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Umbilical cord clamping options

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Cord clamping basics

After birth, the baby is still attached to the placenta via the umbilical cord. The umbilical cord upon exposure to lower temperatures and air, goes through a process of shutting off the blood supply between the baby and the placenta. It does this by collapsing the blood vessels (vasoconstriction) and collapsing the special jelly (Wharton’s Jelly) that surrounds the blood vessels. If left alone, the umbilical cord clamps itself within about 5-20 minutes and nothing more is needed, even when cutting the cord.[1] If preferred, a cord clamp can be applied before the cord is cut. This can also help stop the small amount of residual blood trapped in the umbilical cord from coming out. When non-severance or Lotus Birth is followed the cord is not cut at all.

The different clamping options

Following are the different methods of treating the umbilical cord after birth.

Newborn baby with umbilical cord stump and cord clamp attached
Plastic clamp

The most common umbilical cord clamp used is the plastic peg type. The cord is clamped with forceps, then the plastic clamp applied near the baby. The cord is then severed between the clamp and the forceps. Many parents find these to be bulky, hard and unpleasant, often catching on clothing or digging into skin. They can be removed at any time, however usually require a special clamp cutter to snip them off.

Umbilical cord tied with cotton tape
Cotton tape

This used to be the most common way to clamp the umbilical cord before plastic peg clamps. There are several different ways the cord can be tied and severed. The tape is flat so as to avoid cutting into the umbilical cord when the tape is wound and knotted tightly. The tape is not elastic and won’t shrink as the cord dries. As such, it can often end up loose and sometimes comes off.

Umbilical cord clamped with a ring/band
Cord band or ring

This is another common method depending on where you are. The cord is clamped with forceps, severed, then a tight band placed over the umbilical cord. Different types of bands are applied with different methods. This is often preferred over the plastic peg clamps as the band is soft and doesn’t obstruct, poke or catch like the plastic clamps do. Note that these are usually made with latex rubber and should be avoided if there is a family history of latex allergy.

Umbilical cord tie made from multi-coloured strands of cotton plaited together
Plaited/Braided or crocheted tie

A more aesthetically pleasing version of cotton tape. This also has the advantage that the parent, a family member or friend can plait/braid or crochet the tie giving more significance and sentimentaility to the cord tie. It is applied in the same way as cotton tape. Also like the cotton tape, it can sometimes come off as the cord dries and shrinks. Most ties are simply plaited/braided (three or more strands) from embroidery cotton or silk. Ties can also be crocheted with embellishments on the end. When making your own tie, they should be at least 30cm long (about the length of your forearm) to ensure enough length to tie them adequately.

Umbilical cord tied with muka and pounamu attached
Muka (New Zealand Flax fibre) tie

Muka is the dried fibres extracted from Harakeke/New Zealand Flax (Phormium tenax). It is naturally very strong and has antibacterial properties.[2] It is usually plaited/braided like a cotton tie. See below under Further Reading for a video on how to remove muka/flax fibre from harakeke. After it has been separated out, it is left to dry and can then be plaited/braided. When making a muka tie, they should be at least 30cm long (about the length of your forearm) to ensure enough length to tie them adequately. In this photo, the muka tie is adorned with pounamu (greenstone/New Zealand jade).
In Maori tradition hapu/pregnant women should not harvest harakeke/New Zealand flax or weave muka.[3] This may in part be due to the laxative effect harakeke sap can have.[4]

Cord burning ceremony at Bumi Sehat, Bali
Cord Burning or Candling

This involves severing the umbilical cord by burning through it with a small flame, usually a candle. A container is used to catch wax (this can be a simple bowl or a purpose built box), the cord held over it and candles or other small flame held underneath the cord till it burns all the way through. This usually takes 5-10 minutes.[5]. It requires at least two people who hold a flame each. Either the cord is left long and burnt away from the baby or more commonly, a barrier is placed between the baby and the cord burning. Any excess cord attached to the baby can be left to dry or can be looped in a small ‘knot’. Cord burning has the advantage of cauterising the cord, further decreasing the (rare) chance for infection. In some areas where clean equipment is difficult to source, cord burning has become more common place.[6]

Baby with severed umbilical cord after naturally occlusion
No clamp

As the umbilical cord naturally occludes (clamps) itself, there is no actual need for any form of external clamp at all.[7] Within 5 to 20 minutes (or sometimes more) of the baby being born, the blood vessels within the cord vasoconstrict and the Wharton’s Jelly that surrounds the blood vessels collapses. Blood begins to clot within the cord and no longer flows through it. Once this process is complete, the cord can be severed and left as it is. A small amount of blood remains in the cord and may come out when it is severed. For this reason some people prefer to tie the cord before severing it and then remove the tie after.

Lotus Birth with baby still attached to umbilical cord and placenta in a silk bag.
Lotus Birth

Also called “non-severance”, Lotus Birth leaves the cord completely intact and attached to the placenta until it dries and comes away by itself. Usually this happens after 3-6 days. The placenta is kept in a fabric bag or a basket to allow air to circulate around it. Herbs like powdered Rosemary and/or salt and sometimes essential oils are applied to the placenta to help dry and preserve it. For this reason, the placenta is preserved with little to no rancidity and smells only slightly musty. Some people find the umbilical cord feels cold against skin before it dries and opt to wrap the cord in ribbon or fabric. A ‘partial’ or ‘short’ Lotus Birth is possible, whereby the baby is left attached to the placenta for several hours or more (commonly 3 – 8 hours) before the cord is severed.

This list is by no means exhaustive and there are many ways that the cord can be clamped, tied, severed or treated. Nor do you need to rely on existing methods – feel free to come up with your own method or ceremony.

Do’s and Don’ts

DO:
  • Research your options fully
  • Talk to your care provider about methods they can offer or feel comfortable with and the method you intend on using.
  • Sever the umbilical cord in a hygenic manner. While umbilical cord infections (omphalitis) are rare, using a clean or sterilised instrument to cut the cord can reduce the risk. It isn’t usually necessary for the clamp or tie itself to be sterile but some may prefer that they are.
DON’T:
  • Sever the cord without a clamp if your baby has any bleeding disorders.
  • Sever and clamp/tie the cord with unclean or potentially contaminated items. While items don’t necessarily need to be strictly sterilised, they do need to be clean. This includes stones, shells, leaves, bark or other items from outdoors as they can be contaminated with the tetanus bacteria. Always clean and, if necessary, sterilise these items first.[8]

What to look out for

Not all care providers are familiar or comfortable with all these options. Some care providers are happy to use whatever is provided or learn a different method. Others may only feel comfortable applying a plastic clamp. If this is the case, you can tell your care provider to leave baby’s umbilical cord long or unsevered and apply your preferred method after, either removing the plastic clamp or severing any excess umbilical cord off along with the plastic clamp.

Plastic clamps can often catch on clothing, dig into skin, etc. and can be removed at any time. Your care provider will likely have a plastic clamp cutter. Alternately, this video outlines how you can remove one with a dulled safety pin.

Non-flexible string type ties (such as cotton tape, plaited/braided ties, muka ties, etc.) loosen as the cord dries and shrinks and may come off.

Homemade ties can be sterilised in an oven. Place the tie in four layers of clean cloth or heavy paper (brown paper sandwich bags work well). Tie shut or seal with masking tape if using paper. Bake in an oven at 170C/340F for one hour or 160C/320F for two hours or 150C/300F for two and a half hours. Store the sterile package inside a ziplock bag to keep it from being accidentally opened or ripped.[9] [10]

Cord burning should be undertaken carefully. Tin foil and/or cardboard can be used to help shield the baby from the flame and many people use ‘burn boxes’ to contain the cord, candles and dripping wax.

With a Lotus Birth, the placenta needs to have air circulating around it to help prevent it from going rancid. Most people wrap the placenta in cloth that should be changed at minimum once a day. Two to three times if needed.
Salt should only be used in lower humidity environments otherwise the salt attracts moisture from the air and prevents the drying process. Herbs with natural antimicrobial properties and essential oils can be used instead.

Gallery

Further reading

References   [ + ]

1, 7.PDF: Umbilical cord clamping is not a physiological necessity: Hutchon 2010, BJM April 2010, Vol 18, No. 4.
2, 4.Brooker, S. G; R. C Cambie; Robert C Cooper (1987). New Zealand medicinal plants. Auckland, N.Z.: Reed. ISBN 9780790002507
3.Harvesting Harakeke: Harakeke – New Zealand flax. Te Papa Tongarewa / Museum of New Zealand Collections. Retrieved 25/11/2015
5.4. How Long Does It Take: FAQ – Sacred Severance. www.cordburning.com Retrieved 25/11/2015
6.5. Delivering Babies After A Tsunami: CNN March 15, 2011. Retrieved 25/11/2015
8.Care of the Umbilical Cord: A review of the evidence. World Health Organisation. Retrieved 27/11/2015
9.Clean and sterilize tools: Baking. A Book For Midwives pages 59-67. Heperian Health Guides. Retrieved 27/11/2015
10.Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Healthcare Infection Control Practices Advisory Committee. CDC. Retrieved 27/11/2015