MSc Midwifery

Independent exploration of practice

- Is there a perfect way of cord care?

NCHMC43/05/C

Assignment 1 - Word count: 3635

Stefanie Marcia Barreto-Nunes

Submission date: 24th July 2006

Title:

Independent exploration of practice - Is there a perfect

way of cord care?

Content:

Introduction 3

The History of Umbilical Cord Care 4

Present Practice of Cord Care 5

German methods for cleaning or treating the umbilical cord 6

Traditional cord care practices worldwide 7

Medical practices of cord care worldwide 8

Evaluation of studies about cord care 9

Conclusion and recommendations for future practice 12

References 15

Bibliography 19

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Introduction:

No matter how far one looks back in the history of mankind: As long as humans are born by

women there were midwives and there will be midwives.

The knowledge of "wise women" led already in the Middle Ages to uncertainty - particularly

among the physicians and church princes. Midwives were strongly affected by witch-hunt.

Many were burnt at the stake, because people did not trust their knowledge and their art ­

because of ignorance or eagerness for power. At that time midwives were considered to work

in the function of a gynaecologist or as a person with healing skills which got their knowledge

as a gift. They acquired their knowledge through the knowledge of older women and own

practical experience. The current and historical literature about the midwife art gives an idea

of this traditional occupation of woman (Skolik 2001). This knowledge developed more and

more and passed on since generations. But nowadays the situation has changed: Many

midwives are working on their own with their own experiences and their own unverified

methods of practice. This already begins in the time of the midwifery training without

standards in many working areas. The care of the umbilical cord of the baby is in the homely

care of the midwife again and again in discussion (Edelmann 2003). The unverified methods

of practice in midwifery tasks are widespread in different working fields and should initiate a

development of caring with evidence-based background. Dannenfeld (2001) stated in their

work about the significance of the salutogenetic concept of the midwifery work that in this

work it is important to deal with scientific topics for achieving a more effective and more

professional work. This statement is emphasised by the Schweizer Hebammenverband (2006).

They mentioned that the midwifery work is including the task of assuring and further

development of their quality of work.

The experiences in Germany with the umbilical cord care are quite heterogeneous. Every

midwifery school is using different methods and every midwife is having their own method

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or, in contrary, is working after a special devised standard of the hospital. Sometimes during

meetings of midwives they share their experiences and knowledge but almost none of the

different methods they share are deeply evidence-based or substantiated with well-written

scientific literature. The search for evidence-based literature was quite difficult for this essay

because many recommendations are not well-explored and based only upon subjective

experiences and opinions.

In 2002 the World Health Organisation (WHO) mentioned in their training modules about

Essential Antenatal, Perinatal and Postpartum Care that throughout the world there are

numerous methods of caring for the cord, but the most effective is to use NO application to

the cord but to keep it clean and allow it to dry over the first two days. In context to this

statement this essay works out the different actually used methods of umbilical cord care and

their advantages and disadvantages in comparison to the recommendations of the WHO.

The History of Umbilical Cord Care:

For a deeper understanding of the progression of the various methods of cord care a short

historical outline if following:

In the 1950s, frequent epidemic outbreaks of staphylococcus in newborn nurseries were

occurring (Haque & Baldwin 1964).

In 1969, a six and a half year study of hexachlorophane baths substantiated its effectiveness in

eliminating staphylococcal infections and resulted in recommendations for major changes in

the standard of care for newborns (Williams & Oliver 1969).

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Since the 1970s, it has been widely accepted to use some form of topical antimicrobial to treat

the umbilical cord. Other accepted cord care practices include assessment of the cord for signs

of infection, good hand washing between infants, folding down the diaper to avoid

unnecessary friction or soiling, avoidance of tub baths widely accepted to use some form of

topical antimicrobial to treat the umbilical cord (Perry 1982).

Since the 1980s, studies have continued to evaluate differences in cord care regimens and

staphylococcal colonization and infection and cord separation times (Dore et al. 1998).

Present Practice of Cord Care:

Mändle et al. (1997) mentioned in their book (often used for the midwifery education) that in

the last years the care of the umbilical cord became worldwide a less important part. The

midwife or nurses of the hospital have to show to the parents that the cleansing of the cord

stump has to be done carefully with good hygiene. The cord care should bring forward the

drying (mummification) of the stump with avoiding an infection of the cord wound.

During more than seven years of work experiences I changed my own method several times.

But with own insufficient case numbers of patients and the lack of evidence-based literature it

is difficult to work out the best own way of caring. At the time when I was an entrant in the

midwifery profession I started working in a birthing centre where three experienced

colleagues were giving me their support. Through and with the different methods of umbilical

cord care of these three midwives I learned a lot and developed my own method. At that time

I or rather we always used the Calendula-Oil for cleaning the umbilical cord. We left the oil at

the parents house and told them to clean with the oil whenever the cord is stinking or seems to

be moist. This caring for the cord when the midwife is not available occupied the parents and

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