What will the nurse’s instructions for a new mother to care for the infant’s umbilical cord include?

After your baby’s birth, the umbilical cord is clamped and cut. The part of the umbilical cord that’s still attached to your baby is the umbilical stump. Often the clamp is still attached to the stump.

During the first few days after birth, the stump gets darker, shrivels and eventually falls off to become your baby’s belly button. Sometimes this takes a week or two.

While the stump is drying up and just after it falls off, you might notice some oozing around baby’s belly button. This might be clear, sticky or brownish, and it might leave a mark on your baby’s clothes or nappy. It might also smell a little. This is part of the healing process.

Check with your GP or child and family health nurse if:

• the stump hasn’t fallen off after more than two weeks
• the area around the cord is red, has a bad smell and/or is warm and tender to touch.

Cleaning and caring for your baby’s belly button

Wash your hands before handling the cord stump. Avoid touching it whenever possible.

Use only water to keep your baby’s belly button area clean, except if the area gets wee or poo on it. If this happens, wash off the wee or poo using clean water and a pH-neutral cleanser. Look for ‘pH-neutral’ on product labels or ask your pharmacist or child and family health nurse to recommend a product.

Make sure the stump dries properly after bathing. Also, the stump will dry and heal much faster if you expose it to air as much as possible. Try not to cover it with plastic pants and nappies. Fold nappies down and away from the stump if you can.

Never try to pull the stump off yourself, even if it looks like it’s ready to fall off.

After the cord stump has fallen off, keep the area clean and dry until the area heals completely. It helps to fold the top of your baby’s nappy down so that the belly button is exposed to air.

Umbilical granuloma

Once the stump has fallen off, some babies can develop an umbilical granuloma. This looks like a small pink or red lump in the belly button area. Sometimes the lump might be oozing.

An umbilical granuloma might get better on its own, so keep the belly button area clean and dry. It’s also good to have your GP or child and family nurse look at the lump.

Umbilical hernia

If your baby develops a bulge or swelling near the belly button, it might be an umbilical hernia. An umbilical hernia is often more noticeable when your baby cries or strains to do a poo. This usually isn’t dangerous, and it doesn’t hurt your baby.

An umbilical hernia will often go away between the ages of three and five years. It’s a good to have your GP or child and family health nurse look at the bulge.

See your GP as soon as possible if you’re still seeing sticky liquid several days after the stump has fallen off, if your baby’s belly button area gets hot, red or swollen, and/or if your baby has a fever or is otherwise unwell.

Please note that all guidance is currently under review and some may be out of date. We recommend that you also refer to more contemporaneous evidence in the interim.

When caring for the newborn’s umbilical cord, current evidence supports the use of standard infection control procedures only.

Alcohol, antibiotic sprays, physolex or chlorhexidine should be used with caution and under medical direction.

Universal precautions to be maintained

Follow these precautions when caring for the umbilical cord:

1. Wash your hands.
2. Place cord clamp x 1 approximately 2 cm from skin.
3. If LUSCS or high-risk baby, cord is clamped 4-5 cm from skin
4. Cord is checked for ooze hourly for two hours after birth.
5. Midwife to check cord area daily and record cord status.
6. The area around cord stump is washed carefully with water and dried when bathing the baby. If it is moist, encourage mothers to fold nappy and plastic under cord area, leaving cord exposed to air.
7. Educate parents to observe and report any signs of infection (redness, stickiness or offensive odour).
8. Clamp the cord with sterile clamps and cut it with sterile scissors.
9. The recommended length of the stump after cutting is 2-5 cm.
10. Use rooming in where possible, with the mother as primary carer.
11. Keep the cord dry and exposed to air.
12. The nappy should allow for the cord to sit out of it.
13. Wash hands before handling the umbilical cord and where possible avoid touching the cord stump.
14. The cord clamp will fall off between days 5-10, you do not need to remove the clamp on discharge from hospital.
15. Educate parents regarding separation of the cord.
16. Explain there might be slight bleeding at the time of separation of the cord.

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.

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.