My Baby’s Cord Blood: To Bank or Not To Bank? by Jodilyn Owen you may reprint this and distribute it for educational purposes as long as you cite the source!! You may copy and paste this onto your website with a link to www.seattlebirthnet.com
This is the question so many parents are faced with from the time they receive their first flier or see an ad for cord banking from one of the many companies promoting their services. Unfortunately, these companies often use scare tactics instead of well documented information parents can use to make informed choices. This pamphlet aims to dispel the sales pitch and present objective research based evidence about the effects of cord blood collection on your newborn baby—someone often overlooked by these organizations. It will also connect cord blood banking to the effects of losing that blood on your baby. Throughout your pregnancy, your baby's blood cycles constantly from the placenta where it receives oxygen and nutrients, through the cord, to the baby's body, and back through the cord to the placenta again. At birth, this cycle naturally finishes in a state where the baby has the blood volume it needs, the cord stops pulsing and then closes. In order to bank your baby's blood, you will need to clamp the cord before the natural conclusion of this process, preventing your baby from receiving the full volume of blood that it would normally receive. ____________________
What are the Options?
After the birth of your baby, there are several pathways providers will be familiar with. It is important to understand the consequences of each and make an educated decision. They are: • Wait for the cord to stop pulsing and then clamp and cut it • Wait for the delivery of the placenta and then clamp and cut the cord • Have a ‘Lotus Birth’ which involves leaving the placenta and the cord attached and intact until they naturally separate from the baby • Clamp and cut the cord immediately after delivery without collection • Clamp the cord immediately after delivery and proceed with collecting the cord-blood from the placenta according to the instructions from the blood bank
____________________
How Does It All Work? Here’s a brief overview of how the normal, physiological relationship of the newborn, placenta, and umbilical cord works [5]: • Before birth, the placenta is responsible for supplying your baby’s body and brain with the oxygen it needs • After birth, the baby takes in air, which pushes the fluid out of the alveoli in the lungs, and after 4 or 5 breaths the fluid is gone and replaced by air, and the lungs take over the duty of supplying oxygen to the baby • The shift from being supplied by the placenta to being supplied by the lungs occurs after the baby is born but before the placenta is delivered • With the increase in blood volume provided by the flow of blood into the baby through the cord, from the placenta, this transition is seamless and the baby has the full amount of oxygen it needs for its body and its brain at all times • During this uninterrupted process, the placenta does not stop providing oxygen for the baby until the lungs take over
When this process is interrupted by early clamping of the umbilical cord, there is not a seamless transition of oxygen supply to your newborn’s brain, leaving your baby vulnerable to the consequences of time spent without oxygen and a less than ideal amount of blood. These consequences can include brain damage and anemia of varying degrees [7]
One way of understanding how much blood volume is denied a baby who has a cord that is clamped early, is by looking at the fact that if you were to remove that much blood volume by percentage in an older child or adult, they would go into hypovolemic shock.
____________________
Why Clamp and Cut Immediately After Birth?
While there is well documented history of obstetricians dating from 1733 honoring the natural physiological process of allowing the cord to stop pulsing before clamping and cutting it, around the 1970’s things started to change. [1] The practice of clamping and cutting the cord immediately after birth became common and recommended, followed by the placing of the baby on the warmer for administration of respiratory therapy and other treatments the newborn was given while separated from its mother. As labor and delivery increasingly became a medical event during which both mother and baby were treated as though they were ill and needed healing, obstetricians micromanaged every element of birthing. This included the cutting and clamping of the cord to streamline and increase the efficiency of the delivery and newborn care.
Some providers clamp and cut immediately because of respiratory distress in the newborn. However, “any required resuscitation is safer and more effective when done while the cord and placenta are supplying the child with oxygenated blood" [7]. Some immediately clamp and cut as a matter of course unless asked to do otherwise, simply because this is what the learned. ____________________
Why Wait to Clamp The Cord?
After birth, the newborn child will increase its blood volume by 30-50% [2] [7]. After the process of respiration starts in a newborn (gasping), uterine contractions continue to push blood from the placenta to the newborn. There is evidence that the child will reflexively control its own blood volume and permanent, natural closure of the vessels of the umbilical cord occurs and the child now has the optimal blood volume for survival [2]. ____________________
I have a child or relative with leukemia or another transplant-treatable disease and doctors have told us we should bank our child’s blood Please visit the CHORI Sibling Donor Cord Blood Program for more information regarding how to proceed with proper collection. This service may be free of charge or at the most require the family to cover costs and is not for profit.
____________________
What does the American Academy of Pediatrics say about potential benefits to my child if we do not have any transplant-treatable diseases in our family history?
The AAP states that, “Families may be vulnerable to emotional marketing at the time of birth of a child and may look to their physicians for advice. No accurate estimates exist of the likelihood of children to need their own stored cells. The range of available estimates is from 1:1000 to 1:200,000. Empirical evidence that children will need their own cord blood for future use is lacking…For these reasons, it is difficult to recommend that parents store their children's cord blood for future use.” The AAP also “points out that if cord clamping is done too soon after birth, the infant may be deprived of a placental blood transfusion, resulting in lower blood volume and increased risk for anemia later in life” [6]
Clamping before the vessels of the umbilical cord naturally close is a disruption of this process and will leave the newborn without the optimal volume of blood—requiring it to spend precious energy (calories) in the early weeks of its life generating new blood instead of using those calories for warmth and growth. ____________________
What is the Role of Blood Banking?
Whether you are looking into blood banking as a donation to a public bank or to place in a private bank, it is important to consider the effects of collecting cord blood on your newborn and the actual real potential for its future use.
Some information to consider: • Collecting cord blood involves the early clamping of the umbilical cord, interrupting the physiological process your newborn would otherwise be engaged in of regulating the amount of blood it takes into its system from the placenta. • By the time your child or their sibling would need the cells; they will likely be too big for the amount of cells present in the amount of blood taken at birth [3] though research is being done to improve this situation. • Iron stores and Hemoglobin in infancy can be improved in neonates born to anemic mothers by delaying cord clamping at birth [4].
____________________
Exceptions There are of course, times when clamping early is necessary as in the case of a cord wrapped too tightly around the neck for the Midwife or OB to get her fingers in to loosen it and unwrap the cord, or the threatened health of the mother. This is one of many reasons parents should be with a provider they trust will make the right decision at the right time for the health of their newborn and the mother.
Sources: 1. http://www.cordclamping.com/History.htm 2. Gunther M. The transfer of blood between the baby and the placenta in the minutes after birth. Lancet 1957;I:1277- 1280. 3. http://www.parentsguidecordblood.com/, Medical Pros & Cons to Banking Cord Blood 4. Gupta, Rajesh and Ramji, S. Indian Pediatrics 2002; 39:130-135 5. Adapted from Morley GM. Cord Closure: Can Hasty Clamping Injure the Newborn? OBG MANAGEMENT July 1998, 29-36 6. http://www.consumers-info.org/cordblood/id4.htm 7. Morley, George M. http://www.mercola.com/2002/jan/2/umbilical_cord.htm
Written by Jodilyn Owen of www.seattlebirthnet.com