What happens to the umbilical cord?

This is one of the frequent search terms I get, and I don’t think I’ve fully addressed it, so will do so now.

First, a brief elementary look at the placenta, umbilical cord and fetus. Within a few days after conception, the embryo implants in the lining of the uterus; part of the “conceptus” becomes a tiny placenta, while the rest of it becomes the fetus, with the umbilical cord in between. As the baby grows, so does the placenta and the umbilical cord. From what I’ve read, both the length of the cord and how much it coils depends on fetal activity; so a short cord and a straight cord are both correlated with low fetal activity. Fetal inactivity is associated with higher rates of fetal problems, so if either of these things is noted in an ultrasound, fetal abnormality is suspected. Short and straight cords may not be problems in and of themselves, but are associated with babies that have problems, although most babies are still fine with short cords. Long cords tend to be associated with very active babies — again, not a problem in and of itself, but babies can more easily become tangled in long cords, perhaps impeding birth, or if the cord wraps around the neck or tightens into a knot, can compromise or kill the baby with lack of oxygen. Long cords also increase the possibility of umbilical cord prolapse, since there is more cord that can come down before the fetal head.

The placenta is where the exchange of nutrients, waste, oxygen and carbon dioxide happens between mother and baby. During labor, the placenta keeps the fetus supplied with oxygen, just like during pregnancy; although the exchange is slowed or stopped altogether during contractions. This is why some babies go into fetal distress during labor that is artificially stimulated with Pitocin — the contractions can be too long or too close together, depleting the fetal supply of oxygen. It’s like holding your breath under water — if you can come up for air and breathe normally for several minutes, you’ll be fine; but if you can only take a quick gasp before being held underwater for another minute or two, you’ll eventually suffer.

When the baby is born, most hospitals will immediately clamp and cut the cord, although there is no reason for doing this, and the evidence simply does not support the practice. Other options include a “lotus birth” in which the cord is never cut, but the placenta is placed in a bag and carried with the baby until the cord dries up and falls off; waiting for several hours and cutting the cord (no clamp needed, because the cord begins to gel internally, cutting off the blood supply to and from the placenta, and the blood dries up); or at least waiting until the umbilical cord stops pulsing before clamping and cutting. If they don’t clamp the cord, it will be quite messy, since there is a lot of blood reserves in the placenta, and if they don’t clamp the baby’s side too, the baby can lose blood through the umbilicus.

Assuming the cord is not immediately cut, the baby is usually placed on the mother’s chest, where he may begin nursing, and where the midwife, doctor, or nurses observe the baby or give him a neonatal exam on the mother’s chest. The cord is typically long enough for the baby to reach the chest, even while the umbilical cord is intact, with the placenta still in the uterus. Usually within 15-30 minutes, the placenta detaches and the mother pushes it out.

Assuming the cord is immediately cut, the baby may be placed on the mother’s chest, or taken across the room for a neonatal exam, and other typical neonatal procedures (which you may request be delayed or not done altogether, like a vitamin K injection, eye drops or ointment, etc.). Many times, doctors will pull on the placenta to help it come out (controlled cord traction), although this is not necessary.

Once the placenta comes out, it should be inspected to make sure it is all there (occasionally a piece may be retained inside the mother’s uterus), or else the woman may experience continued bleeding, because the uterus acts as if the pregnancy is ongoing until all the “products of conception” are expelled. Once the placenta is entirely out, the uterus normally clamps down at the site where the placenta was attached, which is most easily described as a large, open, bloody spot, since that was where the fetus’s entire nourishment and oxygen supply was.

What happens to the placenta and the umbilical cord at this point may depend on where you give birth. At home births, it is not uncommon for women to choose lotus birth, to plant a tree or bush on top of the placenta (perhaps freezing it until springtime), or even to consume it (typically, dried and put in capsules; although I’ve heard of people eating it raw or cooked). If the woman doesn’t want it, some midwives or other birth junkies may save it for educational purposes — for instance, to show the next childbirth class what a placenta looks like.

In a hospital, choices may be more limited, especially if the hospital staff just follow whatever their routine is, and don’t ask or consult you. Some hospitals take samples of all placentas, as a sort of record that the placenta was healthy, should there be any future problems or questions with the baby’s health. I assume that most if not all placentas will be discarded as medical waste, and in fact have seen headlines (but did not read the story) about one couple’s fight with the hospital to be able to take their placenta home with them to plant a tree over it, which was traditional in their culture.

Here is an Australian midwife’s blog post in which she discusses the placenta, as well as has pictures of a real placenta, with descriptions.

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9 Responses

  1. Hi Kathy!

    This post about placentas and umbilical cords was very
    interesting. You know, I never even thought about asking
    to see mine, and now I wonder what they both looked like.
    Was the cord thick, blue, and curly like I see on video, or
    was it short, and straight? What about my placenta? I wish
    I could’ve seen it.

    Thank You
    B.

    P.S. Are there two membrane sacks around the baby? I often
    hear about one sack being ruptured when a women is in labor
    but not the other for the instant, and when I went to the
    linked site, she said something about the baby being inside
    of two sacks. Am I understanding this correctly?

  2. Hi, im trying to find some information about correct medical practises when it comes to delivering a baby. My sister in law went into hospital as she was having contractions. She thought she was 34 weeks. The doctor said she was 2 days from 9 months. The doctor told her it would be better to hold off the labor for as long as possible to give the child the best chance of survival. They were injecting her with something to hold off the labor, although concerns were raised that the baby is actually full term. My sister inlaws BP was through the roof, she was swollen and changing colour. They were left this way over night, a whole day and again over another night. The nurse done a routine check of the babys heart 3 times through the morning, each time the heart beat seemed weeker than the time before (when she first went into hosp the heart beat was fine) the 3rd time the nurse couldnt hear a heart beat, she raced to the doctor. the doctor put his hands up inside my sister in law, and pulle the umbilical cord out (disconnected from the baby) and they done a c-section. Is this normal practise? he pulled the umbilical cord out and cut it from the baby before the baby had been born. The baby died, still born, the baby didnt look premature, he looked like a full term healthy baby, his head was pink and the rest of his body was grey/blue Everyone is devistated at what happened, and we dont know if what happened is a normal practise. the doctor couldnt even tell if the baby was full term or not. So is pulling out the umbilical cord and severing it from the baby while its still in the womb normal practise if the doctor thinks that the heart has stopped beating?

    • Angel,

      First, let me give my condolences about this horribly sad situation — I cannot even imagine!

      I am not a doctor, so I would suggest getting in contact with a doctor in your area to verify what I will say in this response. There are multiple concerns your narrative raises, so this response will be lengthy, but I hope will give you the information you need.

      There is a big difference between a baby at 34 weeks gestation and “two days from nine months”; although with a modern Western hospital, survival rates for babies born at 34 weeks are very high. If she was nearly term, most doctors (at least in the United States) would not try to stop labor; in fact, some might not even try to stop labor at 34 weeks. The biggest concern with a premature baby is that they will not be able to breathe well after birth. If your SIL was in fact at 34 weeks, an extra day or two in the womb may have helped the baby avoid several days in the neonatal intensive care unit (NICU); if she was nearly term, the baby should have been able to breathe just fine, and I don’t know why the doctor would have held labor off.

      In a “typical” pregnancy, most women go to the midwife or doctor early in pregnancy, they assess how far along she is (using her information about when her last menstrual period was, and/or when she likely conceived; as well as a pelvic exam to feel how big the uterus is; and possibly an ultrasound to see how big the fetus is — the date of a pregnancy is accurate to plus-or-minus 5 days in early pregnancy; ultrasound dating is less accurate as the pregnancy goes on, being plus-or-minus two weeks by the end of the pregnancy), and tell her when her estimated due date is. But sometimes the pregnancy cannot be so accurately dated, or there is some discrepancy between the different ways of dating the pregnancy, and some resulting confusion. If there was concern about how far along your SIL was when she went into labor, I would think that the first thing that would be done would be an ultrasound to see how big the baby was — even though it would have a margin of error (+/- 2 weeks, and +/- 1 lb of weight), it would still be useful to get an estimate of the baby’s gestational age and due date. “Palpation” (feeling the baby through the mother’s abdomen) can also be accurate to estimate the baby’s size. It is rare for a baby at 34 weeks to be seven pounds or more (about 3 kilograms or more), and it is also rare for a full-term baby to be less than about six pounds or so (about 2.5 kg or less). So if the estimated fetal weight was about 3 kg, then it would be a good indication that the baby was full term; if the estimated weight was 3.5 or even 4 kg, then it would be almost unheard-of for the baby to be premature. On the other hand, if the baby’s estimated weight was 2 kg, then it would have been unlikely (but still possible) for him to be full-term.

      If there were concerns about the baby being premature (again, the biggest concern is not being able to breathe properly), they could have done an amniocentesis to check fetal lung maturity. Amniocentesis (“amnio”) is a procedure in which doctors insert a long needle through the mother’s abdomen and into her uterus to draw off some of the baby’s amniotic fluid; it is usually or always done with ultrasound (u/s) guidance to make sure the baby isn’t pricked. Amniotic fluid contains fetal cells, and by looking at these fetal cells, they can tell if the baby’s lungs are developed enough to breathe. If they are still immature, then steroids (not like body-building testosterone steroids, but another kind) can be given to the mother to help with the maturation process, so that the baby will be able to breathe better when born. Sometimes there is no chance to do this — labor cannot be stopped, or the baby’s or mother’s condition is so poor that it really is best to hasten the baby’s birth; but usually if there is a way to get the baby’s lungs more mature before birth without compromising the health of either mother or baby, then it will be done. However, many times an amniocentesis will show that even a preterm baby has well-developed lungs and will not need steroids to help him breathe properly after birth. You don’t mention if your SIL had an amnio done, or if the doctor was just working on assumptions.

      You say she was injected with something to hold off labor — she may also have been given an injection of steroids to help the baby’s lungs mature. Steroids of this kind often make a person swell and gain weight (although my knowledge and experience with this is limited to oral corticosteroids like prednisone dispensed in pills for certain types of allergic reactions or asthma — long-term use can cause a person to swell — a day or two shouldn’t; but I’m not sure if the medications used for the baby’s lungs would cause the mother to swell like this.

      Generally, high blood pressure and swelling are a cause of concern in a pregnant woman — these can be markers or signs of preeclampsia, which can be dangerous or even deadly to mother and/or baby if ignored. If these symptoms were a result of the medications she was given, then it likely wasn’t preeclampsia, but I would certainly look more into this possibility.

      Now, about the heartbeat — if it was fine at first, and then grew weaker, I would think that would be a cause for concern! I would question the doctors and nurses as to why nothing was done if the heartbeat was non-reassuring. Instead, what happened was, they waited for the baby to have an absent fetal heartbeat before doing anything. It seems as if the doctor was more concerned about the baby’s possible prematurity than his intra-uterine demise.

      I cannot imagine the scenario in which a doctor would pull out an umbilical cord and cut it before the baby’s birth! What I can imagine happening is the doctor attempting to put in an internal fetal monitor to check the baby’s heartbeat (it is possible for it to be difficult to get the baby’s heartbeat using a fetoscope or electronic fetal monitoring or by some other external method; but with an IFM, a sensor is screwed directly into the baby’s scalp to get his pulse, so is definitely accurate), and then when he broke her water (also known as amniotomy, artificial rupture of membranes, AROM) in order to apply the sensor, the umbilical cord prolapsed and came out. You said that the cord was disconnected from the baby — that is possible, but if I were you, I would verify that this is what happened, and not that part of the cord came out. Umbilical cords can be fairly long, so a section of the cord could come out of the vagina while still being attached to the baby and the placenta. It is also possible that there was a problem with the cord (such as velamentous insertion or vasa previa), which caused the umbilical cord to detach when the doctor broke her water and come out of the uterus. It’s also *possible* but not likely that the doctor reached up into your SIL and felt the baby’s umbilical cord to see if there was still a pulse in the cord which would show that the baby was still alive (even if he were barely alive); but I still cannot imagine the doctor cutting the cord before the baby was born!

      Finally, once a baby is born, his or her gestational age can and should be assessed. I have the papers (somewhere) of the newborn assessment of my first son, and watched the newborn assessment of my second son, and remember that they did things like estimate the amount of vernix (the creamy substance that coats the baby’s skin before birth), lanugo (fine body hair on a fetus that usually disappears by term), the way he held his arms and legs (babies of different gestational ages have different amounts of flexibility or something — I forget exactly what), etc. There were probably a dozen different things they looked at; of course, with a stillborn infant, some of these couldn’t be done, but there should still be enough “markers” to determine the approximate gestational age — certainly enough to determine if the baby was premature or not.

      Sometimes stories get mixed up and facts are poorly understood or confused. I would strongly suggest that you (or someone in the family) talk again with this doctor, as well as with the nurse(s) who took care of your SIL while she was in the hospital. It may be that some of your questions and concerns are the result of poor communication from the medical staff to your SIL, or getting the facts confused when telling you. If, however, what you’ve said is accurate, I would be greatly concerned about the doctor’s handling of the case. Again, once you verify the facts of the case (your SIL probably can get her medical records from when she was at the hospital, which I strongly suggest — in the US, while the physical records are the hospital’s property, the information contained in the records are considered the patient’s property, since it is information about her, so hospitals are typically required to give copies of the records to the patient if she requests them, although sometimes they have to insist upon the right to the information), and review any questions with the doctor and/or nurse(s) at the hospital, I would discuss it with another doctor or midwife (somebody with obstetrics training), if there are still any questions or concerns. There are several things which seem irregular to me, but I may be mistaken in these, and someone with more education and training in this field may have better answers than I can give.

      If you have any further questions or concerns, don’t hesitate to ask.

  3. Hi, Just wanted to say thank you for this post! Very insightful.
    Kindly,
    Mona

  4. my 5 and half month fetus in my womb died.. he has a malformed umbilical cord..what could be the possible reason for that?

    • I’m sorry for your loss! I don’t know what could have caused it; sometimes the cause can be known or identified, and other times it’s still just a mystery.

  5. Another destination for the placenta is donation. I have arranged to donate ours to the team that trains search and rescue dogs as well as cadaver dogs. One placenta can be used for up to 100 training sessions for the dogs. We are having a hospital birth and the team has arranged to come pick it up from the staff after our birth.

  6. Hai,

    Please help me to find answer for below mentioned quotation?
    After the delivery umbilical cord will be clamped and little cord remaining with baby after healing will fall down , Do that cord can help infertility?

    I have hard this from last generation say same that having the umbilical cord can help in pregnancy. Would it be possible?

    Please revert on mail me back awaiting for replay with positive hopes.

    Yours

    • I haven’t heard that; I don’t see how it would help with future fertility. If it does, it seems more logical to keeping the entire placenta and the long piece of umbilical cord that is cut off from the baby would be better than keeping the little stump that is left on the baby which falls off to form the belly button.

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