Which is better -- saving cord blood or delaying clamping?

[Shell]

I have looked all over the boards, but I have not found any discussion on cord clamping. I have read a bunch of articles on-line that suggest that it is best to not clamp the cord until it has stopped pulsating. The idea is that the pulsating cord is filled with oxygen-rich blood that is intended to go back into the baby's body immediately after birth to help increase their blood volume, antibodies, iron and oxygen levels (which help inflate the lungs).

Yet, at the same time there is a big movement to save the cord blood to preserve the baby's stem-cells, in case the baby needs them to battle disease later down the road in life. In order to do this, from what I understand, the attendant needs to clamp the cord within a minute or two of birth.

To further complicate things. I have also read that early cutting of the cord (which is the norm in the U.S.) may be responsible for the high incidence of hemorragic disease (failure of the blood to clot), since the blood from the placenta includes the clotting factors babies need to prevent hemorrhaging. This is why babies have come to be required to have Vitamin K shots at birth.

So where is the better benefit? Saving the cord blood or letting the cord pulse? I would think that there would be at on of discussion on this dilemma, but I just haven't seen it. Maybe because saving cord blood is pretty new.

I have had a few friends give birth in the last few months, and I have not had good information to pass on to them. My honey and I will be trying to conceive next month (WAHOO!!!!!!!) (we're very excited), and I know that this will be a big dilemma for us. My instincts say to let the cord pulse. Better to be preventative now than reactive later. But of course, I just want to do the right thing for my baby...

A disclaimer -- I'm not sure about all of my facts here. I'm learning as I go. So please correct me if I've said anything that is not correct.

I look forward to an interesting discussion.

[Eman'smom]

JMO, but I think it's better to wait for the cord to stop pulsing, yes stem cells can do amazing things, and I'm all for that, but the odds of your baby needed them for cancer or something is slim. But the immediate benefits are huge.


Again JMO, but ds's cord was clamped immediatley (it was around his neck, his heart rate was very low, I had Fentanol during birth). He didn't breath well, had very low clotting factors, coudn't maintain temperature, he wasn't very stable. DD didn't have the cord cut right away and she has been super stable.

[mamaroni]

I don't have any solid facts at all, just my opinion/experience. We waited until the cord stopped pulsing with both dc's, skipped vitamin K shots, and had no problems at all.

I haven't read a too much about banking cord blood, because it seems to me like it's just big business trying to make money off vulnerable new parents, who may be scared or guilted into thinking they NEED to do that.

I agree with Eman'smom that the immediate benefits are huge. The chance you'll need the cord blood in the future is probalby slim.

[pamamidwife]

I personally think that cord blood banking is big business. Because we routinely rob newborn babies of their blood, we're able to charge parents an arm and a leg for storage of this blood in the very, very, very rare instance they may use it in the future.

Here is a FABULOUS site on leaving the cord intact:

http://www.cordclamping.com


I know that leaving the cord intact until the placenta is born helps facilitate a smooth birth of the placenta, reduces postpartum hemorrhage, and also is healthier for baby.

I'd much rather resuscitate a baby that is still attached to the placenta. This is one of the biggest mistakes that is made against baby's transition to life.

There is speculation that many babies go through the equivalent of a hemorrhage by having early cord clamping and may actually be the babies that have low iron stores in the first year of life.

If the cord was meant to be cut right away, don't you think it would come with a pair of scissors?

[mamaroni]

Thanks so much for that link, Pam! I didn't fully research this issue when my kids were born, but we did delay clamping/cutting until the cord stopped pulsing. whew!!

[Tanibani]

Re: Which is better -- saving cord blood or delaying clamping?

Originally posted by Shell
Yet, at the same time there is a big movement to save the cord blood to preserve the baby's stem-cells, in case the baby needs them to battle disease later down the road in life.

Yes there is a big movement... but it's only coming from one direction, the companies who provide the services. I'm getting Cord Blood bank mailers in my mailbox with Leeza Gibbons (Entertainment TV correspondent) about how she saved it with her last kid and is so happy to have it just in case

Consider what the American Academy of Pediatrics says about this issue.
Cord Blood Banking for Potential Future Transplantation: Subject Review - July 1999

Families may be vulnerable to emotional marketing at the time of birth of a child and may look to their physicians for advice. No accurate estimates exist of the likelihood of children to need their own stored cells. The range of available estimates is from 1:1000 to 1:200 000.4 Empirical evidence that children will need their own cord blood for future use is lacking. There also is no evidence of the safety or effectiveness of autologous cord blood transplantation for the treatment of malignant neoplasms (Table 1). For these reasons, it is difficult to recommend that parents store their children's cord blood for future use.

I believe the health benefits to the baby (if you delay clamping) far outweigh the "potential" benefits of saving the cord blood.

It is big business. It preys on families. Yuck.

[Shell]

This is great! I can't believe that there were five posts in one hour! Thanks so much for the responses -- and I still hope to see more. While intuitively I know that letting the cord pulse is what is best for the baby, it is tremendous for me to have others affirm my belief. It seems to me that there is so little information about this very important topic!

I definately agree that this new industry seems to be praying on the vulnerabilities of soon-to-be parents. The pressure to do the "right thing" is enormous.

How long has the blood banking business been around? Why do I see blood cord banking signs/pamphlets at the midwife-staffed birthing center near where I live? It seems so surprising to me!

[lilyka]

We did both : After the cord stopped pulsing she just drained what was left from the cord. It didn't take much to fill the small tube, mabey a couple of teaspoons. Maybe the cord hadn't completely stopped pulsing. Ava was unresponsive and not breathing and we were not in a position to help her while the cord was attatched but she let it go for a good long while while rubbing Ava. We didn't have anything to clamp or cut the cord with for a long while it had to stop pulsing before they cut it and took her away. (went in for a prenatal and had a baby in under 5 minutes, no one could find the emergancy birth kit. It is kept in a prominent place now) I don't know, maybe the blood they collected wasn't the stem cells. I am not sure about all that. We didn't bank it for ourselves just donated it. We did not get vitamin K shotor anything like that and her clotting was so good that they couldn't rvrn get blood for any of her tests.

[~Megan~]

If the cord was meant to be cut right away, don't you think it would come with a pair of scissors?

You crack me up!

I think I posted about this a while back or maybe I just asked Pam. I don't remember.

I wonder if there might still be enough blood in the cord after it stops pulsing to do both. Its worth a try and you can ask your care provider.

[hahamommy]

For me it comes down to what the baby *does* need vs what the baby *might* need. The baby *does* need it's own stem cells, that's a given. It's seems a birthright to get all the essential building blocks to grow up healthy and strong ~ that's what stem cells are for.
My biggest beef with this issue is the hospitals stealing cord blood to be sold for a HUGE profit to cancer patients. Both my children's cords were *milked* after cutting and the nurses finally confessed to collecting the stem cells. They would not discuss WHY, but when my husband was dx with cancer, I figured it out!
Now, if they'd trade some of the cord blood for a free delivery..... hmmm, I think I'll ask next time

[beanma]

i think we'll let the cord stop pulsing with newbaby (due in 2 weeks), but i did want to echo lilyka on the donation thing. not all cord blood banks are for profit. there's one through the area hospitals here that is like a bone marrow bank or regular blood bank. the parents donate the blood to the bank to be used for anyone in need that's a good match. if your child needs it later on down the road and it's still available your child gets it, but there's no guarantee it will be available. we did this with dd. i don't know that we would've done the ones you pay for, but this seemed like it might help somebody out and i hadn't researched the cord clamping issue at the time. dd had no complications at birth and no anemia so i think it turned out fine for us.

hth

[Shell]

It would be great if Mothering could do an article on the cord blood industry -- and the pros and cons.

[Tanibani]

Originally posted by hahamommy
My biggest beef with this issue is the hospitals stealing cord blood to be sold for a HUGE profit to cancer patients. Both my children's cords were *milked* after cutting and the nurses finally confessed to collecting the stem cells. They would not discuss WHY, but when my husband was dx with cancer, I figured it out!

Arrrrgggghhhhh!!!!!!!!!!!!!!!!

That is really infuriating! To everyone involved... mothers who are not aware of it and not to mention desperate cancer patients. My son's neighbor (age 6) just finished his round of chemo (shocking and sad that he got cancer) but thankfully mom says he's OK. He'll be getting a bone marrow transplant next.

Interestingly... this month's issue of Fit Pregnancy magazine has a story from a couple whose son was very sick (some rare disease) and they received cord blood from a bank (didn't know they existed) which saved his life. Too bad I can't find it right now.

Mothering should write an article.

[norasmom]

IMO, I think it makes sense to give your baby what nature means for it to have. We delayed clamping of the cord untill it stopped pulsing, but only after we convinced our doctor that it was the best option for the baby. When I brought it up at a prenatal she was against it but willing to look at some of the research I found. Now she routinely practices LCC.

It does make sense that you would still be able to save the stem cells that are left in the cord. I would love more info on this topic if anyone finds some.

[Clarity]

In a natural delivery, I agree I would allow it to serve te baby rather than be collected. But, if you end up with a c-sec, the surgeon will likely NOT allow the cord to stop pulsing. In which case I would certainly collect for your own use and not the hospitals -best to get a kit just in case. Many send them for free or low cost. I found http://www.californiacryobank.com whose history is in sperm banking to be much much more affordable than someone like viacord. I had medical problems that ruled out using a public bank, but that would be a great option for most people. I have a friend in medical research who recommended cord blood collection.. She said a need was rare, but more uses seem to be coming down the road.

[Tanibani]

Clarity, your link didn't work. Here is the California Cryo Bank website:

http://www.cryobank.com/

I may want to show up to a hospital tour and ask the RN (in front of all the parents) that question.... "do you typically collect cord blood and sell it for research purposes?"

I didn't have a C-sec, but I tore badly (I blamed the OB for that and was angry for a long time over it). My OB immediately clamped the cord (I asked for delayed clamping) so he could sew me up. I really don't care for me - to personally keep it. So I don't regret having a kit handy. So I guess in a way, I'm saying that I hope it wasn't wasted. I hope they saved it and donated it (rather than for profit ). I'll ask.

[bec]

My understanding is that, even when you do bank cord blood, you don't have access to your baby's blood should you need it in the future. It just goes into a general pool, and you would get whatever was available at the time.

I want my baby to get those stem cells right in the beginning. I plan on delivering the placenta before having the cord cut.


Bec

[Clarity]

private banking you get YOUR baby's blood, you pay them to store it. Public banks, you get the shared pool and the fee is minimal or free. There are a lot more public banks now than there were a few years ago.

[lovebugmama]

We also did both. We talked it over with our midwife in advance and she agreed that we should let the cord stop pulsing, then withdraw the blood. She couldn't guarantee that there would be enough blood, but there was. You really need surprisingly little. It was important to us b/c we have a LOT of cancer in our families.

[EmmaJean]

Well, what if you need to get some cord blood to test baby's blood type? I know we can use eldon cards, but I think we will also need an "official" test to confirm. Anyway, for my first, I didn't feel strongly, but knew my mw's didn't believe in immediate cord clamping. But watching the birth video, I can hear her saying, I'm going to go ahead and cut the cord now, and it had only been maybe a minute. This time, I feel strongly that I want the baby to stay connected (at least) until the placenta is born. I'm wondering if this is an option since I also need cord blood drawn for blood typing. Can you draw some while it's still in tact?

OH, and I am for sure the cord blood banking business is mostly about money. I can't believe all the ads in all the pregnancy mags! It's overwhelming. And then to find out how much it costs??!!! Makes you feel like a bad parent for not being able to afford that finacial investment. If your child ended up with that extremely rare disease, wouldn't you feel guilty for not harvesting the cord blood? I think I would, but it's not necessarily a choice we have right now. It all comes to money. And I had no idea they harvested it at births (unknowingly to parents)!!! That is nuts! But what else is new.... :