When it comes to making decisions about cord blood banking and delayed cord clamping, are parents given accurate, balanced and honest information?
Recent years have seen the rise of cord blood banking (among those who can afford it), while at the same time, there has been much buzz about delayed or optimal cord clamping, as more and more studies continue to show the benefits of this practice.
Why harvest stem cells?
The blood found in a baby’s umbilical cord immediately after birth is rich in stem cells – the body’s building blocks for blood, skin, bone, muscles, nerves and cartilage – and can be used to treat over 80 blood-related diseases. Banked cord blood stem cells are biologically younger than adult stem cells (from bone marrow) and present fewer risks of complications when used in transplants. While finding a match in public databases can be difficult, storing a baby’s stem cells provides families with the reassurance that the stem cells could be of therapeutic value to the child later in life, or to parents, siblings or blood-related family members if they are a close match.
On the other hand, the biologically in-tune practice of waiting for blood to transfer from the cord to the baby’s body has been shown to have numerous benefits. Studies have shown that a delay in cord clamping increases a baby’s blood volume by 32% and his iron reserve by 27–47mg of iron, helping to prevent iron deficiency and lowering the risk of anaemia, as well as resulting in fewer transfusions and fewer incidences of intraventricular haemorrhage.
Other long-term benefits of optimal cord clamping include improved neurodevelopment (especially fine motor and social skills) years later, for children whose cords are cut more than three minutes after birth, according to one Swedish study.
The original stem cell transplant
Many are questioning the ethics of depriving a baby of his own blood through stem cell collection – blood (and stem cells) that would have immediate benefits to him. The question of whether parents are making informed choices, or are being given inadequate and misleading information, is also increasingly under discussion.
While many stem cell collection companies state that the procedure is ‘safe’ and ‘risk-free’, most parents do not realise that opting for cord blood banking means premature cord clamping (immediately Baby is born and before original physiology would determine), which in turn, means missing out on the many benefits of this practice.
There is also often the perception that cord blood is medical waste that would otherwise be discarded, when in fact, the blood being collected would be transferred to the baby if the cord isn’t cut early.
According to Dr Sarah Buckley, the likelihood of low-risk children needing their own stored cells is 1 in 20 000, whereas these valuable stem cells may well prevent future illness if more umbilical cord blood is allowed to pass to the baby. As one lead researcher, Dr Paul Sanberg, states: ‘Cord blood also contains many valuable stem cells, making this transfer of stem cells a process that might be considered “the original stem cell transplant”.’
Is it possible to do both?
No doubt hoping to allay new clients’ concerns, stem cell collection companies tend to tell parents investigating the possibility that they can still store stem cells and delay cord clamping if they wish, but warn that delaying for too long means a higher risk of suboptimal collections.
Successful stem cell banking hinges on the number of stem cells in a given sample (where more blood means more stem cells), and while the amount of cord blood collected varies, collection size averages around 60ml. Of course, delayed cord clamping will result in a smaller cord blood collection, with one study showing that the success rate of cord blood donation drops seven-fold after just one minute of delaying clamping.
Official recommendations regarding how long to wait before clamping the cord after birth vary considerably. The World Health Organization does recommend delayed cord clamping of no earlier than one minute after birth, but notably, research has shown benefits of waiting longer. One 2015 study, for instance, showed that blood continues to flow to the baby for up to six minutes, even after the cord has stopped pulsating.
As much as parents may want to do cord blood storage and optimal cord clamping (and stem cell collection companies may want to reassure them that they can), in reality, the two are mutually exclusive if done properly: either the baby gets all his own blood, or a substantial amount of it is taken away, ‘harvested’.
Another pertinent consideration is the many who are subject to immediate (premature) cord clamping without even the option of cord blood or stem cell collection – a doubly negative outcome!
Placental blood collection
Some claim that the cord can be left to finish pulsating, and plenty of cord blood can still be collected from the placenta – with some time and effort of course. But how practical is this really?
As Rachel Reed points out, on her blog MidwifeThinking: ‘The large umbilical vessels are empty and by the time the placenta has been birthed, the blood in the small vessels has begun to clot. You have to faff about trying to scavenge enough un-clotted blood from the small vessels covering the placenta.’ She urges parents and practitioners to look at a photograph of a placenta that has finished its circulation and says, ‘If you reckon you could get 45mls out of that, you deserve a certificate and some chocolates.’
And yet, technology is continually evolving. Just recently, the UK’s leading blood cord bank, Cells4life, announced the development of Toticyte – a new cord-blood-processing technology, which enables cord blood banks to take as little as 10ml from the residual blood left in the placenta after optimal cord clamping. Toticyte delivers three times more stem cells from small blood volumes than any other method. Developments such as these could go a long way to resolving the current debate.
Sensitive Midwifery points out that having someone hovering over mother and baby, waiting to harvest cord blood, isn’t conducive to a calm, unhurried, physiological third stage. If the responsible technician could wait in the wings for spontaneous placenta delivery, the impact would be substantially less, though not totally non-existent.
Whose responsibility is it anyway?
While the decision is ultimately a personal one, it is not unrealistic for parents to expect their care providers to provide them with important information. Some clinics or health practitioners will claim that they assume parents will do their own research, but the fact is that the amount of new information a pregnant couple must grapple with can be overwhelming.
Moreover, this stance by care providers presupposes that parents have access to a well-rounded, balanced view on the matter. In reality, the information parents receive is often coming directly from a stem cell banking company or an antenatal class that receives commission for promoting these companies. It must be up to midwives and doctors – the care providers handling the cord in the third stage – to ask patients about the reasons and research behind their choices, and to provide unbiased information if necessary.