Most new mothers find the umbilical cord somewhat intimidating, this cold, gooey, cold thing on their newborn’s tummy that keeps getting stuck in their clothes and nappies. There are also various cultural habits and beliefs surrounding the umbilical cord, as well as different opinions on how you should manage it. And in recent years the guidelines on cord care has changed quite a bit…
What is the umbilical cord?
The umbilical cord surrounds the blood vessels that carries blood between your baby’s body and the placenta during your pregnancy. When your baby is born, the cord will be clamped and cut about 3-4 cm from your baby’s belly.
But don’t worry. The umbilical cord doesn’t contain any nerves, so cutting it and keeping it clean is not painful for your baby at all.
How does it separate?
After your baby’s birth, the cord will dry out and turn black. It will eventually fall off between day 5 and 15 after the birth. It may take another 7-10 days for your baby’s navel to heal completely.You may find it will spot some blood onto your baby’s nappy.
Your baby’s body sends white blood cells to the base of the cord that literally digest it and leads to it eventually coming loose. This process can leave a small amount of yellowish sticky fluid at the base of the cord, which moms sometimes mistake as pus.
Your baby’s skin is also colonised after the birth with good bacteria from your body, which helps with this process. Harmful bacteria can also colonise the skin and the cord, and you should always wash your hands before handling baby.
The risk of infection
The blood vessels inside the cord remain there for several days after the birth, leaving an opportunity for infection that can easily spread to your baby’s body. However, as I’ve mentioned, the body is well prepared to prevent this from happening. The real risk of infection in hygienic settings is very small.
In less hygienic settings there is, unfortunately, the very sad risk of babies developing tetanus infections in their umbilical cords. Tetanus is an extremely dangerous disease, caused by bacteria that are universally present in the oil.
The chances of tetanus infection is also increased through certain cultural practices, which involves putting various substances like cows dung, herbal mixtures, butter or fat on the umbilical cord.
In South Africa, about 300 cases of neonatal tetanus is reported each year. Most of these cases occurred in economically deprived areas due to poor immunisation practices and unhygienic circumstances.
To prevent neonatal tetanus, the Department of Health recommends routine immunisation of all pregnant women during pregnancy. This is so that they can pass on antibodies against the disease to their babies. This will protect baby after birth. In the private sector, most moms don’t receive this vaccination, so it’s agood idea to discuss this with your doctor and to request the vaccine, especially if you haven’t been vaccinated against tetanus in the last 10 years.
How to care for baby’s cord?
Because of this risk of infection, the guidelines for many years has been to clean the cord with a chlorhexidine solution. In South Africa, surgical spirits is used.
However, as you can imagine, using an antiseptic agent on the cord will kill the white blood cells at its base and interrupt the skin’s colonisation with good bacteria. Although this is unlikely to cause any harm in the long run, it can delay the cord’s drying out and falling off.
Studies done on babies living in circumstances where there is good sanitation and hygiene shows that cleaning the cord with an antiseptic agent makes no significant difference in the risk of infection. In fact, the risk of infection in these circumstances is extremely low. For this reason, many countries have adopted open cord care, in other words, the cord is left alone to dry and fall off on its own.
Please note that for babies in low socio-economic areas with poor sanitation and unhygienic circumstances, cleaning the cord will always be the safer option. For this reason the guidelines on cleaning the cord in South Africa is unlikely to change.
Babies who are admitted to NICU or who cannot stay in the room with mom will be more exposed to hospital infections and their cords should also be cleaned with an antiseptic.
Many moms also feel more at ease cleaning the cord. And of course, you can do so if you wish, as it won’t cause harm. But it’s important to note that once you’ve started cleaning the cord with surgical spirits, you will need to continue doing this until it has fallen off and healed.
Whichever method you choose to care for your newborn’s cord, keep the following principles in mind:
- Always wash your hands before touching baby’s cord, and make sure that baby’s bedding and clothes are clean and dry.
- From the start, do lots of skin-to-skin care with your baby and keep baby in your room in hospital (called rooming-in) as this reduces the risk of infections spreading between babies and from healthcare workers.
- Fold baby’s nappy down to expose the cord at each nappy change.
- Once the cord has dried out completely the cord clamp can be removed if you want to.
If you choose to practice open cord care:
- After baby’s first bath in plain water, pat the cord area dry and then leave it open. Do not submerge baby in water again until the cord has separated. Rather just wipe baby down (top-and-tail).
- If the area becomes soiled with urine or stools you can clean it with wet cotton wool and cooled down boiled water.
- Never use a dry cotton wool as this can leave segments behind.
- There is no need to use wound healing powders or other cleaning products.
If you choose to clean your baby’s cord:
- Wet a cotton wool with surgical spirits and, in a rotating movement, clean the skin area around the cord.
- Once it starts drying out, use an earbud to clean the crevices of the cord and navel.
- Once the cord has fallen off, continue cleaning until the navel is fully healed.
Watch out for these signs of an infection on your baby’s cord:
- The skin surrounding the cord area becomes red and swollen.
- It has a bad smell – this on its own without any other symptoms may actually be normal, but it should still be checked out.
- There’s pus draining from the area (not to be confused with the normal yellowish, sticky discharge).
- There’s bleeding from the cord area.
- Your baby has a fever.
- Your baby is sleepy and not feeding well.
Christine Klynhans is a nursing sister and South African Certified Lactation Consultant (SACLC). She currently works at Parentwood Baby and Family Wellness Centre in Pretoria as a well-baby clinic sister and antenatal teacher. She also has a breastfeeding practice and a Breast Pump Demo Centre. She is passionate about supporting parents on the journey of pregnancy, breastfeeding and the early childhood years. Learn more about Christine Klynhans.