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 Post subject: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 3:34 pm 
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So in doing my research it seems like it's hard if not impossible to do both delayed cord clamping plus cord blood banking. I have been reading the studies that have been done in developed countries with full-term babies and it seems like there are definite advantages to delayed clamping, but cord blood banking seems really important too. I talked to my OB about it and she didn't seem very informed on the current research at all and seemed quite dismissive about talking about it with me, but that could be because I'm only 14.3 weeks and she was thinking why the heck is this lady so adamant about talking about this in the second trimester.

I guess I'm curious what other people have done (i.e., did you choose delayed clamping? cord blood banking? neither?) and why.

As a side note, this entire pregnancy I seem to be preoccupied with the weirdest things ("oh no! I must spend hours reading up on delayed clamping!") rather than actual practical things, like changing a diaper or how to hold a baby or breastfeeding (none of which I have any experience with).

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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 4:30 pm 
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I am maybe a broken record about this book, but I really loved Expecting Better by Emily Oster for things like this. She's an economist who works with medical research, and she does a great job of summarizing the current research and putting it into perspective.


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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 4:52 pm 
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There may be newer research since I had my kiddos, since mine are 7 and 5, so take the following with that in mind.

I chose not to do cord blood banking, but chose instead to do cord blood donation. From what I read, there is not great evidence that autotransfusions work that well. If a person's original stem cells lead to a medical problem, putting the same person's stem cells back in their body led to the same problem. Whereas transfusions from other people's stem cells seem to work really well. Further, just playing the odds, there was a slim chance my kiddo would ever need those cells, and an almost certainty that someone else somewhere will need them. And lastly, they weren't sure how long the stored cells would be good for, so even if an autotransfusion works, if you don't need it for 30 years, the cells may not be good in 30 years. So with all of that in mind, donation made more sense to us.

I did not do any research into delayed cord clamping, so I have nothing to add as to the importance of that.


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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 5:09 pm 
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The research we did when L was born was that it was uncertain whether or if you'd ever be able to really use the banked blood. So you would be paying storage fees for no verifiable benefits. We thought about donation, but heard a lot about the benefits of delayed cord clamping on iron stores in the baby and figured we'd try that instead. http://www.nytimes.com/2013/07/11/healt ... .html?_r=0

For what its worth though, the residents at the hospital where L was admitted for jaundice after birth tried to tell me that the delayed cord clamping is what caused the jaundice, because the breakdown of those additional blood cells resulted in added bilirubin which sent her levels up, necessitating treatment. I have never seen anything that corroborates that and both my pediatrician and doula did some research into it as well, and couldn't find anything credible to support that. The residents were also really annoying and generally wrong about everything though - first they diagnosed me with breastfeeding jaundice (and said I would have to wean) even though L was 3 days old and BFjaundice only comes up once the baby has been BFing for a few months (heck she was still drinking colostrum at that point), and they managed to fork up all the paperwork they touched, so I'm going with they were full of crepe. They also tried to terrify me out of cosleeping, which was fun.

Mollyjade that book sounds great - would you mind bottomlining what you got from it? I'd be so interested to hear her take on this!

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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 5:11 pm 
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Thanks for the info DEG, that was helpful!

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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 5:38 pm 
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You'll have plenty of time to figure out how to change a diaper and breastfeed once you have a baby in your arms. :) I hadn't done either before and did fine. Of course you may want or need a lot of support with breastfeeding but you can't usually anticipate what issues might come up. So don't worry, I think you're thinking about the right things now!

I feel very strongly that delayed, aka physiologic cord clamping, is important and that the evidence strongly supports it for term and preterm babies. Immediate cord clamping and cutting was a practice that started arbitrarily and now we are in a position of having to prove that not doing this intervention is better than doing it. If you have access to research databases, Judith Mercer has published a lot on the topic. Common myths that you will hear from providers who are not up to date on the evidence are that it causes jaundice and polycythemia (too many red blood cells). The concern about polycythemia doesn't make sense-- the baby is not receiving extra packed RBCs, it's receiving plasma and cells in the same ratio as the rest of their blood. Also, our understanding of normal newborn hematocrit is based on immediate clamping as the standard. The research does find a somewhat elevated rate of jaundice, but NOT of pathologic jaundice that can actually cause harm. Breastfed babies can develop what's called physiologic jaundice as the mother's milk is coming in. It's obviously normal to not have a full milk supply at the moment of birth and healthy newborns are equipped to handle this.

The benefits of physiologic cord clamping are much lower rates of anemia for at least six months but possibly even the first year of life, and reduced risk of bleeding in the brain in preterm babies, which is a significant risk for them. There are also potential benefits that we don't yet understand to a baby receiving all of the stem cells and antibodies that are in cord blood. Immediate clamping prevents a baby from receiving up to a third of its blood volume!

A lot to providers are opposed to changing their practice because it's what they've always done, but I think this is really important and worth advocating for. Unfortunately in a hospital setting it's very unlikely that a cord won't be cut immediately if there is a need for any resuscitation, because the tables and equipment are too far from the bed. There are hospital delivery beds that some countries are using that have an attached resuscitation table so that a resuscitation can happen while keeping babies who may need that extra blood the most attached to their cords. I hope we get those into practice in the U.S. soon! Bedside resuscitation and delayed clamping have always been the standard of care in out of hospital birth.

Well, that turned into an essay! Ha, what can I say, this topic is a professional passion of mine.


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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 5:57 pm 
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I was planning on delayed clamping for the reasons mooo said, but there was a knot in the cord so she got cut before she was all the way out and then needed to be resuscitated anyway. . That all sucked. Planning delayed clamping this time around and hopefully will not have to deal with those complications.


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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 6:01 pm 
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Thanks for that information mooo!

Quote:
The research does find a somewhat elevated rate of jaundice, but NOT of pathologic jaundice that can actually cause harm. Breastfed babies can develop what's called physiologic jaundice as the mother's milk is coming in. It's obviously normal to not have a full milk supply at the moment of birth and healthy newborns are equipped to handle this.


I think I'm still somewhat traumatized by what happened at the hospital after L was born and having better information is really helpful. I wish my MDs had known as much as you do.

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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 10:58 pm 
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If I was going to choose between the two I would definitely go for delayed cord clamping. Cord blood banking had too many "what ifs" for me.

I requested delayed cord clamping in my birth plan but am relatively certain they did not "delay" very long. I think was told in the hospital something to the effect that you don't need to "delay" it for more than a few seconds to get the benefits which is crepe but I was doped out of my gourd and my birth plan pretty much got shot to hell after I was admitted with preeclampsia. By the time I delivered I don't think anyone was thinking about it. I think that's one of the big pluses for midwives or doulas they are much more the advocate for the mom (though overall I was happy with my care this is just one of the areas where I was not happy how things went)

Delayed cord clamping would have been beneficial for us since BP is not eating food.

I have a very vague fuzzy memory that I may have signed something authorizing donating the cord blood but I'm not 100% sure

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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 11:22 pm 
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For me, it was an easy decision to do delayed (i.e. normal) cord clamping. In fact, I'm not even sure if it was something I really had to advocate for - it was just the usual standard of care in my midwives' procedures, which made perfect sense to me in light of the available evidence, and it just wasn't an issue. When I looked into cord blood banking I pretty much immediately ruled it out as cost prohibitive, particularly in light of the current uncertainty.


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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Fri Jan 30, 2015 11:36 pm 
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I didn't mean a knot in the cord when I wrote that above. I meant it was around her neck. Nuchal cord.


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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Sat Jan 31, 2015 10:30 am 
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Wow you guys have such great replies! Mr. Lobster was really advocating for the blood banking, but the more I read the more unlikely it seems that you can use your own cord blood for much of anything. I'm finding it hard to find a lot of unbiased info though, as most of the stuff I'm finding comes from cord blood banks and they obviously want your money. So basically I'd like to find a stem cell scientist expert person to talk to me, that doesn't work for a cord blood bank!

Mollyjade, I did read Expecting Better (thanks annamal for the recommendation!) and I agree, it's a really good book. As I recall (I checked it out from the library awhile ago, so I don't have it in front of me), she concluded that there weren't benefits of delayed clamping for full-term babies, correct? I'm just not sold on that from some of the recent review articles I've read (I still loved her book though, and I'm not poo-pooing it in any way).

Maybe I'm just a hormonal pregnant lady, but I love having all of the PPKmamas to ask questions like this to - it warms my heart! I don't really have mom friends in real life and other pregnancy boards can be a little...wacky.

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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Sat Jan 31, 2015 11:19 am 
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She says that there's good evidence for doing it for preterm babies, and mixed evidence for full term (but leaning towards doing it). If you're full term, it's a trade off between increased risk of anemia (no delay) and increased risk of serious jaundice (delayed). But overall, she says both anemia and jaundice are easily treatable, so it's not a question to stress out over.

My choice was not to do it because babies of moms with type 1 diabetes already have an increased risk of jaundice. But something about the c-section made it a moot point (I'm fuzzy on this because I was having a c-section).

For blood banking, she says what everyone above says. For a person without a blood disorder, the high cost isn't worth the tiny possibility it will help in the future. If it is helpful (with current technology), it will be helpful to a sibling, not the baby that donated it.

A big thing I like about the book is that it places all these questions in context. So many baby books make every question seem hugely important. Not smoking while pregnant, a hugely important decision. Delayed cord clamping, a small concern. It's factual and reassuring.


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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Sat Jan 31, 2015 1:24 pm 
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Thanks for the recap mollyjade, I knew it was more nuanced than I could remember! I should probably pick up an actual copy of the book to keep to reference.

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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Sat Jan 31, 2015 2:23 pm 
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lobsteriffic you hired a doula right?
maybe ask her what her thoughts are?

i didnt do tons of research so i didnt realize there were any cons to it.
i didnt realize it could make jaundice worse. jaundice is super common but i think there is a broad spectrum of not that big a deal to bad.
my mom always tells the story how i was born yellow and they took me home and stuck me in the sun.

BP was jaundiced when she left the hospital but not enough to raise any flags. when i look back at pictures of her though im like DAMN SHES YELLOW!

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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Sat Jan 31, 2015 3:48 pm 
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If it helps anyone's decision: cord blood is not the only source of stem cells. Teeth, including baby teeth, are also a rich source. So if a need for stem cells arises, you still have options even if you haven't banked cord blood. I have to say I haven't read any further on the topic!


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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Sat Jan 31, 2015 5:38 pm 
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LP, asking my doula is such a good idea! I don't know why I didn't think of it!

aelle that's helpful to know, thanks! I'll read up on that.

Mr. Lobster is sold on cord blood banking but I think if I had good info on how not likely it is to be useful he'd find that helpful.

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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Sun Feb 01, 2015 1:13 am 
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Another thing that was fairly important to me was having long-term iron stores, because as I think was alluded to above, the current recommendation to introduce iron-fortified cereals (or other iron-rich foods) at six months is based on iron stores in babies who have primarily had their cords cut immediately. I was (am) sort of inherently suspicious of recommendations like this, as if evolution failed so miserably that all six month olds are prone to nutritional deficiencies without vigilant intervention.

As LisaPunk and others can attest, not all six month olds are interested in chowing down. My son didn't start eating solid food in appreciable quantities until he was more than 18 months old, and not for a lack of trying on my part. He just loved breast milk, got it on demand, and considered food more of a hobby than a means of sustenance.

Recommendations are made on the best available evidence but they are constantly changing as new information becomes available. In this case, an important fact that we didn't really understand until recently is that the iron in breast milk is much more bioavailable than the iron in food, fortified or otherwise. Recent research is even starting to question whether infants are getting too much iron (e.g. this study, in the case of formula: http://www.ncbi.nlm.nih.gov/pubmed/24142500).

My bottom line is that I want to know what the available evidence and recommendations are, but it's always necessarily going to be limited and in a bit of a state of flux, so at a certain point I'm taking a step back and going with what makes sense overall to me.


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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Sun Feb 01, 2015 3:30 am 
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Cord blood banking isn't really a thing here, so that never even came into my thought process.
I really wanted delayed clamping, and my midwife was 100% on board with it, but unfortunately due to a [really minor] complication at the last second of my daughter's birth, the hospital staff were called into the room [was otherwise just my husband and midwife] and one of the hospital midwives overrode mine and clamped her cord immediately.
Will have delayed clamping in my plan again this time, and hopefully will manage to avoid that last second intervention.


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 Post subject: Re: delayed cord clamping vs. cord blood banking
PostPosted: Wed Feb 04, 2015 2:17 pm 
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My husband and I would have loved to bank the cord blood but we just couldn't afford it. We did delayed cord clamping and my midwife was very supportive of it asking both my husband and myself to verify that it had stopped pumping before they cut. I was too overwhelmed to really care so I told her I trusted my husband and her :)


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