The umbilical cord provides the connection between you and your little one when they are growing in your womb. It is through the cord that nutrients and oxygen are supplied to the unborn baby, and waste products find their way back to your bloodstream, to be excreted out. Once the baby is born, the cord will have completed its work. It will be cut to separate you and the baby, but a small part (about half an inch to an inch long) will be left with the baby.
The process of cutting and clumping is not a painful process since the cord has no nerves. The part that is left is what we are referring to as the stump. It will be clumped with a plastic cord clump or ligature to prevent bleeding. The part that is left needs utmost care until it dries and falls off or else it can be an entry point for microbes.
The umbilical cord provides direct access to the to the bloodstream of the newborn. In case of any entry of disease-causing microorganisms, they will spread throughout the body causing neonatal sepsis. Infections are the leading cause of neonatal morbidity and mortality globally. Therefore, taking care of the cord to prevent irritation and contamination should be taken very seriously.
Table of Contents
Care of the cord starts instantly after delivery as there is a risk of bleeding if it is not well ligated. Also, the bleeding may occur as a result of shrinkage of the cord resulting in loosening of the ligature. In the first 24 hours, ensure that there is no blood coming out of the cord. If any, please apply pressure and call your healthcare provider. Within 24 hours, you will still be in the hospital, and so, your healthcare provider will ligate it properly.
Blood loss is a concern in newborns as it can easily lead to shock and necessitates blood transfusion. It also puts the life of the newborn in danger, and will definitely prolong your hospital stay.
What Should You Do?
The primary goal of cord care is to leave the stump and cord area clean and dry. If cared for properly, the stump will dry and fall off eventually. You should never attempt to pull it out even if it is just hanging by a thread- let nature take its course. Forcing it out will increase the likelihood of bleeding and infections.
The World Health Organization (WHO) recommends that if the baby was born in sterile conditions, clean, dry cord care should be adopted. However, if the delivery was in a home setting or an area with high neonatal mortality, daily chlorhexidine digluconate aqueous solution or gel should be applied to the stump during the first seven days of life.
The organization further advises against the application of traditional substances. You may or may not be surprised to hear that there are diverse cultural belief systems on umbilical cord care worldwide. In some communities, the cord is cut using grass or non-sterile blades for home deliveries. Other people use drying agents like baby powder, spirit, charcoal or dust while others use lubricating agents such as oil and traditional herbs. All these practices are discouraged.
In the past, pediatricians used to recommend cleaning of the cord with alcohol. However, research has shown that alcohol may irritate the skin and even delay healing. Furthermore, there is scientific evidence that dried cords fall faster than ones swabbed with alcohol.
For the cord to fall off naturally, it must remain dry. So, always keep the stump dry. Avoid covering it with the diaper as it risks irritation and soaking in urine or stool. You can either fold the front edge of the diaper down or buy ones that have a special cut-out notch around the area of the cord. You can also improvise by cutting out the diaper by yourself.
If the weather allows, expose the cord to air by dressing the baby in just a t-shirt or diaper, to give it more time to dry out naturally. In addition, when dressing the baby, use loose clothing to allow free circulation of air and prevent moisture accumulation.
When bathing the baby, do not immerse them in water until the stump falls off. Give sponge baths and if you must put them in a tub, basin or sink, ensure that the cord stump is above the water level, and bathe them when gently sloped. This position will help you support the baby and to keep the cord away from water. Once the cord has healed, you will have the freedom of submerging your little in their special tub.
After bathing, dry the baby by gently patting using a soft towel or cloth, to avoid friction and irritation of the stump. Do not dress the baby until the cord area is completely dry.
Always ensure that you wash your hands before handling the stump. If you need to clean the stump may be after it is accidentally soiled, ensure that you gently do it to avoid trauma and irritation.
To clean it, put a swab in lukewarm water with mild soap then squeeze it (you can also use a cotton-tipped applicator). Wipe the cord and the area surrounding it, removing any dirt that may have collected. Do not worry about pain as there are no nerve endings on the stump. When done, do not rub the area but pat it dry with a soft cotton cloth.
When changing a diaper or nappy, pay attention to the base of the stump. Ensure that the area is not moist and no debris has collected.
Most umbilical cord stumps fall off between 10 and 14 days, but some may extend up to 21 days. When drying, you will notice that it changes color from a shiny white appearance to yellowish-green then to brown or black. It also turns from a soft and damp stump to a hard and thin base as it dries, and finally, it falls off. When it falls, you may notice a raw spot, and at times it may have a small amount of fluid with a tinge of blood. This should not worry you not unless it is more than a few drops.
The small wound that is left will take about two weeks to heal and dry out completely. You should continue keeping it dry and clean until it is totally sealed. If after two weeks it is not completely dry, you should visit your doctor. Once healed, the area will become the baby’s belly button.
If not taken care of properly, an infection may set in. Every time you are handling the cord, keenly inspect the area to identify any sign of infection. In case of inflammation, you may notice the following symptoms
- The cord oozes yellow pus that may or may not be accompanied by bad odor
- The base and the area surrounding the stump may be red. Redness may also be caused by irritation. To determine whether it is due to an infection or irritation, leave the area untouched for about one hour and check whether it reduces. If it is clearing, it may be due to irritation, but if persistent, it could be a sign of inflammation.
- The area is tender, and the baby becomes irritated when you touch it
- The infected area may be hot, but if the infection has spread, there may be general body hotness
- You may also notice bleeding from the cord, especially after it falls. If you see blood, apply pressure on the area for about 5 to 10 minutes. If the blood drops persist, you will need medical intervention.
If you notice any of the signs of infection or you have any uncertainties, you ought to visit the hospital.
For some babies, you may notice a firm pinkish-red lump of tissue which may be accompanied by a discharge after the stump has fallen off. The lump is a like a scar that forms after the cord falls. The discharge is not an infection as it is not accompanied by the other classical signs of infection which are redness, warmth, tenderness, and fever. The swelling may persist for up to two months, and if left untreated, it can progress to a serious infection.
An umbilical granuloma is treated by a healthcare provider with a drying medication known as silver nitrate for about two to three times. If it persists, the doctor may opt to use nitrogen to dissolve the tissue or perform surgery to remove the granuloma and prevent complications.
It is not difficult to take care of your baby’s umbilical cord stump. You just need to apply the simple measures in this article, and in less than a month you will have your little one’s belly button healed and safe.