Tying umbilical cord
How to Use an Umbilical Cord Tie
What is an umbilical cord tie?An umbilical cord tie is a piece of thread that is used to tie off an umbilical cord when separating the baby from the placenta.
Cord ties are woven with fibres like cotton, wool, linen, bamboo, or a blend, for example with nylon. Personally I prefer using cotton because it’s strong, it’s natural so there’s no microplastics, it’s also vegan-friendly, and it’s easy to get hold of in the form of embroidery threads. All my cord ties are made with cotton thread.
A cord tie is an alternative to the plastic clamp that is traditionally used in almost all settings.
Why would you use a cord tie?
There are several reasons why you might choose to use a cord tie.
The clamps are big, bulky, awkward to move around when changing nappies and dressing the baby, and frankly, they’re really ugly to look at.
In comparison, cord ties are soft against the baby’s skin and take up much less room under the clothes, which makes them more comfortable for baby. They are less likely to get caught as you change baby's nappy and they’re also prettier - especially if you splash out on a crocheted one.
Anecdotally, cords tied off with ties seem to fall off sooner than clamped ones. However, it would be wrong to make a causal link here. It is possible that they fall off sooner because of optimal cord clamping (waiting for the cord to turn white before cutting it), not because of the method used to clamp them. Or it is possible there is no link and it is just coincidence.
How do you use a cord tie?
Tie it in a regular knot around the cord, but make sure it's really tight. Ideally you would hold the ends of the tie under your little fingers, and push your index fingers against each other for leverage in order to get it as tight as possible. Then loop it round to the other side of the cord and repeat. When you're happy it is as tight as you can get it, tie a second knot and then a bow so that the long ends don't dangle, or simply cut the excess off if you don't want a bow.
I appreciate that is a bit woolly as a description, so for those who can see it, here’s a video demonstration:
Some common concerns and questions about cord ties
Not everyone is comfortable with using a cord tie. It’s understandable that we are slightly nervous about using new things, especially when it comes to our children.
Is it more likely to catch than the clamps? In my experience, no. The cord ties are much less bulky which means they don't catch as much, even though they have loose ends or loops if they've been tied in a bow. If you really feel like your cord tie has too much excess, you can cut the ends shorter.
Are there any times where using a cord tie is not the best course of action? Yes there are! Cord ties are just one tool in the box. In the next section I talk about times where you might choose not to use one.
What about oozing or leaking from the stump, is this more likely when using a tie? The short answer is that it depends. A small amount of oozing from the stump can be normal, and you can clean it with some cooled boiled water and sterile gauze. If the cord tie has been used appropriately, then it shouldn't leak any more than a clamp. It is important to tie the cord tie really tight, as tight as you can manage it. Don't bother with fancy knots, just get it super tight.
Do they need to be sterilised in advance? No. You can, if you are concerned, but it isn't necessary. Babies aren't sterile. Birth isn't sterile. Baby clothes aren't sterile. It is incredibly rare for a baby to develop problems around their unbilical cord stump. That being said, don't go dipping your baby in mud or anything. Do clean your baby after nappy changes as you would normally. Standard baby cleanliness is fine!
My cord ties come packaged in a cellophane wrapper with instructions on the back, and they can be used straight from the pack.
The umbilical cord and how it works
The blood in the cord belongs to the baby, not to the mum or gestational parent. At the time of birth, the three blood vessels in the cord are full of blood which is travelling to and from the placenta to collect oxygen and nutrients, and drop off carbon dioxide and waste. The cord is thick with blood, and because it is the baby's blood it carries the baby’s pulse.
In a physiological birth where no early clamping occurs, the baby’s circulatory system slowly changes from pumping blood to the placenta to pick up oxygen, to pumping blood to the lungs instead. The blood in the placenta, which often accounts for around a third of their total blood volume, drains slowly back into the baby. The baby breathes and cries and this circulatory shift occurs, but the speed at which it happens varies from baby to baby - if a baby is slow to breathe then the shift takes longer.
Once all the blood has returned to the baby and the baby is relying exclusively on their own lungs for oxygen rather than their mother or gestational parent, their cord will no longer be filled with blood.
It will be limp and floppy and no longer carry a pulse. The best way to describe it is like a piece of cooked spaghetti. The clear/translucent substance that the cord is made from is called Wharton’s Jelly, and it turns white and solidifies. The blood vessels collapse as there is no blood to hold them open, and the Wharton’s Jelly is acting to clamp them shut. Using a cord tie to tie the cord off in this scenario is a very gentle end to this process.
There are some circumstances where a cord will need to be clamped and cut immediately or very soon after birth. In those circumstances the cord blood vessels are still wide open and full of blood. The plastic clamp is the right tool to counteract the pressure of the blood in the cord and close the blood vessels when they haven't shut down by themselves. Using a cord tie in this scenario would potentially lead to more risk of oozing blood, because the cord did not shut itself down physiologically.
Midwives can sometimes be reluctant to use cord ties at births, and want to stick with what they know.
If your midwife is not sure about the tie, you can ask them to apply the clamp further down the cord away from the baby (approx 4 inches), and then you can tie the cord tie onto the cord yourself later, and trim off the excess cord with scissors. This is also possible if your birth circumstances mean that the baby’s cord is clamped before the cord has stopped pulsating and turned white.
Did you use a cord tie when your baby was born? Are you thinking about using one for your next birth? Or maybe you have a question that I haven't covered!
Leave me a comment below!
Umbilical cord care | Pregnancy Birth and Baby
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In the womb, the umbilical cord delivers the oxygen and nutrients needed to allow your baby to grow.
After birth, the cord is clamped and cut, leaving a stump. This eventually falls off, healing to form the umbilicus (belly button). There are ways for you to prevent problems during healing.
What happens immediately after the birth?
After birth, the doctor or midwife cuts your baby’s cord from the placenta and puts a clamp on the remaining stump to pinch it off. After a couple of days, once the cord has dried, you can take the clamp off.
How long does the cord stay attached for?
The cord stump usually stays attached for 5 to 15 days. Over this time, the cord dries, shrinks and turns black. Sometimes, especially in the day or so before it falls off, the stump can ooze a little and may leave marks on your baby’s clothes.
Do not pull the cord stump off, even if it looks like it will come off easily, as this can prolong healing time and cause scarring. Let the cord stump fall off by itself in its own time.
When the stump falls off, there is sometimes a little bleeding at the stump site.
This is normal and it should stop quickly.
Please see your doctor or maternal and child health nurse if you have any concerns, or speak to Pregnancy, Birth and Baby on 1800 882 436.
Caring for the umbilical cord
Wash the cord stump as part of your baby’s usual bathing routine.
Make sure you wash your hands first. Use only water and cotton pads, and dry it carefully. If wee or poo gets on the stump, you can use a mild soap to help clean it off. You don’t need to use antiseptics and alcohol.
Let the cord sit out of the nappy so it dries out in the air; this can be done by folding the nappy under the cord stump. There is no need to cover the cord stump with Band-Aids or bandages, as this stops airflow around the stump.
If you’re not washing the cord stump, try not to handle it.
How long does the belly button take to heal?
The belly button should heal completely in days. It may bleed or ooze a little after the cord falls off, but if there is continuous stickiness or discharge, it may be infected and you should show your doctor or maternal and child health nurse.
Sometimes the belly button does not heal completely and moist red tissue forms over the stump site, often with a lump present. This is called a ‘granuloma’. It is usually harmless, but you should ask your doctor or child and family nurse to have a look at it.
How to tell if the cord is infected
Signs of an infection of the belly button may include:
- redness, swelling, stickiness or a bad smell on or around the belly button
- fevers, poor feeding and tiredness in your baby
If you think your baby’s cord stump or belly button is infected, see your doctor as soon as possible.
Sources:
Victorian Agency for Health Information (Umbilical cord care for neonates), Raising Children Network (Umbilical care), Royal Children’s Hospital Melbourne (Umbilical granuloma – pre-referral), Cochrane (Topical umbilical cord care at birth)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: December 2020
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Related pages
- What is the placenta?
- Mum's first 24 hours after birth
- Baby's first 24 hours
This information is for your general information and use only and is not intended to be used as medical advice and should not be used to diagnose, treat, cure or prevent any medical condition, nor should it be used for therapeutic purposes.
The information is not a substitute for independent professional advice and should not be used as an alternative to professional health care. If you have a particular medical problem, please consult a healthcare professional.
Except as permitted under the Copyright Act 1968, this publication or any part of it may not be reproduced, altered, adapted, stored and/or distributed in any form or by any means without the prior written permission of Healthdirect Australia.
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Scientists: cord should not be tied immediately after childbirth - May 27, 2010
Lifestyle
May 27, 2010, 17:04
discussShare
Traditionally, the umbilical cord is tied after 30-6 seconds after birth. However, a group of scientists from the University of South Florida disproved this need.
And, moreover, confirmed the benefits of a late separation of the umbilical cord from the baby.
A group of scientists from the University of South Florida says that traditionally in the West, a baby's umbilical cord is tied quite early - somewhere after 30-60 seconds after birth. If this procedure is postponed for a few minutes, then more blood will flow to the child, coupled with vital stem cells.
So, during childbirth, the placenta and umbilical cord begin to contract, pumping blood to the baby. As soon as enough blood is transferred, the pulsation in the umbilical cord decreases and blood flow stops.
Dr. Paul Sunberg, who participated in the research, notes that several clinical studies have shown that delaying the umbilical cord ligation procedure a little will help prevent anemia due to the large volume of blood flowing to the baby. Also, blood from the umbilical cord contains many valuable stem cells. This is a natural stem cell transplant.
And delaying cord ligation in premature babies (at least 30 seconds later) reduces the likelihood of bleeding, anemia and reduces the need for blood transfusions, reports NEWSru.
com citing Reuters.
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Does delayed cord clamping or cord pumping improve the health of premature babies?
What is the problem?
In this Cochrane review, we wanted to determine whether delayed cord clamping or cord pumping improves health outcomes for infants born before 37 weeks gestation.
These interventions have been compared to early cord clamping.
Why is this important?
Babies born before 37 weeks or premature babies are less healthy than babies born at term, especially if they are born before 32 weeks of gestation. Premature babies may experience problems with the functioning of many major organs, including the lungs, intestines, and heart. There is a risk of death or the development of serious diseases such as cerebral palsy. After birth, babies may need blood transfusions and drugs to increase heart rate (inotropic drugs) and increase blood pressure. It is important to find ways to improve the health of premature babies.
Early cord clamping has been standard practice for many years. This allows the infant to be quickly transferred to a specialized team of doctors who are nearby or in another room. However, delaying cord clamping for half a minute to three minutes or more will help maintain blood circulation between mother and baby, which can help the baby adjust to breathing air.
Squeezing blood along the umbilical cord towards the baby (cord pumping) can increase the baby's blood volume and improve his condition. We wanted to know if there is any benefit or harm from delayed cord clamping or cord pumping.
What evidence did we find?
To answer this question, we collected and analyzed all eligible studies (search date: November 2017). Our updated review includes 40 studies involving 4884 infants and their mothers. Research has been done all over the world, but most of it is in high-income countries. The delivery took place in a hospital where early clamping of the umbilical cord was practiced. As a result, there were not enough data for many of the outcomes to be confident in our conclusions.
1) With delayed cord clamping (with immediate care for the child after cord clamping), compared with early cord clamping, we found a lower chance of death among infants before discharge (20 studies, 2680 children).
In addition, fewer infants had cerebral hemorrhage (15 studies, 2333 infants), but there probably was no difference in the number of infants with severe intracerebral hemorrhage (10 studies, 2058 infants).
2) Only one study, involving 276 infants and their mothers, provided evidence of delayed cord clamping with immediate care for the baby next to the mother with an unclamped cord compared with early cord clamping. This study was small and did not reveal any marked differences in health outcomes.
3) We did not get enough data on delayed cord clamping (with immediate care for the child after clamping) versus cord pumping (three studies, 322 children) to compare results/outcomes.
4) On cord pumping versus early cord clamping, we found 11 studies reporting data on 1183 infants and their mothers. We also lacked data to make a clear comparison of outcomes.
What does this mean?
Delayed cord clamping is likely to reduce the risk of death in preterm infants.
