Cord cutting and Cord Care

Published 22 January 2020, updated Nov 2020

**Reminder - this is not medical advice and should be used as a guide only. Please consider if this is right for you**

The umbilical cord

I know you want to get straight into how to cut the cord, but bear with me, let’s set some background. It's important to not just know how to cut the cord, but what the cord does, and why we cut it, so you can make informed decisions at the birth.

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The umbilical cord develops in the fifth week of pregnancy and becomes the lifeline between the mother and baby. It connects to the baby at its abdomen, and also connects to the placenta, which is attached to the mother’s uterine wall. The placenta allows for transference of oxygen, and nutrients between mother and baby without direct mixing of blood. 

The placenta pumps healthy blood into the baby via the one vein the cord contains, and the baby sends oxygen-depleted blood back to the placenta via two arteries. The vein and arteries are encased in a tube filled with a substance known as Wharton's jelly. This jelly insulates and protects inside the uterus.

When exposed to air, Wharton’s jelly collapses and occludes the cord, forming a natural physiological clamp in as little as 5 minutes. The umbilical cord doesn’t contain any nerves, therefore neither the baby or mother feel any pain when the cord is cut or drying.

At full term, the umbilical cord is approximately 50-55cm long, and 2cm in diameter. 
After birth, the cord will usually be quite thick, and have a blue-ish helix of the warm blood still pumping through to baby. Slowly over time though, the cord will get limp, cold, and stop pulsing.

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What you need to cut the cord

Depending on what method of cord cutting you choose, you will need different supplies.

Each method goes into more detail below, but for the most commonly talked about, delayed cord clamping, you simply need 

• A bowl

• A pair of scissors or sharp knife/scalpel

• A cord tie or clamp

Your supplies do not *need* to be sterile, they simply need to be clean and dry. 

This is because the cord tie goes on the outside of the cord before the cord is cut, so germs are unable to travel through. The severed cord then is in contact with the baby’s skin, clothing, and nappy, so making sure everything is sterilized isn't really a big deal.

If you would like to sterilise the cord tie and scissors before using them,  you can boil and store in a glass jar on the bench, or in a ziplock bag in the freezer. If you plan to boil, use only full metal scissors or cutting implements.

If you are going the partial lotus or delayed clamping method, you may even have time to boil right before cutting!

You can also wipe the scissors with a sanitiser instead of boiling.

Cord clamping may seem scary, initially, but it’s really not. It's a simple process, so don’t overthink it.

The weirdest part is that the cord can feel quite rubbery!

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What you can use as a Cord tie/clamp 

Clamps 

• Usually plastic, and can order online from any reputable birth/medical store, and also purchase on Ebay

• In a pinch, some people also use large food/bread clips, but this is not recommended as they are not always tight or strong enough (umbilical cord is a lot thicker than plastic bags!)

• Recommended to have two clamps on hand in case the cord breaks and you want an instant option

Cord ring

• Umbi ring: Popular USA choice, due to lack of bulk, and easy to keep clean but it's currently out of stock everywhere (2020) due to a manufacturing error

• Cetro Cord Ring: A great alternative is the Cetro Cord Ring available from In His Hands or Precious Arrows. Only available privately in Australia. Instructions can be found in Google images and on YouTube.

Ties 

• Purchase cord ties online eg from Australian company or an Etsy store https://www.blissfulherbs.com.au/category-umbilical-cord-ties-25.aspx 

• Make your own crocheted cotton or hemp ties from embroidery thread or other strong thread or thin cord

• You can also use string, paracord, new shoelaces, wide dental floss etc (anything that is clean, strong, will tie tightly and not so thin that it will sever the cord)

• New Zealand women might like to buy or make a Muka Pito from flax https://aotearoagemstones.co.nz/products/umbilical-cord-tie and Australian stockist Natural Beginnings

No ties at all

• If you have delayed the cord clamping long enough, you will not need to tie the cord at all, because the blood has all moved into baby, pulsation has stopped, and the cord being exposed to air, becomes limp, clamping itself. 

• Fun fact: This is why animals don't bleed out after birth, as the Wharton's jelly makes its own clamp.

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How to cut and tie the cord

Most people like to cut the cord relatively quickly, for many different reasons.  Before cutting, tie the cord as a prevention against blood loss.

Leaving cord clamping longer can mean you don’t have to tie the cord.  However, if after cutting, and not tying, the cord oozes, or bleeds, please do tie it, and if you have already tied it, please retie tightly.

• You should tie the cord on baby’s side approximately 1-2 inches/2-3 centimetres away from the bellybutton. (I prefer the cord tied a little longer rather than shorter, as you can always retie and trim later but you can’t add length later.)

• You do not need to tie the mother’s (placenta) side IF the placenta has already been birthed. You may see a trickle of blood ooze out but it doesn’t matter since the placenta is detached.

• If the placenta is still inside the mother, please do clamp the mother's side too, as there is a small risk that it will bleed out.

• Usually for cutting, the placenta will be in a bowl next to the baby. You may like to place a towel or pad underneath the cord where you plan to cut to protect the baby and absorb any leaking blood.

• When clamping, follow the instructions on the packet that came with the clamp (Most bought cord ties also have instructions)

• Remove the clamp after 24-48hrs to prevent it catching, and therefore pulling and hurting the baby's skin and healing umblicus. You don't need to remove a cord tie as it is softer, and less likely to catch, but you can trim it short if you feel like it.

• If you have made your own tie, wrap it tightly around the umbilical cord twice and then double knot

• Cut the cord about a centimetre away from the cord tie with sharp scissors

• Tip: The cord is like a thick rubbery cold rope so it may feel strange, slippery, or difficult to cut. But remember, it doesn't hurt the baby.

Types of Cord Cutting

There are many benefits to delaying cord clamping:

• This allows the baby to receive up to ⅓ of its blood that may still be circulating.

• Receiving all its blood is always beneficial for the baby, and is extra necessary for preterm babies

• The placenta is emptied of blood which reduces its size, and helps its descent

• Slowing down the “third stage” of birth allows everything in your body to catch up with the miracle that has just happened, and allows you time to focus on your baby

• It is only hurried in the hospital because they hurry everything. They need to cut it fast so they can move on to the next intervention.

• In an undisturbed birth, severing the cord is an afterthought. You are focused on the baby and the mother, rather than hurrying the process. There is no rush to separate, and no risk to leaving it attached.

Instant cord cutting/tying (under 3 minutes)

In my opinion, should only be used when in an emergency ie. if the cord is too short to perform life-saving measures.  Resuscitation should first be attempted while baby is still attached and receiving oxygen from the cord. If possible, always wait until the baby has taken its first breaths.

You will need to tie/clamp the cord immediately if it breaks during birth.

And you can of course cut it if you simply prefer not to wait.

• Tie/clamp and cut

• (Tie quite tightly if the cord is fat since it will become thinner and  may need to be retied.)

• Do not milk the cord, as this forces the blood across at a greater speed  and can leave baby with excessive levels of hematocrit.

A note on Short cords

Short cords are annoying! They make it difficult to hold baby up to your chest for warmth and nursing. When you cut should be up to your own discretion.  You may like to try to wait for the placenta, but if it takes longer than an hour or two, it is more important for the baby to nurse. As long as the cord has stopped pulsing, baby will have received all its blood.

Delayed  cord cutting (over 3 minutes)

• Wait for white, and no pulsing, then tie/clamp and cut when you are ready (as above)

Partial Lotus Birth (a few minutes up to one day)

• Wait for white, and no pulsing, then tie/clamp (or don't tie at all) and cut when you are ready

• Cut the cord 1-2 inches away from baby even if you aren't tying, to leave room to tie if the cord doesn't clamp itself. 

• May use some herbs in the meantime, but not usually

Burning (can be done any time the cord is white and limp)

• No need to tie

• The flame cauterises the end of the cord, sealing it.

• Burn it further away than cutting (3+ inches)

• You’ll need a bowl,  candles and a makeshift baby protector, usually a box or shield covered with foil 

• Read how to http://www.birthtakesavillage.com/umbilical-cord-burning-2/ 

Lotus birth aka Umbilical non-severance (until the cord detaches itself naturally 1-10 days)

• You’ll need a bowl, special herbs, muslin/cloth, salt. You may also like to have some pretty dried flower petals

• No tie or scissors required

• Read articles on how to http://www.lotusbirth.net/ 

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"Remember, scissors, hemostats and cord clamps have only been invented for a short time in human history. Before that, people waited till the placenta came out naturally before doing anything about the umbilical cord. When the baby is adjusting to life with the cord intact, the blood goes back and forth through the two arteries and one vein in the cord. . . it isn’t just going in to the baby from the placenta, it’s coming out, too, in correct balance for that baby’s anatomy. The placenta was trusted to sustain the well being of the baby in every way for nine months, I am certain that it’s okay to let it keep performing that function for another 30 minutes." - Gloria Lemay

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Cord Care after cutting

As the cord stump dries up after birth, it will become shorter, darker, and drier.

It usually takes 1-2 weeks to fall off, but  may fall off in just a few days.

After the cord falls off, your newborn's bellybutton will be visible.

• Keep the cord clean and dry

• Sponge baths rather than immersion are best 

• If the cord tie gets damp and gross eg baby pees on it (it happens!) you can trim the cord tie, and wipe the cord gently with clean cloth and water

• Avoid tugging on the cord as it separates from baby. Leave it to fall off naturally.

• Remember to remove the clamp, if used, after 24-48hrs.

• You can tuck the top of the nappy down to prevent it covering the cord, and to help the cord get air.

• Having baby wear an extra layer like a singlet will help prevent any blood or fluids from staining your cute newborn onesies.

• Don't put baby powder, oils, or antiseptics on the cord

• Once the cord falls off, keep the belly button clean and dry. It may weep fluid for a few days, and much like a scab, may even bleed a little, but if there is no signs of pus, redness or infection, then it is just naturally healing

• If a bulge or swelling occurs near the belly button, and is more obvious when your baby cries, it may be an umbilical hernia. This is not usually an issue, but you may like to get a second opinion.

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True knot 

• This is a fascinating natural phenomena of the cord tying itself in a knot, usually from the baby moving around in the uterus earlier in pregnancy

• The knot does not usually tighten and cause issues, due to the protective functions of the Whartons jelly.

• Occasionally during birth, the stress of the labour and stretching in the birth canal can cut off circulation

• True knots are rarely diagnosed before birth, even with ultrasound, and often are only noticed after baby is born

• Article https://www.pregnancy.com.au/true-knot-of-the-umbilical-cord/ 

Only 2 tubes

• Very occasionally, upon severing the cord you may inspect it and only find 2 tubes (1 artery, 1 vein)

• Can be a sign of congenital defects in baby, so watch baby for issues and perhaps get baby checked for a second opinion

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All about the placenta

• Read more about birthing the placenta and disposing of it here 

• Placenta and cord gallery

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Watch

Video on Cord tying https://youtu.be/BNdCLOyebCU

Short video https://youtu.be/b4L7gkoKCno

Further reading

• Australian herbs and homebirth tinctures kit, cord ties https://www.blissfulherbs.com.au/  

• Cord ties

https://kordsbykensa.com.au/

• Natural 3rd stage and placenta info https://sarahbuckley.com/leaving-well-alone-a-natural-approach-to-the-third-stage-of-labour/ 

• Umbilical cord facts https://www.sacredsagebirths.com/sacred-sage-doulas-blog/2020/1/4/z3awtipwk5n8ae4xzqz8lpca9b083p 

• Wikipedia basics
  https://en.wikipedia.org/wiki/Umbilical_cord 

• Cord clamping conversation https://www.sacredsagebirths.com/sacred-sage-doulas-blog/2019/12/31/ec94kxp6jqfq7hf63abg667lqzv7p8 

• Delayed cord clamping and PPH prevention https://www.who.int/elena/titles/full_recommendations/cord_clamping/en/ 

• Podcast goes over all the options, how to go about it and what to do with the placenta for lotus birth etc. 

https://www.freebirthsociety.com/blogs/the-free-birth-podcast/what-to-do-with-the-cord-and-placenta 

• Delayed Cord Clamping vs Cord blood banking 
  https://midwifethinking.com/2015/09/16/cord-blood-collection-confessions-of-a-vampire-midwife/