Overview
A nuchal hand is one of several compound presentations where an extremity is alongside the presenting part of your baby at birth. With a vertex baby, the presenting part is their head, and with a breech baby, it is their bottom. A nuchal hand means that their hand is up by their face when they are born, which is the most common presentation irregularity. Ideally, your baby retracts their arm and comes out headfirst. A nuchal hand doesn’t automatically mean a C-section, but it does have the possibility to bring up some complications. This episode answers several questions about a nuchal hand, how it affects your birth, and whether you can do anything during pregnancy or labor to prevent it.
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Thank you so much for covering this topic — I may have had a compound birth with both hands, and I thought I would share in case it helps others to know about this (I also have some questions). I was laboring at home with a home-birth midwife for about 32 hours before transferring to the hospital due to an inability to pass urine at what my midwife said was 8.5 cm. I ended up opting for an epidural, as I really needed sleep and I wanted to have energy to push. However, the first (and then second) epidural wore off on my right flank within about 30 minutes. I was finally at 9.5 cm and told I could start pushing after around 38 hours of labor. The pushing only took about 15 minutes, and while I was stretching well, I still tore upwards around the clitoris (which is more rare, I hear). My home-birth midwife, who was photographing the birth, said that it looked like both of my girl’s hands were up by my her face, kinda crossing each other at her chin, and that her elbow passing out was what caused the upward tear on her exit. This was not captured in the notes by the hospital staff though — those involved in handling my daughter’s exit either didn’t notice, or it’s possible that my home-birth midwife was incorrect in her observation. I’m curious how common that is… to have different providers have a different take on such a thing as compound hands? I’m also saddened to hear that so little research has been done on this issue, and I’m curious about double-compound hand presentations, and if that might have been why my labor was so long. I hope to deliver my next child at home (as I had intended to with my first baby), and I don’t want to be afraid of this happening again. Thank you for covering this issue, as this is the most helpful thing I’ve found online about the matter.
Elisabeth, thank you for sharing your story. It sounds like you had quite an eventful birth. I am not sure how common it would be to have different providers observe two different things. Although during a birth where there is a lot going on and multiple people focusing on different things I could see that something could not be caught, especially if they aren’t looking for it. I am happy to add double-compound hand presentations to my Q&A list and see what research I can find on it. I will keep you posted!