Tuesday, July 07, 2009

To Bank or Not To Bank...

I've been doing lots of "research" lately... on various baby-related topics, including vaccination, birthing procedures, state statutes & laws regarding prenatal tests, and this rather unexpected topic: cord clamping. Today I wrote a letter to the editors of American Baby, a magazine which many new parents receive for free around here. I thought I'd post it here (with extra hyper-links for your perusal) for your benefit:

Dear American Baby-

As expectant parents, my husband & I enjoy reading through your magazine each month. We love the quizzes especially. They're such good date-night conversation starters. :)

I've been a bit concerned though, as in every single issue there is at least one ad for umbilical cord blood banking. In drawing up a birth plan, I began to research options regarding cord cutting & clamping, and found that there are HUGE benefits to delaying the clamping & cutting of the cord. The placenta & baby are on a closed blood-cycle, with up to 1/3 of the baby's blood being circulated through the placenta at any given time. Cutting the cord immediately upon birth (as is required for cord blood banking) means that the baby's blood volume is drastically reduced. This means that the baby has fewer oxygen and iron- carrying red blood cells, as well as fewer disease-fighting white blood cells. Several recent studies (including one from the May 2007 edition of the Journal of the American Medical Association) have shown that waiting even 2-3 minutes before clamping & cutting the cord allows the baby's blood to drain out of the placenta & into the baby where it belongs, protecting against anemia and irregular breathing for weeks after birth. This is crucial for low birth-weight babies as well as babies whose breathing is delayed (the placenta keeps supplying oxygen-rich blood until the baby can breathe on her own). Ideally, a cord can be left attached to the placenta (in the mother) until it stops pulsating, indicating that all the blood has drained out, and then cut as usual.

For blood to be banked from the umbilical cord, the cord MUST be clamped & cut ASAP. That blood then must be stored, against "some day" when my child (or someone else's) MIGHT need it. That seems a bit backwards-- taking blood that should be in my baby now (which she definitely needs right then) for someday when he or someone else might need it. When you add $$ for storage to the equation, you positively have a racket going on. Quote from the American Academy of Pediatrics' 1999 statement: "It has been shown that the timing of umbilical cord clamping has an important effect on the neonatal blood volume and the subsequent hematologic status. If cord clamping is done too soon after birth, the infant may be deprived of a placental blood transfusion, resulting in lower blood volume and increased risk for anemia in later life. Immediate cord clamping will, of course, increase the volume of placental blood for harvesting for cord blood banking. There may be a temptation to practice immediate cord clamping aggressively to increase the volume of cord blood that can be harvested for cord blood banking. This practice is unethical and should be discouraged."

Please consider these things as you continue to advertise. I think parents deserve to hear the benefits of delayed cord-clamping-- benefits which must be foregone if umbilical cord blood banking is pursued. (An article looking into both sides would be most appreciated!)

--Christina Szrama, Louisville KY
NB: A recent article in the Washington Post along these same lines. Interestingly, there is a story at the end about a family who is using cord-blood to treat their daughter who was brain-damaged by oxygen deprivation at birth. This is precisely what delayed cord-clamping/cutting protects against!
NB2: "Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use, because most conditions that might be helped by cord blood stem cells already exist in the infant’s cord blood (ie, premalignant changes in stem cells)." (revised statement by AAP) --Children who are healthy at birth, with healthy cord blood, are precisely the ones who are least likely to need treatment (possibly using cord blood) in the future. Children who would need it later are precisely the ones who couldn't use their own blood. If anything, storing cord blood for treatment of other people in public banks is the way to go. Of course, this isn't what's marketed to parents...


Jenny said...

Good point. We opted for delayed cutting/clamping for this very reason. I think Jane's was cut like five minutes after she was born.

Eowyn's Heir said...

yeah it's not like it's a hard transition to make. my guess is that in the future delayed clamping will be the norm again.