Clean delivery and cord care means observing principles of cleanliness throughout labour and delivery and after birth until the separation of the cord stump. Principles of cleanliness at birth are:
• clean hands
• clean perineum
• nothing unclean to be introduced into the vagina
• clean delivery surface
• cleanliness in cutting the umbilical cord
• cleanliness for cord care of the newborn baby
The hands of the birth attendant must be washed with water and soap, as well as the perineum of the woman. The surface on which the baby is delivered must be clean. Instruments, gauze and ties for cutting the cord should be sterile. Nothing should be applied either to the cutting surface or to the stump. The stump should be left uncovered to dry and to mummify.
Principles of cleanliness are as essential in health facilities as they are at home. In addition to hygiene during delivery - clean hands, clean environment, sterilized/disinfected equipment and supplies - these principles include special measures for newborns to prevent hospital infections - rooming-in, prevention of overcrowding, provision of clean water and washing of hands by health personnel. Institutional policies need to define methods for prevention, detection and control of nosocomial infections.
There is an abundance of traditional practices for cutting the umbilical cord. Many of them are harmful. Those that observe the principles of cleanliness can be preserved but others must be changed. For home deliveries, the use of simple disposable delivery kits will help in achieving a clean a delivery as possible. The kit should contain, as a minimum, a nail cleaning stick, a small piece of soap for clean hands and clean perineum, a plastic sheet of about 1 x 1 m to provide a clean surface, and a sterile razor blade, ties and gauze for the clean cutting and care of the umbilical cord. All the materials should be packed in a sealed plastic bag with instructions on how to wash hands thoroughly before delivery and again before handling the baby's umbilical cord, and how to use other items in the package. The best means of producing, distributing and promoting the kits to pregnant women should be determined locally. One option is the local assembly of disposable delivery kits by women's groups.
The cord stump remains the major means of entry for infections after birth. Principles of clean cord stump care (keep it dry and clean and do not apply anything) apply at home as well as in the health facility. The stump will dry and mummify if exposed to the air without any dressing, binding or bandages. It will remain clean if it is protected with clean clothes and is kept from urine and soiling. No antiseptics are needed for cleaning. If soiled, the cord can be washed with clean water and dried with clean cotton or gauze. Local practices of putting various substances on the cord stump - whether in health facilities or homes - should be carefully examined. They should be discouraged if found harmful and substituted with acceptable ones.
If the umbilical stump is draining pus, the skin around it is becoming red and it has a foul smell, these are signs of an umbilical infection that requires treatment with antibiotics. If the baby stops suckling well, is sleepy, does not wake up or is having difficulty breathing, this may be a sign of serious infection. The baby must be referred immediately to the hospital for proper treatment.
Infections acquired after birth need special attention. They can be prevented by clean practices, clean delivery and cord care, early and exclusive breast-feeding, rooming-in, thermal protection by early skin-to-skin contact, and eye care. Maintaining the mother-infant contact that was established immediately after birth favours colonization of the infant's skin and gastrointestinal tract with the mother's microorganisms, which tend to be non-pathogenic and against which the mother has antibodies in her breast milk. The infant is thus simultaneously exposed to and protected against the organisms for which active immunity will be developed only later in life. There are a number of ways to organize rooming-in to allow a mother free and easy access to her infant, whether the infant shares the mother's bed or is in another bed in the same room. In health facilities where mothers and babies are separated, babies are often kept in nurseries where they share equipment and supplies. Here they may be exposed to microorganisms of the hospital staff which are more pathogenic, are often resistant to many antimicrobial drugs and for which breast milk contains no specific antibodies. Keeping babies with mothers, and having mothers taking care of them, eliminates the danger of cross-infections.