At birth, the human umbilical cord contains three distinct blood vessels: two thick-walled arteries and one large, thin-walled vein. These vessels are surrounded by Wharton's jelly, a specialized mucous connective tissue that prevents compression of the cord in utero. Immediately following birth and the application of a cord clamp, circulation through these vessels ceases.
Over the first few days of life, the remaining cord stump undergoes a natural process of ischemic necrosis, commonly known as mummification or dry gangrene. The tissue dehydrates, turns brown, and eventually black. Separation typically occurs between 5 to 15 days postpartum, leaving a small, healing umbilical wound that epithelizes rapidly. Midwives must understand that a moist, foul-smelling stump or bleeding after separation falls outside normal physiological parameters.
Standard clinical management of the newborn umbilical cord focuses on keeping the area clean and allowing natural drying to occur. Midwives should instruct mothers to wash their hands thoroughly with soap and water before handling the baby's cord area.
Global health guidelines, including those from the World Health Organization, recommend dry cord care—leaving the cord clean and dry without applying any substance—for newborns born in health facilities with low neonatal mortality rates. However, in community settings across Nigeria where home delivery rates remain significant and neonatal tetanus and omphalitis pose severe threats, the application of 4% chlorhexidine digluconate gel to the umbilical stump is strongly recommended.
Chlorhexidine significantly reduces severe umbilical infections and neonatal mortality in settings with high risk of bacterial contamination. Midwives practising in rural Nigerian primary healthcare clinics must distinguish between urban facility protocols and high-risk community guidelines, ensuring that chlorhexidine is applied once daily during the first week of life where indicated.
Omphalitis is a serious bacterial infection of the umbilical stump and surrounding abdominal wall tissue. Midwives must teach mothers and recognize clinical red flags early, as localized infection can rapidly progress to systemic sepsis and neonatal death.
Preventing umbilical infections requires strict adherence to infection control principles across all levels of care. In the labour ward and postnatal unit, healthcare providers must practice proper hand hygiene before and after handling any newborn. Instruments used for cutting the umbilical cord must be thoroughly sterilized, and clean delivery kits must be distributed to pregnant women anticipating home births.
Furthermore, health workers must promote hygienic practices during bathing, ensuring that newborns are not immersed in unboiled water until the umbilical stump has completely fallen off and the wound has healed. Community health extension workers and traditional birth attendants must receive continuous training on clean cord cutting and the avoidance of harmful cord applications.
Effective maternal counseling bridges the gap between clinical instruction and home-based newborn care. Midwives should conduct practical demonstrations during antenatal and postnatal education sessions, showing mothers how to fold diapers away from the umbilicus and how to perform gentle cleaning when necessary.
Midwives must also empower mothers to recognize danger signs and seek prompt medical attention rather than relying on home remedies when complications arise. Clear, respectful communication ensures that mothers feel confident in caring for their babies without fear or the pressure of unscientific cultural practices.