Delayed cord clamping and cord blood banking – can I have both?

dcc-and-cord-blood-bankingWhen discussing after-birth choices, during BabyNatal Practical Baby Care classes our teachers are sometimes asked whether it is possible for parents to have both delayed cord clamping AND collect their baby’s umbilical cord blood.

As more and more talk is made about cord blood banking these days, we felt that it was time to share some information in order to continue to encourage and empower families to make informed choices for themselves and their babies.

What is delayed cord clamping?

In a nutshell, delayed cord clamping is the practice of not clamping and cutting a baby’s umbilical cord immediately once the baby is born. Clamping can be delayed for a set amount of time (1-2 minutes), it can be delayed until the cord has stopped pulsating (meaning that all the blood that is still in the placenta has finished transferring to the baby, or it can be delayed entirely until after the placenta has been born (something which is thought to support a physiological third stage).

As soon as a baby is born, approximately two thirds of their blood is still in the placenta. If the cord is cut immediately (or within a minute) after the birth, this blood will be effectively lost. What this means for the baby is that they will have lower blood volume, a decreased red cell flow, and therefore lower levels of oxygen and iron.

Also known as ‘optimal cord clamping’, the practice of waiting a few minutes (and no less than 1 minute) after the blood has transferred from the placenta to the baby is currently part of the NICE (National Institute for Health and Care Excellence) guidelines for Intrapartum Care.

And what is cord blood banking?

Cord blood banking is the process of collecting ‘cord blood’, which is the blood that has not yet passed to baby, from the placenta and the umbilical cord, after they are born.

Why is cord blood important?

Cord blood is rich in stem cells, which have been found to help cure many life-threatening diseases like cancers, immune deficiencies and genetic or metabolic disorders. In simple terms, the stem cells found in cord blood (similarly to what happens when using bone marrow) can help restore the function of a patient’s immune system and their blood.

Do people collect and ‘bank’ blood for their own family or can the blood be donated to others?

This is completely a personal choice. If nothing is specified and arrangements are made, the placenta and umbilical cord are generally disposed of by medical staff following the birth of a baby. People can however decide to collect this blood to either donate it to others (a bit like when you become a blood donor), or to have it safely and correctly stored for their own baby, in case they ever need it.

Does it cost money?

Donating cord blood is completely free.

If you want to collect and store (or ‘bank’) your baby’s umbilical cord blood for your own personal use in case your children or immediate family ever need it, there is a charge associated with the service of safely storing that blood for you on a yearly basis.

How is blood collected?

After the birth a baby, when cord blood banking or a donation is requested in advance, the cord (once cut) and placenta (once birthed) are collected by qualified staff and taken to a sterile environment. Here, the cord is cleaned and a needle inserted into it for the blood to flow out into a collection bag. For a donation or collection to be successful approximately 40ml of blood need to be collected; however, minimum quantity requirements may vary, depending on the organisation that is collecting the blood.

Are cord blood donations and banking available through the NHS?

The NHS does run a cord bank for blood donations (the NHS Cord Blood Bank), which is a free service. However, it is only available in certain NHS hospitals. This is to ensure that the service is available in those hospitals with a high delivery rate and with the widest ethnic mix, to allow for the greatest variety of tissue types to be collected. This increases the chances of having the right match when a patient becomes in need of a stem cell transplant.

Cord blood banking for private use is NOT available through the NHS.

How do I go about arranging a cord blood banking for private use?

There are various private organisations which offer cord blood banking for your own use. We suggest that you start doing your research during your pregnancy to make an informed choice as to which organisation is the best suited for your needs and budget.

There is of course a fee attached to this service (both for the collection and for the ongoing storage), but the benefit is that this blood will remain yours and never donated (unless you decide to do so), and in the unfortunate circumstance that a member of your family should ever develop a condition that could be successfully treated with your baby’s cord blood, the blood will be available to you.

When considering whether private cord blood banking is for you, you should also take into account that, according to recent studies, the probability of an average child requiring a transplant of their own stem cells before the age of 20 is estimated at between 1 in 5,000 and 1 in 20,000 (or less than 0.5%). This is also down to the fact that only a limited number of diseases (and not all) can be treated through cord blood.

So, if I decide to collect my baby’s cord blood, does it mean that I lose the choice of delaying cord clamping until the cord has stopped pulsating?

Not necessarily, but you may find that depending on which organisation you ask, you get a different answer to this question.

Because collection (for private banking or donation) of cord blood takes place once the cord has been clamped and cut, and the collection is from the cord, we can see that the longer you wait to cut the cord, the less blood will be left in the cord, as the blood that was meant for the baby will have made its way from the placenta to its rightful owner.

So, if the amount of blood that is collected after the cord has been cut meets the minimum quantity requirements, the blood can be banked or donated. If not, banking for private use or donating the blood will not be possible.

Having delayed cord clamping does not preclude being able to collect enough cord blood to bank or donate, but it does depend on how long after the birth the cord is cut – if the cord is clamped and cut between 1 to 3 minutes after the birth, chances are that enough blood will be collected for banking or donation. If more than 3 minutes have passed, there is a higher likelihood that not enough blood will be able to be collected.

It goes without saying that the decision to have the cord clamped and cut earlier to reduce that likelihood is one that you need to weigh up and discuss with your partner, and what you decide to do is entirely up to you and your family. If banking your baby’s cord blood is of the highest importance for you, you have much higher possibilities of collecting a higher amount (or the required amount) of blood if you clamp and cut the cord a little earlier.

But if I have the cord clamped and cut sooner, does it mean that the baby has less blood?

Effectively, yes. If the cord is cut before it finishes pulsating, it means that some of the blood that was meant for your baby didn’t make it to them. Because babies only have approximately 80ml of blood per kg of body weight, a baby whose weight is between 3 to 4 kg (which is an average birth weight for a newborn), only has approximately 250ml of blood. Collecting 40+ml of that blood for banking or donation purposes means taking approximately 16% of their entire blood volume, and recommendations from the WHO (World Health Organisations) state that no more that 2.5% should be taken at any one blood draw.

This isn’t to say that collecting cord blood is dangerous or not recommended for your baby, but there are a range of aspects to consider when deciding what to do, and it ultimately comes down to you deciding what aspect is most important to you, as a family, and this could depend on a multitude of factors. It is very much a personal decision for a family and one that you should feel free to discuss with your healthcare providers and give plenty of consideration to before making an informed choice.

We would love to hear your thoughts and experiences – did you choose delayed cord clamping and were you still able to bank or donate your baby’s cord blood? Please share your stories with us in the comments below.

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