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.

(L) umbilical cord engorged with the baby's blood (R) natural cord closure after placental transfusion is complete

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.

About these ads

About Kate Emerson

Kate Emerson, BA (sociology/politics) Kate is a clinical student pursuing her interest in neonatal transitional physiology and clinical cord clamping practices. She produces articles and popular media to increase the level of awareness about delayed cord clamping, for parents, students and interested practitioners. Please visit www.cord-clamping.com to read more.

Posted on August 12, 2011, in Doula and tagged , , , . Bookmark the permalink. 14 Comments.

  1. Possibly your best article yet :)

  2. Thank you so much Gifted Birth Support for sharing the TRUTH!
    It is disgusting that cords are continuing to be cut immediately and we need to do something to stop this harmful practice!

  3. Did you know that the same stem cells that are harvested from cord blood can also be found in menstrual blood? So now we can stop stealing blood from babies for research and donate the blood we otherwise flush down the toilet :)

  4. I my view there are three debates going on here….the timing of cord clamping, the benefits to the baby of delayed cord clamping and the benefits of collecting cord blood. As a midwife I have spent many years reading the evidence of the first two – incorporating that evidence into my practice to enable the women I have been honoured to care for to make an informed choice – and the last five years working with Anthony Nolan to create a national public cord blood bank here in England. Historically early clamping came into practice to prevent maternal mortality due to PPH, through the use of an oxyticic drug to deliver the placenta quickly and aid the contracting of the uterus to prevent massive life threatening blood loss. Today, because we have better antenatal care and our socio economic environment has improved those risks are lowered in developed countries. However, on the whole the practice of early cord clamping prevails. Evidence is irrefutable on the benefts of delayed clamping for premature babies yet it is this group who suffer most. These babies continue to have their cords clamped and cut immediately at birth to enable the paediatricians to resusitate them! There is currently a lot of research being performed in this area and thinking is beginning to change. As for the term baby most midwives know the benefits and this too is finally recognised with the RCOG having it’s Green Top Guidelines recommend leaving the cord to pulsate for a minimum of 2 mins prior to clamping and cutting. The evidence shows that the baby recieves the most benifical amounts in that time frame. Cord blood collection and storage is a very emotive area but one that needs explanation and clarification. There are many private companies who, yes, are out to make a profit – they are a business after all and have shareholders to answer to. They do advertise and claim all sorts of things to encourage couples to ‘buy their wares’. Indeed many use such emotive language as to make a couple feel guilty if they DON’T store their baby’s cord blood! Sadly in England, I’m not sure about the rest of the world, there is no Advertising Standards Agency to ensure the claimed facts are verifiable! What they don’t state is that 70% of people cannot find a match within their own family should an haematopoetic stem cell transplant be needed.They also do not state that should the child who’s stem cells have been stored, should they need a stem cell transplant, their own cells are UNlikely to be a match because there is already an underlying predisposition for the condition within those stem cells, therefore transplanting them back into the child would only invite that same condition to re emerge!!!! This is where public banking comes in! Given that only 30% of people with a blood condition, such as leukaemia, who need new blood to give them a second chance at life find that chance within their own family circle the need for public banks is enormous. The Anthony Nolan Cord Blood Programme was developed to ensure that, unlike every other public bank in the world, NO interference with the woman’s birth plan was made for the collection. As the midwife who developed this programme I have ensured that any woman wanting to donate has no fear that we will interfere or encourage her to change her birth plan. I, and my team of specialist Dedicated Collectors, have collected from water births, physiological third stages, delayed cord clamping to surpising amounts at times! You never know what you are going to get till it’s been got!!! Our programme has also proved that there is no risk to either the mother or her baby in the collection process as it is performed ex utero, the placenta having already been delivered. There is very little evidence proving the benefits of storing privately. One private bank here in England when asked how many samples have been called for transplantation, and they have been operating for 10 years, answered…..none! Need I say more!!?? Private banking will remain an option but should be overseen by a governing body such as ASA to ensure their information is correct and the claims made are scientifically proven. Anyone wanting more infrormation on Anthony Nolan please visit their website http://www.anthonynolan.org

    • Thank you for sharing your response you originally wrote on Invisible Midwives Terie!
      While my post was focused on private blood banks and misinformation in their advertising, your comment contains some great ‘food for thought’ regarding the potential for stem cell collection for public benefit without disrupting the physiology of birth/ compromising babies.
      All the best with your programme.

  5. I’m grateful for this article and the debate – I really am. This subject keeps coming up for parents and I feel compelled to find some answers.

    I’m concerned…..when I observe the cord at 2 minutes post birth it is full of blood! Bulging, pulsating, much like the picture in the article. It looks slightly less full at 5 minutes. In fact the cord isn’t empty until between 10 and 20 minutes post birth. In my opinion the function of the placenta for the baby is not complete until that cord is empty. The placenta having delivered all that it is designed to deliver is then in the optimal condition for the woman to birth, herself, physiologically with minimal complication. Pscho-physiological birth of the placenta facilitated by skilled attendants is more beneficial and carries less risks for a healthy woman and negates the necessity for active management of the third stage that should be resorted to only when there is a medical indication for the administration of that intervention or prophylactically if a traumatic birth increases the risks of a PPH. I really need a straight answer as to whether cord blood can be collected following a properly conducted, physiological 3rd stage where the cord is not clamped or cut until the cord has stopped pulsating and the placenta delivered. If it is possible to collect ‘cord’ blood from the placenta after that then I’m all for it and will inform the women in my care who are a little confused over the whole matter as am I.

  6. As an oncology nurse I see cord blood save lives daily. I have privately stored my children’s blood and advise all parents to at least consider publicly banking the cord blood as most practitioners immediately clamp. Also many babies are born jaundiced and hemolysis of extra blood may actually exacerbate the condition.

    • I understand as an Oncology nurse your perspective on cord blood would be on the benefits of using stem cells to heal. The discovery and use of stem cells for this purpose is a testament to just how clever human beings can be. But routinely and immediately clamping the umbilical cord before placental transfusion is not, sadly. My post was about questioning the practice of immediate cord clamping that ‘wastes’ the newborns blood – not clamping is my message, and being informed about placental transfusion when considering banking/storage.
      I would encourage you to differentiate between physiological jaundice that occurs in newborns (benign and has an oxidative function) and clinical jaundice. Babies receiving their full blood volume are not receiving extra, babies that had their anatomy and physiology changed during transition from clamping are receiving less.
      Thank you for reading and sharing your comment. I’m pleased your family was able to achieve time for placental transfusion and your wish to collect for storage.
      Kind regards
      Kate

  7. p.s. I allowed the cord to pulsate for a couple minutes prior to collection and they were able to obtain an adequate amount of blood for banking so a mother can do both.

  8. Terie Duffy’s response to Kemi Johnson, shared with permission from the Facebook discussion:
    .
    ..in a truley physiological third stage, such as you so adeptly decribe, there maybe no blood left, but, having said that you don’t know untill you try! The placenta is a beautiful organ full of mystery and surprises so who knows what she contains! The art of collecting is specialised and is not just about placing a cannula in the umbilical vein..I have devised a collection technique which uses gravity so that what may seem like an ”empty” cord is actually, full in the right environment.

    What you have to appreciate is that my programme is for PUBLIC cord blood banking and therefore if a collector feels that there is nothing to collect would not try, where as a commercial collector may think otherwise. If you have a couple considering banking their baby’s cord blood they have to ask the commercial company many questions before opting for this.

    There is, unfortunately, no straight answer to the do I donate or don’t I debate. It’s all down to the information given and the expertise of the collector. In England, the collectors for private companies are on the whole phlebotomists who may have undergone some sort of training to collect cord blood but, given it takes approx 40 collections to be deemed competent, it’s unlikely that they have the experise to make crucial decisions regarding whether it is appropriate to collect. Are they are looking to collect potential stem cells or money? They have been employed to collect cord blood and collect cord blood they will, sometimes to the detriment of their clients.

    Stem cells from the blood left in a placenta and umbilical cord are undoubtably an excellent souce of life saving haematopeotic stem cells, but they have to be collected in an ethical way with full and evidence based information given to the parents before informed consent can be given.

  9. My question is would leaving the cord attached and unclamped until it stopped pulsating decrease childhood cancers? My husbands brother died of leukemia (in the 70’s) when he was only 18 months old, fighting cancer almost his whole life. His mom knew right away that there was something not right. If he would not have been deprived of those vital stem cells would he have had a better chance of surviving, or maybe not even getting cancer?

    I went through Chemo for Hodgkin’s disease less than a year after we got married. Instead of starting a family I got cancer and spent our first year anniversary in a chemo chair. And while going through chemo I looked into banking cord blood if we ever have children. But then I started thinking why take it away from them at birth just to give it back to them at a later time, when it could have possibly been avoided if left alone in the first place?

    I do see the importance and the wonderful things that donated cord blood can do and the lives it can save, and I do think that if the parents want the cord clamped and cut right away that the blood should be collected for the cord blood bank instead of thrown out. But the parents should be informed of all of their options as well before they make their decision.

    If their were less cords clamped and cut immediately, there might be less cancer in the world, especially in the most precious little children.

  10. Telula….thank you for bravely sharing your family’s history!
    Sadly, blood cancers are genetic and so no matter when the cord is cut and clamped the genes are set! It would have made no difference if your brother in law’s cord had been clamped and cut at birth or left to pulsate…the cancerous cells were there! If his stem cells were to have been collected then they would have been of no bebefit to him because of that predisposition…he would have benefitted from publicly banked stem cells.

    You, with your family’s history may benefit from banking privately but, having said that rememeber that the child’s cells would be of little if any benefit to him/her if they did develop a blood cancer, a siblings may be of more benefit.

    Private banks thrive on the message that you bank your baby’s cord blood for him/her should it be needed. What they don’t say is that the baby’s stem cells within their cord blood would not be of benefit should that child (donor) develop a blood cancer where haematopeotic stem cells be required to cure that child.This means that IF you bank your baby’s cord blood in the hope that IF (God forbid!) your baby develops a blood cancer/condition that requires a transplant of haematopeoptic stem cells then the likelihood that YOUR baby’s cells would be a match are thousands to one!!! Your child’s cord blood already has the predispostion genetically so would be of no use to it….but might be of use to a sibling! But there’s still no guarantee…

    We assume that because we are family, related, that we will match!! Not so!!! Rememebr only 30% of people needing an haematopoetic stem cell transplant find a match within their own family, which means that 70% need public banking….

    Public banking of blood, organs and cord blood is a sure way of ensuring that we all have hope of surviving……xx

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 457 other followers

%d bloggers like this: