Newborn blood, truth & advertising
Today I received an email asking me to choose between banking or storing my baby’s ‘cord blood’, after recently subscribing to an Australian parenting website.
This email plus my Facebook newsfeed has directed me to articles with advice about cord blood collection along with reassuring quotes from private blood bank employees.
So why aren’t these articles identified as advertising, given that private blood banks profit from this procedure? If they’re not advertising, why aren’t the claims about ‘cord blood’ collection backed up with evidence?
It looks to me like the advertising dollar and pre-prepared ‘advertorial’ is the reason why several Australian magazines and websites are promoting (simultaneously) ‘banking or storage’ as the only two options other than ‘waste’.
Unlike advertorial, an independently researched piece may have at least described the biological function of the umbilical cord and birth where the blood is not ‘wasted’.
Cosmopolitan Pregnancy Australia is featuring an article titled Should you store or donate your baby’s cord blood, where the author describes the umbilical cord as a “slimy, weird-looking thing” that contains a “small amount of blood”. I doubt you will be surprised the article quotes a manager from a private blood bank.
This subtle denigration of the umbilical cord is done to minimise the truth about the importance of the intact cord before, during and many minutes after birth.
An Australian parenting site, the Bub Hub, is promoting their new online ‘hub’ about cord blood to help inform parents. While the amazing properties of ‘cord blood’ are explained there is no mention of the purpose of the blood, stem cells, and immune cells to the baby. The blood is typically described as waste, then quickly followed up by the ‘reassuring’ comment that the waste can now ‘serve a purpose’ for research and medical treatment.
Quoting the articles from the Bub Hub:
“Collecting umbilical cord blood is not harmful to the baby or mother and if you don’t choose to store your baby’s cord blood, it would normally be discarded as medical waste after the birth.”
No mention is made of the true purpose of the blood that is prevented from reaching the baby by the clamp.
The Bub Hub provides content from the private blood banks about how cord blood ‘should be be collected’:
“Immediately after the birth of your baby, the umbilical cord is clamped and cut, separating your baby from the placenta and mother…The procedure is painless and risk-free to both mother and baby. It takes about three minutes and does not alter the birthing process in any way…Collection can only take place at the time of delivery and should be done as soon after the birth as possible. The longer you wait to collect the blood, the less blood you will be able to collect, which means fewer stem cells. To maximise the volume of cord blood collected the umbilical cord should be clamped and cut as soon as possible after the delivery of the baby. The cord should be clamped and cut as close to the baby as practical.”
This same article is also seeking to reassure parents there is no harm or risk:
“Are there any risks?
No. The cord blood is collected after your baby has been born and the umbilical cord has been clamped and cut. The cord blood that is being collected is blood that would routinely be thrown away. The procedure is painless and risk-free to both mother and baby. It takes about 3 minutes and does not alter the birthing process in any way.”
Both the Bub Hub and Cosmopolitan Pregnancy Australia are regurgitating content from the private blood bank Cell Care Australia’s website (and most probably receiving advertising dollars for doing so). There is an advertisement on the Bub Hub website by Cell Care that “celebrates the launch of the Bub Hub’s new cord blood info hub”.
So what are the truths about ‘cord blood’?
The truth and science surrounding physiological birth, placental transfusion and cord clamping still has some way to go before many clinicians cease clamping the umbilical cord at birth.
It is a no-brainer really, but ritual, commercial interests and false assumptions are still in the way of true understanding and change. So in the meantime, I offer to share my truths:
-Human beings are placental mammals, sharing in many millions of years of evolution that never required a surgical clamp for the umbilical cord.
The baby’s transition to ‘adult’ respiration and circulation at birth is complicated to explain, but the umbilical cord makes it simple – leave the baby attached to the mother until the cord ceases to pulse, until the placenta is delivered, until the mother and baby are ready.
-The umbilical cord is not weird or slimy – it is wondrous and the function of the umbilical cord is of vital importance to the baby before and after birth.
-The blood in the umbilical cord is not ‘cord blood’ or ‘waste product’ at all – it is the baby’s blood.
Studies have shown (for a long time) that up to 30-60% of the baby’s blood can be in the placenta at birth. This is because the placenta performs the exchange of oxygen/carbon dioxide until the baby transitions to breathing – the baby then needs this blood in their body to perfuse the lungs and meet the increased organ function of ‘adult’ respiration (compared to placental).
A higher amount of blood may be in the placenta at birth due to compression/ cord compression during the second stage, which can block venous return to the baby. The transfusion of blood back to the baby is especially important in this instance– a prior decision to immediately clamp can have grave outcomes for the baby with a very low blood volume at birth.
-Clamping of the cord is a surgical intervention that is ‘ritual’ and unfortunately upheld by those who will not cease interrupting a placental mammal birth in progress unless a random controlled trial tells them to.
-Despite what the advertising is claiming, there is clear evidence that “immediate cord clamping to collect as much blood as possible” is a harmful intervention – more harmful for some babies than others.
It absolutely does disrupt and interfere with the normal birth process and the baby’s transition (to breathing, to meet demand for increased organ function).
Associate Professor Judith Mercer explained in 2002 that “early clamping of the umbilical cord at birth, a practice developed without adequate evidence, causes neonatal blood volume to vary 25% to 40%. Such a massive change occurs at no other time in one’s life without serious consequences, even death. Early cord clamping may impede a successful transition and contribute to hypovolemic and hypoxic damage in vulnerable newborns.”
-Despite what the advertising is claiming, immediate cord clamping is not risk-free and does disrupt the birthing process, in many ways.
All disruptions to the physiological birth process pose risks to mother and baby. We know that immediate cord clamping causes and risks hypoxia, hypovolemia, hypoglycaemia, respiratory distress, and reduced red blood cells in the newborn. Infant anaemia from reduced red blood cells may not sound that serious but it is linked to cognitive deficits – low IQ and developmental delay.
Given the known side effects of cord clamping, we can refute the claim by private blood banks that collecting the baby’s blood will not disturb the birthing process in anyway (like the Bub Hub/Cell Care are claiming). If the early clamping does produce the results Judith Mercer describes (impeding the baby’s transition to breathing and creating pathologies) the baby may require resuscitation, artificial warming, monitoring for respiratory distress, treatment and observation for low blood sugar levels etc…all of these procedures separate the mother and baby at birth and subject them to untold stress and anxiety.
Something else for women to consider is that immediate cord clamping leaves the placenta unnaturally engorged, which can complicate or risk the safety of the ‘third stage’ of labour. This is yet another way the collection of ‘cord blood’ can interfere with the natural birth process.
-Despite the excitement about stem cells and their application in research and healing, we don’t yet fully understand the impact of depriving newborns of their own blood and stem cell/immune cell transplant at birth. Many aspects of human childbirth are not yet understood which makes it impossible to measure the true impact of intervening and altering its processes.
-The truth for some families is the decision to disrupt the physiology of placental transfusion and collect the baby’s blood in the cord may be made on compassionate grounds for a gravely ill family member. But for all of these families and anyone else contemplating banking/storing, it is vitally important they have all the information about the natural purpose and function of this blood.
Informed decision-making cannot be made based on false claims that collecting the blood is risk-free and an altruistic act using medical waste only. This surgical intervention/procedure deserves the same careful consideration and disclosure of other bodily donations (like bone marrow and organs).
-Ask your friendly equine veterinarian about placental transfusion!
Care providers that work with other placental mammals know the life or death importance of not disturbing placental transfusion at time of birth. Observing animals giving birth, if done properly, is designed to not disrupt the mother to ensure the baby receives their full volume of blood in the minutes after birth. Homebirth midwives and other progressive care providers know this is just as important for human beings too.
To expand further on my own ‘truths’, I can provide a clear example where the medical community concurs that immediate cord clamping alters the birth process and is not risk-free.
In 2009 the Royal College of Obstetricians and Gynaecologists released an Opinion Paper about Clamping of the umbilical cord and placental transfusion.
The Opinion Paper states:
“Immediate cord clamping became routine practice without rigorous evaluation. There is now a body of evidence suggesting that immediate, rather than deferred, clamping may be harmful for both term and preterm births.”
“Infants who have immediate cord clamping have lower iron stores for up to 6 months after birth. The potential implications of the reduced iron status in early childhood have not been adequately investigated. Iron deficiency in the first few months of life is associated with neurodevelopmental delay, which may be irreversible.”
“The suggestion that, for preterm babies, immediate clamping may increase the risk of intraventricular haemorrhage is of particular concern and merits rigorous and prompt evaluation in randomised trials. Possible mechanisms for this increase are hypovolaemia or increased fluctuation in blood pressure during the abrupt transition from fetal to neonatal circulation.”
“Current guidance on the collection of umbilical cord blood for stem cell banks does not state when the cord should be clamped. It would be reasonable to advise parents of the advantages and disadvantages of placental transfusion when they are considering cord blood banking. (emphasis mine)
In summary, while researchers and advocates for safe birth are trying to educate parents about cord clamping, wealthy blood banks are targeting parents via magazines and websites.
The content that trusted parenting websites are hosting should be clearly labelled as advertising, otherwise it should disclose ALL the information about placental transfusion, neonatal transition and the risks of immediate cord clamping for the baby and mother.
Gifted Birth Support 2011
References are hyperlinked within this article.
This article contains opinion and does not constitute medical advice. Please research your own medical decisions thoroughly and in consultation with a clinical care provider.