What instruction should nurse nurse include when teaching a mother to care for her newborns umbilical cord?

In the womb, the umbilical cord delivers the oxygen and nutrients needed to allow your baby to grow. After birth, the cord is clamped and cut, leaving a stump. This eventually falls off, healing to form the umbilicus (belly button). There are ways for you to prevent problems during healing.

After birth, the doctor or midwife cuts your baby’s cord from the placenta and puts a clamp on the remaining stump to pinch it off. After a couple of days, once the cord has dried, you can take the clamp off.

How long does the cord stay attached for?

The cord stump usually stays attached for 5 to 15 days. Over this time, the cord dries, shrinks and turns black. Sometimes, especially in the day or so before it falls off, the stump can ooze a little and may leave marks on your baby’s clothes.

Do not pull the cord stump off, even if it looks like it will come off easily, as this can prolong healing time and cause scarring. Let the cord stump fall off by itself in its own time.

When the stump falls off, there is sometimes a little bleeding at the stump site. This is normal and it should stop quickly.

Please see your doctor or maternal and child health nurse if you have any concerns, or speak to Pregnancy, Birth and Baby on 1800 882 436.

Caring for the umbilical cord

Wash the cord stump as part of your baby’s usual bathing routine.

Make sure you wash your hands first. Use only water and cotton pads, and dry it carefully. If wee or poo gets on the stump, you can use a mild soap to help clean it off. You don’t need to use antiseptics and alcohol.

Let the cord sit out of the nappy so it dries out in the air; this can be done by folding the nappy under the cord stump. There is no need to cover the cord stump with Band-Aids or bandages, as this stops airflow around the stump.

If you’re not washing the cord stump, try not to handle it.

How long does the belly button take to heal?

The belly button should heal completely in days. It may bleed or ooze a little after the cord falls off, but if there is continuous stickiness or discharge, it may be infected and you should show your doctor or maternal and child health nurse.

Sometimes the belly button does not heal completely and moist red tissue forms over the stump site, often with a lump present. This is called a ‘granuloma’. It is usually harmless, but you should ask your doctor or child and family nurse to have a look at it.

How to tell if the cord is infected

Signs of an infection of the belly button may include:

• redness, swelling, stickiness or a bad smell on or around the belly button
• fevers, poor feeding and tiredness in your baby

If you think your baby’s cord stump or belly button is infected, see your doctor as soon as possible.

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Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Please note that all guidance is currently under review and some may be out of date. We recommend that you also refer to more contemporaneous evidence in the interim.

When caring for the newborn’s umbilical cord, current evidence supports the use of standard infection control procedures only.

Alcohol, antibiotic sprays, physolex or chlorhexidine should be used with caution and under medical direction.

Universal precautions to be maintained

Follow these precautions when caring for the umbilical cord:

1. Wash your hands.
2. Place cord clamp x 1 approximately 2 cm from skin.
3. If LUSCS or high-risk baby, cord is clamped 4-5 cm from skin
4. Cord is checked for ooze hourly for two hours after birth.
5. Midwife to check cord area daily and record cord status.
6. The area around cord stump is washed carefully with water and dried when bathing the baby. If it is moist, encourage mothers to fold nappy and plastic under cord area, leaving cord exposed to air.
7. Educate parents to observe and report any signs of infection (redness, stickiness or offensive odour).
8. Clamp the cord with sterile clamps and cut it with sterile scissors.
9. The recommended length of the stump after cutting is 2-5 cm.
10. Use rooming in where possible, with the mother as primary carer.
11. Keep the cord dry and exposed to air.
12. The nappy should allow for the cord to sit out of it.
13. Wash hands before handling the umbilical cord and where possible avoid touching the cord stump.
14. The cord clamp will fall off between days 5-10, you do not need to remove the clamp on discharge from hospital.
15. Educate parents regarding separation of the cord.
16. Explain there might be slight bleeding at the time of separation of the cord.