Newborn Belly Banding

Why is it still happening in some countries?

Deborah Hamilton works with a midwife in Madagascar and witnesses the routine practice of binding a newborn baby’s umbilical area. She wonders why it is still practiced there. "I've asked the  Midwife I work with, "Why do midwives in some countries cut the cord at 2", wrap it with gauze and then wrap an ace bandage around the baby's belly?" The midwife, (who knows only a little English), either doesn't understand the question or doesn't know the answer. She says it's to keep air from getting into the baby's stomach. Some mommies bring their babies in for well-baby checks and every one I've seen has had some degree of infection in that area. “


Peace, Deborah
 

Answer:

 Susan Oshel, CPM:  Binding of the cord was a practice prior to the 1940's. It was thought that the cord stump was at risk of becoming infected and wrapping it kept bacteria from entering and causing infection. The result was infection. The cord area, the part that loosens and falls off at the umbilicus, does not dry while being bound and the constant moisture on an area of human tissue that is decomposing and wanting to fall off actually causes the resulting infections by promoting rampant growth of bacteria in the area. In the 1940's it was being investigated with more knowledge of bacteria and deemed a dangerous thing to do and it was discontinued in most industrialized nooks of the world. Actually, most countries have ceased the wrapping of the cord area after birth. Instead, the cord is clamped and cut and allowed to "dry" by being exposed to air and not kept enclosed and moist.

Currently, every midwife has her own way of advising parents about cord care. Some midwives leave the cord long and clamp it, some clamp it shorter. Some cords are left alone and exposed to the air to dry, others apply Goldenseal Powder and/or Hydrogen Peroxide to the area. Many midwives have ceased recommending both of those because they keep the cord area moist, causing irritation or infection even though Goldenseal and Hydrogen Peroxide both have antibiotic properties. Some midwives simply crimp the cord with hemostats for an hour after birth and leave with the cord un-clamped. Occasionally a crimped and unclamped cord has opened and bled and needed attention. Some families have chosen to leave the cord attached to the placenta till the cord falls off on its own. This practice is called "Lotus Birth". The placenta stays with the baby until the cord and placenta fall off.

Through my years as a midwife, babies have taught me that leaving their cords alone and kept dry works best. If their cord area becomes reddened with a strong odor, the remedy that works best is to apply a few drops of alcohol to the umbilical area against the skin a few times a day. It works very well. The 600(+) babies who have been my teachers didn't protest when the alcohol was applied, especially if it was warmed to room temperature. Mostly, the baby's cord areas were left alone, exposed to air and did just fine.

The practice of banding the baby's umbilical area, which is still being done in countries like Madagascar, has intrigued me. I decided to travel back in time through some of my old textbooks and research how it was medically handled in the early 1900’s ~ 1970's.

I'll share a bit of this history with you through a few old textbooks. Notice the change of practices caring for the cord throughout the years as reflected in these texts.

1914

THE PRINCIPLES AND PRACTICES OF OBSTETRICS by Joseph B. De LEE, A.M., M.D., 1914 pages 336~337

Care Of The Child “While the third stage of labor is being conducted, and the accoucher and the nurse are devoting their attention to the mother, the infant lies in it’s crib, securely and warmly wrapped up with the cord being observed occasionally for possible bleeding. After the confinement room is set to rights, she takes the baby and dresses it, preferably in an adjoining apartment, to avoid disturbing the sleeping mother. First the whole body is rubbed with warm, sterile, solid alboline or benzoinated lard, paying particular attention to the places where vernix is accumulated. The fat dissolves the vernix. No bath is given. Next the stump of the cord and the navel region is washed and the wound dressed with sterilized gauze, a sterile belly-band being put over this primary surgical dressing. All this must be done near a fire, away from chilling drafts.”

Attention To The Cord “The navel is treated like any surgical open wound. While the binder is changed as often as it becomes soiled, the dressing of the cord is not disturbed. If the gauze becomes dislodged or wet it is changed. Dusting-powders are not used unless the stump shows signs of moist gangrene.”

1943

NURSES HANDBOOK OF OBSTETRICS 7th edition by Louise Zabriskie, R.N. and Nicholson J. Eastman, M.D. 1943 pages 350~352

Care Of The Cord“As soon as the baby has cried vigorously and expanded the lungs, the pulsation in the cord will begin to fail, and the physician will then clamp or tie the cord. The cord is usually tied about one inch from the umbilicus, a sufficient length to allow a second ligature if there is any subsequent bleeding. After the cord has been ligated and cut, a sterile pad of gauze is applied. The corners are folded over the stump and then the straight binder is applied as a bandage.”

“In some hospitals, the binder and dressing are removed within 48 hours. The cord is left open and it apparently dries and separates more quickly than when covered. There is less irritation of the back and abdomen which sometimes results from the moist binder. Some pediatricians think the abdominal muscles become stronger by not being bound. “

1971

MATURNITY NURSING 12th edition by Elise Fitzpatrick, R.N., M.A., Sharon R. Reeder, R.N., M.S. and Luigi Mastroianni, Jr., M.D., F.A.C.S., F.A.C.O.G. pages 367~368

Cord“A cord dressing is considered to be unnecessary in most hospitals since exposure to the air enhances drying of the cord. No attempt should be made to dislodge the cord before it separates completely. The cord usually becomes detached between the 5th and 8th days after birth, but its detachment may be delayed until the 12th or the 14th day without concern. No further treatment is necessary, except to keep the part clean and dry. When inflammation is present, the physician will give specific orders for care. “

....And Now ~ As we speak about old practices and our evolution toward better ways of handling situations, it brings to mind the need to truly learn about the Health Care Professionals who have gone before us. Many of our granny midwives also banded the baby’s bellies and have remarkable stories. It comes to my mind in this journey into the past to remember and honor our ancestor midwives who gave us our soulful foundations. Though they practiced things we no longer do, they also fostered care that was from the heart. Though we now disagree with belly banding and many other things, because we have grown in knowledge, prayerfully we have maintained the heart that was set before us; the heart that has been lost in some of our litigious societal beliefs and practices. Let’s never forget.

Please read some of the biographies of our ancestor midwives, who probably did band the baby’s belly. So many wonderful stories that will touch your hearts! They are priceless! Following are a few:

MY BAG WAS ALWAYS PACKED The Life and Times of a Virginia Midwife by Claudine Curry Smith & Mildred H.B. Roberson

ORLEAN PUCKETT The life of a Mountain Midwife 1844~1939 by Karen Cecil Smith

MOTHERWIT An Alabama Midwife’s Story by Onnie Lee Logan as told to Katherine Clark

WHY NOT ME the story of Gladys Milton by Wendy Bovard & Gladys Milton

A MIDWIFE’S TALE The Life of Martha Ballard, Based on Her Diary, 1785~1812

LISTEN TO ME GOOD The Life Story of an Alabama Midwife by Margaret Charles Smith & Linda Janet Holmes

MABEL The Story of ONE MIDWIFE by Elizabeth Redditt-Lyon

SISTERS ON A JOURNEY ~Portraits of~ American Midwives by Penfield Chester (More current bio’s of sister midwives, some older ones, too.)

HOUSE CALLS IN THE HILLS Memoirs of a Country Doctor by Jay Banks, MD (Dr. Banks was not a midwife but might as well have been one!)

Hope this helps!
Love and Joyful Learning, Susan

We welcome your views on this. Where have your experiences with cord care led you? Feel free to share your beliefs and educational journeys.   It is through the uniqueness of our combined knowledge that  wisdom can be grown, and I would love to hear from all of you.