Independent exploration of practice - Is there a perfect way of cord care?

Content

Introduction

The History of Umbilical Cord Care

Present Practice of Cord Care

German methods for cleaning or treating the umbilical cord

Traditional cord care practices worldwide

Medical practices of cord care worldwide

Evaluation of studies about cord care

Conclusion and recommendations for future practice

References

Bibliography

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 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).

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 we got the feeling that the family felt good with doing it. After some time we experienced no better results with the method of cleaning with Calendula-Oil. One disadvantage of using oil was sogginess which appeared after a few times of cleaning with it though we explained how to cleanse and dry the umbilical cord after using the oil. We did not think about whether it would be better to use Calendula-essence with alcohol rather than oil and stopped using the oil. Following we tried to get better experiences with cleaning just with water and cotton swabs, drying and a compress around the umbilical stump. And after this once more we thought about doing more with better results than just cleaning with the water. In this time I left the birthing centre for being on my own with homebirths. After reflecting the last years of my work experiences I decided at that time to use the Wecesin-Powder of WELEDA for preparing the stump of the umbilical cord for a quick falling off. But the parents should use the powder ample only if the umbilical cord was moist otherwise the cord should dry up without any measures. Until today the method of using powder or any other substance became less and less and nowadays I am using powder only in worse cases with a long delayed healing process or foul-smelling moisture around the cord stump. This essay now evaluates the (evidence-based) literature about the different sometimes already named methods and certainly every midwife finds her own used method included in this essay – a time to think about the own action.

[...]