Immediately after delivery of the head, the umbilical cord is around the neonate's neck. Which action should you take?

• A. Slip the cord over the head
• B. Assess if the cord is pulsating
• C. Rotate the head toward mother's anus
• D. Apply slight traction to the superior shoulder

Answer: (A)

When a nuchal cord is present after the head delivers, the immediate goal is to relieve any constriction of the umbilical vessels. If there’s slack, slipping the cord gently over the baby’s head frees the neck and restores unobstructed blood flow through the cord. This simple maneuver is the fastest way to prevent ongoing cord compression and potential hypoxia. Tugging on the cord or pulling the baby can tighten the cord or cause neck injury, and rotating the head or delaying action won’t address the obstruction. If slipping it over the head isn’t possible due to tightness, avoid force and seek additional help, but the first, best step is to try to slide the cord over the head.