Cord blood banking vs. delayed cord clamping. - Page 2

[Peggy O'Mara]

When to clamp the cord has been a controversy since I was a young mom. Research continues to show that delaying cord clamping benefits the baby. Waiting allows more umbilical cord blood volume transfer and can even help prevent anemia. Here's a recent study from South Florida's Center of Excellence for Aging and Brain Repair.

I like to look at the results from the Cochrane Reviews as they review and summarize research all over the world: "This review of 11 trials showed no significant difference in postpartum haemorrhage rates when early and late cord clamping were compared. For neonatal outcomes it is important to weigh the growing evidence that delayed cord clamping confers improved iron status in infants up to six months after birth, with a possible additional risk of jaundice that requires phototherapy."

For some families, delaying cutting the cord has spiritual significance and is called Lotus Birth, first popularized by Jeannine Parvati Baker. According to Sarah Buckley, "Lotus birth is the practice of leaving the umbilical cord uncut, so that the baby remains attached to his/her placenta until the cord naturally separates at the umbilicus...at 3 to 10 days after birth." Sarah writes about Lotus Birth in one of our most popular articles: "Ecstatic Birth," first published in Mothering Magazine in 2002. 

Lotus Birth is a topic of frequent conversation on MDC. Here's the most recent thread.

[jessjgh1]

I also researched this a lot and waited till the cord stopped pulsing and then collected. Our midwife said she would try to get enough of a collection but couldn't guarantee it.
The directions in my kit specifically said to wait and then gave an end time as before the placenta was birthed. It even had procedure for sections. We waited at least 10 minutes.

It would be interesting to see what the composition of collections are w delayed vs immediate.

Jessica

[Mommel]

Originally Posted by jessjgh1 

I also researched this a lot and waited till the cord stopped pulsing and then collected. Our midwife said she would try to get enough of a collection but couldn't guarantee it.
The directions in my kit specifically said to wait and then gave an end time as before the placenta was birthed. It even had procedure for sections. We waited at least 10 minutes.

It would be interesting to see what the composition of collections are w delayed vs immediate.

Jessica

I would be interested in this too... from what I understand though ten minutes is an average time until the cord stops pulsating and it could be as long as 15 or 20 minutes... in any case, the required collection amount is probably different if you want to bank the blood for your family vs. donating it for research, which is what I was inquiring about when I called around to ask. Also, I just read an interesting article that explores both sides to delayed vs. immediate cord clamping: http://www.womenshealthforyou.com/2011/04/wait-till-cord-stops-pulsing.html Not that I'm changing my mind or anything, but it was interesting to hear an argument for immediate cord clamping... still doesn't make sense to me though.

[Chrisa]

Originally Posted by Mommel 

I would be interested in this too... from what I understand though ten minutes is an average time until the cord stops pulsating and it could be as long as 15 or 20 minutes... in any case, the required collection amount is probably different if you want to bank the blood for your family vs. donating it for research, which is what I was inquiring about when I called around to ask. Also, I just read an interesting article that explores both sides to delayed vs. immediate cord clamping: http://www.womenshealthforyou.com/2011/04/wait-till-cord-stops-pulsing.html Not that I'm changing my mind or anything, but it was interesting to hear an argument for immediate cord clamping... still doesn't make sense to me though.

You are right, it doesn't: studies have shown that the baby's position relative to the placenta doesn't matter. Gravity doesn't affect the placenta to baby blood transfer, it's not a cannula. http://www.youtube.com/watch?feature=endscreen&v=t5CelB63QR8&NR=1

[Haelmoon]

Delayed cord clamping beyond the 2 minute mark may not provide any additional blood for the baby.  There are two main issues with delayed cord clamping - continued oxygen supply for the baby and the extra red blood cells for the baby.  Emerging evidence suggests there a blood pressure differences between delayed and early clamping.  However, there is little evidence that there are additional benefits beyond two minutes or so. 

For c-sections, it is possible to delay cord clamping.  Just dry of the baby on mom's abdomen before you clamp the cord, no big deal.  If it is an emergency c-section for fetal distress, you just need to keep an eye on the placenta.  If the baby needs resus, it is ok to delay the cord clamping, as long as the placenta is still attached and supplying oxygen.  Once the placenta separated, no more oxygen is being transmitted that way, if the baby is not breathing, it is not getting oxygen at all, so better to clamp and hand the baby to the paeds team.

Physiologically, there is a pulse in the cord as long as the umbilical artery is till open, this can take a long time to close (NICU docs use the umbilical artery as an access point in newborns).  It can be very constricted though, and only small amounts of blood begin transmitted.  However, the rest of the connections (ductus venous and ductus arteriosus) close much quicker in response to fetal breathing, meaning the baby is now sending more blood to the lungs.  Too delay cord clamping can lead to fetal anemia, because the baby had three circulations to perfuse (body, placenta and lungs), while the fetus only has two (lungs only get a tiny bit of blood).  The initial delay is good, I am not convinced about longer delays.  Back to c-sections though, it is definitely possible, even in twins.  I did a delayed clamping on 32 week mono-mono twins.  It was great (we just had to be sure not to mix up the babies because mom had already named them).  Babies did great.

Cord clamping can be delayed, and then followed by stem cell collection.  The problem is you wont get quite as much (on average).  If you are privately banking, it may not reach enough to be bothered with, however, in a public banking system, samples could be merged to creat full units of stem cells (like other blood products currently are), and it would be available for all children.  In Canada, this is the plan - a public banking system, and a few busy centres would be used to collect the samples.  Adult bone marrow transplants can be done with stem cell from fetal blood, but one collection is not enough, they need to combine multiple units.

Cord blood is good, and there is enough to go around.  Some for the baby, some for the lab and some for the bank. 

[womenswisdom]

Originally Posted by Haelmoon 

Delayed cord clamping beyond the 2 minute mark may not provide any additional blood for the baby.  There are two main issues with delayed cord clamping - continued oxygen supply for the baby and the extra red blood cells for the baby.  Emerging evidence suggests there a blood pressure differences between delayed and early clamping.  However, there is little evidence that there are additional benefits beyond two minutes or so. 

Could that be because in all of the studies I've read (and I'm willing to be open to the fact there are ones out there I'm not aware of), the "delayed" cord clamping happened at 3 minutes or less. Are you aware of any studies which included statistically significant numbers of truly delayed cord clamping (defined as when the cord becomes limp and white and is no longer pulsating)?