Cord blood harvesting (more commonly known as cord blood donation) involves taking the blood from a new born baby's umbilical cord immediately after birth to farm the stem cells from the baby's blood for the purpose of scientific research (and supposedly to save lives and cure terminal illnesses, although research has shown stem cells can be collected from other sources, and the usefulness of stem cells for these theraputic purposes remains contested).
As an advocate of normal physiological birth and a supporter of lotus birth (leaving baby, cord and placenta intact for the first week of the baby's life until such time as it naturally detaches from the baby's belly button), cord blood donation makes me uneasy. My primary concern is that it is not possible to donate cord blood to science and allow mother and baby to have a natural third stage of labour (the period between when the baby is born and when the placenta is born). Another significant concern I have is that the blood in a baby's umbilical cord belongs to the baby. When one considers that stem cell therapy is still largely experimental, what must be done to the mother to harvest cord blood, and that a baby is deprived of his or her own blood, I don't believe the possible benefits of cord blood donation outweigh the inherent risks.
Natural (or physiological) 3rd Stage
When a mother first sees her baby, holds her baby, feels her baby's skin against her own, and breathes the scent of her baby in, her body responds by releasing the "love" hormone: oxytocin. Oxytocin stimulates the uterus causing contractions, which are not usually as strong or uncomfortable as those of the first two stages of labour (more like menstrual cramps). During these contractions the placenta detaches from the walls of the uterus, drops into the mother's vagina and is subsequently born.
Before the oxytocin causes the mother's uterus to contract, nature usually gives her a rest period. The length of this rest period will vary for different women. The placenta can stay within the mother's uterus for hours not causing harm to her. But if the mother becomes anxious and wants to do something to help her placenta detach from her uterus nipple stimulation is a natural way of stimulating uterine contractions. Often mother's find that feeding their babies in those first few minutes or hours will bring on contractions. Quite often if the mother is in an upright position the placenta will fall out of her vagina effortlessly rather than requiring her to push.
The mother's hormones do some quite magical things during this immediate babymoon period including; help bond her to her child forever which ensures she will have a drive to nurture and protect her youngin, and act to prevent haemorrhage. If baby is given adequate skin to skin time with mother she or he may use this time to work his or her way to the breast and use instinct to nuzzle and latch on for the first feed (this is known as baby led attachment).
Third Stage When Cord Blood is Harvested
For blood to be harvested from a baby's umbilical cord, mother and baby must have an actively managed third stage of labour. "Active management" is the term given when a natural third stage of labour is interfered with by care providers. This interference involves routinely involves:
- Injecting the mother with a narcotic called Syntocinon. While usually this injection is given after the baby has been born, some care providers administer the drug while the mother is still pushing (in second stage labour). Syntocinon can also be administered intravenously via a drip if the mother already has a drip line in place.
- Clamping and cutting the baby's umbilical cord immediately (or within a few minutes) after birth.
- Pulling on the umbilical cord (which is attached to the placenta, which is still inside the mother's womb) to force the placenta to separate from the mother's uterine walls and subsequently be delivered quicker.
After the placenta is born (which would most likely happen after care providers performed the third step of actively managing third stage of labour) cord blood collectors are likely to take another 20mls of blood from the placenta as well. Alternatively the entire harvest can be taken from the walls of the baby's placenta after the placenta is born.
The mother is required to have a blood test shortly after birth to determine whether she has HIV, AIDS, Hepatitis or other infectious diseases. Six months later she will be required to have another blood test for the same infections because some of these can be within the body for three months before detection.
A questionnaire regarding the mother's medical and family history is also required. Then the blood is taken (within thirty-six hours of harvesting) to a cord bank where it is frozen and stored in liquid nitrogen after it has been tested. The blood can be stored like this for twenty years, or until it is used for experimentation.
Effects on Mother
The most noteable effect of actively managing the third stage of labour on the mother is rushing her. The period immediately following the birth of her baby is an incredibly important time for both mother and baby. It is a time when the mother's natural hormones are ensuring she and her child bond which has great ramifications for both of them emotionally, psychologically, physically, and mentally.
It is a time for familiarising. Mother and baby get to know each other. They learn one another's smell, baby will most likely have his or her first suckle at the breast - thus letting the mother's body know it's time to begin milk production. What happens during this sacred time can have a big impact on how smoothly their breastfeeding relationship goes.
The primary motivation for routine managing the third stage of labour is to shorten the length of time it otherwise would have taken for the placenta to be born. There are some cases where active management of the third stage is necessary (for example if a woman has had a necessary caesarean , or if the mother has low levels of haemoglobin in her blood which could mean her blood's ability to clot may be delayed) but for the majority of women a natural third stage is safe and superior given the many risks active management carries with it.
Some of the risks of active management of the third stage include:
- Once syntocinon is administered to the mother there is an urgency to remove placenta from her womb because the narcotic causes the uterus to contract in size quite quickly (approximately ten minutes) and if this happens before the placenta has been born the placenta will remain trapped inside her and she will require surgery to remove it. If surgery is required the mother faces the risks of the anaesthetic, separation from her baby soon after birth, and that separation can lead to bonding and breastfeeding difficulties.
- Time limits are placed on the woman, and this sense of urgency can be very disruptive to mother/baby bonding and the first breastfeed.
- If the mother has undiagnosed twins, active management can lead to the second twin getting trapped inside the uterus, requiring a caesarean.
- It can cause intensely painful and unrelenting contractions of the uterus.
- Prolonged use can lead to a build up of the narcotic in the newborn's body (something worth considering if this narcotic was also used to induce or augment the mother's labour earlier), which can increase likelihood of the baby developing jaundice and requiring phototherapy.
- Prolonged use can cause a mother's kidneys to stop excreting water which reduces urine production. The body then retains water and in some cases causes fluid overload (fluid can accumulate in the lungs and cause pressure on the heart). This can be life threatening.
- Syntocinon (which is a synthetic form oxytocin) over-rides the body's ability to naturally release oxytocin, which can lead to problems with mother/baby bonding.
- It interferes with the natural oxytocin peak that happens at/after birth which prevents postpartum bleeding, therefore active management of labour poses a risk of increased or major bleeding in the mother.
- Natural oxytocin is released in response to a baby suckling at mother's breast, and therefore if this natural hormone is decreased or over-ridden by the synthetic version breastfeeding difficulties could be encountered.
The most significant risks to baby of harvesting cord blood are associated with premature clamping and cutting of the umbilical cord.
Clamping and Cutting the Umbilical Cord
The umbilical cord should not be cut until it has stopped pulsating because the baby is still receiving nutrient rich blood from his or her placenta. Some medicos don't regard this blood as important to the baby's well-being, however we know that it is rich in stem cells at the very least, given that there are those who wish to harvest it!
It is generally accepted that the baby's cord should be cut immediately in a couple of cases; when the cord is tightly around the baby's neck, if the baby is unwell, or if the cord is short. However, at the time of birth the baby is making that very important transition from relying on his or her placenta for oxygen to learning how to breathe using the lungs. The placenta was also responsible for regulating the flow of blood into the baby's body and during the first twenty minutes of life the baby's circulatory system is in a process of stabilising. Given this, I would argue that it is more important to maintain the baby's connection to cord and placenta in cases where the baby is unwell rather than to cut the cord.
Dr Sarah Buckley notes:
Adaptation to life outside the womb is the major physiological task for the baby in third stage. In utero, the wondrous placenta fulfills the functions of lungs, kidney, gut and liver for our babies. Blood flow to these organs is minimal until the baby takes a first breath, at which time huge changes begin in the organisation of the circulatory system
Within the baby's body, blood becomes, over several minutes, diverted away from the umbilical cord and placenta and, as the lungs fill with air, blood is sucked into the pulmonary (lung) circulation. Mother Nature ensures a reservoir of blood in the cord and placenta that provides the additional blood necessary for these newly-perfused pulmonary and organ systems
Immediate clamping and cutting of the cord at birth denies a baby up to half of his or her total blood volume (imagine the heamorrage an adult would have minus 50% of her blood volume!) and poses risks including:
- Causing anaemia in infancy due to baby not receiving all the iron intended for them from cord blood/placenta.
- Blood being sacrificed from other organs to establish blood flow to the lungs.
- Lack of blood which was meant for baby's vital organs.
- Respiratory stress.
- Fatality to babies who are low on blood and have not taken their first breath before severence.
Many people believe that when the umbilical cord stops pulsating it is safe to sever it from the baby, however just because we can't see it moving, doesn't mean it's not doing something for the baby. In her article on lotus birth Lisa Schuring notes:
Once blood volume reaches an optimal level in the baby (for that specific baby), the rest of the cord vessels will close off. Closure of all vessels DO NOT occur when the cord visibly stops pulsing! Umbilical cords can continue to pulse at the umbilicus (at the belly button) for much longer than the centre of the cord - about 2 to 3 hours longer!The only way to ensure a baby gets the perfect volume and type of blood intended for her or him is to leave the umbilical cord to carry on with the excellent job it has been doing for months. I do wonder why nature would leave baby, cord and placenta attached for days after birth if the placenta and cord had nothing to offer the baby during this time? If there was no purpose, surely nature would have the cord naturally detach immediately after birth? In any case, the only way to be sure the placenta and cord have finished their work is to let them.
What About Stem Cell Storage For Baby Rather Than "Donation"?
In her comprehensive outline of both the active management and the natural processes of the third stage of labour Sarah Buckley says:Another reason some parents decide to harvest the blood from their baby's umbilical cord after birth is to store the stem cells within that blood for the baby in case the baby might require it later in life. However, if your child develops a rare blood disease that may benefit from stem cell therapy, for example leukemia, she or he could not use their own stored cord blood because their blood has a predisposition to leukemia. And this cord blood could not be donated to anyone else.
It is worth noting (in the words of Sarah Buckley, Gentle Birth, Gentle Mothering page 195) that "the likelihood of low-risk children needing their own stored cells has been estimated at 1 in 20, 0000 and cord blood donations are likely to be ineffective for the treatment of adults.". Buckley goes on to note that between 1998 and 2005 over 13,600 units of cord blood were stored in banks but only 7 units were used by those who donated the blood, and 16 units for sibling transplants (siblings have a 25% chance of being compatible).
It is worth noting (in the words of Sarah Buckley, Gentle Birth, Gentle Mothering page 195) that "the likelihood of low-risk children needing their own stored cells has been estimated at 1 in 20, 0000 and cord blood donations are likely to be ineffective for the treatment of adults.". Buckley goes on to note that between 1998 and 2005 over 13,600 units of cord blood were stored in banks but only 7 units were used by those who donated the blood, and 16 units for sibling transplants (siblings have a 25% chance of being compatible).
If Stem Cells Are So Great, Why Can't Baby Have Them?
Again, I wonder why nature would create these stem cells for the baby's body if they did not fill some purpose? I doubt it would! The reality is that those cells are intended for the baby.The recent discovery of the amazing properties of cord blood, in particular the stem cells contained within it, heightens the need to ensure that a newborn baby gets its full quota. These cells are unique to this stage of development, and will migrate to the baby's bone morrow soon after birth, transforming themselves into various types of blood-making cells. (Emphasis added.)
For Further Consideration
Furthermore there are issues of informed consent and true freedom of choice. At my local hospital I know that some women are not told anything about cord blood donation until they are in the third stage of labour (or even after it has happened) but so-called "donations" have been taken from these women's babies regardless. It is worth noting that my local hospital is in a region populated by working class families with lower levels of education than other areas of Melbourne. One woman told me after her birth that she was exhausted and overwhelmed with all that had just happened to her when the midwives told her they had taken her baby's cord blood and that this made her baby a life-saver (and I believe to prevent her from taking legal action against them for performing this procedure without her consent).
It is dubious that the baby was a life-saver, if the midwives were being honest they would have said "your baby's blood is now being sent to a laboratory for scientific experimentation in the hope that a hypothesis some scientists have about the use of stem cell therapy may be successful and may cure some diseases". But that's not as catchy as "your baby is a life saver".
Even if she had have been informed about cord blood donation by the hospital prior to the harvesting taking place during third stage there is still the issue of how the information would most likely have been presented. For example, would parents simply be misinformed, as this woman was, that the procedure simply and unquestionably save lives? Would parents be told that stem cells can be harvested for medical research from other sources? Would the women actually have been asked if they wanted to donate their baby's cord blood, or would they be told that they should and simply expected to do so when the time came? The potential for coercion when it comes to participating in experiments that could cure life-threatening and debilitative diseases is huge. Even the way cord blood donation is written about on birth.com.au is politically charged. When explaining where blood is stored it states that it is kept there: "until required by a compatible child or adult needing a transplant for leukaemia or another rare blood disorder." No mention of experimentation or research, and it's not there for "someone" or a "person", they specifically mention a child suffering a disease.
The usefulness of stem cells may be one area of science worth researching for potential cures to terminal illnesses, but it is only one possible solution. While stem cell therapy remains by and large an experiment, the third stage of labour is not a test-run for each mother and each baby. A baby's blood cannot be harvested from his or her umbilical cord without the third stage of labour being unnecessarily interfered with, which poses health risks for both mother and child. Considering it is possible to harvest stem cells from sources other than a newborn baby's blood, stem cell therapy need not depend upon donations from cord blood.
Still receiving cord blood over three hours after birth.
Above is based on information obtained from:
Leaving well alone: a natural approach to the third stage of labour - Sarah Buckley
3rd Stage Labour - Birth.com.au
The Active Management of Third Stage - Birth International
Cord Blood Donation - Birth.com.au
Lotus Birth - Lisa Schuring
For more on this see:
Collecting Cord Blood - Gentle Birth Archives
Don't Cut The Cord - Gentle Birth Archives
Umbilical Cord Issues/Delayed Cord Clamping - Gentle Birth Archives
2 comments:
I am an avid supporter of Lotus birth. I really think more women would chose Lotus, or at least delayed severence, if they were more educated about it. I think you're doing a wonderful job of trying to get the word out.
One question, you mentioned that immedicate clamping and cutting would be OK if a c-section was done, is there any way possible, or has it ever been done, that a woman can have a section and still keep the placenta attached to babe?
Excellent question Jill, indeed lotus caesareans have been done (one of my friends had one). I don't know why I forgot to mention that in the article - I suppose my focus was less on placenta and more on cord, I guess. An oversight nonetheless (I do plan to write about lotus birth seperately at some stage).
I think it involves a little more care and thought from surgeons, but it is most definitely possible, and arguably very important in terms of trying to make a very rough start to life a little smoother.
I don't know much about lotus caesareans other than they are possible.
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