THE BIG UMBILICAL CORD ARTICLE

 

The umbilical cord connects the baby in the womb to the placenta and thus to its mother. The placenta is attached to the inside of the uterus. Blood, which is rich in oxygen and nutrients, flows from the mother's bloodstream into the uterus, the placenta and through a vein in the umbilical cord to the baby in the belly. There are also two arteries in the umbilical cord and these carry carbon dioxide and other waste products from the baby back through the umbilical cord to the placenta and mother, who disposes of the waste products for the baby.

 

Even after birth, the umbilical cord still has an important function. Nature has arranged it in such a way that the newborn baby is supplied with oxygen twofold for a while after the birth: via the umbilical cord and via the baby's own breathing. This double supply is intended to ensure a gentle, safe transition and a constant supply of oxygen. 

 

When the baby starts to breathe, first the blood flow from the baby to the placenta is stopped. The remaining blood from the placenta and umbilical cord flows back to the baby and stays there. When this process is complete, the umbilical cord is white and thin. We say it has stopped pulsating. It has now fulfilled its task. 

 

 

In hospitals, the umbilical cord is usually cut very soon after the birth, often within seconds. At this point, the umbilical cord is still bulging with blood. Two clamps are then applied, one towards the baby's side and one towards the mother's side, and the umbilical cord is cut in between.

 

This procedure has several disadvantages:

• The baby does not get all the blood from the placenta and umbilical cord. This blood is about a third of its total blood and it will feel the lack of it for weeks and months to come. It could even have lifelong effects.
• By cutting the umbilical cord early, the baby is not supplied with oxygen in nature's genius twofold way, i.e. via the umbilical cord and its own breathing, during the transitional phase after birth. If the baby is not breathing on its own at the time the umbilical cord is cut, it will have no oxygen supply at all after the cord is cut and this is very bad.
• Early cord clamping is basically traumatic for a baby. Even for the mother, too, as mother and baby are an inseparable unity. And even for the father who witnesses what happens to his loved ones. And also for any other witness and those who inflict this on the baby.
• The natural process of detachment of the placenta from the uterus and the birth of the placenta are also disturbed by early cord clamping. For example, by leaving an unnatural amount of blood in the placenta because it does not drain, the placenta is thicker and larger and that can make it more difficult for the uterus to contract effectively, which in turn may interfere with the detachment and birth of the placenta and even encourage increased postpartum haemorrhage.

 I therefore consider the procedure of early cord clamping and cutting to be very nonsensical, even criminal, and I deliberately use such a strong word for it. 

 

 

The time between the birth of the baby and the birth of the placenta is called the third stage. In a natural, physiological third stage the blood circulation via the placenta and umbilical cord continues to function for a while after the birth. This is to ensure that the newborn baby receives all the blood it is entitled to. It also ensures that the baby experiences a gentle transition from being supplied with oxygen via the cord to breathing on its own. For a while it is supplied in a twofold way, a natural form of "health insurance".

 

In a natural third stage the detachment of the placenta from the uterus and the birth of the placenta can proceed undisturbed.

 

In order to experience these advantages, one should wait to cut the umbilical cord at a minimum until the cord has completely stopped pulsating and is white and bloodless. Ideally, one should wait until well after the birth of the placenta. In a natural third stage, the placenta is usually born within the first two hours after the birth. 

 

When I attend births, I cut the umbilical cord or help the parents to cut it when the parents want me to, which is usually well after the placenta was born and just before I leave after a home birth. I usually leave 2-3 hours after the birth. And I don't leave until at least one hour has passed after the birth of the placenta. Some parents prefer to wait even then, and cut the umbilical cord the following day, for example. That is also perfectly fine.

 

There is also the so-called lotus birth, where one doesn't cut the umbilical cord at all, but waits until it falls off naturally.

 

 

One of the most common methods of cord clamping nowadays is the umbilical cord clamp. If you attach it after the umbilical cord has fully finished pulsating, you do not have the disadvantages mentioned above. But there is still the disadvantage that a plastic umbilical cord clamp is hard and uncomfortable and sometimes causes pressure marks. Also, many parents want to avoid plastic on their child as much as possible.

 

If the child has already been given an umbilical cord clamp and it is found to be bothersome, it is also possible to open it again with umbilical cord clamp pliers. 

 

To avoid hard umbilical cord clamps, umbilical cord rings made of latex were invented. These are sterilely packaged and can therefore also be used in the operating theatre, for example. 

 

Another way of tying off the umbilical cord is simply to use a piece of string or a crocheted umbilical cord tie, preferably made of 100% cotton. By the way, such a tie or string does not have to be sterile, only clean. It only touches the umbilical cord from the outside, just like clothes, and clothes are not sterile either. However, if you want, you can boil it for 10 minutes beforehand and leave it to dry in a clean place and store it, e.g. in a glass that had previously been filled with boiling water and then left to dry. Another sterilisation option is wrapped in aluminium foil (although I prefer to avoid aluminium foil) or in a fire-safe container in the oven for two hours at the highest heat. 

 

Organic dental floss without flavour is also a very good, neatly packaged option for tying the umbilical cord. It is what I have actually probably used most often as a midwife in recent years. 

 

Actually, if the umbilical cord has completely finished pulsating, you don't even need to tie it before cutting it, because it is then bloodless. There is a fear that blood could come out of an umbilical cord that has not been tied or clamped, but at least as long as everything is physiological, this is not the case. At the most, you'd see a few drops of blood. 

 

Remember: To cut a cord without clamping it, ideally wait until well after the birth of the placenta. At a minimum, wait until it has fully stopped pulsating, is thin, white and bloodless.

 

SO SHOULD ONE TIE A CORD BEFORE CUTTING IT OR NOT?

 

I would encourage mothers to follow their intuition on this question.

 

Personally, I used to feel for years that one must clamp or tie a cord before cutting it as that is what I learned as a student midwife. We were taught to double clamp a cord to both the mother's and baby's side and were told horror stories about what would happen if we did not. Basically, that mother and baby might bleed to death. Of course, we also were taught to clamp the cord early, while it still was pulsating, and then it could actually be dangerous. Over the years, I reflected on much that I was taught back then and understood that a lot of what was presented to us as medical facts, physiologically speaking made no sense and was to be located more in the realm of myths than reality. I only practiced late clamping of the cord. I stopped double clamping. I mostly stopped using plastic clamps, using more comfy material instead. But the first time I saw a cord that had been cut without tying it, I still felt a shock. I examined my fear and found that it was not based on facts, but fiction and fear. I worked through this fear and overcame it. I am now fully ready to support families who choose this option.

 

WHAT INSTRUMENT SHOULD BE USED TO CUT THE CORD?

 

You should use a sterile instrument to cut the umbilical cord, usually sterile scissors are used. In principle, any type of knife or scissors that can be sterilised can be used. To sterilise, either boil before use. Or sterilise in the oven, as described above. With the oven method, you can also prepare everything in advance, which is handy. I used a beautiful forged little jewellery knife when my youngest daughter was born, which I boiled during labour and left in the covered pot in the hot water until I needed it. I also once heard of a family who used a flint knife for this purpose. An original wrapped, non-sterile but clean razor blade is another option, especially if you live in conditions where it is difficult to sterilise anything or you don't have sterilisable instruments. 

 

There is another not sterile, but clean and very down-to-Earth option: the mother can chew through the cord. This might sound strange, but actually is what animals usually do. And while they're at it, they might eat up the placenta as well. (More about this in the big placenta article, coming soon.) Chewing through the cord takes a while, as it is made from quite a tough material. There is an interesting benefit to the tenacious cord chewer, though: There are substances in the cord that causes her to bleed less after the birth. 

 

Apart from cutting and chewing, there is also another hygienic option: burning through the umbilical cord with a candle flame. This takes quite a long time, there is a possibly unpleasant smell and you have to take good care of the baby because of the flame, possibly keep a shield between the baby and the flame or use a cord burning box (see picture below). In some parts of the world, this is a traditional method. Some families also appreciate the quiet, contemplative nature of burning through the cord by candlelight.

 

HOW FAR AWAY FROM THE BABY IS AN UMBILICAL CORD TO BE SEVERED? 

 

In modern obstetrics the umbilical cord is often cut quite close to the baby, in my opinion sometimes too close. When cutting the cord, I find it intuitively right to keep at least 2-3 cm away from the skin and possibly 10-15 cm or even more. You can do this according to your preference and intuition. When burning through the cord, it is obvious that you have to keep a good distance away from the baby. When chewing, too, you would naturally do that quite a bit away from the baby as not to mistakenly pull on the cord. In general, when severing the umbilical cord, it is important not to pull on it and of course to be careful so that everyone is safe. 

 

IS IT CLEAR WHETHER LEAVING THE CORD SHORTER OR LONGER, USING A PARTICULAR METHOD TO SEVER IT, TYING IT OR NOT TYING IT WILL HELP TO AVOID INFECTIONS?

 

To my knowledge, there is no evidence of this. Common sense tells me that the instrument with which to sever the cord should be sterile as it touches upon open flesh. Burning apparently is an equally safe option. There is not much known nowadays about chewing cords, although that's probably how most cords in the history of humanity were severed and apparently it worked fine for a long time. The baby's clothes, the water used for washing, whatever else touches the umbilical cord stump and ideally the whole environment should be clean. (Not over-the-top clean, just normal clean.) Also, that one should wash one's hands before taking care of the cord. No disinfectant needed, just wash hands with soap.

 

IS IT KNOWN WHETHER THERE WOULD BE A HIGHER INCIDENCE OF BLEEDING FROM THE CORD IF ONE DOES NOT TIE OR CLAMP IT BEFORE SEVERING? 

 

If one waits until the cord has completely finished pulsating, when it is thin, white and bloodless and ideally until well after the birth of the placenta, all blood circulation of the blood vessels in the cord have been shut down and in normal physiological cases there will be no blood coming from the cord, other than possibly a few remaining drops when it is cut. It is not clear whether there could possibly be a somewhat higher likelihood of blood coming from a non-tied versus a tied cord in certain non-physiological cases, e.g. of Vit. K deficiency.

 

 

And now another possibility that may surprise some people: You can simply not cut the umbilical cord and wait until it falls off by itself. In this case, of course, the placenta is still attached to the baby for a few days and you have to take care of it so that it doesn't start to smell unpleasant. Normally you wash it thoroughly, let it drain in a sieve for 24 hours, then rub it with salt and herbs and wrap it in a cloth, which you change when it has become damp. The whole process is called a lotus birth and the umbilical cord should fall off on its own after a few days. Of course, if at any point you find that the attached placenta becomes bothersome, you can always change your mind and cut the umbilical cord. You are free to do what feels right for you! 

  

It should be self-evident that a baby that is not yet breathing should not have its oxygen supply via the umbilical cord cut off, and yet it happens every day. Newborns who do not start breathing on their own after birth and need to be reanimated, recover better if they are resuscitated directly next to the mother with the umbilical cord intact. There is now even a study that has scientifically proven this. How sad that we live in a world where it takes a study to show that resuscitation of babies with intact umbilical cords is beneficial. My common sense, logical thinking and experience as a midwife have been telling me this for a long time.... Nevertheless, I am glad that this study was done, because it shows that there is hope....

 

Here is the link to the study: https://doi.org/10.1186/s40748-019-0110-z

 

I look forward to a time when mothers and babies are never separated from each other after birth, under any circumstances, including when babies need resuscitation after birth or when mothers or babies need intensive care. Rooming-in and bedding-in must become a matter of course for everyone, for healthy as well as sick mothers and newborns. Sick babies need their mothers the most. And there must also be room for the fathers, because they, too, are needed by their wives and children.

 

 

After the umbilical cord has been cut, an umbilical cord stump remains, which dries up within one to two days and after a few days detaches at the base and finally falls off on its own. This is how the baby's belly button is formed. By the way, you cannot influence its shape.

 

Taking care of the umbilical cord remnant or stump is much easier than most people think. All you have to do is keep it clean. Nature will take care of the rest.  

 

It is best to close the nappy (the diaper) underneath the umbilical cord remnant so that air can get to it. Clothing should be as loose and comfortable as possible and made of cotton or other natural materials such as wool, silk or linen. If stool comes to the umbilicus or it becomes soiled in any other way, wash it off with clean water. If urine gets on it, it doesn't matter. If water gets on it, it is okay, too. Bathing in clean water is also allowed. The umbilical cord stump softens from the water, but dries up again afterwards. 

 

For cleaning the umbilical cord stump and for bathing while the belly button has not finished healing yet, you can use tap water if you live in conditions where the water quality is good and it is clean enough to drink it straight from the tap. If you live in a place where the water is of dubious quality, you must boil it first.

 

Cleaning or disinfecting with alcohol or disinfectant is not recommended and can cause skin irritation.

 

It often happens that when the umbilical cord detaches, that it becomes gunky at the transition between the umbilical cord and its base and may even smell unpleasant. It often happens that an umbilical cord stump smells extremely unpleasant very shortly before it falls off. There may also be a small amount of blood secreted during the detachment process. None of this is usually a problem and there is no need to do anything about it. The important thing is that the skin around the navel does not become red and inflamed. Then you would have to do something. Fortunately, in my experience and with this kind of cord care, real infections are extremely rare.  

 

To treat reddened, infected navels or, if desired, as a preventive measure, you can use something naturally disinfecting, healing, astringent, drying. I use Wecesin powder from Weleda for this, dusted 2-3 times a day on the umbilical cord stump, especially on its base. It contains powdered echinacea, arnica and calendula and I have had very good experiences with it for many years. Caution: The powder also contains talcum and must not be inhaled. Therefore hold low over the navel when dusting. 

 

In North America, powder from the root of the Canadian turmeric is often used as navel powder. Other possibilities are e.g. myrrh (possibly that's why the Holy Three Kings brought it as a gift after a well-known birth?), yarrow, lavender, rosemary... Herbs of the best and cleanest quality can be dusted on as a powder. In addition, herbal healing baths are also a very good way of administration. For this, the herbs, e.g. calendula blossoms or lavender, are scalded with boiling water and left to infuse, then added to the bath water. Very good healing baths can also be prepared with calendula extract (from Wala or Wecesin or home-made) or essential oil of lavender. It is a good idea to prepare a full bath and let mother and child bathe in it together. This is relaxing and has a positive effect on both the umbilical cord stump and any birth injuries the mother may have. Another well-known navel treatment is honey. And dropping breast milk on it. 

 

But as I said: normally you don't have to treat the navel. Unless an infection (recognisable by reddening of the skin around the base of the umbilical cord stump) occurs, then it must be treated and a midwife or doctor or other knowledgeable person should also be consulted. 

 

The shortest time I have experienced an umbilical cord stump take to fall off was three days. The longest time was over three weeks. An enormous difference!

 

 

If the remnant of the umbilical cord has fallen off, it occasionally happens that a granuloma is visible at the base of the navel. This is an often reddish small lump of moist tissue, which can cause the belly button to shed some moisture. It can smear easily or even bleed a bit. In the past, and sometimes still now, these umbilical granulomas were cauterised with silver nitrate. This quickly takes care of the granuloma, but can cause skin irritation. Sea salt or Himalayan salt can also be used for this purpose. Sprinkling a little salt once is usually sufficient. In rare cases, however, even this can cause skin irritation. And besides, it is perhaps important that the baby activates its own formative powers and uses its own abilty to heal and create the form its body is meant to have. Silicea, the siliceous earth, might be a homeopathic remedy to activate the formative forces. As a midwife, when dealing with umbilical granulomas, I have done less and less over the years and have more and more learned to be patient. If it did smear, we just kept applying a little Wecesin 1-2x daily or as needed, in order to dry it out and as a prophylactic treatment to prevent infections. In the end, every umbilical granuloma went away on its own, even if not treated and even if it sometimes took a few weeks. 

  

Here you can take a look at and also buy umbilical cord rings made from latex: 

https://www.gottlob-kurz.de/nabelschnurring

Gottlob Kurz is a well-known shop for midwifery supplies in Germany.

  

A very interesting blog article by Adele Jarrett-Kerr about umbilical cord ties:

https://www.adelejarrettkerr.com/making-and-using-an-umbilical-cord-tie/

 

Extraordinarily beautiful crocheted cord ties:

https://www.primabellacordties.com/

  

Organic dental floss made from silk with beeswax, all natural and neatly packaged:

https://www.amazon.de/gp/product/B000LQX8MA/ref=ox_sc_act_image_1?smid=A889S0ACE580X&psc=1

 

Here, in a short video that has become famous, Penny Simkin shows how much blood is in the placenta and umbilical cord at birth and why one should not cut the umbilical cord immediately after birth. 

https://m.youtube.com/watch?v=W3RywNup2CM