Cord blood banking vs. delayed cord clamping

A reader wrote in, "Sarah, What can you tell me about cord blood donation, I have heard so many different things on the contribution and I just want correct information to make an informed decision. Thanks for any information you can share."


I'll put together a link roundup so that each family can decide what's best for their situation.


Before we look at cord blood donation or banking as an option, let's first consider the importance for baby to receive his/her own cord blood immediately after the birth. There are options for collecting cord blood for donating or banking that *are* compatible with delayed cord clamping. 


If you haven't yet seen Academic OB/GYN Dr. Fogelson's Grand Rounds on Delayed Cord Clamping, it's well worth the 50 minutes to watch. He touches upon volumes of data supporting the importance of delayed cord clamping, including the effects of premature cord clamping that is common in the US, namely baby losing approximately 40% of his or her blood volume and the oxygenation from that blood. Baby also receives that rich store of his or her own stem cells, which is sometimes called "Nature's first stem cell transplant."  


The World Health Organization supports delayed cord clamping as well. Specifically, WHO states, "The optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless, approximately 3 minutes or more after birth." 


The World Health Organization continues with these reasons for the recommendations:

• "For the first minutes after birth, there is still circulation from the placenta to the infant, the majority of which occurs within 3 minutes, generally coinciding with the end of cord pulsations.
• "Clamping the umbilical cord immediately (within the first 10 to 15 seconds after delivery) prevents the newborn from receiving adequate blood volume and consequently sufficient iron stores. Immediate cord clamping has been shown to increase the incidence of iron deficiency and anemia during the first half of infancy, with lower birth weight infants and infants born to iron deficient mothers being at particular risk. Up to 50% of infants in developing countries become anemic by 1 year of life, a condition which can negatively and perhaps irreversibly affect mental and motor development. According to one longitudinal study, Costa Rican children with chronic iron deficiency in infancy had 10 to 25 point lower cognitive test scores at 19 years of age, when compared to similar children with adequate iron status. Waiting to clamp the umbilical cord allows a physiological transfer of placental blood to the infant which provides sufficient iron reserves for the first 6 to 8 months of life, preventing or delaying the development of iron deficiency until other interventions—such as the use of iron-fortified foods—can be implemented.
• "For premature and low birth weight infants, immediate cord clamping can also increase the risk of intraventricular hemorrhage, and late-onset sepsis. In addition, immediate cord clamping in these infants increases the need for blood transfusions for anemia and low blood pressure."

Australian midwife Rachel Reed's blog "The Placenta: essential resuscitation equipment" is well cited and helpful in understanding the crucial roles the placenta plays immediately after birth. She also explains how delayed cord clamping need not be at odds with neonatal resuscitation, should that become necessary. In many other countries, resuscitation equipment is on wheels and is brought close to the bed so that baby can continue to receive oxygenated blood while medical teams administer oxygen or other helps. 

Here's an article from the UK: "Trolley saves lives of newborn" with a description of a mobile bedside resuscitation unit that is currently used in 3 UK hospitals and may become standard in all UK hospitals. Here's a news clip that shows the Trolley and describes its use.

Here's an FAQ page on cord blood donation at marrow.org. Their page does not appear to address the need of each newborn to receive his or her own cord blood before considering donation for other purposes. It does state "No blood is taken from your baby, only from the cord and placenta after the baby is born," but this is only true if delayed cord clamping is done first. Otherwise, up to 40% of baby's entire blood volume IS taken from baby, only a small amount of which is donated for useful purposes, and the rest of which is disposed of as medical waste.


It's easy to find materials promoting the potential benefits of cord blood banking (many of which are industry advertisements for private banking). I don't currently have any bookmarked links on any solid independent research weighing the pros and cons of private cord blood banking. I do, however, have this article from an Irish newspaper titled "Stem cell storage can put lives 'at risk''. An excerpt: "‘‘In the vast majority of cases, the costs of storage are therefore not justified and the rationale being used by commercial companies recommending storage is misleading," said Sullivan. Sullivan said there was insufficient evidence to recommend its practice in Ireland except for a small number of at-risk families with rare blood diseases, malignancies or bone marrow failure... Collection of cells usually happens within minutes of a baby being delivered, ‘‘where there is a risk of post-partum haemorrhage and when both mother and baby require one to one care’’, Sullivan said.The harvesting of stem cells at this time led to added complications that might actually put the lives of mothers and babies at risk, he added."

For those who feel that cord blood banking or donation is right for them, Science and Sensibility posted an excellent article on the skill of some care providers to accommodate both delayed cord clamping AND cord blood collection after the birth of the placenta. This would mean that baby receives all of the blood that he or she needs, and that cord blood would be collected from the "excess" after the cord quits pulsating. It's not always possible as sometimes the cord blood has begun to coagulate by that time, but it's worth a try, if you would like to have the best of both worlds. Here it is for more info: "Journal of Perinatal Education 20.1 Feature Article: Umbilical Cord Blood: Information for Childbirth Educators."

See also my previous blog "Photo illustration: delayed cord clamping vs. immediate cord clamping"


As I collect more research on the subject, I'll add more links. I hope this helps as a springboard for more info.

UPDATE:

Nurturing Hearts Birth Services posted this fantastic series of time lapsed photos of an umbilical cord transitioning from full of blood immediately after birth, to thin, limp, and empty in fifteen minutes, after which time the cord was clamped and cut. If you are wondering how you will know whether the cord is ready to be cut, this is a great resource. Magic Umbilical Cords