What should a first responder do if a tight nuchal cord is present during delivery?

In the case of a tight nuchal cord, which is when the umbilical cord is wrapped around the baby's neck, the recommended action is to clamp and cut the cord only if absolutely necessary. This approach allows the first responder to maintain the safety of both the mother and the newborn.

Clamping and cutting the cord may be necessary if the cord is so tightly wrapped that it could compromise the baby’s circulation or breathing during delivery. However, it should be emphasized that this step should be a last resort after considering other options. If the nuchal cord is loose enough, gently manipulating it over the baby's head without pulling can often be done.

Waiting for delivery to occur without intervention is generally encouraged as well, provided the nuchal cord is not causing distress to the infant. Immediate resuscitation is not indicated unless there are clear signs of the baby needing assistance, such as being non-responsive or not breathing.

Overall, the rationale behind choosing to clamp and cut only if absolutely necessary is to balance potential risks while prioritizing the safety of the newborn and the natural delivery process whenever feasible.