Umbilical cord: Functions and Cord care in Postpartum

Umbilical cord is a key structure because fetus in-utero can not  survive without obtaining oxygen and nutrients from maternal blood stream which is connected to the fetal surface of the placenta by  umbilical cord.  

Abnormal cord either in structure or function can absolutely affect the fetal growth and development.  Hence, healthy umbilical cord is very essential for healthy pregnancy. 

What is umbilical cord?

Umbilical cord is otherwise known as funis, refers to a thread-like structure that extends from the fetal surface of the placenta to the umbilical portion of the fetus. 

Normal length of umbilical cord

The  diameter of umbilical cord is about 1-2cm while that of length is 40-60cm with an average of 50cm. 

A cord is considered to be short when it measures less than 40cm. However, there is no definite length considered to be an anomaly. 

Development of umbilical cord

Umbilical cord is formed at the 5th week of pregnancy. It is highly essential for life and any disruption in its structure can result  in a fetal stillborn. It transmits blood vessels (two umbilical arteries and one large vein which supply the fetus with nutrients and aid in removal of waste products. 

These vessels are protectively embedded within a white gelatinous substance called  Wharton’s jelly which is developed from primary(embryonic) mesoderm. Loss of Wharton’s jelly may put the fetus at risk of cord compression and, hence fetal distress.

Naturally, the umbilical cord falls off within 7-10 days after birth through a process known as dry gangrene.

Nerve supply to Umbilical cord

The cord has no nerve supply and this makes cutting it at birth painless to the baby.  The whole cord is covered with a layer of amnion which is continuous with that covering of the placenta. 

Umbilical cord  appears helical(95%) due to winding of the blood vessels.  However, umbilical cords of absolutely straight(5%) appearances are more prone to disruptions of blood flow.  

Placental attachments can be in the center, off-center, on the edge, or in the membranes. The membranous insertions of the umbilical cord are known as velamentous insertions. These placental cord designs have flaws that can lead to cord tears.  

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Function of the umbilical cord

  • The cord bears the umbilical arteries that carry deoxygenated blood pumped by the heart away from the fetus. 
  • It also bears the umbilical vein which carries oxygenated blood and nutrients supplied by placenta to the fetus. 
  •  It serves as a link between the fetus and the placenta. 
  • It is the life-wire of the fetus in-utero.
  • Umbilical cord can be used as a route for administration of drugs or blood transfusion shortly after birth. 
  • It helps in the management of third stage of labour via controlled cord traction(CCT) to deliver the placenta. With the delivery of the placenta, the uterus contracts firmly to arrest haemorrhage from the placental site. 
A cross section diagram of umbilical cord

 Care of the newborn umbilical cord 

The cord normally falls off within 7-10 days by necrotic dry gangrene.  There is no specific care for cord, rather maintenance of optimal environmental and personal hygienes are advocated for the baby. Below are tips for cord care:

  • Keep the cord stump clean and dry.
  • Properly hand washed before touching the baby especially the umbilical area. 
  • Expose the cord stump to air: don’t cover it with clothes or baby’s diapers. 
  • Prevent contacts with urine and faece. Contacts with these excreta might result in umbilical infection.
  • Give baby sponge bath: damp the skin and dry with clean absorbent cloth or towel. 
  • Deep a  cotton swabs with warm saline water, gently clean the base of the cord and its surrounding skin and thoroughly dry with absorbent cloth. Methylated spirit can be used to swab the cord. 
  • Avoid pulling the umbilical cord as it may result in injuring the baby.
  • Never apply cow dungs or any other thing in the name of encouraging the cord to fall off. Doing this exposes the baby to infection or irritation. 

Physiological changes in umbilical cord during delivery:

Considerable physiological changes occur in umbilical cord following delivery and clamping of the cord by the midwife.  We shall look into these changes for better understanding. Labour and delivery cause a lot of changes in the baby’s systems and not only in the umbilical cord. The birth of a baby brings the essential functions of the cord in-utero to an end. The baby needs to adapt to extrauterine life. Therefore, at clamping and cutting of the umbilical cord by midwife during delivery, the followings occur:

  • The  baby takes its first breath at birth and blood is drawn to the lungs through the pulmonary arteries. 
  •  It’s then collected and returned to the left atrium via the pulmonary veins, resulting in a sudden inflow of the blood.
  •  The placental circulation ceases soon after birth and so less blood returns to the right side of the heart
  •  In this way,  the pressure in the left side of the heart is greater while that in the right side of the heart becomes less.
  • This results in the closure of a flap over foramen ovale and stops blood flow through it from the right atrium to the left. 
  • Because of pulmonary respiration,  oxygen  concentration in the blood rises, causing ductus arteriosus to constrict and close. 
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Major changes in umblical cord after delivery

The cessation of the placental results in the collapse of the umbilical veins, the ductus venosus, and hypogastric arteries:

  • The umbilical veins turn to ligamentum venosum.
  • The ductus venosus turns to ligamentum arteriosum. 
  • The Foramen ovale turns to fossa ovalis.
  • The hypogastric arteries turn to obliterated hypogastric arteries except for the few centimeters, that remain patent as the superior vesical arteries.

Other subsequent changes:

  • Initiation and establishment of breastfeeding or formula feeding. 
  • Waste elimination through kidneys and gastrointestinal system.
  • The development of communication and the parents-child relationship.

Examination of umbilical cord at birth

During the examination of the placenta and  membranes following delivery, the cord is usually examined for any abnomality. These steps are involved: 

  1. Inspect the foetal side:
  • Check the location of the insertion of the cord (central, marginal or velamentous) 
  • Trace blood vessels on the periphery to detect any torn vessels. It indicates a succenturiate or extra lobe of the placenta
  •    Check second hole on the membranes
  1. Inspect the umbilical cords:   
  • Check the number of blood vessels. Normal cord has two arteries and one vein.
  •    Check the length of the cord.
  • Check for the presence of a true knot or anomalies 
  1. Inspect the maternal side:
  • Check for the cotyledons   
  • Observe for areas of abruption, infarction or calcification

Steps in educating newly delivered  primigravida on umbilical cord care

General baby care poses a great concern and challenge to first time mothers. The tips on cord care above will be of help to the  midwife instructing the mother. However, below are simple steps to follow:

Phase 1: Preparation 

  • Warmly greet the mother and introduce yourself.
  • Explain the procedure to the mother and obtain her consent.
  • Thoroughly wash and dry hands and put on sterile gloves. 
  • Gently expose the umbilical areas only to avoid exposing the baby to excess cold. 
  • Ensure that all the requirements for the procedure are properly set on a tray or trolley. 
  • Get nearby windows and doors closed to avoid cold. 
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Phase 2: Demonstrate the procedure as follows:

  • With your left hand pick a methylated spirit swab.
  • Hold the tip of the cord with the swab 
  • Pick  another spirit swab with your hand.
  • Clean the base of the cord with the swab. 
  • Continue to clean it until very neat. 
  • Check if the ligature or clamp is still intact.
  • Tie another ligature below the former if it is loose without trying to remove it. 

Phase 3: Observe the following while you do the procedure

  • the colour of the cord for any discolouration.
  • Feel the temperature of the umbilical cord, to see if it’s cold, warm or hot. 
  • Presence of pus
  • Presence of any redness or haemorrhage.
  • Presence of infection.
  • Allow some minutes for the cord to air dry.
  • Make the baby comfortable.
  • Appreciate mother for her cooperation.
  • Encourage her to maintain hygiene when caring for the baby.
  • Hand the baby over to the mother.
  • Ask her to put the baby to breast. 
  • Discard  used items, wash and dry hands. 

Complications resulting from improper cord care

Failure to observe these simple tips about cord care could result to the following problems:

  • Infection e.g tetanus neonatorum, omphalitis. 
  • Delayed healing.
  • Fever and dehydration as a result of infection.
  • Bleeding.
  • Protrusion of bowel through the umbilicus.
  • Excessive crying of the baby owing to pain and discomfort.
  • Social distancing/isolation(due to    offensive odour from the baby  scaring people   away).

Conclusively, I hope you have learnt more on umbilical cord and what to expect during health education on care of umbilical cord. With these hints you can no longer feel naive when your midwife is teaching you or with other women the proper cord care.  Read: Abnomalities of umbilical cord and their management.

Proper umbilical cord care helps to keep your baby free from infections. This in turn boosts his/her health and fitness. If you find this piece resourceful, share to others. I hope to hear from you via your comment below. Always stay safe. Tofort cares!