Cord blood banking vs. delayed cord clamping. - Mothering Forums

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#1 of 26 Old 10-06-2009, 08:55 PM - Thread Starter
 
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Disclaimer: I don't have any medical education, and I don't have any specific information for or against my theory.

I keep hearing about children being sick with various conditions, and getting transfused with their cord blood, which then treats or cures the condition. It is my understanding that in order to collect cord blood, the cord needs to be clamped immediately following birth, therefore depriving the baby of the rich cord blood.

Now it seems to me, that given the benefits that can come from the cord blood later on down the road, that it would be the most beneficial to delay clamping the cord, allowing the cord blood to reach the baby. This way their getting all the benefits of cord blood from the beginning (thus preventing future conditions?), rather than if/when there is a problem.

Does this make sense to anyone else? Does anyone know of any studies or information along these lines?

Maybe I'm totally off track with this, but it just seems like something so obvious is being totally overlooked-at least in mainstream obstetrical medicine.

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#2 of 26 Old 10-06-2009, 10:50 PM
 
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You should check the various blood banking companies to see if they all require immediate cord clamping. There have been many discussions here with posters reporting this was not the case with the companies they chose.
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#3 of 26 Old 10-07-2009, 12:52 AM
 
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Is this for a public bank, or banking it privately for personal use? Both ACOG and the AAP oppose private banking, unless there is a sibling who could benefit. Very little is used (according to the AAP, as few as 1 in 200,000 children will benefit--at most, 1 in 1000). Even at public banks, 75% is unsuitable for use (not even unused--not even usable).

I did public donation. As it happens, I had a section and delayed clamping wasn't an option, but I would absolutely ask about how long you can delay clamping and still donate.

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#4 of 26 Old 10-07-2009, 12:58 AM - Thread Starter
 
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It is really more a question about whether or not the conditions that arise that could be/are treated with cord blood, could be avoided by allowing the cord blood to go to the baby at birth. That something that could be so important should be going to the baby from the start.

It's just something that's been on my mind and that I've wondered about.

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#5 of 26 Old 10-07-2009, 01:29 AM
 
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IMO, based on what I have read, cord blood banking for a "just in case" scenario seems like a bit of a rip-off. Apparently there is a lot of doubt about whether the stem cells (the beneficial part of cord blood in this case) are viable after storage for any length of time. Also the amount of stem cells in one cord collection is not likely to be enough to make a significant difference. And, as far as I know, there is no regulation of storage facilities so the conditions in which the blood is kept are variable and may affect the quality.

I would rather my baby had the benefits at birth.

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#6 of 26 Old 10-07-2009, 01:42 AM
 
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The stem cells wouldn't necessarily prevent the specific conditions they're used to treat later. (I can't say they never do because we don't know just how many things they could be used to treat.) For example, I know someone who had a stem cell transplant for leukemia--as far as I know, no one's ever shown that delayed cord clamping reduces the incidence of leukemia later in life. But there are general benefits to delayed clamping. The only downside is an increased likelihood of jaundice, and I couldn't say that that outweighs the benefits.

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#7 of 26 Old 10-09-2009, 11:24 PM
 
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Thefreckledmama, that's an interesting theory, and I bet there are no studies about it at all. Cord clamping is another one of those things the medical establishment does because that's what they're used to, rather than because it's supported by evidence. It would certainly be interesting to see a really long-term study of early cord clamping vs. not, and whether there were any noticeable differences between the groups.

Just as a note, we donated our son's cord blood (and placenta). We didn't have to clamp the cord early. We waited until it was done pulsing, and cut it because I couldn't get the baby up high enough to nurse. The placenta was born just a minute or two after that, and my midwives got enough blood to donate. Waiting will probably decrease your chances of getting enough, but it's not impossible, so unless someone has a really important reason for wanting the cord blood, I think it's usually best not to rush things.
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#8 of 26 Old 10-10-2009, 11:45 AM
 
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No one could make money off preventing illnesses through delayed cord clamping.

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#9 of 26 Old 10-10-2009, 11:49 AM
 
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No one could make money off preventing illnesses through delayed cord clamping.
Totally!

The blood in the cord belongs to that baby now. We delayed for 1-2 hours.

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#10 of 26 Old 10-12-2009, 04:25 AM
 
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I totally agree. I looked into banking, it was pretty pricey so I considerd donating. Then I discovered benefits of delayed cord clamping and am so glad I did. Now it almost seems like common sense, how could I have been so dumb to consider otherwise? This is the way it is meant to be. I am curious though... why cannot they do delayed cord clamping with c - section? Can't they lift both placenta and baby out together? Just clamp cord after 10 min or so? I don't get it.

I think mine was 10 or 15 minutes later, the cord went white long before that, I was just being safe and giving it more time because I thought I felt the pulse (although my OB says there was none, so I may have felt my own, not sure)

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#11 of 26 Old 10-12-2009, 10:59 AM
 
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For Dd1 we initially looked into donating her cord blood into a public bank. Then when we had our Bradley classes we learned about the benefits of not clamping immediately and opted to not cut it right away. When I was in labor they really wanted Dd's cord blood. Maybe because I am O-. I don't know why, but they were almost pushy about it. We said we didn't want to because we wanted to delay the cord cutting. The OB piped up and said that wouldn't be a problem. So we agreed.

They cut the cord immediately and were agressive at getting the placenta out. The OB pulled on the cord with her full body weight. I could feel it. I thought she was going to pull my uterus out. They passed it off to the Red Cross volunteer and she rushed it over to the other side of the room to get the blood out of it. I asked to see the placenta and she hesistated and said she needed to get the blood out first. She seemed like she was in a hurry to do so.

They were supposed to notify us if anyone used her cord. They never did, so I assume it was not used.

For Dd2 we gave birth at home. She got all the benefits of her own cord blood at birth.

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#12 of 26 Old 08-20-2011, 07:06 AM
 
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http://truthaboutdelayclampingandcordbloodcollection.webs.com/

 

Mothers can delay cord clamping and cutting AND bank or donate their cord blood! 

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#13 of 26 Old 08-23-2011, 11:38 AM
 
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I disagree very much with cord blood banking and premature cord clamping. Babies deserve their cord blood and the stem cells in it.


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#14 of 26 Old 08-24-2011, 06:54 AM
 
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To me, it makes sense to let the baby have it's own cord blood at birth.  Not to deprive them of it just in case something happens in the future. 

 

 


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#15 of 26 Old 08-24-2011, 08:55 AM
 
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Quote:
Originally Posted by thefreckledmama View Post
Now it seems to me, that given the benefits that can come from the cord blood later on down the road, that it would be the most beneficial to delay clamping the cord, allowing the cord blood to reach the baby. This way their getting all the benefits of cord blood from the beginning (thus preventing future conditions?), rather than if/when there is a problem.

Does this make sense to anyone else? Does anyone know of any studies or information along these lines?
 

The specific benefit of cord blood as used by the banking industry are the stem cells.  Stem cells are cells which can turn themselves into any kind of cell in the body--if there is a need for bone marrow cells, for example, the stem cells can turn into marrow cells.  Most cells in the body are destined from the moment they are formed to be only one kind of cell, that is, a skin cell cannot be turned into a marrow cell.  So in some illnesses where certain cells in the body are sick, stem cells can be used to replace the sick cells, thus curing the individual.  It's a lot more complicated than this, obviously, but that is why cord blood is important for curing disease: it is one of the rare sources of stem cells.  Thus it is not the blood which is important, but the stem cells found in the blood.

 

Unfortunately, many of the diseases which can be cured using stem cells are genetic diseases.  The disease comes from a malfunction in the cell's DNA.  All the cells in the body, including stem cells, have the same DNA.  Therefore, in the case of genetic illness, it does absolutely no good to receive one's own stem cells, because those cells have the illness too.  The stem cells used to cure the disease must come from an unaffected individual.  This means that receiving one's own cord blood (and thus one's own stem cells) at birth does not do anything to prevent or cure any present or future genetic illness.  This is why private cord blood banking is really only useful when there is a case involving siblings.

 

Please understand that this is all "generally speaking," that is, there are rare instances in which a person's own stem cells may be beneficial, and not all illnesses that can be helped by stem cells are genetic.  But in the vast majority of cases, this is how it works.  I hope this helps you understand a bit more about why and when cord blood is beneficial!


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#16 of 26 Old 08-24-2011, 12:06 PM
 
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I looked into donating my baby's cord blood to a public bank, because I have family and close friends with certain chronic illnesses who can really benefit from stem cell research. The three cord donation services I contacted all told me that they clamp the cord within a set time frame (usually less than ten minutes). When I inquired if I could do it at my home birth, they were hesitant, but offered to send a collection kit to my midwife. When I called my midwife, I discovered why they were hesitant... according to my midwife, ten minutes is not exactly delayed cord clamping. She said that she would let the cord stop pulsing (because that blood actually belongs to my child - duh) and then see if there was anything left to extract. She mentioned that it is usually not enough for the donation centers to accept, and ends up being a waste of time and effort for all involved, so I just opted out altogether, despite her reassurance that if I truly want to do it she will collect it for me.

 

Bottom line: I trust my midwife because she showed me specific research from reputable publications on both sides of the issue that I could read to make an informed decision, and I wasn't terribly confident in the folks I spoke to at any of the donation centers I contacted. I asked them ALL to point me to studies that showed that cord clamping was not detrimental to a baby's health, or any other study supporting cord donation, and they couldn't even point me to a study telling me that cord blood stem cell research has been beneficial in any way at all. I pressed them repeatedly to show me ANYTHING that proved a benefit, and they never gave me so much as a direction to look or a web site other than their own, which had no actual research or studies. Wow. 


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#17 of 26 Old 08-26-2011, 04:47 PM
 
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I considered donating as well, until I realized that it's not really "cord" blood you are donating, but your baby's blood that just happens to be in the cord at the time.  Because I didn't any complications post-birth, I was able to delay cord clamping, and I feel like it was the best choice for the health of my DS. 

I really liked this article about this same conundrum from an midwife: http://midwifethinking.com/2011/02/10/cord-blood-collection-confessions-of-a-vampire-midwife/  


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#18 of 26 Old 08-27-2011, 01:54 PM
 
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Which is why those who are properly educated can do both!  ;)  Bank AND delay clamping.  No need to ever do it before the cord has stopped pulsating.  Just more education for mothers, midwives and doctors who don't already know this simple truth.

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#19 of 26 Old 08-28-2011, 12:42 AM
 
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Which is why those who are properly educated can do both!  ;)  Bank AND delay clamping.  No need to ever do it before the cord has stopped pulsating.  Just more education for mothers, midwives and doctors who don't already know this simple truth.


This position you've restated now twice interests me. All of the agencies I spoke to told me that they do not wait for the cord to stop pulsating, because if they did the sample of cord blood left in the cord to collect would not be enough for them. Do you know of any agencies that take smaller amounts for their collection samples or am I missing something here?

 


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#20 of 26 Old 08-28-2011, 05:55 PM
 
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Which is why those who are properly educated can do both!  ;)  Bank AND delay clamping.  No need to ever do it before the cord has stopped pulsating.  Just more education for mothers, midwives and doctors who don't already know this simple truth.

This is what we did.   We waited quite awhile after the cord had stopped pulsing, and the midwife was still able to get plenty of blood for the banking.  Before the birth, we told her that our priority was that our baby got the stem cells, and if that meant sacrificing enough blood for banking, we were fine with not being able to bank.  We would have still had to pay the collection fee that the birth center charged, but it was minimal.   But in the end, it worked out, and we got to delay clamping and bank the cord blood.  For our next child, we are looking into a lotus birth.  We won't need his cord blood since we have the blood banked from his big sister.
 

 

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#21 of 26 Old 08-29-2011, 11:42 AM
 
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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.

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#22 of 26 Old 08-29-2011, 09:15 PM
 
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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.

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#23 of 26 Old 08-30-2011, 03:14 AM
 
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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.

 


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#24 of 26 Old 06-24-2012, 03:20 PM
 
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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


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#25 of 26 Old 06-30-2012, 12:54 PM
 
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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. 


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#26 of 26 Old 06-30-2012, 01:18 PM
 
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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)?

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