Umbilical Cord Issues: Understanding Two Vessels & Knots at Birth

Question
Our third son was born May 22nd.  At birth we learned that he only had 2 vessels to his cord and that it was tied in a knot.  First of all, I want to know if the two vessel cord should have been caught in the ultrasound.  What could have been done if they had seen the problem at that time?  I was told by my son's pediatrician that they cannot tell if there's 3 vessels because the ultrasounds are not that good.  Why did he tell me that and then I obtained my records from my 2 previous pregnancies only to learn that they checked those babies?  My second issue is that of the knot in the cord.  I went to my doctor in my 9th month and demanded a stress test.  I felt that he was not moving around much at all and that his movements seemed weak.  The doctor gave me an ultrasound yet only checked the fluid.  She did not spend all of 2 minutes looking at the fluid.  I was never a worry wort when I was pregnant with my other 2 babies.  They monitored his movement for about 10 minutes.  Should they have done more that day?  Should she have been able to see the knot had she looked at the cord?  What could have been done about it at that time?  Would it have been benificial to know about both of these problems before his birth?  When I was feeling decreased movements was it do to the knot in his cord?  How do you think I should go about confronting my doctor with my findings and concerns?  I am extremely desperate for information.  I feel like I was completely overlooked.  I always respected and took my doctors/nurses advice to be best out there.  I had absolute trust in all my caregivers previous to this.  I didn't realize how much I trusted until this happened.  I find it hard to sleep at night with all my unanswered questions.  Thank you for your time.  

Answer
Hello Shawna. While I am happy that you have doubts about putting complete trust in your medical caregivers, there is nothing they could have done about this situation and they are not at fault in their care. Ultrasound is NOT a very accurate tool and though the number of vessels is sometimes obvious, just as often, it is not. Two cord vessels sometimes indicates problems with the baby, but just as often there is nothing wrong with the baby. From your message, I assume all is well with the baby. The reduced fetal movements is very normal and has a wide variation from one baby to the next. Was this baby larger than the others? Larger infants have less room to move, so seem to move less. At the point of late pregnancy, the amount of fluid is really all that can be learned from a scan. A true knot would be almost impossible to see on a scan unless it was right under the transducer. It is most often hidden behind the baby or caught up in the folds of it's body. A knot often occurs if the cord grew longer than average and the baby was very active in the first 20 weeks of pregnancy. Even if both these situations had been seen on ultrasound, there is nothing I would have done differently. If the knot had been seen, I'm sure you would have been advised to have a c/section- thank goodness that did not happen. A knot in the cord does not cause any difficulties for the baby until it starts moving down into the vagina and puts tension on the cord. I have been the midwife at three births with true knots in the cord- all was well. I hope that answers your concerns. If you have more children, I urge you to seek the care of a midwife rather than a dr. You will find much more personal attention and skilled care from a midwife. You will also feel comfortable discussing such thing with her. This has been a traumatic experience for you - I hope you are now able to put it to rest and move on with your parenting. Please feel free to post again with any further questions. Cheri.