The umbilical cord is a temporary organ connecting the fetus to the placenta, serving as the biological lifeline during pregnancy. It facilitates the transport of oxygen and nutrients to the baby while removing waste products. The cord contains one vein carrying oxygenated blood and two arteries returning deoxygenated blood. Cutting the umbilical cord separates the newborn from the placenta, marking the final physical transition of birth. Performing this procedure safely and at the proper time is an important aspect of newborn care.
Optimal Timing for Clamping and Cutting
The decision of when to sever the umbilical cord has evolved significantly from the practice of immediate clamping, which occurred within seconds of birth. Current medical guidelines favor a period of delayed cord clamping (DCC) for most healthy newborns. Major health organizations, including the World Health Organization and the American College of Obstetricians and Gynecologists, recommend waiting at least 30 to 60 seconds after birth before clamping the cord.
Allowing this time ensures the newborn receives a significant transfer of blood from the placenta, a process known as placental transfusion. This extra blood volume provides term infants with measurable benefits, notably higher hemoglobin levels and improved iron stores for up to six months after birth. Adequate iron availability is fundamental for neurodevelopment during the first year of life.
For preterm infants, delayed clamping is even more important, contributing to better transitional circulation and red blood cell volume establishment. This practice has been associated with a lower incidence of severe complications, such as necrotizing enterocolitis and intraventricular hemorrhage. However, clinicians must monitor term infants who undergo DCC for an increased risk of jaundice, which may require phototherapy treatment.
Immediate clamping remains necessary in specific medical scenarios where the placenta’s function is compromised or there is a serious maternal health risk. Conditions such as placental abruption, bleeding from placenta previa, vasa previa, or significant maternal hemorrhage may require rapid intervention. In these situations, the immediate need to stabilize the mother or begin infant resuscitation takes precedence over the benefits of delayed cord blood flow.
Essential Steps for a Safe Procedure
The physical act of separating the cord is a straightforward procedure that must always be executed under sterile conditions to prevent neonatal infection. While a parent or trained birth partner may sometimes perform the cut, it is typically carried out by a medical professional, such as a doctor or midwife. The process begins with the professional washing their hands and donning sterile gloves.
The necessary equipment includes at least two clamps and a sterile cutting instrument, usually a pair of sterile scissors or a scalpel. All instruments must be sterile, either single-use or appropriately sterilized. The clamps are applied to the cord to compress the vessels and ensure hemostasis, or the stopping of blood flow, before the cord is severed.
The first clamp is secured approximately two to three centimeters from the baby’s abdomen, marking where the remaining umbilical stump will begin. The second clamp is then placed a few centimeters further toward the placenta. The goal is to create a sealed section between the two clamps.
The cut is then made cleanly through the cord tissue in the space between the two clamps. This technique ensures that the vessels on the side remaining attached to the baby are securely closed by the clamp, preventing any blood loss from the newborn. The clamp on the baby’s side remains attached until the stump has dried sufficiently, often for the first 24 hours of life.
Immediate Post-Cutting Care
Once the cord is cut, a short umbilical stump, typically two to three centimeters long, remains attached to the baby’s navel area. This tissue contains no nerves, so the newborn feels no discomfort as the stump begins to dry and shrivel. The primary focus of post-cutting care is to keep the area clean and dry to facilitate natural separation and prevent infection.
The stump will naturally change appearance over the first few days, transitioning from a white or bluish-white color to a hardened, dry, black, or grayish structure. It will separate and fall off on its own, generally occurring between five and fifteen days after birth. It is important not to pull or attempt to remove the stump, even if it is only hanging by a thread, as this can cause bleeding or delay healing.
Parents should keep the diaper folded down below the stump to allow maximum air exposure, which helps the tissue dry out quickly. Sponge baths are recommended until the stump has fallen off, as submerging the area in water can prolong the drying process. If the area becomes soiled by urine or feces, it should be gently cleaned with plain water and gauze, then patted dry.
While infection is uncommon, parents must monitor the area for warning signs that require immediate medical attention. These include redness or swelling of the skin surrounding the base of the stump, a foul-smelling yellow or green discharge, or active bleeding that continues after gentle pressure. Other symptoms, such as a fever or lethargy in the newborn, may indicate a more serious systemic infection.