So you may think, WTH?  Why would I even need to worry about removing the sac or cutting the umbilical cord on a kitten?
WARNING: Graphic photo may not be suitable for those weak at the stomach.

Photo owned by 9 More Lives

There are several reasons. If this is the mama cat’s (queen) first litter, she might be cleaning the previously born kittens and leave the newborn in the sac for several minutes or in some cases not have the strength or even reject the kittens. If this happens, put on your sterile gloves then tear open a couple sterile gauzes and clear the airway as soon as possible. The sac will feel as strong as a latex balloon and requires a good pinch by the mouth. Once you have broken the sac, start from the face with a clean sterile gauze and rub away from mouth area. Continue rubbing the sac until removed from newborn. This process could easily take up to a dozen sterile gauze pads.

Photo owned by 9 More Lives

This kitten was the last of the litter. While it is normal for a mama cat to lick herself until the kitten is born,  this particular mama cat only did for the first of five.  All others were born with her laying on her side.    Kittens 2, 3 and 4 needed assistance with sac removal to clear the airway and kitten 5 was left in the sac for several minutes.    Following each kitten will be the placenta.  After a while you can lose track of what’s next. What you might think is placenta laying there could very well be a kitten.

Still attached to the placenta (graphic parts cropped), this kitten went straight for the nipple after airway was cleared. If the placenta has been born and ignored by the mama cat, take your hemostats and clamp a couple of inches from the kitten.  Then get thread or spool of dental floss (you will need about 8-12″ to cut umbilical cord) and measure 1″  from the point where it is attached to the newborn or about half way between kitten and hemostats, tie and pull hard until detached. This was recommended by the vet though I found that using the sterile scissors and cutting 1″ from newborn is easier and works the same. Just make sure you do not cut the newborn kitten.

As disgusting as it sounds, the mama cat eats the placenta. Supposedly this gives her strength to continue. Before you cut the umbilical cord, offer to the mama, if she refuses or rejects, you must cut this yourself.

By now, the kitten will naturally find the nipples and begin to eat. Allow the mama cat to clean them and put her own scent on each newborn kitten.