The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Umbilical Cord Care

Subsections on this page:

• General
• Cord Clamps to Support Breastfeeding
• Sterifeed Cord Ring
• Cord Tape
• Averbach Cord Bander
• Baby Baths with Cord Attached
• When to Remove the Clamp
• Umbilical Cords - Aftercare
• Other Applications
• Umbilical Granuloma

DO NOT USE CLAY ON UMBILICAL CORDS!!!

Considering this, it makes sense to sterilize any unorthodox preparation for the umbilical stump.  But why not just leave it alone?!?

General

Umbilical cord care: a pilot study comparing topical human milk, povidone-iodine, and dry care.
Vural G, Kisa S.
J Obstet Gynecol Neonatal Nurs. 2006 Jan-Feb;35(1):123-8.

CONCLUSION: The cultural practice of applying human milk to the umbilical cord stump appears to have no adverse effects and is associated with shorter cord separation times than are seen with the use of antiseptics.

"The findings of this literature review indicate that the current standard of umbilical cord care may be based on historic practices and traditions rather than scientific investigation and justification. There appears to be little support for continued alcohol use. Yet, insufficient evidence is available to support an immediate change in the standard of care from topical antimicrobial treatment of the umbilical cord to natural healing. Further research is recommended to evaluate natural healing and to establish evidence-based recommendations for practice."

"Although it is unclear which antimicrobial is the most beneficial for cord care treatment, many researchers recommend their use as a result of their studies. Others argue that the role of decreasing bacterial colonization has an uncertain relationship with the development of infection. If topical antimicrobials are going to be used in the prophylactic treatment of infection in newborns, it is important to realize the potential for adverse local and systemic reactions."

"In fact the research that demonstrated this was done during a transition into a newly built nursery and was able to present findings that indicated that the cross-contamination was coming from the infants themselves.[12] Another study was also able to relate an increase in colonization with an increase in length of maternal or neonatal hospital stay.[11]"

'They recommend the use of antiseptic treatment for umbilical cords because cross-infection happened principally when no antiseptic was used on cords.[26]"

"Of the current cleansing agents, a one-time application of triple dye seems to have the fewest adverse reactions and is associated with a significant decrease in staphylococcal colonization."

"Alcohol, on the other hand, seems to offer more adverse effects than benefits. Several studies demonstrated it as inferior with regard to decreasing colonization. Some studies could not even demonstrate a significant difference in alcohol and water or no treatment. Alcohol was also significantly proven to prolong cord separation time. In light of alcohol's limited effect on decreasing colonization, and its deleterious effect of prolonging cord separation time, it is not recommended as a routine treatment for umbilical cord care."

As a homebirth midwife, my conclusion from reading this article was that most umbilical cord infections come from being in the hospital.

Care of the Umbilical Cord - A review of the evidence (from World Health Organization - WHO)

Cord Clamps to Support Breastfeeding

It's always bothered me that the typical umbilical cord clamps are rigid and relatively large and firmly attached to the baby for at least the first day of life.  What fun is it for a baby to be belly-to-belly with mom when there's this nasty clamp sticking into the tummy?  I've seen babies who weren't latching on well because the clamp was pinching, twisting, pulling or poking some part of their body.  That's not the easiest way to get breastfeeding off to a good start!

Fortunately, there's an easy solution to this problem . . . the Averbach Cord Bander, invented by Dr. Louis Averbach; it leaves only a tiny rubber band securely "clamping" baby's umbilical cord.  It's a bonus that they're environmentally more responsible as the disposable rubber band is very tiny compared to the bulky plastic disposable clamps.  (Those reusable, metal clamps were most reusable of all, but they are no longer available, and they were still very poky to new babies!  A newer type of cord band, the Sterifeed Cord Ring, costs only $1.50 and doesn't require a special instrument.  Cord tie (also called cord tape) is also soft and flexible, but may come off as the cord dries and shrinks; this isn't really a problem but can be troubling to new parents.)

Right now, it is primarily homebirth midwives who use the Averbach cord bander instead of the common, plastic clamp. I would love to see other providers and hospitals make this simple change to support breastfeeding.  Most maternity care providers seem unaware of the availability of the Averbach cord bander, so it's up to expectant parents to lobby for positive change here. You can purchase your own Sterifeed Cord Ring for about $5, including shipping.  Or, if you have the resources to try to help other mothers and babies, you could buy your own Averbach Bander for your baby and then give it as a gift to your birth attendant.  Alternatively, you could pass it around among your friends and families, sterilizing it in between uses, of course..  [NOTE - The Averbach cord bander is significantly more cost effective as well - the instrument itself costs $85, but each little rubber band costs only eight cents, compared with sixty-five cents per plastic cord clamp.  The cost of the instrument is recovered after only 132 births!  All the subsequent births actually save the hospital money, in addition to helping mom and baby get off to a better start with breastfeeding.  The Averbach Cord Bander can be purchased from Cascade, 1-800-443-9942, item #3376.]

Sterifeed Cord Ring

The Sterifeed Cord Ring works like the Averbach Cord Bander except they do not require the instrument; it comes sterile and you use your regular hemostat to put it on.  These are available from birthwithlove.com.

Cord Tape

Cascade now offers single-use packets of cord tape, ideal for parents to provide for a birth attendant who routinely uses one of the inferior cord clamps.  800-443-9942, item #0362 for $5.00

I take the cord clamp off at one hour and leave the cord tape on forever. It falls off with the stump. Aren't the rubber bands just like the tape: small and no problem with leaving on.

Averbach Cord Bander

The Averbach Cord Bander is available from Cascade HealthCare Products, which is the only manufacturer and distributor.  HURRAY for Cascade for continuing to make this great instrument available to caring birth attendants everywhere.

It is a hemostat with a little wire attached the allows the placement of a simple rubber band on the cord stump. Similar to a rubber band used in dental braces. It is so small that it allows no return blood flow into the stump and there is not the hassle of a large metal or plastic clamp.

With the Averbach, is there any bleeding routinely? I have been using the cord clamp at first because it closes the stump off so well and then taking that off at about and hour (during the newborn exam) and replacing it with cord tie.

Parents are so scared of a little blood from the stump. I need to know that the bands don't allow much spotting.

Many of us clamp first with a hazeltine or kelly and then use the averbach later after everything has settled down and parents are ready to dress the baby. So often an hour or more has passed before we use the cord-bander.

I'll bet there was an extra strong 'snap" when the band slipped off, or else a little bit of a jerk on the cord. (and possibly a friable cord?).

The only trouble I had with the cordbander was once when it when down too far to almost the skin edge. Since then I keep a kelly nearby to stop it from going too far. Also, it seems to help if the cord bander is wet -- as if the rubber slips off more easily without quite as much snap. You might want to dip it into alcohol or sterile water just before use.

It really depends on the width of the cord. On those really skinny ones the band does allow a very small seeping of blood for the first couple of hours, but on those normal big home birth baby cords I don't see any seeping at all.

Since the bander is part of a clamp/forceps, the cord is pretty well crimped and the band usually settles nicely into the groove the forceps makes. I can think of two things to do to eliminate any blood at all....1) double band, or 2) use a plastic clamp first and replace with a band at the newborn check-up or at the 24 hour visit.

I used to tie off the cords with cord tie, and saw much more blood seeping with that method than I do with the bands. I think I paid around $50 for my bander from Cascade a couple of years ago.

But you don't have to buy a cordbander (averbach). You can use two hemostats. Slip a couple inches of cord tape (or dental floss etc) through the rubber band. Slip the band over a kelly. Open the kelly and clamp the cord. Use the second kelly to grasp the tape/string and pull the band off of the first kelly and over the cord. Practice on something first... Pretty easy.

I hope my description is clear.. if not, there is an illustration in Myles Textbook For Midwives, pg 315 seventh edition.

It's easy to do with two kelly clamps and a piece of umbilical tape through the band (to use to pull the band off the kelly.) Or you can put the band around one kelly - put the kelly (with band) -- on the cord. Shorten the cord. Use a second kelly to pull the cord through the band and to slide the band off the first kelly and onto the cord. (I did this once, when the flipper mechanism on the averbach broke . Worked fine). You don't really need the averbach, but it' s just a bit simpler..

You can practice on an old placenta, piece of the cord, or even a piece of yarn.

If you do buy an averbach -- or other bander gizmo - then you would need only one.. I don't know anyone who HAS more than one, anyway.

Are you thinking of needing a second in case you need to run to another birth with no time to sterilize? The bander is not a cutting instrument so you could probably be safe with scrubbing really well and soaking in alcohol or Zirconium Chloride.. But often we will clamp the cord rather long with a hazeltine, and then shorten it up and apply the band when it's time to dress the baby.. This may be an hour or so after birth.. So plenty of time to boil, or bake the averbach if you felt the need.

The averbach is designed to be a one-step clamper/bander.

You put the rubber band on the averbach and clamp the cord just as if you were using kelly's (placing a second clamp if you with on the mothers side). After cutting the cord near the averbach clamp, you use that flipper-thingy to slide the band from the averbach onto the cord.

But sometimes we end up cutting the cord and then shortening it later.. Perhaps mom wants to nurse baby and the cord is too short -- and she doesn't want to wait till placenta comes.. We might just clamp with a kelly or hazeltine, leaving the cord quite long, and then use the averbach later to shorten the cord and band it.

yeah. The tiny rubber band is nearly invisible -- it shrinks as the cord shrinks and eventually falls off with the cord stump. You shouldn't attempt to remove it. I think you'll be impressed if/when you switch to bands!

We put a band on the cord bander after it has been cleaned and boiled, but before baking it in the tube pouch. So, when the cord bander is removed from it's pouch, the band is already on it. It's possible that the rubber band could fly off before you got it put on correctly, though that's not happened to us yet, so we carry a few extra and would probably dip it in betadine before putting it on the cord. We like the bander so much better than the plastic clamps or the cord tape.

The picture in the catalog looks like someone somehow got a teeny tiny rubber band over the clamps itself as well as the little wire doohickey - just how does one go about this?

You close the averbach and slip the band over both the clamp part and the wire doohicky. It's not as hard as it seems, though you will probably shoot a few bands across the room before you get the hang of it!

One trick is to slip the band over the point of a kelly clamp and then use the kelly to slip the band on the averbach. I wish I could show you; it is very simple once you see it done!

And do you "load" it like that before or after you sterilize it?

either way. boiling doesn't seem to harm the bands, but I don't know about autoclaving or cold sterilizing. You can place the band on the sterile averbach and then dip it in alcohol if you are wish. (though if we think about it; the teeshirt, diaper, and baby's clothing will not be sterile. If the scissors are sterile, it's doubtful whether the band needs to be more than clean.)

Before... only I'm not sure if it makes a diff how you sterilize. I autoclave and there is no problem w/ it.

we bake the bands right on the bander.  They do fine.

It does not melt on the bander and yes I always sterilize it with my instruments.  I clean and instralube all and then place them in a steri pouch and bake them in the oven at 225 degrees for one hour.  I place the pouches on a cookie sheet and also have a bowl of water in there as well.  Never have any probs with the cord melting as longs as temp is steady at 225 and I do not bake over 90 min.

I put a band on the tip of the bander before I wrap and bake it.  I've only had one band disintegrate on me and that happened when I overbaked the instruments.  The band looked really dark and it broke when I tried to stretch it over the bander itself.  Just replaced it with another nonsterile one.  I doubt that it makes much, if any, difference.  I just bake them so I can write on my little note to the peds that "a sterile band was applied to the baby's cord and does NOT need to be removed."

I have put them on the averbach and boiled them together. Seemed to work OK ---- but I worried the heat would weaken the band.

I don't sterilize them.

I figure the utensil cutting cord MUST be sterile, but after that the entire cord is going to come in contact with many unsterile objects (including the baby's own skin!!!) . The baby is about  to be wrapped in clothing or a tee-shirt and the tee shirt isn't sterilized so why should I worry about the band (which only touches the sides of the cord -- not the end, and not the skin margin?)

The bands have never melted on mine, but I quit sterilizing them because if it is too long before you use it the band gets stretched out.

Then, do you clamp the cord near the base with this clamp, then cut it, and slip the teeny tiny rubber band over the stump with the little wire doohickey and hope that it's on right?

just pretend the loaded averbach is a kelly clamp. Clamp the cord with the averbach, cut it as usual and (lo and behold!) there is a rubber band right there to "tie" the cord! Just slip it off the averbach and on to the cord stump.

(can't imagine one can adjust it much once it's on...). Always cut the cord a little longer than what seems to be necessary. The only remedy for adjusting is to re-clamp w/ your hemostat, cut the rubber band w/ a blunt blunt scissor. I would have some alternative around in case the procedure fails. Maybe carry an extra stainless or plastic clamp for emergency. It might take a little getting use to. It seems to be easier and so much more comfortable for those sweet little ones. I load the devise w/ the wire pulled back over the hemo. w/ the angle curved downward and wire over top. You can do it both ways only I found this works best for me. Then I carefully pull the band over the tip oh maybe 2/3 - 3/4" up the hemostat. When I first got it lost several bands - rocketing across the kitchen (my little boy loved it, thought I was playing!), due to getting the hang of how to affix them little critters. Don't let that dismay you... you'll get it. Be tenacious and you'll find it a snap soon. I like mine bunches!

I have one of these and I find it very helpful. First, take a piece of rope and practice clamping it, pulling the arm holding the band over the end of the rope, and then releasing. Easy cheesy, right? And to sterilize, I use sterilization pouches with one band loaded onto the instrument, and one or two extra bands in the pouch just in case the first one breaks. That way I have another sterilized as spare. The parents like it because the baby won't be rubbing against that big plastic cord clamp that's usually used.

Many of us clamp first with a hazeltine or kelly and then use the averbach later after everything has settled down and parents are ready to dress the baby. So often an hour or more has passed before we use the cord-bander.

I'll bet there was an extra strong 'snap" when the band slipped off, or else a little bit of a jerk on the cord. (and possibly a friable cord?).

The only trouble I had with the cordbander was once when it when down too far to almost the skin edge. Since then I keep a kelly nearby to stop it from going too far. Also, it seems to help if the cord bander is wet -- as if the rubber slips off more easily without quite as much snap. you might want to dip it into alcohol or sterile water just before use.

Baby Baths with Cord Attached

I have my moms and babies do a pretty astringent herb bath about two hours after birth, pound of sea salt, yarrow, comfrey, garlic, lavender,
calendula, plaintain, and they soak for a half hour, heals mom beautifully and baby's cord falls off usually in three days.

My moms take their babies in water all the time. Pat the cord dry afterwards, don't put alcohol or peroxide, or goldenseal on it. It will get goopy but not gross or smelly.  Alcohol and peroxide actually make that thing stay on longer I swear!

When to Remove the Clamp

When I worked at the hospital a few years ago, we always removed the plastic clamps at 24 hours, not replacing it with anything.

We are talking about removing the clamp at 1 hour. I like to do this so the baby does not have to lay on it and the mother doesn't have to diaper around it and yes since we do alcohol on the stump it helps get the alcohol down into the cracks.

I'm nervous about removing bands at one hour because I once saw the results of a cord tie slipping an hour or two after birth - - and there was blood ALL OVER, spurting out of the cord! Very scary! I was just a kid -- the teenage apprentice who was left with the baby. I don't know what type of knot the midwife used or any details. I've always been afraid that removing a tie/clamp too soon after birth might cause a repeat experience. I used to take the clamps off after two days -- but deeply love the rubber bands!

Umbilical Cords - Aftercare

DO NOT USE CLAY ON UMBILICAL CORDS!!!

Care of the Umbilical Cord - A review of the evidence (from World Health Organization - WHO)

Alcohol versus natural drying for newborn cord care.
Dore S, Buchan D, Coulas S, Hamber L, Stewart M, Cowan D, Jamieson L.
J Obstet Gynecol Neonatal Nurs. 1998 Nov-Dec;27(6):621-7.

"CONCLUSIONS: (a) Evidence does not support continued use of alcohol for newborn cord care; (b) health care providers should explain the normal process of cord separation, including appearance and possible odor; and (c) health care providers should continue to develop evidence to support or eliminate historic practices."

Cleaning solutions and bacterial colonization in promoting healing and early separation of the umbilical cord in healthy newborns.
Medves JM, O'Brien BA.
Can J Public Health. 1997 Nov-Dec;88(6):380-2.

The efficacy of alcohol or water in promoting umbilical cord separation was compared in a randomized controlled trial. Rates of skin colonization between groups were also evaluated on three occasions. Time to cord separation, rates of colonization, and species of organisms that colonized were compared between groups. Of 148 participants, 136 (92%) completed the protocol. Cords that were cleaned with sterile water separated more quickly than those cleaned with alcohol (t = 3.15, p = 0.002). Between-group differences in colonization rates were not found (F = 1.59, df = 2, p = 0.205). Umbilical or other infections did not occur. Bacterial colonization of the umbilical area and surrounding skin occurs over time in healthy term neonates. Cleaning with alcohol will increase the length of time from birth to cord separation but will not prevent colonization of the umbilical area.

There was an article in a recent JOGNN (Journal of Obsteric, Gynecologic and Neonatal Nursing) about not needing to put anything on the cord. (Dore, S., Buchan, D., Coulas, S. et al. (1998). Alcohol versus natural drying for newborn cord care. JOGNN 27(6):621-7.) Our hospital is just phasing out the alcohol routine.

I have found that triple dye on the cord delays the healing process - these cord stumps do not fall off until 7-10 days, while just routine cleansing of the area (no ETOH either), the stump is usually off or ready to fall off by my 72 hour PP Visit.  Much faster and cleaner healing.

How long does it take the cord to fall off? I have found that cords not cut before about an hour, fall off within 3 days.

I just learned alcohol on cord has a longer fall off time then using nothing!-I will still use goldenseal though......Its hard to do nothing.

Alcohol has been shown to delay cord separation when compared to just keeping cord clean and dry... there was NO difference in the rate of cord infections..... hmmmmm so really no reason to use alcohol for those who believe in evidence based care.

Since our last discussion of cord care, I do nothing but have parents alcohol about once/day. The cords drop off much faster (usually within a week), but get more stinky before they go...

We use nothing at all!

I have started recommending using nothing on the cord as research shows cords fall off faster this way. Another study just came out in Canada confirming this.

Goldenseal

Having practiced for 15 years and always telling moms to use alcohol/sterile cotton balls every diaper change, etc. I was intrigued by the "do nothing to cord at all" approach, read all comments with interest and put it into practice. We have had about 90 or so babies this year and to date all cords have fallen off in record time (we use either plastic clamps or metal clamp pins and remove at 24 hours) and only one mom said cord looked a little gooey on day 2, so used golden seal powder on it...Great results all around and pleased by knowledge learned.

I really believe in the good qualities of this stuff, but have found that some people develop a contact dermatitis from it. That has made me leery of using it for cord care. How long have you done this & have you ever noticed any problems - apparently not . .

I have never had a cord bleed and when used in combination with golden seal POWDER, the cords fall of quickly and cleanly. A capsule or two is included in the birthing kit. I had my families use alcohol for years then made a change to dressing the cord with Golden Seal powder. Most cords are off with little residual bleeding within 2-4 days. Alcohol is 70% alcohol and 30% water. When the alcohol evaporates you are left with a wet cord. Smells and becomes sticky. No odor with GS.

I use capsules, three doses/cap. Or bulk using a straw cut at one end at an angle and used to scoop up a small amount and sprinkled onto the cord, covered with a gauze square and only used once per day.

For the last year or so we have been using Aztec Healing Clay on all our cords, no alcohol or hydrogen peroxide at all. I have been very impressed by how rapidly these cords are falling off. No smell at all. We used the golden seal powder a few years ago, but I am much happier with the Aztec Healing Clay. I think the lack of moisture and the drawing power of the clay make for quickly dried up cords.

We use golden seal powder on the cord during the newborn exam, and the parents follow suit with every diaper change. Golden seal is a wonderful herbal anti-viral, anti-bacterial and drying agent...cords usually fall off in 4 - 6 days.

We use goldenseal on the cord at the newborn exam, and instruct the mom to use alcohol twice a day. At each postpartum checkup, we apply more goldenseal, if mom doesn't object to the smell. It seems to work real well at drying the cord up, and we don't have a problem with gooey cords. If not goldenseal, I use ground rosemary, which smells much better. We also have the moms take herbal baths for three days, which, by itself, does a great job with the cord. Herbals baths include shepherd's purse and uva ursi, comfrey and sea salt and myrrh.

I use goldenseal powder applied 3 to 4 times per day. The cords usually fall off in 2 or 3 days and are totally healed by day 10. I do not keep my moms from bathing the baby, just apply the goldenseal after the bath.

Yes, golden seal! It is in powder form so the cord never gets oozy - the g.s. just soaks it up and forms a nice hard crust. Some people swear that the cord will fall off in three days, but that hasn't been my experience. (5-10 days) It is also a yellow dye - will stain clothes and if it spills on the baby will look like jaundice and freak out the pediatrician (again speaking from personal experience).

Parents can use alcohol if it makes them feel better[Grin]. Most common among the midwives here is a goldenseal and myrrh powder (some use only one or the other). A few recommend calendula tincture. A couple use hydrogen peroxide; or BFI powder. Rarely, sea salt.

Everyone claims their own formula is wonderful and makes cords dry and fall up "really fast" -- usually in 3 to 5 days. That's what I see with nothing at all on the cords too[Grin]

Aztec Healing Clay

The woman who puts together our birthing kits first introduced this product to me, she packages it up in small 1 oz size jars and puts them in the kits. I have since heard that it can be found at health food stores.

One of my partners makes it into a paste (using a little water) and uses it on her children's insect bites, splinters, cuts and scrapes, and it can be used as a drawing agent for cysts and boils. For the cords we instruct the mothers to sprinkle it on the stump several times a day.....it seems like magic the way it dries those cords up overnight!!!

It's sold under several names (including French Beauty mud!). I think it's just bentonite clay and can be ordered by that name...... We use it quite a bit in my family on rashes, insect stings etc -- or dissolved in the bath tub -- and it's WONDERFUL for chicken pox (which we recently experienced!). My only (slight) concern is to question the sterility of the substance... we're always told about tetanus bacterium in soil. Hope this is NOT something which might live in clay as well -- Does anyone know? (Perhaps the clay is baked? or perhaps it "could" be baked.

Other Applications

We use Tea Tree Oil for cord care.

I've used witch hazel on cords with better results (and less squawking from the baby) than alcohol. Cord comes away in 3-5 days and heals cleanly.

For cord care, I use this wonderful stuff called B.F.I. powder. It is "antiseptic first aid powder". Very drying, and very mild. Kind of hard to find in some places, so all my relatives look for it for me. I give a little envelope full to the parents at their birth. Works well & quickly!

Umbilical Granuloma

CURATIVE EFFECT OF COMMON SALT ON UMBILICAL GRANULOMA

More on salt for umbilical granuloma

Yet more on salt for umbilical granuloma

More on umbilical granuloma