This guidance is intended only for the scenario of an unplanned, unassisted birth where professional medical assistance is delayed or unavailable. Cutting the umbilical cord is a medical procedure that carries risks, particularly infection and hemorrhage, and should be performed by trained personnel. The priority is the health and stability of the newborn and the birthing person, not cutting the cord. These instructions serve as a measure for managing the cord in an emergency situation. The safest course of action remains keeping the baby attached to the placenta while awaiting the arrival of emergency medical services.
Immediate Stabilization Before Cutting
The most pressing concern after birth is ensuring the newborn is breathing effectively and maintaining a stable body temperature. Before any thought is given to the umbilical cord, the infant must be dried vigorously with a clean towel to prevent rapid heat loss through evaporation. Once dried, the baby should be placed immediately onto the birthing person’s chest for skin-to-skin contact, which is the most reliable method for warming and stabilizing the newborn. Covering both the baby and the birthing person with a blanket further helps to conserve heat.
If the baby is not crying or breathing well, gentle stimulation, such as rubbing the back or the soles of the feet, may encourage respiration. The umbilical cord, while still attached to the placenta, continues to deliver oxygenated blood to the infant, functioning as a physiological lifeline during this transition phase. For this reason, the cord should not be cut unless a specific emergency requires the baby’s immediate transfer or resuscitation away from the birthing person. If the situation permits, waiting until the cord naturally stops pulsating allows the baby to receive a beneficial transfer of blood volume from the placenta.
Preparing Emergency Clamps and Cutting Tools
In the event that the cord must be cut due to an emergency or prolonged delay of medical help, selecting and preparing the necessary items is the next step. To prevent blood loss, two methods of occlusion are required: a cutting tool and materials for clamping or tying off the cord. For the cutting tool, a clean, sharp instrument like a new, unused razor blade or a sturdy pair of full-metal scissors is preferred, as the cord is tough and requires a sharp edge for a clean cut.
To reduce the risk of introducing bacteria, any metal cutting tools should be sterilized by boiling them in water for a minimum of ten minutes. If boiling is not feasible, cleaning with soap and water followed by soaking in 70% isopropyl alcohol for several minutes is an alternative.
For clamping or tying the cord, suitable household items include clean, unused cotton string, strong thread, or a new shoelace. The tie material must be strong enough to compress the cord vessels. These tying materials should also be sterilized by boiling for twenty minutes if possible, or by soaking them in alcohol. Home sterilization methods are inherently imperfect compared to clinical standards.
Step-by-Step Cord Clamping and Severing
The physical act of clamping and severing the umbilical cord requires precision to ensure the newborn’s safety. The first tie or clamp must be placed on the segment of the cord closest to the baby’s body, approximately two to three inches (5 to 7.5 centimeters) away from the baby’s abdominal wall. Tying this first ligature tightly is necessary to fully occlude the blood vessels, preventing backflow of blood into the remaining cord stump.
The second clamp or tie is then placed further down the cord, towards the placenta, leaving a small gap between the two occlusions. This second tie should be positioned about one to two inches (2.5 to 5 centimeters) away from the first tie. This space between the two ties is the designated area for the actual cut, sealing both the newborn’s side and the placental side.
Once the two ties are securely fastened, the sterilized cutting tool is used to make a single, clean cut through the cord in the space between the two ligatures. It is imperative to cut only in this central section, away from the baby’s body. After the cord is cut, the tie on the baby’s side must be immediately checked to confirm it is holding securely and that no blood is visibly leaking from the cut end.
Immediate Follow-Up and Monitoring
After the cord has been successfully severed, attention must shift to the newborn’s stump and the management of the placenta. The stump requires constant monitoring for any signs of hemorrhage. Bleeding, even a small amount, necessitates immediate tightening of the tie or application of a second ligature if the first one fails. The stump should be kept dry and exposed to air as much as possible to help the tissue dry out and fall off naturally, typically within one to two weeks.
Monitoring the stump for infection is important, especially when using non-sterile emergency tools. Signs of potential infection include localized redness and swelling around the base of the stump, a foul odor, or any discharge that is not clear or yellowish.
The placenta remains attached to the maternal side of the cut cord and will need to be delivered in the third stage of labor. The birthing person should not attempt to pull or manipulate the cord to hasten the placenta’s delivery, as this can cause severe hemorrhage. If the placenta delivers naturally, it should be placed into a clean container until medical professionals arrive. Immediate contact with emergency medical services or transfer to a hospital is mandatory for a full maternal and neonatal assessment.