pair of scissors must be ready at the time of delivery.
Figure 5.14 - Cut between 2 forceps as soon as the head is delivered