Cord Blood Banking
Delayed and optimal cord clamping
The benefits of delayed and optimal cord clamping (DCC/OCC) are now well known. Despite this it is thought that there are still many babies who are not given adequate chance to receive transfer of their own blood from the cord and placenta at birth. Tommy's (2018) report that a survey completed by The Positive Birth Movement demonstrates that 40% of babies continue to have their cord cut immediately after birth.
This presents a clear need for continued and sustained education about the benefits of delayed and optimal cord clamping to both parents, healthcare practitioners and healthcare students.
Cord blood banking
It is also recognised that many parents are becoming aware about the practice of umbilical cord blood banking (UCB) and may wish to choose to bank their infants stem cells for future use.
New research evidence indicates the increasing potential for the use of this residual blood left in the placenta, which contain stem cells with regenerative potential to treat many age related conditions such as diabetes, heart disease and arthritis (Roura et al., 2015). Although in their infancy, these advances offer potentially life changing benefits for the infant and possibly other family members in the future.
Amanda Burleigh and I recently wrote a blog on All4Maternity about the tensions between the two practices of OCC and UCB. Please click the picture below for a more detailed explanation and further information.
So whats the big deal about cord blood banking?
UCB requires collection of babies' blood from the umbilical cord and/or placenta following birth. When immediate cord clamping is practised , it is common for 60mls of blood to be easily collected from the cord and/or placenta (Allan et al., 2015). Stem cells can then be extracted from this blood to be cryogenically stored ready for use at a later time.
In comparison, if delayed or optimal cord clamping is carried out, the amount of blood and stem cells that can be collected is significantly reduced. Residual blood collected from the placenta after OCC has been performed can be as small as 10-15mls.
The blood collected after immediate cord clamping is however, part of the newborns circulating blood volume and necessary to ensure a smooth transition to life outside the womb (Farrar et al., 2010; Mercer and Erickson-Owens, 2012). We know know this blood provides the newborn with necessary stem cells to support its own immune system (Sanberg et al., 2014), protecting baby from potential adverse conditions in later life and ensuring adequate iron stores for crucial neuro-development (Andersson et al., 2011).
Public cord blood banking compounds this issue. Currently, samples need to contain at least 25 million nucleated cells per kilo of body weight in order to be successfully used in a transplant. This means that public cord blood banks are highly likely to discard the smaller samples collected after DCC or OCC. Unfortunately, parents looking to donate cord blood for the public good are often faced with choosing either to donate or to delay clamping.
Fortunately, in light of the important knowledge and evidence about the benefits of delayed and optimal cord clamping some UCB companies are starting to adapt practice and respect newborn physiology. They have developed new ways of preserving small blood volume collection of stem cells from the placenta after the baby has received OCC. Making it possible, should parents wish, to choose both OCC and UCB stem cell and tissue collection.
So how do we affect change?
I am keen to educate about the critical questions women, midwives and other maternity workers may have about UCB. The focus on ensuring physiology is not compromised whilst also considering aspects like parent education (antenatal counselling) and informed consent. So in effect to minimise the chance of parents inadvertently falling foul of making an uninformed choice.
Given that stem cell banking is an option some families wish to consider and that they expect to receive this information from their healthcare providers, it is important to ensure health care professionals have impartial evidence based information about stem cell banking (Machin, 2016; Peberdy, Young & Kearney, 2016).
For this reason I have prepared the first evidence based resource about UCB especially for healthcare professionals - this can be downloaded from BloodtoBaby's online store. Healthcare professionals must ensure that within this conversation they educate parents about the importance of OCC and the benefits this offers to their baby's long term health and development.
Cass McNamara, Midwife and the Founder of the MaMa Conference agrees there is an opportunity to support the way stem cells are collected without harming newborns, you can read her overview here!
BloodtoBaby.com continues its focus on supporting midwives to practice OCC, tackling clinical issues like; OCC and collection of cord gases, active management of the third stage of labour, OCC at caesarean section and resuscitation with the cord intact.
I also plan to explore subjects relating to UCB. As well as preparing the new impartial, evidence-based resource to educate maternity healthcare professionals about UCB, I plan to explore anecdotal accounts of coercion of families to ask for ICC to facilitate large blood volume retrieval for stem cell collection. I will raise the profile of vulnerable groups in relation to UCB practice. In addition, I plan to make a new resource to help parents in their decision making if they wish to have UCB - watch this space!