First, a thank you to Faith Gibson who taught me the term, “Physiologic cord clamping” in contrast to the phrase “delayed cord clamping” we most often hear and have in turn been trained to use. The former reminds us that waiting for cessation of blood flow in the cord is the normal standard in human birth, and that deviation from that is, in fact, interference in the natural process. When we participate in the phrase “delayed” it seems to suggest that in waiting, we haphazardly veer from sound practice. It is a subtle difference, but an important one. More from Faith on the subject in an upcoming guest post very soon!
Before I enter the discussion about cord clamping and cord blood banking, I have made the assumption that you are already familiar with the concepts and the benefits of physiologic cord clamping. If not, and you need a quick tutorial on the topic, see this post here on Newborn Procedures, which includes discussion on the topic along with a wonderful visual demonstration video by Penny Simkin.
So, in talking about physiologic third stage practices in my CBE classes (including physiologic cord clamping), the question often arises:
“If we wait to cut the cord until it stops pulsating, can we also still donate cord blood?”
This is a good question. Until very recently, my answer was based on what health practitioners have told me:
“No. There is simply not enough blood left in the cord when the blood is allowed to fully drain to the baby.”
Made perfect sense to me. So, my counsel to women and their partners was to evaluate the potential benefit of utilizing those cells vs. the risk of depriving baby of that full volume of blood following the birth as they made their decision.
Then, I came across a timely thread – timely in that it followed the previous night’s CBE discussion on the topic – which argued that
YES, in fact, cord blood banking IS possible with physiologic clamping.
Following delivery of the placenta, using gravity, the health care provider holds the placenta higher than the collection bag, and inserts the needle into the cord vessels closest to the placenta, draining the remaining blood into the collection bag. Most of the time, this method results in sufficient blood to enable cord blood banking. Check out this article, detailing one midwife’s standard of care.
And then this study comparing in utero and ex utero collection methods:
“CB can be collected successfully using either the in utero or ex utero methods; both methods produce comparable nucleated cell, MNC, CD34+, and CFU-GM numbers. Bacterial contamination, low volume, clotting, and delay until processing are generally higher with in utero collection.”
Thanks to Kerry Tuschhoff, Founder and Director of Hypnobabies, who shared the above information, as well as the following from Pacificord, on their ex-utero collection instructions (which is included in their cord collection kits):
In the event of a precipitous delivery, emergency surgery, or a parent’s desire to allow the cord to stop pulsating, it is possible to collect the umbilical cord blood after the delivery of the placenta.
1. After the placenta delivers, transfer the placenta into a sterile basin.
2. Elevate the placenta to increase gravity and facilitate blood flow.
3. Uncoil and straighten the umbilical cord and wipe cord clean with the sterile gauze provided.
4. Starting at the most distal end of the cord, disinfect at least five inches of the cord with the alcohol wipes provided.
5. Disinfect the same area with the PVP swab sticks provided.
6. Using another alcohol wipe, remove the iodine prior to collection.
7. Beginning at the most distal end of the cord, insert collection bag needle bevel down into the umbilical vein and hold in place.
8. Lower collection bag and allow the blood to drain to gravity, rotating the collection bag to mix the anticoagulant. It should take approximately 2-5 minutes to collect the remaining blood.
9. If blood flow stops or slows during the collection process, or if the umbilical vein collapses, select another site closer to the placenta. Repeat the cleansing process and reinsert the needle.
10. If blood flow or collection volume is poor, the placenta can be gently massaged to promote increased blood collection.