Umbilical cord care and well-being

The umbilical cord is a kind of conduit that originates in the early weeks of gestation and contains the blood vessels that connect the fetus to the maternal placenta.

Structure of the umbilical cord

The umbilical cord consists of three umbilical vessels (one vein and two arteries) that allow the exchange of blood between the mother and the fetus during pregnancy.

In fact, the umbilical cord connects the baby’s blood circulation to the placenta, the organ that enables the transfer of maternal blood to the fetal circulation, along with oxygen and nutrients necessary for fetal growth and development.

Inside the umbilical cord run three blood vessels:

• one umbilical vein, the largest vessel, which carries oxygen-rich and nutrient-rich blood from the placenta to the fetus;
• two umbilical arteries, smaller vessels that carry deoxygenated blood containing fetal metabolic waste back to the placenta.

After birth, breathing and breastfeeding provide the baby with everything needed for growth, making the umbilical cord no longer necessary.

What happens to the umbilical cord after birth

At birth, the umbilical cord appears as a long, cord-like structure approximately 50 cm in length and 15–20 mm in diameter. The three vessels are externally surrounded by a gelatinous substance (Wharton’s jelly), whose structure allows the cord to compress and deform, quickly returning to its original shape without compromising blood flow to the fetus.

Immediately after birth, within a maximum of 3 minutes, the umbilical cord is temporarily clamped with a specific clamp and then cut; what remains is referred to as the umbilical stump.

While during pregnancy the umbilical cord is immersed in amniotic fluid, after birth everything changes. Exposure to air triggers a natural mummification process lasting approximately 5–15 days, during which structural changes lead to the complete detachment of the stump, resulting in the formation of the umbilical scar (navel).

WHO’s 7 guidelines for umbilical stump care

In 2013 (updated in 2017), the World Health Organization released recommendations on neonatal health, including specific instructions on umbilical stump care:

1. Wash hands thoroughly with soap and water to avoid contamination of the stump.
2. Remove the previous dressing gently; if it sticks to the stump, use saline solution to ease removal.
3. Clean the base of the stump with water and mild soap. Small traces of blood and serum are normal; in case of abundant discharge, consult the pediatrician.
4. Dry the stump and surrounding skin thoroughly by patting with sterile gauze. Do not rub the newborn’s skin as it is very delicate.
5. Observe the skin around the stump: if redness, rash, or swelling appears, consult the pediatrician.
6. Apply a sterile gauze around the stump to cover it completely. Avoid direct contact with the diaper to prevent contamination with feces or urine. You may use an umbilical band or net to hold the dressing in place.
7. Ensure proper air circulation around the stump to avoid creating a warm, moist, and low-oxygen environment that could slow mummification. Whenever possible, avoid closing the diaper over the stump dressing.

How long does the umbilical stump take to fall off?

On average about ten days: from a minimum of 7 to a maximum of 14 days.

Can the baby be bathed with the umbilical cord still attached?

It is generally recommended to avoid immersion bathing (i.e., in a tub) until the stump has detached and the scar is dry.

What to do if the stump gets soiled with urine

If the stump becomes wet with urine or soiled with feces, simply wash both the stump and surrounding skin with water and mild soap. Then dry it thoroughly and apply a clean, dry gauze.