The room is chaotic, nurses are dashing in and out, the doctor or midwife is counting your pushes, your partner, your mom and/or mother-in-law is there (omg!)... Finally, there is silence, and then a loud “Congratulations!” More hustle and bustle, cleaning, suctioning, clamping, cutting, weighing, measuring, apgar testing, swaddling and then… Wow, the cutest little baby is in your arms. The world is calm, beautiful and awe-inspiring.
In the hectic labor and delivery room, it is hard to make sure your nurses and doctor or midwife adhere to your birth plan. It is optimal to wait until the umbilical cord stops pulsating before it is clamped. This is something that you should unquestionably make a fuss over, even in the most frantic delivery or operating room.
While a baby is in utero, blood is circulated between the baby and the placenta via the umbilical cord. Once the baby is born, as much as one-third of the child’s blood volume remains in the cord and placenta. The cord continues to pump this blood for 2-5 minutes after birth, which is why it is so important to allow the cord to stop pumping before it is clamped and cut.
Benefits of Delayed Cord Clamping
A growing number of studies suggest that what is called “delayed” cord clamping is responsible for improving a full term baby’s blood count, reducing the chance of iron deficiency, improving oxygen levels in the brain, reducing serious bacterial infections, stabilizing blood sugar levels, improving organ growth and more.
Throughout almost all of human history, in all parts of the world, the umbilical cord remains connected both to the baby and the placenta at least until the cord stops pulsating and sometimes longer. According to Traditional Chinese Medicine, the blood circulating between the baby and the placenta after birth cleanses the baby from maternal toxins accumulated during pregnancy. By leaving the cord alone until pulsating stops, according to tradition, the baby is afforded even more immunity.
The practice of quickly clamping and cutting the cord within 20 seconds of birth is a recent idea. Doctors do this so that other professionals can take charge of and examine the baby right away. It is not clear that this practice is beneficial for healthy, stable babies. In fact, evidence to support delayed cord clamping is so strong that the Royal College of Obstetricians and Gynecologists recently changed their recommendations, and now require delayed cord clamping in all hospitals in the UK.
Waiting the extra minutes, rather than rushing to clamp the cord, gives the baby an extra supply of iron that can last 6 months to a year. Babies were originally designed to get iron from their mothers, not from fortified processed foods like white rice cereal.
The stages of natural cord occlusion
At one time, the medical community thought, erroneously, that allowing all the blood to evacuate into the baby from the cord could cause jaundice. Doctors who continue to object to delayed clamping do so say either because they do not want to try something “new” or because they have not read current research (British Medical Journal 2007, August 17 18;335(7615):312-3. Weeks, A. “Umbilical Cord Clamping After Birth”). The American Academy of Pediatricians notes: "if cord clamping is done too soon after birth, the infant may be deprived of a placental blood transfusion, resulting in lower blood volume and increased risk for anemia." The Journal of the American Academy of Pediatrics published an article in April 2006 recommending that clamping be delayed to reduce anemia and improve neonatal (infantile) iron storage.
Cord Blood Banking
Some parents choose to harvest the cord blood and bank it in private cold storage for future stem cell use for family members. This necessitates rushing to clamp and cut the cord early, to prevent valuable stem cells from going into the baby.
If, however, a child in the family gets sick, G-d forbid, these preserved stem cells may not be the best option for treatment. This fact is, of course, is in the fine print. The doctor will decide if a transplant using that person's own cells is the best choice. Many diseases that are treated with stem cell transplantation may already be present in the baby's cord blood. For some diseases, a transplant using cells donated from a relative or unrelated donor (someone else’s donation) is the best choice.
It is also notable that if a sibling of the child whose cord blood has been banked becomes ill, the doctor would test to see if the sibling matches the brother or sister who needs the transplant. Because tissue types are inherited from parents, there is only a 25% chance that siblings will match each other. Finally, if your child’s blood is the proper match for the sick child, the doctor would check to be sure that the cord blood unit is large enough (has enough blood-forming cells) and is free from disease and infection. If these standards are not met, then the doctor will have to use stem cells from somewhere else.
That being said, according to actual United States stem cell transplant rates in 2001-2003, the lifetime probability (up to age 70) that an individual will undergo an autologous transplant of their own stem cells is 1 in 435. Some research says that 1 in 20,000 would need a transplant of their own blood. The lifetime probability of undergoing an allogeneic transplant of stem cells from a donor (such as a sibling) is 1 in 400, and the overall odds of undergoing any stem cell transplant is 1 in 217.
Some doctors and patients have stated that the claims of private cord blood banks are deceptive and misleading. These banks promise more than they can deliver. For those at low risk, private storage of one's own cord blood is unlawful in Italy and France, and discouraged in some other European states.
Dr. Alan Greene, a prominent natural-style pediatrician, calls the extra blood the baby receives from delayed cord clamping “once-in-a-lifetime,” rich, umbilical cord blood. This blood is packed with an assortment of powerful stem cells. It would be better to let these potent stem cells plant themselves in the baby as a last gift at birth, to grow within and carry out the purposes for which they were designed. Cutting edge science is just beginning to appreciate and understand the true value of this gift. By letting the baby receive the cord blood, you can be preventing the very diseases that would be cured by banking it.
Dried cord that was clamped right away containing the blood that should have been given to the baby
Dried cord that was allowed to pulse, giving the baby the maximum amount of natural blood.
Donating Out of Good Will: Monetary Corruption at the Cost of Health
Ironically, most materials written promoting cord blood banking and donating state that the only other alternative is waste. The assumption is that it will not be given to the baby who it belongs to. Donating your baby’s cord blood sounds like a very generous and altruistic alternative to throwing the blood in the garbage. After all, donated cord blood samples can aid in the treatment of leukemia and other life threatening illness.
Please know that if a blood sample size is too small for such treatment, it will be sold for research. Fully 50%- 75% of donations are not adequate enough to use as stem cell transplants and, therefore, the hospital takes the liberty of selling them. The exact dollar amount that hospitals are paid for donated cord blood that can’t be used for human transplants is unclear; it tends to be in the thousands to the highest bidder. Even though the mother’s motives for donating her child’s blood are virtuous, the motives for the hospital’s agreeing to cord blood donations is not truly selfless.
It is important to know what happens to sold blood samples because some of us are morally and ethically opposed to the use of our children's cord blood for possible cloning research and developing biological weapons. If the blood extracted from your baby’s cord is not sufficient for treating illness, it may be sold for these purposes.
Do not be embarrassed or afraid to stand up for what you want for your baby during delivery. Be sure to have an advocate (doula, birth coach, husband, mother) who knows your birth plan and will make sure it is implemented. You have a choice about what happens to your child’s cord blood. It is best to be as informed as possible.