Routine vaginal examination to check for a nuchal cord

Many midwives routinely perform a vaginal examination during birth to check for the nuchal cord. Such an invasive procedure would only be consistent with midwifery philosophy if it was common to find a nuchal cord so tight that the only alternative is to cut in order to allow the birth of the baby. A tight nuchal cord, however, seems to be rare. So how did it happen that the invasive procedure of checking for the nuchal cord vaginally became a ritualized practice in contemporary midwifery? The historical literature on the significance of finding a nuchal cord is reviewed in this article. Checking for the nuchal cord has been advocated by medical textbooks. The call to make this procedure routine for all women was not made in medical texts until the late 17th century onwards. Though an exploration of the historical origins of the procedure it is demonstrated that the arguments used act as a model for the way in which all aspects of birth have been medicalized through fear. It is hypothesized that when the midwife avoids routine invasive checking for the cord and instead makes individual clinical decisions for each particular woman and baby this may be a marker of her willingness to practice as an autonomous decision maker and not just of follower of ritual.