Before birth, the umbilical cord is the connection between the baby and the mother through which the baby receives nourishment and oxygen. After birth it becomes useless. By the time the baby is several weeks old, this is something you will likely never think about again, but right after birth it deserves a bit of attention.
You may have heard of cord banking. Cord banking is a trend that comes in and out of fashion. The idea is to save your baby’s stem cells as an insurance policy in case there is a future medical need. In theory it is great. Unfortunately it is very expensive and it is hard to predict if the bank you choose will still be around in the future should you need it. At the time of this post, very few of my patients opt to do this, but it is worth checking to see if there are any updates.
The optimal timing for clamping the umbilical cord after birth has also been a subject of controversy and debate. There is a current trend to delay clamping for a few minutes after birth. It is best to discuss this with your OB ahead of time. The important thing is simple that the baby is tended to. If everything is stable, by all means, delay the clamping for a moment or two. If for some reason the baby needs attention, the clamping is done immediately, and you don’t get that extra time, please don’t focus on this as something to fret about. I imagine your baby's chances of becoming president one day won’t hinge too closely on how quickly they got their cord clamped!
Whenever it occurs, the umbilical cord is clamped and cut close to the baby's body. There are no nerves in the cord, so this is a painless procedure.
The cord clamp should be removed prior to leaving the hospital. It is a good idea to double check. I have occasionally seen newborns discharged with the clamp still on. Once the clamp is off, an umbilical stump remains attached to your baby's navel.
There is not much you need to do to care for it. Often, the less you fuss with it, the sooner it will fall off. It tends to fall off between 7-17 days (not everyone follows those rules.) At some point it will be hanging by a thread and you will see who the lucky person is on diaper duty when it finally comes off.
There are newborn diapers that have the little cutouts that are very useful. This helps you avoid having the cord rubbed and irritated. Hopefully you won’t need more than a few boxes of those. If you have a larger baby who is too big for size one, just roll down the diaper to avoid rubbing.
We want to keep the area dry so no actual submerging the baby in a tub until it falls off. Sponge baths can get the job done. Yes, babies get some pee and poop on there, don’t freak out. Just clean it as best as you can. If the cord gets a foul odor (trust me, you will know if it is smelly or not) call your pediatrician to get it checked out. A stinky cord can be a signal that the baby has an infection (called omphalitis.) The docs will do a good cleaning and get in there in a way that the parents often aren’t comfortable doing. If needed, the doctor may apply silver nitrate. This is a chemical that cauterizes the area. That will leave a grayish/black discoloration around the area that may take a few weeks to fade. It may take more than one application for the cord to be healed.
Once in a while a small piece of the cord stays in place. This is called a granuloma. If the baby is acting perfectly fine in every other respect, there is no need to rush in, but your doctor will want to take a look if things are not healing up. A persistent granuloma will usually need attention.
Once the cord is off, it is normal for the area to continue to ooze a bit for another week or so. It is quite common to have a bit of green or yellow stain on the diaper or shirt. Sometimes there is also what looks like blood. Unless there are actual drops of blood coming from the cord, I am not concerned about little staining. At this point you can clear around the area with a bit of alcohol and a dab of Neosporin.
Another thing that parents might call about are umbilical hernias. An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. Umbilical hernias are common and typically harmless. They are most common in infants, but they can affect adults as well. In an infant, an umbilical hernia may be especially evident when the infant cries or strains causing the baby's belly button to protrude. This is a classic sign. Some of these are as big as golf balls. Usually this resolves on its own. As long as you can gently push the belly button back in, it is not a concern. If you have an inconsolable baby and the area seems to be stuck on the outside, that would need an immediate evaluation.
Before you know it, that cord will be off and most likely you won’t be giving much thought about your kid’s navel until they are teenagers and begging for permission to get it pierced. (It is also quite possible that when they turn that C in geometry into an A you will reluctantly give your blessing, as we did with our daughter Lauren!)