Updated: February 2022
(effective placental transfusion results in an empty white cord)
When I was a bright-eyed and bushy-tailed student midwife, I was awarded with a certificate and a box of chocolates. My achievement was collecting the most ‘cord’ blood in the hospital. At that time, the Local Health District was trialling a ‘cord’ blood bank. The collected blood was to be used for treating leukaemia and for research. Every woman birthing in the hospital was asked to donate ‘cord’ blood for the good cause, and many generously agreed. I was exceptionally good at collecting the blood. This post is a small attempt to repent for my sins.
‘Cord’ blood is baby’s blood
The term ‘cord blood’ is misleading. The blood collected via the umbilical cord is the baby’s blood. When adults donate blood it is collected via their arm. We don’t refer to that blood as ‘arm blood’.
During pregnancy, the baby and placenta share the baby’s circulating blood. The placenta provides an extension of the baby’s circulation. This allows the baby to receive nutrients and oxygen from the intervillous space between the (separate) mother’s circulation and the placenta. After birth, the placental circulation alters, sending all the baby’s blood into their body. You can read more about the ‘physiology of newborn transition’ in this this post and more about transfusion by the placenta in this movie:
Knowledge about the short term and long term health benefits of the baby having their full blood volume at birth is now widespread (see this post for details).
Stem cells
Stem cells can self-renew (make copies of themselves) and differentiate (develop into more specialised cells). At birth, babies have haematopoietic stem cells in their blood. This type of stem cell is similar to those found in bone marrow and can regenerate red blood cells and immune system cells. The likelihood is that these stem cells play an important role in repairing any damage done during birth (Dr Mercer discusses this in a podcast). They may also play a role in longer term protection from disease.
The business of collecting babies’ blood
Companies are targeting parents and making big money by removing and storing their baby’s blood. Care providers are also making money from recruiting parents and collecting blood for these companies. The sales pitch is: if your baby develops a particular type of illness in the future, you may be able use their stored stem cells as treatment. These companies are increasingly sponsoring care provider organisations and events; and buying endorsement from obstetricians and midwives. I have even been approached to endorse their services several times—clearly they had not read this post. I also get fairly regular comments on this post from undercover company reps (I can see their email address). I am deliberately avoiding linking directly to any company websites in this post – I don’t want to send them traffic or potential customers.
My primary concern with ‘cord’ blood banking is the misleading information given to parents. This misinformation raises both ethical and legal issues. There are two main areas that require further clarity: blood collection volumes and cord clamping and the effectiveness of stem cell treatments.
Blood collection volumes and cord clamping
Parents need to be informed that baby’s blood collection requires premature cord clamping, and that the blood being collected belongs in the baby’s body
Paediatric guidelines state that ‘blood draws in infants and children should not exceed 5% of the total blood volume in any 24-hour period’. A 3.6kg newborn has a blood volume of around 280mls – so the maximum blood draw is 14mls.
The collection bags for ‘cord’ blood hold 250mls (35mls already taken up with anticoagulant fluid). The minimum amount of blood acceptable for collection is 45mls, and the maximum possible is 215mls. In one procedure guide, it states “collect as much cord blood as possible [in bold].” Another company reports that the median volume they collect is 60mls. I wonder how many parents would consent to someone coming onto the postnatal ward and sticking a needle into their baby to collect 6 adult vials of blood. Cord blood collection is the equivalent to this… only the needle is in the umbilical cord rather than the baby.
In response to publicity about the importance of ‘delayed’ cord clamping aka ‘optimal’. The latest marketing ploy is to tell parents they can have both ‘delayed’ cord clamping and collect ‘cord’ blood. Some websites even include a page on the benefits of ‘delayed’ cord clamping. They define ‘delayed’ as 30 seconds to 1 minute. However, it usually takes 3-4 minutes for the full blood volume to transfer. If all the baby’s blood has transferred into the baby – however long that takes for that individual baby – then there is minimal, if any, blood left to collect. Look at the picture at the top of this post. If you can get blood out of that cord you deserve a certificate and chocolates! At least one website acknowledges this, and states that the risk of ‘delayed’ cord clamping is “reducing the volume of a cord blood collection such that it cannot be banked…”. Note that public cord banks require even larger volumes of blood than private.
In contrast, one company refers specifically to ‘optimal’ cord clamping ie. waiting until the cord is white. They suggest that their company can effectively process 10-20mls of ‘cord blood’. I have requested evidence of that claim eg. photos or a movie of the collection from a white cord, and further information about the effectiveness of a small sample (most other companies state that effective processing for storage is determined by the size of the sample). I am still waiting…
In the meantime the baby blood company amended their promotion blog after being called out by the BBC for their misleading claims.
The effectiveness of stem cell treatments
Parents need to be informed about the lack of evidence regarding the usefulness of cord blood for future treatment of their baby
There is currently no research evidence demonstrating the effectiveness of ‘cord’ blood stem cells (haematopoietic) in the treatment of disease or disability. Many company websites hint at this by using the terms ‘potential’ or ‘may’ or ‘future’ or ‘hope to’. Sites also claim that ‘cord’ blood stem cells are being used to treat ’80 diseases’ – with no mention of whether those treatments are effective or not. Some sites refer to the treatments as ‘alternative’ ie. not being used in mainstream medicine. However, others include claims of successful treatment, citing case studies or anecdotal news articles (often about stem cells in general rather than ‘cord’ blood specifically). In addition, all of the research (I can find) is being conducted on ‘public’ stem cells ie. used to treat ‘strangers’ rather than the baby who donated, or their family.
I was recently in correspondence with a representative of a cord blood company and asked for some research evidence to support his claims of successful treatments. He sent me a collection of unreferenced statements (marketing) on the company website and two feasibility studies. Feasibility studies are carried out to demonstrate that a treatment is ‘safe’, and a study is possible… they do not test the effectiveness of a treatment. I pointed this out and have not heard back. Whilst there may be a number of trials underway with ‘public’ donations, I am yet to see any actual results relating ‘cord’ blood stem cells and treatments. Send me any you may have (research articles only please).
The European Commission released a press statement about this situation stating:
“If commercial cord blood banks are allowed, appropriate information should be given to the consumers willing to use their services, including the fact that the likelihood that the sample may be used to treat one’s child is currently negligible, that the future therapeutic possibilities are of a very hypothetical nature and that up until now there is no indication that the present research will lead to specific therapeutic application of one’s own cord blood cells. Therefore, information has to be particularly explicit that the auto conservation has little value in the current state of scientific knowledge. This information should be made clear on all media, including Internet, and in any contracts linking commercial banks to their customers.”
Many companies also offer umbilical cord tissue collection as an alternative, or in addition, to ‘cord’ blood collection. Umbilical cord tissue contains mesenchymal stem cells and can be collected alongside optimal cord clamping. However, there is no evidence that this type of stem cell offers effective treatments either.
Summary
I am not suggesting that baby blood banking shouldn’t be an available option. I am suggesting is that parents need adequate information before they make a decision to remove a significant amount of their baby’s blood volume. They need to be able to weigh up the known benefits of full blood volume at birth vs a possible treatment for an unlikely future illness. Cord blood is babies’ blood. Parents also need know if their care provider will benefit financially from persuading them to collect and bank blood.
PS: I no longer participate in stealing babies blood. We live and learn.
Further information
- Placentas and Cord Blood – The Midwives’ Cauldron Podcast
- Private cord blood collection and cerebral palsy – is there a connection
- Is it worth storing your baby’s cord blood? – youtube
Mythbusting:
You can learn more about Childbirth Physiology in my Online Course
thank you thank you thank you for this. every single word the gospel truth! i am plagued by this trend. i would also like to add that many midwives are paid up to $200 for every client they bring. that should tell you why it’s suddenly becoming so popular with midwives, too. we should be the guardians of normal and safe, and not the handmaidens of subversive and violent acts against mothers and newborns. this whole trend has set back the delayed cord clamping movement and all the of the progress made. too bad. and you rocked it when you said you know better, you do better. that’s what it’s all about. thanks again.
I´ d like to ask just one question: Is really possible to remove all the volume of blood from placenta to the baby? Isn´t there any surplus? I think there must be, because without an extra amount of blood placental circulation wouldn´work. In my opinion the placental circulation is something like the extracorporal circulation. Is there any study about it?
Thank you very much!
Yes, there is usually blood left in the placenta just not a large volume. I don’t think there is a study… not that I know of. 🙂
Please tell me, how do you know then, that just a small volume of blood is left in the placenta, when there isn´t any study about it ? Maybe we are confused by the constriction of the vessels and the coagulation of blood after the umbilical cord stopped pulsating. It´s unbearable to admit that cord blood is stolen from babies. Still I believe that stem cell therapy is very usefull and for some people the only chance.
Angelina – I know that when I get to the uni after 8am it is difficult to find a parking space and there has been no study about it. After birth midwives ‘check the placenta’ and I have checked 1000s of them over the years. In addition I have studied the physiology of the umbilical cord and blood transfer. Therefore based on observation and theory (not a study) I know that the vessels vasoconstrict after birth in response to stimuli (temp, handling etc.). This slows and stops the flow of blood. Then the remaining blood clots. What is usually left is a small volume of blood in the vessels running over the placenta (see the photo on the blog). If we can find a way for using this blood – great. But it is usually not enough to meet the collection requirements.
I find it interesting that you ‘believe’ that stem cell therapy is very useful (which it may well be) without studies to back this up. There has been no study to demonstrate that babies who have their blood removed and stored at birth are more likely to be successfully treated for disease later. In fact there has been no study that demonstrates it is safe to remove large volumes of blood from a newborn baby. There are some anecdotal stories of successful stem cell treatments alongside some debate about how best to obtain and use stem cells.
As with most things people make the choices that feel right for them after reviewing the available information.
Thank you warmly for your answer. I think you don´t have to repent for your sins because donation of cord blood is a great deed of humanity and really can save lifes of seriously ill children and adults. There are a lot of studies about it! Please imagine how feels mother whose child needs transplantation and can´t find a donor. A lot of diseases is treatable only via transplantation. I don´t trust information that all blood from placenta can be removed to the baby. We only lose time waiting until all remained blood clots and blood vessels vasoconstrict. Maybe it is not natural but have you seen a baby who died or had serious complications because of early clamping of umbilical cord? For very long time this practise was taken for normal in hospitals…. I don´t advocate it just want to say that baby is ok without cord blood and at the same time can save another child´s life when we are talking about donation not about private banking.
DISTRIBUTION OF BLOOD BETWEEN INFANT AND PLACENTA AFTER BIRTH
AliceC. Yao a b c, Mahmud Moinian a b c, John Lind a b c
Abstract:
The distribution of the circulatingblood volume in the infant-placental circuit at birth and in the first minutes after birth was studied in 111 normal full-term deliveries. The blood-volume of the infants, divided in groups where umbilical cords were clamped at various times, was measured by the 125I-serum-albumin dilution method, and the placental residual blood-volume was measured by drainage both when the placenta was still in utero and after its delivery. The distribution of the blood between the infant’s and placental circuits was about 67%/33% at birth, 80%/20% at 1 minute, and 87%/13% at the termination of placental transfusion.
Thanks! 🙂
Thank you very much, I agree. That ´s obviously a reason, why UK authorities will increase cord blood collections in their country: “The UK Stem Cell Strategic Forum reported in 2010 that the UK needs 50,000 cord blood units to meet the transplant demand in the UK. It is recognised that stem cell transplantation is a potentially life‐saving treatment option for children and adults with blood cancers. NHS Blood and Transplant (NHSBT) together with Anthony Nolan, will be increasing collection in their centres around the UK to reach this target.”
http://www.rcog.org.uk/files/rcog-corp/Joint%20Statement%20-%20UCB%20-%20aug%2011%20%286%29%20v2.pdf
And a reason why your country participates in Bone Marrow Donors Worldwide (with cord blood units) http://www.bmdw.org/index.php?id=number_donors&no_cache=1
I ´d really, really like to know the truth.
Where is this very interesting study published. Can you please share the citation.
The more I read you, the more I really, really like you.
seriously. ditto.
My thoughts exactly!
Agreed! Thanks for sharing so much wisdom and experience!
Thank you for this article!! I get so angry when I get brochures for Cord Blood Banks, from the store where I purchase maternity clothes! Our babies deserve all of the benefits from their blood right from birth! Thank you for this wonderful educational article! I am blessed to find your site!!
Excellent post. Liked it so much that I blogged about it. 🙂 http://archaeologycatmusings.blogspot.com/2011/02/cord-blood.html
I have 4 children and for everyone of them they got to keep their own blood :). We got to cuddle with them for a few minutes before the cord was cut. I love having a free-standing birth center in my neighborhood. Midwives are amazing!
Do you think early cord clamping has any direct effect on whether or not a newborn’s chances of getting jaundice go up? All three of my children have had jaundice. My firsts was the worst because he had a hematoma on his head when he was born. I was just thinking, since it has to do with their blood, that being able to keep more of their own blood would help them to get over jaundice faster or not even get it at all. What do you think?
I don’t know any stats and can only offer an anecdote. My son’s cord was immediately clamped and he got the Vit K injection – he was jaundiced. My daughter’s cord wasn’t clamped & cut until it stopped pulsating and she didn’t get the Vit K – she wasn’t jaundiced. Obviously an anecdote and a sample size of 2 doesn’t mean much either way, but I thought the lack of jaundice was related to the delayed cord clamping and no Vit K injection.
adding more anticdotal evidence: my eldest had his cord clamped before the placenta was born (CNM, she said she was doing it because his cord was too short to allow him to get to my breast… I coulda scrunched up though). He also is the only of my 3 to have gotten Vit K (postpartum nurse scared my husband into it – totally normal birth with less than 30min of pushing, no abnormal bleeding, zero bruising for him, breastfeeding initiated in 1st 10 minutes with perfect latch, not circ’ed, etc etc etc). He’s the only of my three to get jaundice (other two also boys, same father, same time of year, but homebirths with cord not cut until well after placenta was born). His was so bad he was rehospitalized for it, under the lights for 40 hours from day 5-7 after we’d been discharged about 30 hours after he was born. My husband is Chinese and his family is prone to jaundice from what his mom was able to tell me (but he was born via c-section for “failure to progress” in Canada, his mom’s English is barely conversant NOW more than 30 years later, and she didn’t succeed at breastfeeding because of the c-section sedation and phototherapy separation). My 2nd and 3rd sons barely got yellow tinged at all, bili levels never went into double digits (eldest went up to 19.5 and wasn’t coming down, kept creeping up, even though my full milk was in by <48hrs after birth and he was nursing FREQUENTLY and "on demand" – the ONLY thing we did differently was the early cord clamping and Vit K, and I won't allow them without CLEAR indication ever again, and discourage them with friends).
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I agree. I personally believe the Vit K shot and Hep B shot is to blame for so much newborn jaundice. My two births were almost identical and my son had a slight bit of jaundice because we caved and gave the Vit K shot, he also had immediate cord clamping against my wishes, my Doula tried to tell me, but I was too in the moment to understand, I wish she would have spoken up to the nurses to stop immediately. :/ But he did end up slightly jaundiced and also had issues keeping him awake to nurse so we also had nursing difficulties.
But with my daughter who I had an almost identical pregnancy and birth, she did get delayed clamping. But she got absolutely NO shots at all and from day one was full of energy and nursed like a champ and never had a lick of jaundice. My friend had her baby next day and her baby had major jaundice, and she gives all shots to her babies. She ended up having to use a bili blanket at home.
I truly believe these two shots and immediate cord clamping are a major player in all this jaundice. I just don’t believe nature is that flawed. I think it would be simple if we could look at data of babies with Jaundice and babies without and compare who got shots and either delayed or immediate clamping. I’m sure there may be other things that play into it as well like epidurals and other interventions.
Ditto Archaeology cat. My son’s cord was immediately clamped during his hospital birth(without my consent), he got the Vit K injection (and Hep B) and he was jaundiced. My daughter was homebirthed in our spa, the cord wasn’t cut until about half an hour after her birth and she didn’t get Vit K (or Hep B) – she wasn’t jaundiced.
Child 1 – cord was probably cut immediately, had shots, very mild jaundice.
Child 2 – again cord was probably cut immediately, had shots, no jaundice.
Child 3 – delayed cord clamping, had shots, severe jaundice, requiring rehospitalisation (very bruised from a precipitous birth).
So in my case the theory doesn’t hold well. If I had my time again there would be no hep B injections given.
As an adjunct. With births number 1 and 2 I would imagine I got an oxytocic immediately. With 3 – it would’ve been 5 or minutes later… maybe… My memory isn’t that clear as to whether I actually got it or not.
Jaundice is caused by the breakdown of red blood cells (the by product is the yellow biliruben). Bruising = increased red blood cell breakdown and therefore increases the chance of jaundice. It is most likely that this is why your 3rd baby developed jaundice.
This probably needs to be researched. I also notice less jaundice in babies who had a physiological third stage. However, in theory if they kept more of their blood they would have more red blood cells to break down = more likely to get jaundice. Not sure but I can’t help but think nature probably gets it right.
The data on delayed cord clamping do pretty much all show a slight increase in babies getting/needing phototherapy.
Some studies do and other don’t. Nicholas Fogelson reviews all the studies here: http://academicobgyn.com/?p=922&preview=true.
There has been no research comparing a totally physiological third stage with early clamping re. jaundice for newborns. The only studies available involve the administration of an artificial oxytocic (syntocinon or syntometrine) in the ‘delayed clamping’ group. IV syntocinon is associated with jaundice. Therefore, it could be the oxytocic making a difference here – not the clamping. More research needs to be done comparing physiology with intervention. Not just less intervention with more. Fahy, Hastie, Bisits et al. have made a start: http://www.womenandbirth.org/article/S1871-5192(10)00022-3/abstract
But did not look at jaundice outcomes.
Further anecdotal data- I had 3 babies in an out-of-hospital setting, with delayed cord clamping and no pitocin nor Vitamin K; they were all jaundiced, but did not require phototherapy. (My second baby, first home birth probably could have benefited from it, but my pediatrician gave us time for him to work it out- he had feeding issues, as well.) My first was born at a hospital after a natural labor and delivery, no pitocin or Vitamin K, but my OB ignored my birth preferences and immediately clamped the cord. She was also jaundiced. I will say, jaundice aside, my 3rd and 4th babies, who spent the longest time attached (about an hour each, as opposed to maybe 20 to 30 minutes with my second?), were very RED babies. They would flush a dark crimson, especially when upset, but frequently just randomly. I asked the pediatrician about it the first time, and she said it was a good thing, so I didn’t worry with the next.
Both my babies were born by c-section, one had all the medicalisation under the sun from IOL through to vit K injection – none of which was under informed consent, she was hugely jaundiced and had photo therapy My youngest however while a planned homebirth was also born by c-section, I requested delayed cord clamping in theatre (got so much that the placenta separated and I was offered a lotus birth by the O+G) and declined vit K all together – no jaundice at all. As a midiwife I really believe that the more we do the more harm we cause – including jaundice, even directive pushing causes harm to mother and baby, perhaps as someone mentioned earlier it is what we are ‘doing’ that is causing the problems rather than what we are not doing…
Great article. I banked cord blood for my two older children, the first one being born at the hospital. I still remember the panic on the part of the medical birth team when my newborn daughter had some initial breathing struggles. Quick! Cut the cord, get her on the table. NOW! Yes, let’s help her out by cutting off her built-in source of oxygen.
My next baby was born at home and she beat the midwife by 20 minutes so she got to keep most of her blood. About 45 minutes after her dramatic appearance, my midwife worked really hard at it but actually managed to coax an acceptable sample out of the placenta. We figured she deserved every bit of the commission she got. I share this part to say that in some cases, you can have it both ways–delayed clamping and a blood sample–but you’re right, it’s still baby’s blood.
We opted to not bank blood for the third baby who was also born at home–we learned a few more things, plus the family budget wouldn’t allow for it.
I do think cord blood banking could be a good deal and there is some good potential with stem cells. But I absolutely agree that we moms need to be given much better information. There are other ways to offer protection against diseases–good nutrition, not vaccinating, letting the baby get all of the blood–and part of our decision to discontinue the practice came out of learning about those other ways to nurture good health, and that empowered sense that comes when you realize health isn’t this big black box luck of the draw thing that it’s sometimes made out to be.
Just a brief reply to the first paragraph. I had the same issue with my son. He was born with an APGAR of 7 (not bad at all) but not breathing well (if at all??) the first thing the hospital did was cut his cord. It seemed stupid to me at the time and in hindsight seems ever stupider (if that was a word). My daught er had the same difficulties but was born at home with an APGAR of 6. Nobody panicked, nobody made their very own medical emergency.
Love your Blog – and as usual this is a great topic.
Thanks for sharing the truth it its raw real form – soooo refreshing.
We certainly found it was not in any way mentioned you couldnt have delayed cord clamping when reading info about cord blood testing; and considering how delayed cord clamping is becoming slightly more commonplace now (at least in Australia) i wonder how long cord samping will last?
Anyway, keep up the great work – from a fellow birth practitioner.
My first baby was born at a hospital, being an older mum and once the medical profession had filled my head with all the ‘high risk age stuff’ i was to scared to birth at home. I thought i was ahead of the game by waiting till the cord had stopped pulsing before i allowed them to cut it. I never knew i had the option not to have by baby’s cord cut until i was was expecting my second and employed a wonderful home birth midwife (she was like a breath of fresh air) who told me about a lotus birth AMAZING! I suggest to women i meet even those who have had hysterectomies lol lol to have another baby just to experience home birth and lotus. Unfortunately due to the business of being born, the fear and ignorance surrounding childbirth and the general dis-empowerment of women enables such practice to be administered including all unnecessary intervention, with out the full story being told to women thereby empowering them to make a truly informed choice. What other mammal is moved in established labor and what other mammal is separated from their newborn so soon after birth and they call us the superior race????????? The cord continues pulsing for good reason, by not cutting the cord the baby gets all the blood nature intended, the risk of the placenta being retained becomes virtually non existent so too the need for a managed 3rd stage. May information like this reach women in all corners of the globe empowering us with choice and a beautiful birth experience for all, for the ultimate evolution in peace and harmony with mother nature for the greatest good of all.
I have never felt right about this procedure. Compromise the baby’s health now for the possibility of needing stem cells later?
This post is BS. I appreciate that this midwife has had this experience, but I can totally contradict her experience. I am not in favor of “cord blood banking”, but if my clients want it, I will do it. We do nothing different for clients who choose to collect “cord” blood, we always wait for cord to stop pulsing. Oddly, we have always gotten an adequate sample. I also cannot understand how she claims that she can not/can barely get a cord blood sample for baby blood type after waiting. We can pretty much always get enough for a blood type (exceptions being evulsed cord or other freaky things).
Bottom line – “cord” blood collection DOES NOT MEAN EARLY CORD CLAMPING. It is possible to have all of the best of everything.
Thanks Samantha
I’m sorry that you think my post is BS. I am not alone in thinking that delayed cord clamping and cord blood collection don’t mix and that the companies who profit hide this. Check out the comments here: http://academicobgyn.com/?p=922&preview=true by Dr Fogelson.
The women I care for usually have physiological third stages which can sometimes mean a long wait for a placenta. If you are able to get lots of blood out of a placenta that arrives an hour after the baby please share your tips. I am pleased you are always successful in collecting enough blood. I am sure this is important for your clients and the companies you collect for. I would be curious to see how you manage this after the cord has completely stopped pulsing considering the physiology of transition.
I am always open to discussion and debate because this is how learning takes place. I am also happy to be wrong about something. However, I do think it is important to treat each other with respect and not refer to other peoples experiences and understanding as BS 🙂
Sorry about the BS comment, but you stated your case with such authority, as though there was no question that you had the last word on the topic.
Perhaps the difference is in our techniques for 3rd stage. We have our standard way of doing things, that we will obviously change up if the family requests, for example, Lotus Birth. We always wait for the cord to stop pulsing, which rarely takes longer than 15 minutes (one time it took 50 minutes).
We clamp and cut the cord when the cord has stopped pulsing. By then, the mom is usually pretty crampy or will be soon and we might even see signs of separation. We will then gently check with light traction to see if placenta is ready. If it is, we might ask mom to squat to get it out, or just pull it out.
This might strike some as too interventive. However, in an OOH setting where mom is going home in 4-12 hours, we want to minimize blood loss and do not want blood pooling behind the separated placenta.
Our moms are also fine with it (although I certainly respect that some moms would prefer to expel the placenta on their own). They are tired and ready to be done with the birth.
We rarely have a 3rd stage longer than 30 minutes. Most are about 20 minutes.
We don’t do alot of cord banking, perhaps 6 per year out of nearly 100 births. We give info to all clients, but don’t push it. I must say, I appreciate getting paid for it, because it is a lot of work.
When parents are planning banking, we discuss with them how important getting a good sample is to them. If they are banking due to a family history, we suggest that we can be vigilant and cut the cord as soon as the cord pulsing slows, to maximize the sample. It is always their choice.
What I would NEVER offer is immediate cord clamping (well, I guess I can never say never, but I’d need some serious convincing).
I played around with collecting a few years ago when the banks were open to donations (most of them do not accept donations anymore). I wanted to allow the baby to get the placental blood and wasn’t sure if we could do that AND get a bank sample. The first few collections I did were for donations and we discussed it with the parents. They all said it was more important for their baby to get the placental blood and if there was enough left for a donation, so be it.
So, we did things our usual way and I was pleasantly surprised to find I was able to get an adequate sample, every time (with the exceptions noted in my first post). It may not be the maximum sample, but it is adequate.
I also agree that the cord banks are selling fear and trying to make a profit. I explain to clients that cord banking is an insurance policy like any other. If you can afford it (which few of mine can), it might be a nice thing to have handy. However, the odds of ever needing it are tiny. On the other hand, if you had the funds to do it and you didn’t and your child developed a disease that could be treated with stem cells, you’d never forgive yourself.
I am somewhat motivated by a case I participated in as a pediatric nurse. I worked on a pediatric cancer floor, so I am probably more aware of what COULD (but probably won’t) happen and how devastating cancer treatment is. A fair number of the kids I cared for would have had an instant cure if they had had cord blood. One in particular was truly heartbreaking. 1 year old with aplastic anemia.
The parents were medical residents, with a huge, supportive family. Despite having all the resources one would want in this situation, they were unable to find a donor match. They held match drive after match drive, with no luck. This was before cord banking. The baby died.
They needed a near perfect match, because aplastic anemia patients are more likely to have graft vs host disease. Cord blood, even from an unrelated donor, has the advantage of less graft vs host disease.
I think that cord blood banking is a good thing, but not something that should be done universally or pushed on fearful parents. What frustrates me is that everyone seems to believe that cord banking means early cord clamping and robbing the baby.
There is a middle ground.
Samantha McCormick, CNM
Baby Love Birth Center
Perhaps I need to be less ‘authoritative’ in my posting but I do have a disclosure on my ‘about’ page warning that the blog is my own perspective:
“My aim is to use this blog to stimulate thinking and share knowledge, evidence and views on birth and midwifery. The posts reflect my perspective and opinions… not necessarily everyone or anyone else’s. I welcome debate and I’m happy to be wrong – so feel free to comment and put me right if required. My posts are not intended to provide advice or recommendations for individuals.”
The idea is to stimulate thinking and knowledge sharing – which is exactly what we are now doing.
I think the differences here are in the definitions/distinctions we are using. Firstly ‘delayed cord clamping’ to me means waiting until the cord has completely ceased pulsing. In most cases I don’t touch the cord until after the placenta has birthed. Although some women do want it cutting sooner which is fine if they request that. I guess it is possible to delay cord clamping until pulsing is started to stop and before all the blood has been shunted. Then less blood is being taken – but you need at least 45mls to remain. Not sure I could confidently judge this, although perhaps other practitioners could. Either way I think it is important that parents are informed of this. Just as you would inform them if you were taking blood from the baby postnatally. ie. ‘I will have to make sure that the placenta does not send all of the blood to the baby which may involve clamping before it has completely stopped pulsing’. I have done this to collect blood for a mother worried about ABO incompatibility. I waited until the cord pulse started to slow then clamped rather than waiting until the placenta was out.
If cord banks are an insurance policy then the payment is definite short and long term health benefits for possible later benefits. Of course this is the parents decision which is why I believe it should be an option. For some parents it is an easier decision than other ie. family history of disease. I’m sure working with pediatric cancer patients must have influenced your perceptions. I struggle with not allowing the rare situations I encountered in hospital influence my approach to homebirth practice (uterine rupture, severe PPH, undiagnosed congenital abnormality). There are risks associated with treating everyone as if they are the 1 in how every many. That’s how the hospital system operates.
You are probably right there is a probably a middle ground ie. slightly delayed cord clamping and collection. But I’m not sure all practitioners approach it the way you do and the companies certainly don’t discuss cord clamping options in their literature. In Australia the companies employ non-midwives to come into the hospital and collect the blood. I’m pretty sure their remit is to get as much blood as possible. Not to get as little as possible in order to allow the baby to have more. Just take a look at how much blood is in the bag in the marketing shots.
I think more research needs to be done into the use of stem cells. But there are alternative sources of stem cells other than babies blood.
Thank you for the discussion. It’s good to know there is debate on the topic. With my first two (1996 & 98) cord blood donation was only available at hospitals. With my third (2006) I was told I could order a kit for my midwife to use. I went through the process, but went into labor before the kit arrived so I have no first-hand information on collection. But FWIW, I was told that I could wait until the cord stopped pulsing before collection.
What I really wanted to say though is even if I had to clamp it sooner I still would have considered doing it. Hospitals do it all the time, and the world doesn’t end. And while I’d prefer to wait, this is something that could save someone’s life!
I look at it this way: Either the rich and paranoid can save their children’s cord blood so their child is guaranteed a match, or if virtually everyone donated, virtually everyone would have a match.
Maybe that’s naive, and I don’t have all the facts, but it seemed like a small risk to my son to possibly save someone else’s son.
Hi Amy – everyone is entitled to their own opinion and choices. All I hope for is that they have access to information from all perspectives. As I have said in a previous post there is no ‘risk free’ choice. You have to decide which risk feels best for you. For me I wouldn’t want to donate my child’s cord blood and then find that he later suffers from a disease associated with not getting his stem cells and full blood volume at birth. There are definite health risks associated with reduced blood volume at birth caused by early clamping. It particularly worries me that this practice is being potentially linked (by the top expert in this area Dr Mercer) with autism.
I enjoy reading your blog. In fact so much that it is reigniting my teenage dream of being a middie.
When I was pregnant with my DD, I actually rang and asked the private company whether we could do both delayed clamping and collect the cord blood. This particular company offers their services to mothers delivering at a major teaching hospital in South Brisbane. The person I spoke to had no idea what I was asking. In fact I seem to have more idea than he did about ‘cord’ blood. I have no health qualifications, just an inquisitive nature.
In the end we decided not to collect the cord blood, and opted for delayed clamping. However this did not happen as the OB cut DDs cord because she had it around her neck (twice I think). Rolling eyes majorly here. She was put on my tummy for a few seconds but was not breathing, hello, I think an attached cord would probaby have helped here. So then she taken to the resus table where she had an oxygen mask held near her face. Fortunately she started breathing within about 60 seconds and was given straight back to me.
I will be using midwives for any future babies.
This is my major gripe:
“The person I spoke to had no idea what I was asking. In fact I seem to have more idea than he did about ‘cord’ blood.”
If you are offering a service that involves health risks (and benefits) you need to be able to give parents adequate information.
As for your birth drama… aren’t we lucky our babies are so resilient considering all the silly things people do to them 🙂
First of all, let me state that I know many midwives who need training in the proper technique for all cord blood collections, including on when it is safe to clamp and how to get enough cord blood even with delayed clamping.
My first child had a rare genetic disorder called fanconi anemia. He was born before cord blood collection was even known to be done, even though cord blood transplants had been done. My son received an unrelated bone marrow transplant from a donor. I am glad we had a donor because we were able to have six extra blessed years with my son before he died. BUT, the complications from having an unrelated donor and not cord blood caused him to have severe graft vs. host disease and other complications. During this time, my second son was born and we collected his cord blood. He was even premature at 33 wks, and we were able to still collect it. We were devastated when we learned he was not a perfect match for his brother if my son needed a backup after his unrelated donor transplant.
TODAY, I am so thankful that we banked it. #1 cord blood that is donated, the chances of finding it to retrieve it is slim to none, #2 the cost is $25,000 and up to pull it out if it is found out of a public banking agency. My second son ended up needing his cord blood stem cells eleven years after we had it collected. It cost us NOTHING to have it taken from our private cord blood banking agency. My son had been diagnosed with a severe form of juvenile type 1 diabetes that had caused him extreme complications. He entered a clinical trial using his cord blood and his need for insulin dropped dramatically. Since then he was diagnosed with mitochondrial disease and we have been told that it is a mild form of it and probably what helped was the cord blood stem cells he received. So, I am extremely grateful that we saved his cord blood and that we were able to use it.
I was also grateful that I took the step as a parent to make sure I was INFORMED and not listening to others who did not have the CORRECT scientific facts! I did my research! As parents, I think many need to stop and think about this and make the informed decision on what is best for their family. I think there are too many midwives, doctors, and nurses who have not done the research and are just listening to the media frenzy about biased opinions instead of learning for themselves!
Darla I am sorry to hear about the loss of your son. There will always be cases where banking cord blood is the best option. You made an informed decision and to be honest the implications of premature cord clamping pale into insignificance compared with the major health issues your family have faced. Perhaps the cord bank companies could take some responsibility here and address the issue in their literature instead of ignoring it. As I said in my reply to the previous comment it may be possible to slightly delay clamping and collect a smaller volume of cord blood. But, this is not presented as an option. Parents shouldn’t have to learn for themselves. They should be presented with all the relevant information including risks of all options before deciding. Not just be subjected to marketing.
I disagree. I think cord blood sampling is rightly promoted as a potentially life saving measure! When a baby is about to be born, no one wants to think about the worst. Health anomalies are often not known for several days, months or years, by which time it is too late to go back in time and collect cord blood. My daughter suffered a massive stroke at birth and has right hemiplegia. Stem cell treatments offer significant possibilities of recovery for pediatric stroke survivors, which enable them to bypass the conventional nightmares of botox, serial casting, tendon transfers, baclofen pumps etc, not to mention those who get epilepsy subsequent to the stroke, needing antiepileptic drugs, hemispherectomies etc! Now THAT is a nightmare – not missing a bit of the extra blood. I so wish i had spent the money to bank my daughter’s blood. But she was three days old when we found out she had had a stroke at birth.
Don’t get me wrong – i had all my children at home with delayed clamping (which as mentioned above is not a problem with cord blood sampling), i apprenticed as a midwife, i am an acupuncturist/chinese herbalist specializing in ob-gyn who works with homebirth midwives and accompanies women through pregnancy, birth and post-partum. I think midwives sometimes are so used to normal births that they forget the abnormal – this is what made me readjust my direction and become an acupuncturist specializing in ob gyn rather than a midwife… i wanted to be able to help high risk women and infants as well. Sometimes we (i was guilty of this too) focus too much on the details of an idyllic birth and lose sight of the big picture: achieving the best possible health outcomes, long term.
This post is about cord blood collection – no stem cell treatment. There are many other sources of stem cell. For example, the umbilical cord tissue is a good source of stem cells and can be collected after ‘delayed’ cord clamping. Why are the companies not promoting this and collecting umbilical cords? Perhaps because parents are unaware of the risks of cord blood collection and unaware of the alternative sources?
Actually, the stem cells that work the best for hemiplegia/cerebral palsy are the ones from the cord blood. Other sources such as adipose tissue etc do not work nearly as well and are not considered for therapy.
If you were in my shoes, the shoes of a mother whose birth injured child could be treated with that cord blood, you would see that a few CCs of blood is nothing compared with the lifelong pain and suffering of 2 to 4/1000 children who suffer from CP (US statistics, similar to worldwide statistics). Given the prevalence of cerebral palsy and its devastating impact on the child, their family and society at large, i think there is a reasonable argument for systematic cord blood sampling. The life of one in 200 children roughly could be greatly improved. How could one argue with that?…
If you only knew what it means to live in that way for one day even, it might change your outlook.
Some time ago I was hired by Cord Blood Bank to leave comments very similar to yours to support cord blood business. I was payed very well to pretend being “common folk” advocating cord blood collection. Of course, I was deceived myself by sofisticated information of bank…
In fact, there is no need of collecting cord blood. Human body is crowded with stem cells during whole life – they are present in bone marrow, in blood circulation, even in menstrual blood. All of them ready to be used for treatment in case of illness. But alas, there in no scientific evidence of efficacy of such treatment so far. More probably you can cause harm (even CP because of hypoxia) to your child by early umbilical cord clamping. What is the point of taking cord blood and then after some time administer the very same, untreated sample back to the child? Funny? But it is exactly what is happening. You may call it treatment. I call it charlatanism.
I do advocate delayed clamping, and had it for all my children. I HAVE seen with my own eyes drastic improvements with stem cell treatments on children of the Children’s Hemiplegia ans Stroke Association. Furthermore, early clamping does not cause CP or stroke. A clot traveling to the brain does. Early clamping does not cause clotting (or hypoxia to a sufficient degree- rather cord compression in the canal does).
Please do study physiology and medicine. You have no idea what you’re talking about.
Furthermore, are you suggesting that i am guilty of the same dishonesty you openly admitted to when you worked for a cord blood bank? (If indeed that is true?)
Are you sure you are not questioning my motives because you are accustomed to your own lack of transparency?
You have insulted me. How could one ever fake the life of a mom of a child with special needs? Or the best interest of medicine, which is always a question but requires honesty?
Unfortunately your comment above shows your complete lack of knowledge as to what stem cells are and what stem cells can treat.
You said you”re not talking about stem cell transplant, but cord blood banking. You do realise that cord blood is banked so that the stem cells can be transplanted, right? And did you know that the cells in cord blood and cord tissue are not the same? I doubt it as if you did you wouldn’t be posting lies.
I’m so tired of listening to mothers who think their midwives are the be-all and end-all of everything. As a midwife you have no requirement to keep up to date with new medical procedures. It’s down to what you feel you want to do – that’s it. Oh, and your localised experience – but thats all it is… localised – based on your local clientele.
You’re not a nurse or a doctor. 3 years training – not 7 or 9 as with doctors. You don’t even need to study Biology to be a midwife – dentists are much more qualified yet you think you have the authority to tell a mother what she should and shouldnt do with her child…. do us all a favour. Do some research and come back when you’re not talking BS.
“You said you”re not talking about stem cell transplant, but cord blood banking. You do realise that cord blood is banked so that the stem cells can be transplanted, right? And did you know that the cells in cord blood and cord tissue are not the same?” – Yes I do… I have been involved in reviewing research in this area.
I am a doctor and a researcher.
Midwives have a professional requirement to remain up-to-date (in Australia)
I never tell any woman what to do with her child for legal and professional reasons: https://midwifethinking.com/2016/06/28/responsibilities-in-the-mother-midwife-relationship/
(I welcome debate and collegial disagreement on this page – your argument would come across much better without the insults)
Samantha, our son had cancer and was being matched for a bone marrow transplant (or stem cell transplant). I was told that even if I had collected his cord blood, they would not have been able to use it. Maybe it is different for some of the cancers (like you say) but not in our case. So I wonder how informed people really are when they are told what it can be used for.
I have very mixed feelings about cord blood collection. When he was being matched for a bone marrow transplant there were no bone marrow donor matches in Australia. There were two banked cord bloods registered that were a likely match. We didn’t end up needing a BMT because the chemo worked. When I had my next son 2 years later, the oncologists wanted the cord blood as it would be a match if our sons cancer was to return (apparently stem cells don’t need as many markers as bone marrow). I chose to bank it, knowing i was taking something from my son that he really should have kept. The hospital transplant unit paid for it to be stored. I feel VERY guilty about taking it, but would probably do it again if i had another child.
Yes, cord blood is sold as a cure for everything but at the moment it is fairly limited. Hopefully more research into stem cells will increase our understanding about how they can be used to their full potential.
You shouldn’t feel guilty about storing your sons cord blood. Considering your family history that seems a very sensible decision and one that I probably would have made too. This is why cord banking should be an option but a one that is better informed.
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Thank you for this article! It was well-timed since I just received an email from a Representative of Pacificord – Cord Blood Collection. Funny how they got my name and email? Hmmmm. What was most interesting is his offer to give me (as a Doula) a $50 referral fee for every client I sent to them and booked an account. Wow! Now, I know this type of thing happens at doctor’s offices but this is the first time, as a doula, I have been approached and been offered CASH for referrals.
It makes one think about what motivates our doctors to “sell” a drug or childbirth intervention. Of course! There is money behind it! ANd I ahve to admit, for a quick second I thought, “Hmmm, who do I know that I can refer to??” Then I quicked snapped myself back! But I can see how tempting it is.
Has anyone else in the birth profession been approached like this? I don’t want to be a Vampire : )
http://www.serenitybirth.com
Thanks for this information. I’m really not comfortable with this approach. It is tempting – easy money but feels wrong. I know midwives get a fee ($200) for collecting the blood. But I the parents have already decided they want it collected so I guess it is OK to be paid for a service. To profit from the initial decision and to be the person providing the recommendation is different. I would be interested to hear what others think…
Thanks for this. I considered donating it when I was pregnant, but my home birth midwife told me it was not possible with delayed cord clamping. I’m glad you agree!
My dear, I am affraid, that you should go back to school and repeat the anatomy. Please do not scare mothers and write the truth.
After cord clamping remains blood in placenta (and yes, “280ml” in baby`s body). Blood with placenta is the waste. If anybody decides to collect cord blood that means that blood from placenta is collected. This procedure has nothing with child (no “sticking a needle into their baby”) and nothing with reduction of baby blood volume.
If you collected cord blood by other method – from baby side and not from placenta side – I would suggest parents to sue you…
You clearly have a poor understanding of fetal circulation. The placenta and baby are one unit. You can find out more about the physiology of how blood re-distribution occurs after birth here: http://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/
Whether the blood is taken from the cord ‘baby side’ or ‘placenta side’ (as in CB collection) or indeed directly out of the baby’s vein there is no difference. It is still blood that would have ended up circulating as part of the baby’s blood volume. With immediate clamping that blood does end up as waste. But should it? Please take time to watch Dr Fogelson’s presentation (link on post I directed you to) about delayed cord clamping.
My aim is to inform not scare. And if you can provide me with any evidence that what I have written is untruthful I will change the post.
I think Linda misunderstood the penultimate paragraphs in the article, where you posed the hypothetical situation of taking the baby’s blood directly from them rather than from the placenta. That’s how I read her comment, anyway. *shrug*
Anyway, very good article – I have nothing constructive to add though haha
Excellent article! I have a couple thoughts:
1. I’ve long held the opinion that hospitals should be collecting cord blood routinely at any birth where physiologic cord clamping doesn’t happen (cesareans, resuscitations, and until physiologic clamping becomes the norm, all the standard prematurely clamped babes) and the parents should be asked whether they want to privately bank it, donate it, or have the hospital discard it. It’s powerful stuff so we should be maximizing the public banks when the blood would just be wasted – heck, if it was only collected and donated at cesareans, that would be a heck of a lot of stem cells given the sky-high cesarean rate. Also, I’ve had multiple clients who were initially going to bank their baby’s cord blood, who then opted for physiologic cord clamping after we had this discussion, who then either had a cesarean or whose baby had the cord cut to be moved to the radiant warmer for resuscitation or (in most cases, warranted) observation. Many of those parents later said, “So we COULD have banked the blood after all, if we’d known that’s how it was going to go in advance.” These parents shouldn’t have to plan for a complicated birth, it should be an option at the time of birth if they don’t get to allow the baby to get the right amount of his/her blood.
2. With my second daughter, I didn’t know about physiologic cord closure and I wanted to bank the blood. But, I had her in a precipitous, ecstatic, accidental water birth in a birth center, and nobody thought of it until 10 minutes after she was born. The cord had stopped pulsing, so it was clamped and cut, and the senior midwife went to work on the cord blood. They collected all they could and we sent it in to the company, who then sent us a letter letting us know that the sample was inadequate, and gave us a partial refund. We never did tell the midwife the sample had been inadequate – I never thought of it until reading the above midwife’s comments and wondering whether she’s just not finding out that she’s not collecting enough because only the parents would be notified.
I agree that if the cord blood would be disgarded it should be collected instead. However, I think there are rare circumstances when this would happen. Even with c-section some OBs allow the cord to pulse before clamping so that the baby is better prepared for breathing (which c-section babies often struggle with). So, c-section is not an excuse. As for resus… it should take place with baby attached to placental circulation http://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/. Also babies who are compromised at birth need their stem cells to repair any damage done. The warmest place for a baby at birth is the mother’s chest and there is lots of research supporting skin-to-skin as the best way to heat a baby – better than a radiant heater. Baby can be observed with (and by) mother whilst skin-to-skin – this is known to improve their heart rate, temperature, breathing etc. Time to implement evidence based practice I think.
So, I’m not really sure when it would be appropriate to clamp early, especially at a complicated birth.
Very interesting point you make re. the midwife not knowing about inadequate samples… I wonder. 🙂
thanks for that extra tid-bit! I actually had preferenced those things in the birth plan I submitted to my local hospital for my impending birth (not that I expect to need a c-section) and have come across so much opposition from the medical staff, including telling me that if the baby is really struggling they will clamp the cord & remove the baby and if need be fly the baby out to another hospital (without me!). Following which I have decided to free-birth at home.
This is a great look at this complex issue.
Great discussion. Midwives used to get paid $350 in NZ to act as the vampire and that was a good 7 or 8 years ago, so I wonder what the fee is nowadays? Any midwife trying to establish a healthy income may be tempted by that sort of fee, especially when they have a student loan to repay.
When I gave up independent midwifery practice and returned to the hospital, I worked in Quality and Risk management. One of the first things I did was to write a policy statement to ensure hospital staff would NOT be expected to undertake cord blood collection for stem cells for medico-legal reasons. The staff were greatly relieved!
My births had physiological third stages. My births were wonderful experiences (even the O-P one) with that precious, precious time between birth and birth of the placentas. I wanted to behold my babies, no interference, no clamping, no drugs unless I was hosing. I wanted to breastfeeding then sort out the third stage – 25 years ago in England, that was a weird idea! My babies were not jaundiced, both were exclusively breastfed, and both were enormously healthy…..Mother Nature seems to have got it all worked out – why interfere?
At my 1st home birth we got blood out of the placenta after it delivered on its own, for banking. My midwife had to work really hard but she got it out! 😉 ::shrugs::
I’m sure it is possible in some circumstances but parents shouldn’t be led to expect that following a fully physiological placental birth (ie. no syntocinon and no clamping until after the birth) it will be possible. I bet your midwife worked hard! 🙂
I work as a midwife in Ontario. We have an ever increasing number of clients wanting cord blood banking. One of the companies pays us to do it, the others do not. When I talk about this with my clients, I never ever tell them who pays us – even though they ask (“we’re going to do it anyway, so you might as well get something out of it”).
I also have a good discussion with them about the benefits of delayed clamping and the risks of not getting a decent sample in that case – I let them decide. Every single one has said “wait until it stops pulsing, then see what you get”. We never get huge samples, and I always ask them to tell me if the sample was ‘insufficient’ – so far so good.
In terms of 3rd stage, about 60% of my clients request IM pitocin after discussing the risks and benefits – but we still do delayed clamping as much as we can.
Very interesting blog – just stumbled upon it tonight, but will certainly be having a good look around….
Thanks!!
It is good to know that you are honest with your clients about the potential of not getting a decent sample. It is all about informed choice 🙂
This is a lively debate, thanks for posting.
I am due in 2 weeks time and have been researching the pros and cons of stem cell storage for a couple of months now. I am based in the UK and have spoken to 4 companies (Cells Ltd, Cells4life, Smart Cells and Future Health Biobank), all offering slightly different services across a range of prices. I have found I have had to do alot of independent research and comparisons. Even though myself and my husband have no known reason for storing the cells, my thinking is that there is much potential and advancement in medical science in the years to come and hence storing now is worthwhile. Of course I am also wanting to have the benefits of keeping the cord pulsating and have decided I will opt for physiological third stage, to leave the cord to pulsate for say 5 minutes and then to have the cord blood/tissue collected in-utero (prior to placenta has been delivered) as this apparently makes the collection of blood a quicker process, than if collected ex-utero (after placenta delivered). I am hoping that this will allow a good sample to be collected.
The companies I have spoken to have wide ranging views on the practice of delayed clamping, some are against it as obviously jeapordises the success of a successful sample collection, others are quite confident based on experience of getting a sufficient sample using delayed clamping and are very positive about the benefits of delayed clamping. In conclusion, the companies I have dealt with provide you with facts, but as a mother and client you really do have to know which questions to ask in order to make a well informed decison for your individual situation.
I’m pleased you are researching and making your own informed decision. I would be really interested in an update after your baby arrives re. how the collection went. As you can see in the diagram there won’t be much left in the placenta after 5 mins. If there is enough for storage this would be valuable information for parents thinking about doing this. Good luck 🙂
This is pretty much my thinking exactly. I never want to detract from the benefits of leaving the placenta attached, but neither do I want to sacrifice the potential opportunities of storing the stem cells. I think that as this practise becomes more common that this method, or one very similar, will be the standardized method of procedure for your average birth.
This method allows for safe, easy extraction with no risk to the newborn. How this can be a bad thing is beyond me.
I particularly like your stance about your options too – as a mother it is entirely up to _you_ what happens, anyone that gives you facts with opinion is generally biased, so having a clear cut comparison between your options with impartial advice is truly important.
I want to mention that I did both delayed cord clamping and cord blood donation at my second birth (homebirth.) I wanted to donate for my first birth at a birth center, but due to a fast labor, the midwife didn’t have time to familiarize herself with the instructions. I am still disappointed that she immediately clamped his cord, but that’s another story. Anyway, my midwife at my next birth was able to fill the bag with the needed amount of cord blood, and all after pulsing had ceased and we cut the cord. I can’t remember how long it was, but the cord had turned white. Maybe she got it from the placenta. I’m not sure since I was admiring our new baby, but it wasn’t a problem. I only wanted to donate in the same spirit that I’m marked as an organ donor, just hoping to be able to help others. I wanted to donate again with the third birth, but they had changed protocol and no longer accepted homebirths. That time I waited until after placenta birth to cut the cord. The midwife didn’t even arrive until at least 45 minutes after the birth, but didn’t have any trouble getting the needed blood for blood typing purposes. (And, she didn’t rush to do that right away either, but instead admired the baby for a while and then checked us both out before finally turning her attention to the placenta.) We’re expecting again, and I’m considering a lotus birth, but even if we don’t, I’m a huge believer in waiting as long as possible to cut the cord. I’m planning a UC, so I intend to do my own blood typing. With my past experiences, I never knew that it can be hard to collect blood when waiting for the cord to stop pulsating. I’ll keep that in mind so I don’t wait too long. I love your blog and all the wonderful info you share. Thanks!
One more note that I neglected above is that the placenta was also born when the midwife did the cord blood collection.
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Thank you for writing this. I’m still trying to piece together why my healthy baby needed resusing and a week in NICU, but my notes tell me what happened but not why. Maybe early cord clamping and the fact that he was delivered through the placenta played a part (placenta previa grade 4 anterior)
Being delivered through the placenta was probably the main issue. I am guessing that vessels in the placenta were cut during the delivery (unavoidable with your placental site) therefore your baby was probably recovering from a reduced blood volume. Early cord clamping was probably very necessary as placental vessels had been cut and there was a risk that the baby could lose more blood through those vessels. Impossible to say without having been involved – so just my guesses. Is there any way you can meet with the people involved and go through your notes to get some answers?
could this be a reason for behavioural problems? my child’s cord was cut and they put him on me and he didnt breathe for the entire time that it took to push the placenta out, and i was trying to hold him while pushing and was too winded/in shock to speak. also, do you know if its common that midwives may deliberately SAY the cord is wrapped around the babies necks as an excuse to clamp and cut before parents know whats happening?
I can’t comment on your individual situation or child… I don’t think it is common for midwives to say the cord is wrapped around the neck as an excuse to clamp. However, it is best not to cut a cord that is around a baby’s neck anyway.
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Actually, this isn’t true at all. I really loathe when someone makes a statement who doesn’t practice out of hospital and doesn’t know how to properly get blood collecting from the cord nearest the placenta like any midwife I’ve ever birthed with personally or attended a birth with professionally at home, birth center or hospital. This article is highly INACCURATE. I have photos showing the birth of my daughter who was born at home where she came out with her purple pulsing cord and 16 minutes later it was white and not pulsating and the placenta was delivered and cord cut, and my homebirth midwife simply used GRAVITY to help bring blood into the bag of collection and there was PLENTY OF BLOOD for collection after my daughter got her full needed share and the cord was not pulsating any longer. I think your experience in practicing midwifey and doing cord banking collection is obviously too limited to comment and I urge you to retract your article and tell women who are giving birth thinking of donating/banking the truth about collection from the eyes of experienced midwifes, doulas and mothers everywhere who have seen the complete opposite of what you describe above. You CAN delay cutting the cord and collect cord blood. It takes knowledge and experience outside of a setting that routinely cuts cords for collection out of simple ignorance. Educate midwives, doctors and mothers with the truth. As for is it worth it to collect cord blood, that’s another debate. It is a personal choice for parents who feel they want that collection just in case it could benefit their chilren.
Mother of 3 (soon to be 4), student midwife, doula and childbirth educator
Thanks for your comment. You have been lucky to have a very skilled midwife and a placental circulation that stopped in time to keep enough blood in the placenta; blood that did not start clotting; and a placenta that came out quick enough (an hour is common with physiological). I think it is unfair to promise all women that this set of circumstances is possible in all cases.
By the way you may want to find out a little more before making assumptions about my experience or where I practice – have a look at ‘about’.
I am pleased you were able to collect your baby’s blood and have a physiological birth 🙂
Oh and don’t forget the mention of the practise causing autism. What a crock. Let’s just heap more guilt on mums that choose to store cord blood. And you claim that you are all about accurate information being given to parents. Please, spare us.
You wrote this article using your experience at a hospital. Whether you practice at home or not now does not matter. Your article is flawed with inaccurate information. If you made it a practice to delay clamping and get cord blood (just practice it anytime someone doesn’t want their placenta) then you would know that it is possible with every woman and unlikely and uncommonly not a possibility for few. I’m not an exception. I’m the norm. I’m a mother and student midwife and doula. I’ve never seen a situation yet where personally or professionally the midwife could not collect enough for the banking/donating after delaying clamping/cutting. 🙂 It’s all about putting out accurate info and unfortunately this article isn’t accurate. I and others who practice this way and personally find this article to be fear-mongering and unsupportive of a family’s wish to choose banking or donating for the potential benefits of those suffering with diseases we don’t wish on anyone. Science will continue to improve every decade and it is something that by the time my child is a 50 year old adult could save their life. Only God himself knows if that is a future reality in all of the conditions scientists hope to use it for but this article simply doesn’t say factual information about how delaying and banking/donating IS possible and done every day in the United States in my neck of the woods with homebirth and birth center midwives routinely. I again call for your article to be taken down or heavily revised with accurate reality-based information. If you’d like photographic proof for our birth community’s stance on this, please let me know. It is possible and it is the norm not the exception to get the necessary blood collected. Just try it yourself sometime…
I don’t repond well to unnecessary aggression as was demonstrated in your first comment. We are all midwives and can learn from each other and challenge each other with love and respect. If you check out my vbac post you will see I heavily revised it in reponse to positive criticism and dialogue. I stand by my experience and opinion that in the vast majority of settings with the vast majority of practioners CBC = immediate clamping. I am in good company and not the only practioners to hold this view (eg. Dr Fogelson). I have had to collect cord blood at home births for blood typing etc. and have usually had to compromise my usual approach of do nothing until after the placenta births. If your community would like to share their technique this would be great and may help to change practice in this area. In the meantime I think women should know about the standard approach they are likely to encounter. I also would be interested to know if you get paid for collection and if so how much. Let’s be kind and supportive to each other. Midwives have enough enemies without in-fighting.
BRAVO!
If I’ve said this once,…Well, you get the picture. In-fighting is the most counter-productive and counter-intuitive behaviour one can encounter, in my opinion. I’m currently in the US where it is rife. Jan Tritten was once asked by a newly certified Midwife, “Why do midwives eat their young?” An apt sentiment, I think.
Incidentally, I was recently in Honduras, where all babes have blood taken for testing, and I have seen some truly skilled “milking” of placentas. It is a small amount, granted, but more than I would have imagined left behind. Thank you for your blog!
I have to say I am researching this at the moment too – and I have come across accounts of the gravity argument from more than one midwife blog/source. I realise Midwifethinking that you took offense to this commenter but despite this I would love to see you investigate this further, surely it’s worthy of a look into? I was reading an academic paper the other day and in an article about delayed cord clamping research he commented underneath on his belief that there is an accessible amount of blood and stemcells available in the placenta and that that should be a focus of research – my own MW/Doula has requested her colleague experiment with the gravity argument (after awaiting the cord to go white) to see whether this is possible. Would you consider doing the same and blogging about it – I’ve been really enjoying reading your blog and would love to see you write about what happened
sorry for clarity-sake I meant the author of the paper I read who was commenting on article about his work on delayed CC – his name was Dr David Hutchon
I only took offence at the aggressive attitude of the previous post by this person (see their comment above)… not the content of the post you are commenting on.
I have discussed this with a cord blood collector and have experience of attempting to get blood from placentas after DCC for various blood tests (blood group, etc). If left until the cord has stopped pulsing there is usually inadequate blood for a good quality collection ie. can get max 10mls. Gravity makes no different… the cord empties, the vessels close and the blood clots. If a small amount is collect it can be ‘expanded’ and stored… but the process of expanding the blood is not ideal in terms of quality.
Interestingly there are more readily available and useable stem cells in the cord itself. Perhaps research and resources should be used to develop collection and storage of umbilical cords… that would provide a win-win situation. Baby gets all of their blood and can store stem cells. However, this will not happen unless an ethical alternative is demanded by consumers… and the first step is them being given adequate information.
thank you for responding to my question I realised this might have been a zombie thread! That’s a really interesting follow up. I had (interestingly enough) been planning to have a section of the cord itself stored along with the blood – an option the provider I’m considering offers- so you’ve just given me great cause to there with your reply. In fact I couldn’t find any research on the cord itself pertaining to stem cells and storage, it just seemed worth while, like why freeze just the marinara when you can freeze the whole lasagne? (bit of stretch there but I hope you catch my drift…)
Biology is so smart (with closing up the vessels), no wonder it is so hard to get enough blood. It’s refreshing to have a clear physiological explanation. I would certainly choose immediate benefits of delayed cord clamping over potentials of blood banking so will be delaying then collecting with this one with the knowledge that the cord will be making up for the lack of blood, because weirdly enough I can’t see an option to do just the cord. Thank you for the information, can you recommend any further reading?
Sad the previous commenter felt the need to be so adversarial when there was opportunity for an informative discussion here.
It is all about making informed choices… there are no correct or incorrect choices. Each woman must decide what is best for her and her baby. It is good that you are researching what is best for you. I think with more pressure from consumers the collection and storage of umbilical cords would become an option. It is a case of developing the collection and storage procedures, which cost money. As for further reading… there is not a lot of information available re. collection and storage of ‘cord’ blood (it is actually baby’s blood) and the information available is from the blood banking industry. I’ve included links to further reading re. the importance of full blood volume for newborns. I’d suggest having clear communication (before birth) with whoever is going to collect the blood re. timing and what your definition of ‘delayed’ cord clamping is and what you want to happen. 🙂
How long do you delay clamping there is such variance in times? I would like to delay clamping but get cord blood for my child. I also want to keep my placenta and have it encapsulated.Would you also be able to post some photos of instances where there was delayed clamping and still go enough cord blood. I really want to do both for my child’s benefit.
In order to allow full transfusion to the baby you need to wait until the cord is white. You can see some great picture of this here: https://www.nurturingheartsbirthservices.com/blog/?p=1542
You can delay clamping until the cord is white and still have your placenta encapsulated – this is different to collecting cord blood for storage. For encapsulation you just need the placenta – not the baby’s blood that was in it.
I don’t have any photos of delayed cord clamping with cord blood donation… as I discuss I don’t think this is possible. Parents need to choose which option they want – collection or full transfusion of their baby at birth.
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LOL Yes, we get paid for being a doula and a midwife by our clients. You are a character. Good luck with being credible in the birth world.
Dear Passive-Aggressive, I think the inquiry about remuneration was regarding the blood banked, specifically, and not your work as a doula or midwife. Jump the gun much?
I enjoyed reading your view on cord blood. I do agree that it is an individuals choice. I also think that the benefits of preserving the cord blood down the road are invaluable. A site that has some great information on this is https://www.stemcyte.com/ . Hope this helps others interested in the topic 🙂
I am late in the game on this post but from what I understand these cells are not good for a lifetime. That they degrade over time and only have a use for the child in childhood. If I am not correct then I apologize but that is what I have understood. Therefore the claim in the comment above about it being able to help their child at 50 is incorrect and is a concern if this is untrue and is what is being “sold” by these companies
My first comment here is about “tone.” Midwife thinking writes in a calm and reasonable tone. For no reason “Linda” and “The truth about” (if they are two separate people) entered the discussion in a hostile manner, angry and accusing. Her sentences are overlong, the words tumbling all over themselves to get out. She is repetitive. The syntax is confusing. For instance “personally or professionally” was supposed to modify ‘seen’, but it wound up modifying “collect”.
I am someone who didn’t start out with an opinion about this subject. Which writer do you suppose I am most likely to believe?
Susan Peterson
My only experience is with my own home births. We did wait for the cord to stop pumping before we cut it, but were still able to get a standard laboratory tube 1/2 or 2/3 full of cord blood to save for type and crossmatch for a RHOGAM shot. I have never really understood WHY they needed to type and crossmatch for that shot, but that is what I was told was required. Once the doctor gave me the wrong color topped tube so the sample was no good. The lab dumped it in the sink when the doctor handed it to them. He came back to my house and we had to draw blood from the baby, which took us three tries as he was not especially experienced at getting blood from babies. He said he should have told them he had a patient who had a miscarriage rather that put the baby through that. So it can’t have been strictly necessary to supply blood to get the shot.
One time the cord did not stop pulsing for an hour, so we called the doctor, who laughed and said to cut it and the back pressure would cause the placenta to separate. Which it did. But, why did this happen this time, when usually the cord stops pumping on its own? And does that mean we deprived that baby, born for an hour, of some of the blood he was supposed to get? He is an adult now, so I am hardly worried about it, but I am curious.
Susan Peterson
Hi Susan
They take 2 vials of blood – 1 to determine babies blood group and 1 is a full blood count to check no maternal antibodies have crossed the placenta.
Re. the pulsing cord for one hour. Wow! Not sure what was going on there. Sometimes the cord can be felt ‘ticking’ in time with the heart beat if left attached. This may have been what you were feeling – especially if the vessels were not full of blood. But in theory after birth in response to a number of things the cord ceases pulsing… but there is always an exception to ever rule and I am sure your son is just fine 🙂
What an amazing read. I showed my husband and he is totally on board now, I couldn’t get through to him as to why waiting to cut the cord was so important, and now he “gets” it 🙂 I sincerely hope that my doctor will listen to my wishes, my last baby they immediately cut the cord and were just short of slapping him to make him cry. If I could have a midwife I would, but our health care system in our area does not provide one in Prince Albert, Saskatchewan, so we are at the mercy of our doctors. Thanks so much for the information.
You doctor must listen to your wishes. If he/she cuts the cord without your consent it is legally assault and battery. Write down your request and give him/her a copy. Good luck – come back and let us know how you go. 🙂
Hi there. I am currently in hospital at 27weeks with a very short cervix (3mm) and so it is unlikely that I will make it to term. I had planned on a natural third stage with the cord left well alone until the placenta is delivered naturally. I have already been told that if the baby is born prematurely, cord cutting will be delayed by a maximum of 3-10 seconds (hardly sounds like “delayed” to me!) in order for the pediatricians to be able to care for the baby. I will obviously state in my birth plan that I wish for cord cutting be delayed as long as possible.
I was hoping to get your opinion on the following:
Is it possible (and beneficial) to cut the cord without clamping it? I ask this because I believe that this will allow the placenta to bleed out naturally and increase my chances of delivering it without intervention – is this correct?
Also, in theory could this placental blood be collected and given back to my baby? I know premature babies often need blood transfusions, so could the blood be kept in case of this?
How worrying for you 🙁
I’ll try and answer your questions…
Delayed cord clamping is particularly beneficial for preterm babies – there is not much debate around that. The debate was more around full term (see the links to Dr Fogelson). Can the paediatrician bring the resus equipment to the baby? The cord might stop pulsing quickly – but might not.
If cutting the cord you must clamp the baby’s side otherwise the baby will lose blood. Leaving the ‘mother’s’ side unclamped allows the placenta to empty the extra blood left in it (that was mostly meant for baby). This makes the placenta smaller and in theory easier to birth. You can’t give the blood back to the baby once it is out of the body. There is no reason that you can’t have a natural 3rd stage. Bear in mind that with a preterm baby you are more likely to retain your placenta and because you are separated from baby the natural hormones can be disturbed + stress = can reduce the chance your will birth the placenta without assistance. But, you can set out to do so and see how you go. Let us know what happens.
Thanks very much for responding. I will make it clear that our preference is for the resus equipment to be brought to the baby rather than the other way around if at all possible. I also wasn’t aware that the cord is clamped at both sides so that is very helpful information to know and gives me a much better chance at a natural 3rd stage.
Not all practitioners use 2 clamps. You might find this is not the usual practice at the hospital anyway. I was taught to put 2 clamps on the cord and cut in-between but have worked in hospitals where 1 clamp (for baby) is the usual.
I see here a video which openly admits that the risk of jaundice is increased with no direct singular benefit of leaving the placenta attached, other than some inferred benefit of the total volume of blood that you can fit into a baby is 1/3 higher than that which is present at the time of an almost immediate cutting of the cord.
Additionally a baby may well be able to contain the blood within the placenta, but is that really necessary for a newborn? As adults we can lose a significant quantity of blood and survive, but that works both ways. I could easily infuse myself with an extra pint of blood on top of my current blood volume, perhaps even more, but not without consequence. Just because it fits does not mean that it is necessary or even required. I want to see the “why” element of this explained more please.
Notes on my thoughts: even though on average the blood levels of excess platelets in babes who do not have their cords almost immediately cut is on average lower than the levels required to directly cause jaundice, it is still on average _higher_. This means that there is an increased jaundice risk regardless of the average platelet counts as the realm of averages in this instances is shifted entirely towards higher levels. If all babies were left attached to the placenta in this suggested manner then the end result would be more babies, on average, that _do_ have platelet counts in the range of jaundice danger. The statistics here work to prove that this method will put more babies at risk of jaundice, and I can only conclude that this is because the baby in fact has too much blood.
I do strongly acknowledge that in the event of an infant needing to be resuscitated then leaving the placenta attached is clearly beneficial due to the surplus oxygenated blood.
The problem I have here is that the benefits of leaving the placenta attached to fill the baby with its blood, outside the realm of medical emergency at birth, are not clearly defined and are only implied, and there is an equal inference that higher platelets on average will not increase the singular risk to your child at birth, when the statistics say otherwise when correctly applied.
Finally, to leave a comment such as “I no longer participate in the stealing of babies blood” is both inciteful and pretentious.
Thanks for sharing your thoughts. I think it may be worth taking a look at the links at the bottom of this post: http://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/
In particular the link to Dr Fogelson in which he explains the research regarding delayed clamping and outcomes (including jaundice) and Mercer who is ‘the’ expert on the topic.
The increased risk of jaundice is not substantiated by recent research. If you have alternative research please share it. The Royal College of Midwives + Royal College of Obs and Gyn (UK) advocate ‘delayed’ clamping for all babies. I may be wrong about the risks of hypovolemia for a baby but I am in good company. Most full term babies probably can cope with reduced blood volume without significant damage because they are resilient. Most adults could cope with reduced blood volume too but would probably rather not. If physiologically the blood ends up back in the baby, that to me suggests it is meant to – not that we must prevent nature from doing harm by stopping in ‘over-infusion’. It worked well for every generation before the recent medicalisation of birth.
As for my comments being ‘inciteful and pretentious’… I’m sorry you feel that way but the comment represents my feelings about the issue. Stealing is taking something without consent.
The increased platelet count was quoted in the video in your article as Penny Simkin – a woman whom I respect immensely – states herself. The research she quotes states that platelet levels increase but within acceptable levels on average. The point I make is that if all babies were treated with delayed cord cutting then all babies platelet counts would increase linearly, thus exposing more babies to the danger zone of jaundice. This particular statistical angle has not been covered in any of the research I have seen, so I have no specific research to back this up other than a sound extrapolation of the maths behind the statistics in the given papers. I am talking averages as a whole, which brings me to a point I want to make about treating birthing by the laws of averages…
Thank you for also mentioning the term to which babies are brought into the world also as it is a huge factor to consider. I really enjoy that more and more options are being given to mothers (as a father, my opinion is basically moot, I know) and it is only good when professional people backed with both sound logic and tested practises can increase the chances of healthy babies. What I worry about is shifting a paradigm entirely the opposite direction without consideration that even though fast clamping and cutting is a relatively modern thing to do, it by itself has caused no discernible harm, otherwise there would be more evidence of it. Most babies are born healthily, I think there are different things that need to be focused on first that could directly give better birthing results, such as the position of the mother during pregnancy, exposure to things like water birth and doulas, not over medicating but neither removing pain medication from the table. For the “average birth” I do not believe that extended delay of clamping would provide any real benefit given the associated raised platelet levels, but no birth is a textbook average birth.
Another angle that I want to show is that implication of what is best for everyone is a terribly hard thing to define. What exactly is natures plan for the placenta? Even among educated midwives and doulas this is a hot topic that has no one single answer. I can see that it makes logical sense for the cutting of the cord to be delayed, believe it or not I advocate it, but the vast majority of other mammals on the world are separated almost immediately from the placenta by the mother, or are in fact separated during the natural birthing process. The vast majority of modern births for the average child go without incident or problem from fast clamping and cutting. Without definite knowledge of what we each were designed specifically for, it is impossible to say what it is precisely that each of us must do. It brings me back nicely to my main point: options need to be available for mothers to make the decisions, in an well-informed manner as possible, based on what they feel is right. Encouragement of a specific action over another based on the law of averages is not, I believe, the best way to achieve that goal.
With regard to “stealing” I see what you are saying, but technical correctness has a limit. As parents we are responsible for our children and their actions until they can be responsible for their own, which they are certainly not at birth (I want to avoid a debate as to precisely when they are if possible). If we needed our children’s consent for everything that we impose upon them as responsible care givers then they would refuse their immunizations for fear of the needle, eat only fried potatoes and ice cream and never go to bed on time regardless of tiredness the next day. Some things need to be done for the good of the child regardless of their opinion, that is what responsibility is all about, so I absolutely cannot see the use of blood from the placenta as “stealing”. It is also inciteful because while I try my very hardest to keep an open mind and stay firmly in the provable middle ground while trying to argue my perspective, I know that this stance is pretty much a rarity on the Internet. Some of the previous comments here make that point aptly enough for me. People do not need to have their own opinions mocked and singled out as different or inferior compared to your own even before they express them, as usually when this happens you get an angry retaliation rather than an opportunity to educate and learn. Expressing yourself in a manner that directly implies that an opposing viewpoint is automatically inferior should be avoided precisely for this reason.
With regard to the usefulness of the stem cells themselves the research is making such progress that I want to make clear to everyone that while they are not magical and our understanding of them continues to grow, progress is already at a point where new tissues and organs are being grown, and there is nothing to suggest in any research that all that could be achieved in stem cell use has been achieved.
Recent research has now shown that organs can in fact be grown from viable stem cells and a whole oesophagus can and has been grown and transplanted into a patient:
http://www.popsci.com/science/article/2011-07/using-lab-grown-trachea-surgeons-conduct-worlds-first-synthetic-organ-transplant
In this research the stem cells were not harvested from placental blood, but were harvested from the oesophagus itself of the patient. This does not mean than placental stem cells will never be useful for similar procedures, in fact it points that they may in fact be useful, with extended practical knowledge in the subject, for a far broader spectrum of uses.
Given this knowledge and given the advances, I would say that taking stem cells from the placenta of a healthy, full term, full size newborn with delayed clamping (to the tune of two minutes) is hardly something to call bad. Quite the opposite in fact, as long as it does not introduce a risk to the child. There is no point in saving for a rainy day when it is raining right now, so if the newborn needs the placenta and its blood right now then certainly leave it be.
With all this said, I will continue to keep the stem cells harvested from cord blood on ice and I will have them taken again, should the circumstances of the birth be OK to do so. More accurately, I will encourage my wife to allow them to be taken, it is ultimately her decision, always.
I hope that you can see these points as two things: firstly, an alternative viewpoint which is, like yours, based on sound logic and backed by basically the same research by which a newborn is not put under any risk for the obtaining of a potentially life saving resource. Secondly, and most directly for you as the author, that you should not in fact feel bad for obtaining the stem cells that you have and that doing so in certain circumstances is in fact potentially directly beneficial to the infant. I wish that more effort was spent on finding out specifically what these circumstances are for each mother so she can make the best decision possible.
John – please see the article “Late vs Early Clamping of the Umbilical Cord in Full-term Neonates – Systematic Review and Meta-analysis of Controlled Trials” by Eileen Hutton and Eman Hassan which shows clear short term and long term benefits to the baby with no increase in clinical jaundice levels or other negative outcomes.
Thanks for article suggestion rheadeja – link is here: http://jama.ama-assn.org/content/297/11/1241
I think the Waller-Wise (2011) article cited in the post also needs to be considered in terms of the limitations of collected stem cells in future health care.
Perhaps babies are meant to have elevated levels of platelets… we routinely give vit K to prevent NDN which is the inability to clot (just a thought if we are talking theoretical physiology). In any case the research suggests that there is no adverse outcome associated with this increase.
I find it fascinating that we have to provide research to demonstrate that doing nothing is safe and effective yet interventions are introduced (immediate clamping, collecting blood) without any research to suggest they are safe. Kind of the wrong way around don’t you think?
If you read my posts I hope you will realise that I am not about telling people what to do and ultimately support any informed choice a woman makes regarding her birth and beyond. My concern is that they often do not have the information provided by a system with a vested interest – or in the case of cord blood banks a financial interest. Hence this post. If you and your wife want to collect your child’s blood having looked at the information then that is great – you are making an informed choice about what is right for you and your family. No one can argue with that.
I don’t feel bad that I took babies blood – I feel bad that I did so without any consent. I didn’t even consider that there may be implications and I certainly did not give the parents information about the benefits of full blood volume for their baby. They were unable to weigh up the benefits and risks. Instead I was awestruck by the wonders of science and assumed what I was doing was great.
However, you live an learn. 🙂
My midwife waited for the blood to stop pumping (over 9 minutes) and then collected the stem cells. So many in fact they said we had 3x what we needed. But the fact is, my baby had taken all the blood he was going to take so at that point we felt like it was safe to take the rest. If it is not pumping, it is still possible to get blood out of it.
What do you know about the pros/cons of placental stem cell research? Does it present the same issues as cord blood harvesting (as in, are the stem cells actually in the placenta or do they come from clamping early and keeping the blood in the placenta)?
Thanks!
Hi Christina – not much. I would imagine they are from the placental tissue rather than cord blood but not sure, sorry.
My daughter has an autoimmune disorder. At one point, we were concerned about future leukemia. I hadn’t saved her cord blood or my sons’ cord blood so I briefly asked her Heme if it would be advisable for us to make another baby to save that baby’s cord blood just in case….she talked at length about how if we were to do that, it would need to be done by someone at the children’s hospital she was taken to because the commercial cord blood bankers don’t often collect it correctly and many parents end up not being able to use it anyway. :O( That would be awful thinking you had that security, to pay the hefty fees and storage fees, only to be told that it isn’t usable and never was because of a common collection error.
Okay, with this information, I am wondering what the heck happened at my birth. s waiting until it stops pulsating enough? We waited until it stopped pulsating (it was about 7-10 minutes) and THEN got a cordblood harvest. We felt we should bank cord blood since our daughter is part Hispanic, and everything I read said in that case it is more prudent to bank, since there is way less donated Hispanic cord blood available if she did get sick. Anyway, since then, I’ve heard lots of people talk about leaving the cord until it is totally white and limp, leaving it for hours, etc. as if that is really prudent to do. I’m wondering, did I do right just leaving it until it stopped pulsating? I was at a freestanding birth center with midwife and my husband cut it, he said it wasn’t pulsating. I also remember the wait, he didn’t cut it right away. We were hanging out in the tub for a while. It wasn’t pulsating. They were the kind of midwives that gave classes that including information about waiting until the cord stops pulsating and borderline anti-circumcision information. IDK why they would mislead me. I made it clear to the midwives that while we wanted to bank if possible, we also wanted to wait until it stopped pulsating and they understood. The only thing I think might possibly be inaccurate about my experience is if the blood bank lied saying they got a good harvest when they did not…? IDK if they would or could do that. Now, I am concerned. I felt pretty proud that we waited until it stopped pulsating, and I’m pretty sure we did, (again, I remember the wait time in the tub and we got out right after he cut it), but it has been three years. Should I ask to look at my records from the birth center? Talk to the midwife?
Grace – in some cases it is possible to wait until the cord stops pulsing and still be able to get enough cord blood for storage. The main point I am making is that this should not be considered the norm and parents should not delay clamping assuming there will be enough left. You may have been lucky and had enough left after the cord vessels had closed off. Some people leave the cord until it is totally limp or even keep the baby attached for days (lotus birth). The blood transfer from placenta to baby occurs over the first few minutes and is usually complete by 10. This may be longer during a water birth because the cord can remain warm ie. not stimulated to vasoconstrict. If you are concerned contact the cord bank and ask how much they collected.
Reblogged this on Mommy Feel Good and commented:
Cord Blood Banking: something to think about.
The revised and expanded edition of ‘Lotus Birth’ is now available. http://www.womenofspirit.asn.au
In a Lotus Birth the baby and placenta are left intact until the cord comes away naturally a few days after birth. There are many advantages for this practice to be gaining popularity. I have been associated with children born this way for the past 24yrs. I think that contributors to this very interesting and informative blog would find Lotus Birth fascinating. The subtle energies that are part of our systems are catered for in a lotus birth. It is only a matter of time until our science can measure and quantify these energies and understand the importance of them for optimum good health. We now have generations of people who have been subjected to major hemorrhage at birth and most people really have never seen a baby with full blood volume. I think that many of our health problems will be explained when the practice of precipitous cord cutting is stopped. Denying the major organs the blood they expect to receive to function properly is an obvious aberration.
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Just wondering if any of your readers and commenters had considered donating stem cells NOW. I donated menstrual stem cells which I am told are just as valuable as cord blood stem cells. I know my menstrual blood could not help ME if I had suffered a childhood illness but it could certainly help another child if we were a match. If all the menstruating women in the world donated just one of their monthly bleeds how many lives could be saved without risking any of the possibly unknown side effects to a newborn?
Personally I would not consider trying to bank the cord blood of my children. It is their blood and it should be in their body not a bag. (Unfortunatly my first was born by emenrgency c-section and delayed clmping was not an option in our hospital and my second was assisted by forceps and the Dr performing the procedure did not allow for delayed clamping in those circumstances.)
It ´s very interesting! How and where did you donate menstrual stem cells? Which diseases are treatable with them? Thanks
I have to confess I don’t know much about what can be treated with them yet but I was happy to give mine away in the name of research.
I emailed this company offering a free donation and they sent me all the information about donating and eventually a kit to do the collection and send back the sample. (A menstrual cup is used for the collection)
http://www.cryo-cell.com/services/menstrual-stem-cells.asp
I was very impressed actually because it cost them great expernse to ship the collection kit to me in the UK from Florida and then back to them.
Thank you very much I ´m also very impressed. It seems to me like a wonderful option. I ´ve read this patient´s brochure: http://www.cryo-cell.com/services/MenstrualPatientFactsBrochure_012012_LR.pdf
but I can´t find the possibility of donation there. Is it really used for other people (children) or just for donor herself?
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Oh my goodness I didn’t know any of this! I thought we would do delayed cord clamping and then cord blood donation. Thank you so much for saying what those brochures so cleverly leave out.
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It’s really interesting to compare this post to what I see oh physiological birth in other mammals. I’m a vet working predominantly with cattle. If the cow does not think she is being watched (e.g. if I peek out from behind a wall) then they all tend to behave in similar ways. Usually she is lying on her side to push the calf out. Normal positioning in cattle is to come out front feet first – like they are diving. The widest part is the head/shoulders. The hind legs will almost always slither out without any need for a contraction. I will usually observe the cow birth the calf up to around the navel, with the hind limbs of the calf in the vagina. Then both will rest for a couple of minutes. The calf will often right itself a little (i.e. get its forelimbs underneath itself and cough and breath). They then both sit and breath for perhaps two minutes. Then the cow will stand up – breaking the umbilical cord and turn around to lick and nuzzle her baby. Sheep are similar, but as they often have multiples they’ll tend to rest an even shorter time.
In some ways we’re so far from physiological birth being culturally expected I find myself have to look at undisturbed births in other species to try to spot normal. We’d need to observe some great ape births to be sure! I guess my thoughts would be that delayed cord clamping (a couple of minutes, until breathing is established in the neonate) seems to be the norm in other mammal species. But often there is a bit of bleeding from the torn umbilical cord so perhaps it hasn’t completely finished pulsing? My observations of other animals would suggest that slight delay is physiologically normal but long delays aren’t? These are entirely non-scientific observations but I thought they might interest you.
Thanks for sharing your reflections. I agree 🙂
Would it matter if the species are designed to be “up and at ’em” like grazers that have to be mobile soon after birth? What about den species or the ones who are born w eyes and ears closed? I wonder if the birth mechanics varies within mammals as a function of how mobile they need to be afterwards.
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I had a c-section so maybe the volume is different. But, can assure you my Perinatologost who collected my daughters cord blood was not a vampire and he actually endorses the practice.
My daughter had two autologous stem cell infusions which dramatically changed her path. I thank God every day for the medical advances that have allowed her to survive and thrive.
Although I understand every word you are saying about the obvious benefits of delayed cord clamping I would like to show you another aspect of the story. Just for you to see where I am coming from: my brother died at 29 of leukemia, with no history of such illness in or family. My husband’s brother died of lymphoma at 19, my father in law recovered from another type of lymphoma a couple f years ago. My brother was unfortunately too ill to even try bone marrow transplantation while other patients at the ward were succesfully treated with stem cells derived from donor cord blood or with live donor blood.
Being a labour doula myself I do know quite a lot about natural and unmedicated labour having two daughters as well, for whom there was no other option for us than to collect their cord blood; being the only intruding intervention at their births.
I don’t know however that my “stealing” of their righteous property is one that is going to save them in the future or in fact this is something that causes problems with their health. All I know is that – like every parent – I would do anything to save my babies and for this I read, research and ask questions.
I do feel a little offended though – not too bad just enough to write my story for others to see something like this as well – when people, who are spared from the very unlikely believe that it can never happen and think that I am a thief.
I am sorry that you interpreted my post as a personal attack on parents who choose to collect cord blood. The post was a reflection on myself and other practitioners who take cord blood without providing adequate information to parents about the risks and benefits of this intervention… and companies who promote it without addressing the risks. When making decisions about what to do for your own birth/baby/life – you are the expert and need to make the right decision for you and your family. There is no risk free option. You must choose the risk that is best for you/your baby… which you did. My point is that many are unable to make an informed decision because the information is not shared with them.
I am very grateful for this discussion and I for one don’t mind people’s strong feelings each way, at least it continues the debate! I have a cord blood banking kit ready this time but at nearly 37 weeks I have only just now thought (duh) to investigate if delayed clamping is still possible.
With my first, delayed clamping went out the window as during the second stage I agreed to the cord being cut for arterial blood gases, partly from exhaustion, partly from epidural ‘relief’ and partly as I can’t help but give the obstetrician the benefit of the doubt as I am a doctor myself. My baby had mild (i think) indications of distress during labour, ie, never major heart rate/trace abnormalities, just needed perking up with noise or soft drinks. I had studied what to look for. But, after her initial breath she ceased breathing within a minute and went from pink to dusky, and had feeding difficulties / what seemed like fatigue. All otherwise was well, she recovered with a brief resusc, and had to go through antibiotics and observations for 3 days ‘just in case’, and mild jaundice. I believe she was fine (no other sign of infection) and early clamping added insult to injury, whereas blood gases probably only mirrored what could be observable clinically with my baby girl. Haven’t checked with the Dr about that though. And then, the small worry she had to have gentamycin with its risks, and regrets I hadn’t discussed variations to my birth plan in advance.
So far this thread has helped me immensely in drafting a plan to discuss with my obs very soon, to delay clamping with a timer, by 45 seconds, minimising high lifting of my baby other than transfer to my chest, then confirm with me to proceed with clamping and collection. I hope that means at least a moderate benefit / protection for my baby. Any thoughts would be appreciated.
I am guessing from your comment that you are wanting to collect cord blood and delay clamping as long a possible without all the blood getting to baby? I would be careful about being prescriptive re. 45 seconds… the rate of transfer is different at each birth. For some the cord has stopped pulsing at 45 seconds and the blood has been transferred (usually longer though). When I am asked by women to collect cord blood I keep a close eye on the cord following birth and clamp as the pulsing slows down. Is this an option? Of course if the baby requires and resus I would not clamp the cord as placental flow and increased blood volume assists with resus. Let me know what your obs thinks.
Did somebody try to investigate or collect stem cells from different resource – for instance from placenta (after birth)? There must be abundant of various types of stem cells there. And without any damage or threat for baby.
I have just stumbled across this post and found it very interesting! (including all the views and links etc). I am a trained Midwife who has recently taken up a new post as a ‘Research Midwife’. This basically means I consent and collect blood for isolation of cells for research purposes only.
The blood is rich in stem cells which can be isolated and used for studies. They are never used clincally in this case and often discarded after use.
Even though I had spent time looking into ‘cord blood’ banking I’d never read around it fully and have since read a plethora of data, statements, research and anecdotal evidence.
I was actaully quite niave to how private cord blood banks advertise their services and found the recent introduction of the Virgin Health Bank probably the worst offender! Their information leaflet I find very misleading and it is based entirely on hope. Hope that ‘in the future’, ‘maybe’ etc etc that any blood stored would be of use. I don’t think they have considered benefits to baby at all and it seems very profit driven (of course Virgin are a large company but I think this is outrageous!). They have also not considered potential volumes that could be collected, courier times and sample conditions. So for example, baby is born placenta separates, delayed cord clamping occurs and as you rightly point out, the placenta is now drier than the sahara. Even if they do get some blood, they say 5mls minimum, the amount of cells salvageable for storage will be so small, almost insignificant! Also, once frozen and stored, half the cells usually degenerate!! I assume families would then not have to pay but i’m not sure this is explained fully to parents/families before they go ahead.
I know research is slightly different to private banking in that the samples cannot be retrieved once they have been used or stored but everything we do is in accordance with the HTA and national licensing and it is made very clear that they can withdraw at any point if they change their mind.
I also make it very clear to patients when consenting that it’s for research only, we wait for the cord to be clamped and cut and the reality is baby will benefit from most of the blood. This is exactly what we aim for in collection and are fully aware that there will only be small volumes left for us to take. Ultimately though the health of mother and baby are of the most importance and our research comes way behind this. Sometimes the collections amount to nothing but at least we know nature has done what it should!
It is seen as a very valuable resource in terms of numbers of stem cells that can be collected and in rare occurances we can collect larger bags, but very rarely! The average bag size is 50mls of which most will be anticoagulant!
Of course research benefits future generations but for the here and now and that vital first few minutes, we stand back and accept that nature needs to do its thing.
It outrages me that companies would falsely advertise and/or give limited information to parents about this. We inform early in the pregnancy to allow people time to read around the subject and get informed consent. I am lucky to have the knowledge behind me of where to look and how parents can make the right decision for them.
So far we have looked at gestational age and parity in relation to the amount of blood collected. It has been very interesting for us to look at these correlations and I feel that so far we have not interfered with nature to the best of our abilities. It has allowed me to further inform parents on what could be expected from the collection and how it will be used. I think I would be doing mothers and babies a diservice if I stormed in to collect without being mindful of the pros and cons of this procedure.
I am also aware that some people may still find this approach difficult to understand but I hope that my approach has helped inform researchers with limited background on this as to why we wait and why sample size is likely to be small and the babies health comes first!!!
Hi Jade
Thank you so much for contributing your experience and thoughts. I think the key difference between what you are doing and the cord bank companies is consent. Research requires approval via an ethics board – which I know from personal experience are pretty thorough to get approval from. If women are adequately informed and make a choice to donate or bank their baby’s blood then they have the right to make this decision unquestioned. But, as you point out, I think there is rather a lot of misinformation and coercion involved in a many cases.
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Hello, have you looked into stem cells therapy? It seems to be very good: my friend worksin a clinic in Mexico where they give embryonic stem cells treatment and she told me they get better result than anything else… What’s your thought about this kind of treatment? Most people that i talk with are scared because it’s so new!
Hi Daniel
I know stem cells are being used for a various treatments. I don’t really have strong thoughts about stem cell treatment. Only that parents are informed about the impact on their baby of collecting cord blood. 🙂
Dear Rachel,
I gave birth to my first child couple of weeks ago and ever since trying to figure out what happened with my son’s cord blood. I am hoping you as a professional will be able to shed some light please. I had a prolonged first (50 hours) and second stage (26 hours) labour as the baby was posterior. i ended up having ARM, epidural and Syntocinon as i was stuck at 6cm for 13 hours. i dilated to almost 10cm under epi and synto and started pushing on all fours which lasted 3 hours, the baby was on the perinium when i got completely exausted and they put me on my back and used ventouse.As the baby came out the doctor put him om my chest and told they needed to cut the cord as i was bleeding heavily. I so wanted for my baby to get his cord blood that i begged not to cut his cord. However the doc showed me the cord and it was not pulsating at all. It was almost white with some blue clots and it was about 2 minutes after the baby was born! They cut the cord which was not pulsating, however they immediately put a bucket under the cord and drained around 150-200ml of blood from the placenta before pulling it out. My husband was watching them do it. They quickly filled 3 tubes with the cord blood and took it away. I lost almost 2 litres of blood before the placenta was pulled out, the blood was pooring from me once the baby was out but it stopped after the placenta was pulled out.
I cannot figure out why the cord was not pulsating when the baby was born while there was plenty of blood in the placenta which was drained. The baby definitely did not get his cord blood, as for example he had acrocyanosis of feet and hands for almost 2 weeks after birth. Could it be because he was put on my chest which was higher then placenta ? Please help me to unravel this mystery!
Thank you
It is difficult to comment without having been there. However, some things you may want to consider…
If you were bleeding heavily as soon as the baby was born, your placenta may have been partially or fully detached at that point… if it was completely attached there there would be no ‘open’ vessels to bleed – see this post for info on physiology of placental separation/birth http://midwifethinking.com/2012/05/05/an-actively-managed-placental-birth-might-be-the-best-option-for-most-women/
Perhaps your placenta had detached as your baby was born? This would result in the placental circulation stopping before it had finished transferring blood to the baby. It would also result in bleeding until the placenta was out because the uterus would be unable to clamp down and close the blood vessels because the placenta would be in the way.
The baby being on your chest won’t have been a factor. The latest research shows no difference with blood transfer wherever baby is, as the placental vessels alter the blood flow accordingly. http://www.thelancet.com/action/consumeSharedSessionAction?JSESSIONID=laaMcsXV8C0uQ9yVxX_Tu&MAID=tsNptyqu4q5lENHcxBGyPQ%3D%3D&SERVER=WZ6myaEXBLFiKRYNosz3Hg%3D%3D&ORIGIN=801839786&RD=RD
I hope my comments help. Can you talk to anyone who was involved and ask them what they think was happening?
Thank you Rachel, your response is eye opening. And I believe this is the only plausible explanation of the cord not pulsing after birth and my big blood loss. I was told my blood loss was simply due to long labour/overworked uterus. I wish I had a better understanding of the physiology. I would love to ask some questions of the OB that delivered the baby (public hospital in Australia) but i’m not sure if this is possible and how can i do it? I asked my midwife her opinion on what happened (she wasn’t present at the delivery) and she said that blood drained from the placenta was not the baby’s blood but rather blood that ‘pooled behind the uterus’. Not sure what she meant but i know that mothers blood not supposed to enter the placenta and mix with baby’s blood?
sorry i meant to say ‘pooled behind the placenta’ not uterus.
There is an increased chance of PPH following a long labour – if the contractions are strong for a long time – not just having contractions for a long time… although these rates are probably influenced by the way ‘long labours’ are managed ie. IV syntocion. The physiology = there are a certain number of oxytocin receptors in the uterus. If the receptors are saturated with high levels of syntocinon, any further syntocinon or oxytocin (the natural version) will be unable to get onto the receptors and initiate a contraction = uterus is uncontracted. However, in your case it sounds like the placenta was partially detached rather than an issue with oxytocin receptors. Or it may have been a combination of the two factors.
The mothers blood cannot get through the placenta in any volume (tiny amounts rarely). Any blood drained directly from the placenta (ie. the cord) is from the baby’s circulation. The two circulations don’t mix.
Most hospitals offer a debriefing session for women with questions about their birth. It might help to contact the hospital and ask for one. The OB who was there should be able to answer your questions and provide a rationale for their actions. It might be worth ringing the manager of birth suite as they usually organise the debriefs.
Thanks for this article. I have a related question: where would this extrablood typically go if it doesn’t go to the baby (delayed clamping) or into the cord blood collection bag? Back to the mother’s circulatory system? I ask because certain categories of people are not allowed to donate blood generally due to lower than normal blood count levels (eg, people with sickle cell trait or disease). Doesn’t the same risk of anemia apply if these mothers have their cord blood collected? My ob thinks it’s a mystery that I suddenly became medically eligible for a blood transfusion after giving birth (I fell unconscious twice due to low blood count and had a mild seizure as well. That was only the beginning of my bloid related postpartum problems!). The cord blood bank happily told my husband later that we collected 10 times more than normal. Doesn’t anyone see an ethical flaw in saying cord blood collection is safe and painful for all mothers??
Edit on last sentence above: I meant to type “safe and painless”
The very first statement of cord blood banks – that cord blood collection is safe – is a barefaced lie. Baby needs all so called “extra volume” of blood from placenta to activate lung and gut circulation, which wasn´t used much and therefore was negligible during pregnancy. After birth almost all blood from placenta moves to the lungs and to the digestive system as child starts breath and digest.
I am so sorry that despite my education I was also deceived by cord blood bank.
The cord bank propaganda is strong… and many are motivated to do this based on their fear for their child and the reassurance that it is ‘safe’ from professionals. Things may change as more evidence becomes available about the impact of preventing full blood volume transfusion. Here is the latest worrying research: http://archpedi.jamanetwork.com/article.aspx?articleid=2296145 🙁
The blood in the placenta is separate from the mother’s blood and belongs to the baby only. The two ‘circulatory systems’ do not mix. There is an exchange of nutrients and oxygen at the placental bed but not blood. Any blood that does not get transferred to the baby or get collected in a bag will be left in the placental blood vessels and be discarded with the placenta. The blood blank ‘happily’ collected 10 times the normal amount of your baby’s blood. I hope your baby is OK with such a low blood volume and iron… iron is essential for brain development.
As for your blood loss – either you already had a very low Hb count before birth and/or lost a lot of blood from your own circulatory system.
The extra blood would go in the bin. It is your baby’s blood cells and would not necessarily be compatible with the mother.
Be sure that there is NOT any extra blood! All placental blood is absolutely necessary for baby´s afterbirth adaptation. Especially lungs and digestive system are in dire need of proper volume of blood. In my opinion, based on my Embryology education, the early umbilical cord clamping is a kind of barbarism. Of course, there are a lot of studies which discuss pros and cons of delayed clamping but only to gain enough time to keep cord blood bussiness going. Logically, afterbirth adaptation is a highly sophisticated process which have been refined to perfection during millenia. Believe me that there is not any extra millitre of blood to waste! And as for stem cells: Human body is full of them at any period of life ready to be used if needed.
Hi,
This article has some truths but also some false info depending on where in the world you are…
In the UK DCC and Cord Blood Banking can be done together. You saying it absolutely cannot is a little unprofessional and you should check your sources before passing on this information. Not giving parents the choice over their own birth through misinformation is just as bad as a private cord bank not advising about DCC.
There are phlebotomists who are trained to do exactly this and as a cord blood advisory service we only advise people who want to store privately to use a company that does both.
Secondly I completely agree with the benefits of DCC but you are going a little over the top. Did you forget that all of us had our cords clamped immediately and we are all still here? To this day, over 60% of cords are discarded in the UK without delaying cord clamping. It’s a lack of knowledge which needs to be
Thirdly to ‘knock’ donation is going against the RCM and RCOG guidelines.
Cord Blood donation allows new treatments to be carried out all over the world saving thousands of people. It also develops our understanding of disease and is paving the way for treatments to conditions we never thought were curable. So by knocking donation you are essentially knocking current medical developments as a whole.
Stem cells are the most important breakthrough of our generation and are creating the way to personalised medicine for our future. How can you so adamantly advise people against this?
P.s. we are not a bank. We offer free info to expecting couples in the UK and advise them of ALL their options and allow them to make a decision.
Finally “Physiologic studies in term infants have shown that a transfer from the placenta of approximately 80 mL of blood occurs by 1 minute after birth, reaching approximately 100 mL at 3 minutes after birth” http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Timing-of-Umbilical-Cord-Clamping-After-Birth
After 5 minutes the amount of additional blood collected is negligible and so why not try and save it for yours or someone else’s future? Get the best of both worlds.
I would really appreciate some evidence to support the idea that you can allow the baby to complete the process of obtaining full blood volume (physiological transition) AND collect enough blood to store. I would like to see photos or film of this being done. In my experience after transfer the cord and ‘fetal’ placental blood vessels are empty – the blood is in the baby. Of course if you interrupt this transfer you can collect blood. Yes, most blood, in most cases (not all) has transferred within 5 minutes… are you seriously suggesting that you are able to obtain enough blood after 5 minutes?
“Did you forget that all of us had our cords clamped immediately and we are all still here?” – babies are resilient – they adapt. However, most parents would want optimal conditions/health. This argument has been used for smoking in pregnancy.
I am not going against any midwifery professional standards or evidence based practice. Legally and ethically women must be given adequate information in order to make choices about interventions. If you read the post you will see I am not recommending anything. I am making the point that parents need adequate information. Please read my conclusion again.
I actually know a midwife researching this topic (she is a cord blood collector) – she told me that the actual cord itself (empty) can be used for stem cells. Why is this option not being promoted and researched? This would offer the best of both worlds? The current approach = a compromise.
@Vipul Kothari
Regarding just one of your statements, in the context of your arguments:
“…by knocking donation you are essentially knocking current medical developments as a whole.”
This is a shameful statement, let alone completely unprofessional if coming from a (self-proclaimed) advisor of expecting couples. Why? Consider the same structure in an analogy:
“By publicly presenting arguments against (ie “knocking”) your political representative, you are knocking current political development (ie democracy) as a whole.”
The only possible goal of your statement was to attack the character of @midwifethinking and the only logical conclusion of your use of such an attack is that you have a tendency to be deceitful. How do you expect anyone to trust you now?
Hi Rachel,
I don’t have pictures or videos (that would be a little weird as i’m not a midwife) but I have helped many women organise this for their births and it is completely possible I can assure you.
I understand you were a midwife and did collections but successful samples have been stored with as little at 15ml. We usually advise 30 – 60ml but it is based on the number of stem cells in the sample, not just the blood volume. I’m surprised you say that as this image is from your own website
The Placenta and Cord hold 240 ml of blood. As I mentioned above only 100ml is transferred in the first 3 minutes (80 in minute 1, and 20 in the following 2 minutes). So in 5 minutes you will not have more than 150ml (at the very most) transferred into the baby. More likely to be about 115 ml. So you have at least 90 ml left in the placenta and cord. Easily enough for collection and this has been done on many occasions. Unfortunately your information is simply out of date as collection was not done with DCC a few years ago but is practiced today by at least 2 UK banks.
Surprisingly your comments go against an image on your own blog (http://midwifethinking.files.wordpress.com/2011/02/screenshot4.png?w=300&h=262). This image shows that only about 5ml is absorbed (naturally) by the baby after 2 minutes. Surely saving stem cells is more valuable than this 5ml? By using a gravity bag method, more cord blood can be collected after this time than would pass to the baby naturally. Which is why you can do both.
Most parents would want the options, not an opinion. By calling yourself a “Vampire-Midwife” and saying you are trying to “repent for your sins” for “stealing baby’s blood” is not providing options or information. Its bordering on scare-mongering. Yes, your conclusion does give information and options but by then you’ve already planted a seed into the minds of readers to agree with you.
Glad you know someone in the industry but I don’t think you’ve had a proper conversation with your friend. There are 2 types of stem cells in the umbilical cord with completely different uses:
Cord Blood contains blood stem cells which can re-create the entire blood stream. They are one stage before bone marrow cells and can create bone marrow cells as well as some other cell types. They are currently being used to treat 85 conditions including Cancer, Leukaemia, Sickle Cell, Anaemia, Thalassaemia, SCID, Tay-Sachs etc. A full list is on our webste http://stemology.co.uk/conditions
Cord Tissue comes from the whartons jelly in the cord (the type you mentioned) and can create a wide range of cells like bone, muscle, fat, organ, retinal, skin cells etc. They cannot re-create blood or bone marrow cells and are currently in trials for treatment of Autism, MS, Parkinson’s, Alzheimers, Diabetes and hundreds more. There are no currently approved treatments using these cells as all are in trial stages.
Parents in the UK storing privately are given the option to store both as tissue is fast-proving to be a great tool in the fight against degenerative conditions. But both are separate and treat different ranges of conditions.
Hence my position is still that the best start a baby can have in life is delayed cord clamping and safety for their future is through stem cell donation or storage. The more cells that are donateed or privately stored, the better access the whole country has to potential life saving treatments and the quicker we can cure all blood cancers and more life-threatening conditions through medical research.
Sorry for the unusually long post but hope it provides you with a different aspect to research.
Thanks
Vipul
Hi Vipul
successful samples have been stored with as little at 15ml. – according to my contact in the industry you cannot guarantee adequate stem cells in a sample this small and ‘expanders’ may be required which impact on the efficacy of the sample if used.
I’m surprised you say that as this image is from your own website – This image is from a medical source. The medical approach is based on what happens in ‘normal’ practice not ‘optimal’ practice. The actual physiology of transfer is far more complicated and varies based on lots of factors. It is not simply about timeframes and volumes. This article provides a good overview: http://www.ncbi.nlm.nih.gov/pubmed/25389141.
So you have at least 90 ml left in the placenta and cord. Easily enough for collection and this has been done on many occasions. I refute this. As a midwife who mostly sees physiological births where the placenta is delivered BEFORE any clamping – there is not 90mls left. I struggle to get 10mls for blood typing. Like I previously said… I keep hearing this from those advocating for blood collecting but I am yet to see evidence. It would not be difficult for someone (with a big industry budget behind them) to film a collection and demonstrate how to allow full transfusion of baby AND collect enough. I suspect that collections you are helping to organise are happening at births with care providers who clamp early anyhow ie. before the birth of the placenta = they consider waiting a bit as ‘delayed’.
Most parents would want the options, not an opinion. Are you suggesting that the companies benefiting from cord banking are not offering an opinion? Nowhere does the marketing information call the blood what it is – BABY’S blood. It is not cord blood. It is taken from the cord but it is baby’s blood. You may think my language is emotive but it is no more emotive than creating fear in parents about their baby’s potential health and suggesting that their blood at birth is a waste product and solution to their potential ill health. Using the company’s link as evidence for the benefits of stem cells is dubious… having listened to a presentation by a stem cell collector about current research results – the webpage is misrepresenting the literature and provides no reference for the statements.
Thanks for the information about the difference in blood stem cells and cord stem cells. I was unaware of that.
My blog post is an attempt to offer an alternative perspective to the heavy marketing of the industry. It would be good if the industry considered whether the approach it is taking is ethical, and whether in some cases what they are doing is coercion by misrepresenting the procedure and the current research on stem cell use.
As an industry representative you benefit from baby blood collection. I have no vested interest and do not benefit either way.
Very interesting post Rachel, I’ve been looking for something on the topic for a few days and happened to find it here.
I have one question – what happens when a baby is born via cesarian? Does the cord have to be clamped right away or there is an option for delayed clamping?
This is probably best answered by a surgeon. I know many obstetricians clamp the cord immediately to minimise the time the woman’s abdomen is open in theatre (risk of infection etc)… and syntocinon + ABs are usually given IV as the baby is removed from the uterus to avoid haemorrhage. Some OBs are offering ‘natural’ c-sections and delaying cord clamping – not sure how long for or whether they delay the IV medication that would cross the placenta quickly.
Thank you for sharing your experience! First, I would like to say that even though you sounded as if you regretted having “stole” the blood from all those babies when you first started your career; those actions went to the discovery of the importance of that blood!! Thanks to you we now know what that blood can do for the future of our babies health and the alternatives as to how to go about maximizing the usefulness of those findings. It is true that after we discover the harm we have done in the name of research and science we can feel like monsters for the accidental collateral damage we can cause. Although, this article has, in my eyes, amended any wrongs you feel you have caused. Secondly, I do believe it a shame how the private sector can exploit the research of such kind hearted individuals transforming something that could benefit society into an individual gain to maximize the bottom line. I do believe that if everyone would donate instead of storing it for their personal gain this would be a valuable asset available to anyone who needs it. The world needs more courageous intellectual individuals like yourself to speak up with their insider knowledge for their areas of expertise.
Thank you again!!
Hi Maribel,
your first point is spot on! completely agree that without any research we would not be in the position we are currently in where cord blood can treat so many conditions and is now well on the way to treat MS and CP as well.
I do, however, disagree with your second point.
The NHS has 10 donation facilities in the UK.. This means that over 95% of expecting parents do not have the option to donate their stem cells at birth. Of the cord blood samples collected, only 30% goes into the public registry. If the NHS offered donation as standard practice across the country there would be no reason for a private industry.
Sadly, this is not the case. Every month I speak with expecting parents who would want to donate but their hospital doesn’t allow it. In this scenario I firmly believe that storing is better than discarding (those are the only two options available to these parents). To discourage them from an option could literally be the difference between life and death. I’d rather that parents had the facts and made their own choice – after all who am I to decide for them on the safety of their child?
If I’m looking at my personal opinion its a no-brainer… if you can’t donate and can afford to store there’s no downside. There’s no risk, no pain and yes, maybe you won’t need it, but in case you do I’d definitely be happy that it was there. £2500 for 25 years is very reasonable and I’d make the necessary sacrifices to make it happen. But that’s my opinion and everyone is entitled to their own.
As a cord blood information service we’ve questioned the RCM on this and their answer is that the NHS advises them that enough samples are collected to treat everyone who requires a transplant in the UK. My question is then why haven’t we eradicated these diseases? Why are so many innocent adults and children still not finding a matching donor in time?
Taking Leukaemia into account… currently only 52% of people will survive after 5 years of being diagnosed. Sadly, 31% will not survive past one year (Source – Cancer Research UK). How can this be a satisfactory solution and how can there be no more need to open donation centres?
The cost is clearly what is holding back the NHS. I would just appreciate if they came out and said “it’s just not possible for us to do right now”, rather than “we don’t need it.”
NHS & ANT Donation Centres in the UK are:
Barnet
Northwick Park
St George’s
Kings College
UCL
Luton & Dunstable
Watford
Leicester Royal Infirmary
Leicester General &
St Mary’s Manchester.
Anyone giving birth outside these hospitals aren’t give the option of donation. Can I ask what would you suggest they do?
Sorry for the long post – I just find it worrying that public and private sectors seem to choose sides rather than letting the parents decide. I really don’t see the need for a rift between the sectors and surely we would all benefit by working together and informing couples of all their options, rather than just what suits us.
I’d just like to make a couple of points here:
Although there is research happening – currently there is no strong evidence to support the use of stem cell therapy. A public system needs to accountable for how it spends money and until there is strong evidence they may be reluctant to fund a service.
Are these parents being given FULL information about cord blood donation? Are they being offered ALL options ie. optimal cord clamping in which their baby gets the blood rather than a blood bank? This is the point of the post. Parents need adequate information, not just – you can either donate or we will throw the blood away. That is missing one very important option – full perfusion of the new born and optimal blood volume for early development. A decision about taking your baby’s blood should be made with an understanding of the physiology and function of placental blood transfer to baby. For some parents that may be unimportant in comparison to potential stem cell benefits. But not for all.
“There is no strong evidence to support the use of stem cell therapy?”
I think you should tell that to the 1,000,000+ bone marrow transplant patients and the 30,000+ cord blood transplant patients and see what they say. There’s hundreds of thousands of people whose lives have been made better through stem cell transplants. I assume you are aware that a bone marrow cell is a stem cell and that a cord blood cells create bone marrow cells? If not, then I can understand why you feel this way but sorry to say you’re completely wrong.
If stem cell therapy is not a viable solution then why have the NHS and ANT been collecting and using them for transplants for so many years?
To answer you second point, yes at Stemology we give parents their options in full. We advise to DCC as well as CBB and advise them of their options and help them organise a service, whether it’s public or private. The unfortunate truth is that over 99% of the couples I speak to don’t have a donation option at their hospital so their options are store privately or throw away. DCC can happen in all scenarios.
Sadly, it seems that not everyone shares our belief in patient choice – but we pass on this information in FULL.
We have already had this conversation (above)
Please point me in the directions of these robust studies looking at cord blood stem cell transplants. According to your own website bone marrow is NOT the same as cord blood – check out the page comparing them. And the page on your website of ‘conditions cured’ does not include any references.
Please see my previous comments about the combination of optimal cord clamping and CBB (above). It cannot be done. You can delay clamping a little but that is all. The baby ends up with less blood than he/she would have if you did not clamp to collect blood. Again, the information on your website is very misleading and does not include references about optimal cord clamping and neonatal transition to life (short and long-term outcomes). It also demonstrates ignorance about the physiology of placental transfer ie. focusing on timeframes which vary significantly from baby to baby. Also – a general anaesthetic is very rare in a c-section (please check out those stats and include them). A GA is very risky with a pregnant woman and Drs avoid it… and what the hell are antimicrobial medications? Do you mean antibiotics? That is not a reason to prematurely cut the cord. This entire page is very manipulative.
I realise it may be challenging for you to address the ethics of your business. Hopefully parents will do their own research and include sources that do not profit from their decision before deciding to donate their baby’s blood. Patient choice involves full information – not just the sales pitch from the organisation who is vested in your decision.
Hello again,
Yes, it does seem we are going around in circles here….
Bone Marrow and Cord Blood have different benefits, but contain the same types of stem cells. Both Haematopoietic and Mesenchymal Cells are present in the umbilical cord (blood & tissue) and in bone marrow. The cells in the umbilical cord are more adaptable, safer and quicker to transplant hence they are a preferred option.
Therefore, every treatment possible with bone marrow is possible with cord blood – with a higher chance of a match, lower chance of GvHD and much quicker transplant options.
On top of that other treatments (not available using bone marrow) are possible as well.
I’ve revisited our DCC page and made a couple of changes… thanks for pointing it out, the information on there was a little out of date and has now been updated. The sources remain the same but are now using updated study information.
I think this is one of those agree to disagree situations… in my opinion it’s the midwives who are failing their patients by not advising them on their options at all. We are the ones who usually advise parents to request DCC, not their midwife teams.
But anyway, it’s pretty obvious we aren’t going to agree and think its just time to say good luck and thanks for the discussion. Would be more than happy to provide you any proof of what I’ve mentioned if you’d like.
A midwife at our hospital first said that they take blood from the placenta and not the baby. When asked she confirmed that the placental blood is the baby’s, but then added that there can be complications related to having “too many red blood cells”, and that some problems they see possibly arise more often with babies who have been longer on the placenta, for example too high haemoglobin (the baby needs to be put under a special lamp) which can potentially lead to more serious complications. What do you say on that? Some babies might get too high haemoglobin, but I’m curious if you can get too much of your own blood? I’m not a scientist but to me such a claim sounds similar to what doctors suggested some decades ago regarding breast milk not being good enough for the babies.
Clearly the midwife you were working with does not have an understanding of physiology or current research in this area. Or the current recommendation from WHO to delay clamping to allow full blood volume transfer.
Too many red blood cells (polycythemia) is uncommon in newborns and is associated with gestational diabetes, twin-to-twin transfusion or uterine growth restriction.
I discuss the importance of blood volume in the transition for baby in this post https://midwifethinking.com/2016/04/13/the-placenta-essential-resuscitation-equipment/
Why would humans have evolved to require a medical intervention to drain their blood immediately at birth?
And yes – it is similar to suggesting breast milk is not good enough for babies 🙂
Really enjoyed the article. I see that it has been updated in 2018. However, the video discussing the usefulness of the baby’s own stem cells for future illness of the baby is from 2010.The specialist in the video stated that the benefits that stem cell storage companies promise are theoretical for 2010. Is this still the case today for 2019? Are the stem cells from the baby’s own cord blood not particularly useful to grow organs or treat conditions that stem cells are used to treat; such as Cancer, Leukaemia, Sickle Cell Anaemia, Thalassaemia, SCID, Tay-Sachs (I copied these from a previous post since I do not know what stem cells are used to treat)? Are the therapeutic applications from one’s own stem cells still very limited?
There is still no good evidence supporting newborn stem cells for treatment. There have been completed studies now but nothing showing any strong benefit. I think there is a shift towards other types of stem cells now.
There was a recent documentary discussing whether it is worth storing baby’s blood: https://www.youtube.com/watch?v=8cEfSiOTaMI&t=2s
You no longer participate. But you did… my son’s stem cells were stolen by the hospital we trusted he wants our good. We don’t trust anyone anymore, I wouldn’t expected that from a institution.