The umbilical cord is the physical connection between a developing fetus and the placenta during pregnancy. This flexible, tube-like structure contains three blood vessels: one vein carrying oxygen and nutrients to the baby and two arteries removing waste products back to the placenta. The removal of this temporary organ after birth is a two-step procedure: separating the newborn from the cord and delivering the placenta from the mother’s uterus.
Clamping and Cutting the Cord
The first step involves separating the newborn from the placenta, which remains inside the mother. This procedure begins with placing two clamps on the cord, and the cutting is performed between them, typically by a healthcare provider or a support person. Since the umbilical cord contains no nerve endings, the cutting procedure is completely painless for both the infant and the parent.
The timing of this separation varies between immediate and delayed cord clamping. Immediate clamping occurs within the first 60 seconds after birth, while delayed clamping involves waiting at least one minute, often until the cord stops pulsating. This delayed approach permits a placental transfusion, which can increase the newborn’s blood volume and iron stores. If the baby requires immediate medical attention or resuscitation, however, the cord must be clamped and cut right away.
Delivering the Placenta
Removing the rest of the umbilical cord requires the delivery of the placenta, an event known as the third stage of labor. After the baby is born, the uterus begins to contract again, causing the placenta to detach from the uterine wall. Signs of separation include a sudden gush of blood and the lengthening of the umbilical cord still protruding from the mother.
Healthcare providers manage this stage using one of two methods: active management or physiological management. Active management is the most common approach, involving an injection of a uterotonic drug, often synthetic oxytocin, immediately following the baby’s birth. This medication causes the uterus to contract strongly, helping sheer the placenta away from the wall and reducing the risk of postpartum hemorrhage. Controlled cord traction, a gentle pulling on the cord while pressing on the abdomen, is often used alongside the medication to guide the placenta out.
Physiological management involves waiting for the placenta to be expelled naturally by the mother’s own uterine contractions and pushing efforts, without the aid of medication or cord traction. This natural expulsion can take up to an hour, compared to the 5 to 30 minutes typical of active management. Regardless of the method used, the healthcare team carefully examines the delivered placenta to ensure it is complete and that no fragments remain inside the uterus, which could cause infection or hemorrhage.
Care of the Umbilical Stump on the Infant
Once the cord is cut, a small remnant, the umbilical stump, remains attached to the newborn’s abdomen. This stump must be allowed to dry out and fall off naturally, a process that generally takes between one and three weeks. Parents should focus on keeping the stump clean and completely dry to promote this natural separation process.
It is recommended to expose the stump to air as much as possible, often by folding the top of the diaper down so it does not cover the area. Until the stump detaches, a sponge bath is preferred over submerging the baby in a bathtub to prevent the area from remaining moist. Clear or slightly blood-tinged fluid may ooze from the stump as it dries, which is a normal part of the separation process.
Parents should never attempt to pull the stump off, even if it appears to be hanging by a thread, as this can cause bleeding or infection. While infection is uncommon, parents should monitor for specific warning signs. These include increasing redness or swelling around the stump, a foul odor, pus-like discharge, or a fever.