How Should Parents Care for the Remaining Umbilical Cord Attached to the Baby
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The umbilical cord is the connection between a mother and her baby.[1] It enters your baby through what eventually becomes their navel, or belly button, and is pretty big, averaging about 50 cm (20 inches) in length and 2 cm (about ¾ inch) in diameter in a full-term baby.[2] Blood passes through the umbilical cord from your baby to the placenta and then back to your baby by way of a single vein and two arteries.[3] Your baby's umbilical cord will gradually dry up, become hard stiff tissue, and fall off within 1 to 2 weeks,[4] but as a new parent, you have the option of cutting off the umbilical cord.[5]
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Be aware that clamping and cutting the umbilical cord are not necessary. In fact, some new parents decide to leave the umbilical cord and placenta attached to their baby's navel until it falls off naturally.
- Keeping the umbilical cord on until it falls off naturally can be cumbersome, though. Most parents have the cord cut shortly after birth; they don't feel comfortable with the idea of carrying the placenta with their baby until the umbilical cord separates.
- If you plan to bank your baby's cord blood, the cord will need to be cut.[6] Since the umbilical contains no nerves (like hair, for instance), neither the mother nor the baby will feel the cut.[7]
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Expect your doctor to perform "immediate" clamping within the first moments of your baby's life. This is a common practice, as immediate clamping allows the baby, especially if they are high risk or premature, to be evaluated right after they are born.[8]
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Keep in mind your doctor may do "delayed" clamping. Recently, there has been a shift to delayed clamping, where the umbilical cord is not clamped until at least 1 to 3 minutes after birth.[9]
- Many physicians feel that delayed clamping is a more natural process, and provides better circulatory support during the baby's transition out of the womb.
- At birth, a significant amount of the baby's blood is still in the placenta and umbilical cord. Delayed clamping allows the baby's circulatory system to recover of much more blood, often as much as ⅓ of the baby's total blood volume.[10]
- Similar to the procedure in immediate clamping, the newborn should be held slightly below the level of the mother to enable some of that blood to return to the baby.
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Understand the benefits of delayed clamping. In full term infants, babies with delayed clamping had less anemia and iron deficiency during the first 3 to 6 months. However, in some cases, phototherapy for neonatal jaundice was required.[11]
- Premature infants whose clamping is delayed have a 50% lower chance of an intraventricular hemorrhage, or bleeding into the fluid cavities in their brain.[12]
- Keep in mind that skin-to-skin contact between mother and baby should not be postponed with delayed clamping.[13]
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Talk to your doctor about which type of clamping you would prefer. Be clear about your expectations for clamping your baby's umbilical cord with your doctor before giving birth.
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Make sure you have access to the right medical supplies. Cutting the cord is a simple procedure that requires:
- An antibacterial solution.
- Sterile surgical gloves, if available.
- A clean cotton pad or (preferably) sterile gauze.
- A sterile clamp or strip of woven umbilical tape.
- A sterile sharp knife or pair of scissors.
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If the cord is wrapped around your newborn's neck, slide your finger under the cord. Then, gently pull it over your newborn's head. Take care not to stretch the cord tight.
- With your baby's first breaths in the first few seconds after delivery, your baby's circulation shifts away dramatically from the placenta. In fact, flow of your baby's blood through the placenta usually completely stops within the first 5 to 10 minutes of birth.
- You can determine when blood flow through the umbilical cord has stopped when you can no longer detected the umbilical cord's pulse (similar to what the pulse in your wrist or neck feels like).
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Use sterile plastic clamps or sterile woven umbilical tape to tie off the cord. You can find plastic clamps in bulk online, such as EZ clamp and Umbilicutter, but you may have a hard time purchasing just one clamp.[14]
- While these clamps are very secure, they are bulky and catch easily on clothing.
- If you are using sterile woven umbilical tape, make sure it is at least ⅛ inches wide. You can find this product online in single use lengths.
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Look for cord rings or cord binders at a medical supply store. These can be slipped over the umbilical cord to tie it off.
- Keep in mind that some brands require additional equipment to place the band on the umbilical cord.
- One type that requires no additional equipment is the AGA umbilical cord ring.
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Always sterilize any woven materials like silk or a shoelace before using it to tie off the cord. In a pinch, you can use other woven materials like silk, a shoelace or cotton string, but make sure you always boil the material in water first before using it.
- Avoid using thin, strong materials such as dental floss, which could rupture the cord if it is tied too tightly.
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If you are using woven material, tie the knots firmly on the umbilical cord. But take care not to rupture the cord by using excessive force.
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If you are using clamps or tape, put the first tie about 5 to 7.5 cm (2 to 3 inches) from the baby. The second tie should be placed further away from the baby, about 2 inches from the first tie.
- Keep in mind that although a pulse in the umbilical cord may stop shortly after delivery, significant bleeding may still occur if the cord is not clamped or tied.
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Prepare the umbilical cord by swabbing between the clamps or ties with antibacterial solution. You can use betadine or chlorhexidine.
- This step should be done especially if delivery occurs in a public or unhygienic setting.
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Use a sterile, sharp blade such as a scalpel or a strong pair of scissors. The umbilical cord is much tougher than it looks, and will feel like rubber or gristle.
- If the blade or pair of scissors you are using are not sterile, clean them thoroughly with soap and clean water, and then immerse them in alcohol (70% ethanol or isopropyl alcohol) for 2 to 3 minutes.
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Grasp the cord with a piece of gauze. The cord may be slippery so this will ensure you have a firm grip on the cord.
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Cut cleanly between the ties or clamps. Make sure you hold the cord firmly to ensure the cut is clean.
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Bath the baby within the first six hours of life. [15] Sponge baths can be done for the first few days.
- The newborn baby's risk of hypothermia is more of a concern, especially in the first few days of life, than any issues with the cord stump.[16]
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Wash your hands with soap and water before and after caring for the stump. [17] Always dry your hands well before touching the stump as you want to keep the cord stump dry, and exposed to air as much as possible.[18]
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Avoid touching the cord stump or exposing it to unclean substances. [19] [20] While you need to ensure it is not in contact with any dirty or unclean surfaces or substances, you also don't want to cover it tightly with a dressing.[21]
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Treat the cord stump with an antiseptic. Keep in mind the use of topical antibacterial solutions to reduce the risk of serious infections on the cord stump is still not universally accepted by medical professionals.[22] But umbilical infections can be serious, and many practitioners continue to recommend the use of an antiseptic to keep them clean.[23]
- Effective and easily available antibacterial solutions include triple dye and chlorhexidine.[24] Iodine tincture and povidone-iodine are less effective.
- Alcohol (ethanol and isopropyl alcohol) should be avoided. The antibacterial effect of alcohol is brief and can be harmful to the baby. It can also delay the usual 7-14 days of cord drying and separation by a day or two.
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Apply the antiseptic daily or with diaper changes for at least 3 days. Only apply it to the cord stump. Try not to leave any of the antiseptic on the skin around the stump.
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Be aware of your option as a parent to collect and store your baby's cord blood. You can do this at the time of delivery.[25]
- Long term cord blood frozen storage can be a source of stem cells that may be used for future treatment of your child or another child.[26]
- Currently, the diseases that may benefit from cord blood are limited and rare. However, as medical science advances, other future uses for cord blood are very likely.[27]
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Keep in mind you can still collect your baby's cord blood even if you use delayed clamping. It is not true that delayed clamping of the UC removes the option of cord blood banking.[28]
- Even after the transfer of blood from placenta to baby, additional blood can be acquired from the placenta for storage, if desired.
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Article Summary X
Cutting your baby's umbilical cord is a significant moment of their birth, and it's a simple procedure you can do yourself. Make sure you have sterilized scissors or a knife, antibacterial solution, and clean cotton pads or sterile gauze. You'll also need sterilized clamps to hold the cord, or you can use string or shoelaces, as long as you soak them in boiling water first. Within a few minutes of your baby's birth, place 2 clamps or tie 2 strings on the umbilical cord about 3 inches and 5 inches from your baby's stomach. Swab the area with an antibacterial solution. Then, grasp the cord with a piece of gauze and make a clean cut in between the clamps or strings. For more tips, including how to care for your baby's stump at home after cutting its umbilical cord, read on.
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How Should Parents Care for the Remaining Umbilical Cord Attached to the Baby
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