Treatment of umbilical cords: a randomised trial to assess the effect of treatment methods on the work of midwives

The national code of practice for midwives practising in England and Wales defines duties during the postnatal period for the care of mothers and their babies. This period is a minimum of 10 days, and up to 28 days. Visits after the 10th day are at midwives' discretion, but a survey of heads of midwifery services suggests that most midwives would extend postnatal care beyond the 10th day if the baby's umbilicus was not healed. Methods used for routine treatment of the umbilical cord in the newborn babies vary widely. Previous studies suggest that the rate of healing depends on the treatment method used. This, in turn, can affect the workload of midwives responsible for the care of newborn babies. Babies born in the Royal Berkshire Hospital in the summer of 1984 were allocated at random to have their cords treated by one of four dusting powders, one of three cleansing methods and one of two frequencies of treatment, in a trial with a factorial design. The effect of treatment on the time to separation of the cord and the number of midwives' visits was estimated. It was found that the treatment method used could significantly affect the healing process and therefore the number of visits made by midwives after the 10th day, and that the choice of cord powder could significantly affect the midwifery workload in the district. The difference would be enough to account for the work of one whole-time equivalent community midwife for every 3000–5000 births.