The umbilical cord holds special significance in the events of the postpartum era both for the mother and the baby and this significance transcends the physical and enters into the realm of the spiritual in certain cultures of the world especially for the Igbo race in Nigeria hence the management of the umbilical cord at delivery is an act that holds both health, cultural and spiritual significance to the mother and the baby and is addressed with care in the early postnatal period to achieve an outcome that is desirable for the continued health and wellbeing of the new born child.

The umbilical cord

The umbilical cord is the vascular connection through which the fetus received nutrients and nourishment from the mother in utero. It leads from the baby to the placenta and carries both nutrients to the baby and removes wastes from the baby to the mother for onward disposal by the mother.

At birth the umbilical cord is severed and cut by the attending nurse or physician with a stump still attached to the baby and the management of this stump is the essence of this discussion because poor management can be disastrous for the newborn.

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Cutting the cord

At the delivery of the baby and before the delivery of the placenta, the connection between the mother and baby is severed by cutting the umbilical cord. This is done by placing a clamp first on the maternal side of the umbilical cord then expressing cord blood towards the baby to empty the vessels of blood to prevent splash on cutting the cord and placing the second clamp on the fetal side of the cord and using a scissors to cut in between the two sections of the clamps close to the baby. This is done to prevent blood loss from both the mother and the baby.

The baby is then left with a stump that is clamped with an umbilical cord clamp and the management of this clamp and stump is the subject of this write up.

Daily Cord Care

It usually takes between 5 to 21 days for the umbilical stump to shrivel up and fall off and care of the cord during this time is important so it doesn’t constitute a source of worry or concern and become a possible nidus of infection to the newborn.

The cord needs to be cleaned on a daily basis with cotton wool and clean water. This is the standard advocated in high resource settings.

It can also be cleaned with alcohol in poor resource settings though it has been proven that alcohol can kill the bacteria necessary for early umbilical cord fall off but the risk of infection when the cord is cleaned with just water as against alcohol has to be weighed against delayed fall off in resource poor settings and the better decision taken.

• Ensure your hands are clean before touching or cleaning the cord.
• Use cotton wool and clean water and clean the base of the cord and its attachment to the abdomen
• Clean then the stump and ensure you remove all dirt on it.
• Expose the cord to air dry
• Ensure the nappy is below the cord while dressing the baby
• Inspect the cord each time you change nappy to ensure that there is no undue wetness or area of redness around the cord or on it.
• Maintain the baby on sponge bath until the cord falls off
• The cord should be cleaned at every diaper change to prevent the chance of infection from soiled diapers on the stump.

Care after it falls off

When the cord falls off it is pertinent to observe the umbilical cord as there might be a self limiting bleeding from the site which will resolve naturally just like in a normal scab falling off from a wound. If the bleeding persists do take your child to the emergency room for examination.

Also observe the cord for continued freshness or redness of the site after falling off as if it continues to be fresh and red for more than 5 days after the stump has fallen off it may be that there is development of umbilical granuloma.

This is also self limiting and may ooze yellowish fluid and blood stain especially if traumatized but should resolve in time with proper cleaning and exposure to dry air still. if it persists beyond 7 days you should take your child to the paediatrician.

If the cord has fallen off normally the child should have a tub bath going forward and the diaper should now be allowed to cover the belly button.

Cultural significance of the stump

The umbilical cord is the connection between the baby and the mother physically through which it receives it’s nutrient and source of life. It is an attachment that develops to connect via the mother the vessel through which a new life is nourished.

In the Igbo world view the cord is that through which life is given and nourished throughout the early gestation till delivery and it is the connection between babies coming to this life and their earlier sojourn here and even their future sojourn hence must not be completely severed by throwing the stump away for it is through that route that they came to be and hence in the igbo world view this connection needs to be maintained for a safe and peaceful return to the afterlife after their sojourn here and for a proper rebirth.

This belief system is the reason why in the igbo culture the stump is not thrown away after it falls off but rather the stump is kept and a tree is planted with the cord buried at the site of this new tree as a connection between this newborn and this tree of life and then each child delivered to an igbo person no matter where they are on earth has a duty to bring the stump home for a tree to be planted in the child’s name in Igboland Nigeria with its umbilical cord and the tree is tended to on the child’s behalf till it grows and the child is shown that tree when he or she comes of age and is mandated to ensure that nothing happens to that tree prematurely as that will severe his connection to peaceful return to the cosmos and a gentle and peaceful rebirth or reincarnation.

Conclusion

The umbilical cord has significance that goes beyond the physical and medical and, extends into the cultural and spiritual significance for certain cultures or races so it must be handled with the utmost of care both medically and spiritually.

The care of the newborn umbilical cord is of critical importance both in resource rich and more importantly in resource poor settings as it can be a nidus for infection if not well taken care of and can be devastating to the life of the newborn especially in poor settings where tetanus infection is still rampant and it can easily get infected with disastrous outcomes.

The care of the umbilicus after delivery is simple and effective till it falls off in a week or two time if the simple hygienic steps as stated above are followed to the letter and the outcome is always positive when duly observed.