Umbilical Cord Cutting by Relatives Without Medical Supervision
Relatives should not cut the umbilical cord without trained medical personnel present, as proper cord management requires specific timing, sterile technique, and immediate assessment of the newborn's condition to optimize outcomes and prevent complications.
Critical Timing Requirements
The timing of cord clamping is a medical decision with significant physiological consequences that cannot be safely delegated to untrained individuals:
For term infants not requiring resuscitation, cord clamping should be delayed for at least 60 seconds to allow optimal placental transfusion, which improves iron stores and reduces anemia risk in infancy 1.
For preterm infants (<37 weeks), cord clamping should be deferred for at least 60 seconds when immediate resuscitation is not needed, as this reduces mortality and improves hematologic outcomes 1.
Approximately 30% of the fetal-placental circulation remains outside the fetus at birth, and premature cord clamping before the onset of breathing can have major hemodynamic consequences affecting coronary and cerebral perfusion 1.
Medical Assessment Required Before Cord Cutting
The decision about when to clamp and cut the cord requires immediate clinical evaluation that relatives cannot perform:
Assessment of whether the infant requires immediate resuscitation must be made by trained personnel, as this determines the appropriate cord management strategy 1.
Evaluation for maternal, fetal, or placental conditions (monochorionic multiples, congenital anomalies, placental abnormalities, fetal compromise) requires individualized medical decisions 1.
The plan for umbilical cord management should be discussed between maternity and neonatal clinicians and parents before delivery, taking into account individual maternal and infant circumstances 1.
Sterile Technique and Infection Prevention
Proper cord cutting requires sterile technique to prevent life-threatening infections:
Neonatal sepsis is the third leading cause of death in the first month of life, and the newly cut umbilical cord is a pathway for bacteria causing sepsis and death 2.
Proper umbilical care requires keeping the area clean and dry using evidence-based dry cord care principles in settings with adequate obstetric care 3, 4.
Signs of umbilical infection requiring immediate medical attention include erythema extending >2 cm from the umbilicus, purulent discharge, fever, or systemic signs of sepsis 3.
Potential Complications Requiring Medical Management
Several complications can arise from improper cord management:
Umbilical hematomas may develop and require monitoring for excessive bleeding, signs of coagulopathy, or hemodynamic instability requiring fluid resuscitation or blood transfusion 3.
Active bleeding from the cord necessitates direct pressure and potential surgical consultation 3.
Polycythemia risk increases with delayed cord clamping (relative risk 3.82), though this is generally benign when managed appropriately 5.
Critical Pitfalls of Unsupervised Cord Cutting
Relatives attempting cord cutting without supervision risk serious errors:
Topical agents should never be applied indiscriminately, as silver nitrate or caustic substances can cause chemical burns 3.
Occlusive dressings must be avoided, as they create moisture and increase infection risk 3.
Prophylactic topical antibiotics should not be used, as they promote fungal infections and antimicrobial resistance without proven benefit 3, 6.
Recommended Approach
Medical personnel should perform all cord clamping and cutting procedures with appropriate timing based on the infant's gestational age and clinical condition, using sterile technique and proper equipment. Parents can participate in the birth experience through other meaningful ways while ensuring their newborn receives evidence-based care that optimizes survival and long-term outcomes 1.