The Somersault Maneuvre

I often hear birth stories with accounts of cords being cut before the baby’s body is even born, usually because a tight nuchal cord was discovered.

Nuchal cords are very common and normal, and approximately 20-30% of babies have their cord round their necks, though most of those cords are not tight enough to need any intervention. The reasons for panic are two fold, firstly……education on how to deal with a tight nuchal cord is lacking, and the worry is that the cord may tear…… which is actually quite possible with a very tight nuchal cord. And secondly, the damage that premature cord clamping and cutting can do is still not fully acknowledged by many HCPs, so cutting a cord so prematurely doesn’t seem like a particularly big deal.

However it IS a big deal…..babies who have their cords cut prematurely are more likely to suffer anemia, shock, hypoxic-ischemic encephalopathy, and cerebral palsy. .

Additionally, when a baby has a tight nuchal cord, the accompanying cord compression makes the baby have less blood volume at birth than necessary for easy transition to extra uterine life, so it is ESPECIALLY important for those babies to receive optimal cord clamping.

So, what to do when a tight nuchal cord holds the baby back from being born easily? Well, easy. The Somersault manoeuvre!! It was described formally for the first time by Mercer in 2005 I believe, but has probably been done forever by midwives and Drs. And it’s an easy intervention to do if needed.

Once the head is born (and usually once it has restituted) and the shoulders look like they want to be born/are partially born but are being held back by cord, gently push the baby’s head towards the birthing person’s thigh.

The aim of the game is to bend the baby’s head forwards toward its chest, so that the next contraction pushes the baby’s bottom and lets the body be born, while the head stays close to the thigh/perineum. It’s almost like the baby’s body flips past the head in a somersault like motion (hence the name). The baby will end up with it’s head close to the birthing persons perineum and it’s feet towards their knees. It is then easy to unwrap the cord. The illustration is inspired by the one in this article but styled out by me 😬 https://pubmed.ncbi.nlm.nih.gov/16154063/