Having a new addition to the family is truly something worth celebrating. It’s a journey in which families invest months of preparation and planning. There are important decisions to be made about the birth plan, and the practice of delayed cord clamping and cord blood banking is one in which guidelines have continued to evolve over time.
There is something we need to know about the moment a baby’s umbilical cord is clamped and cut, that is, at birth, a third of their blood is still outside of their body. The blood that has been coursing through them throughout pregnancy is still flowing through the placenta and umbilical cord.
What is so interesting is that a newborn’s first breath initiates placental transfusion. The cord would start to pulse and it would pump and push blood into the baby. This movement can transfer approximately 80 ml of blood by the first minute after birth, and can go up to 100 ml in three minutes. Overall, a baby would get at least 30% more blood or 214 grams of cord blood. With that are iron, antibodies, and other important cellular factors that are beneficial for the baby.
However, in the 20th century, the established medical protocol was to immediately cut and clamp the cord and whisk the baby away for initial care. Once the placenta is delivered, it is common practice that we just throw it out along with the umbilical cord. Therefore, the baby is missing out on all the potential benefits, and we end up wasting precious material that could potentially save a life; but we’ll talk more on that later.
Delayed Cord Clamping
This is the practice of clamping the cord and cutting it immediately following birth, generally within the first 15 to 20 seconds. However, recent evidence suggests that delaying the clamping and cutting of a newborn’s umbilical cord may be beneficial to them, hence the concept of delayed cord clamping (DCC).
The benefits of delayed cord clamping are clearly understood in premature births. The American College of Obstetricians and Gynaecologists recommend delaying the clamping of the cord in babies born before 34 weeks in part to reduce the risks of complications of premature birth.
Delayed cord clamping also benefits full-term babies by increasing blood levels in the newborn and improving their iron stores in the first months of life. The side effects of iron deficiency at birth include cognitive impairment and central nervous system problems. Therefore, ACOG now recommends a delay of clamping the cord for at least 30-60 seconds in most newborns, including full-term, unless medically contraindicated.
Source: World Health Organization
In the actual clinical setting, DCC involves waiting until the cord has stopped pulsating and becomes white before it is severed to enable full benefits to the baby. The midwife or the OB-GYN should be able to feel this when it happens by just touching the cord.
When is Delayed Cord Clamping Not Allowed?
While delayed cord clamping may have several benefits and is even encouraged today, there are a few circumstances when this practice may not be suitable. It includes the following instances:
- The mother is experiencing heavy bleeding
- There are issues with the placenta such as placenta praevia, placental abruption, vasa praevia
- Umbilical cord bleeding so blood flow to the baby is interrupted
- If the baby needs resuscitation. In such a case, the cord may have to be clamped early in the absence of facilities in the hospital to do this besides the mother. (DCC should be possible while the baby is assessed and breathing support is initiated)
Delayed Cord Clamping and C-Section
DCC may still be applied for caesarean deliveries, whether it is planned or an emergency. This has already been practised in several hospitals that recognise its benefits. Specifying this in your birth plan will give you an opportunity to discuss it with your OB-GYN. Data from a 2018 pilot study suggests that cord clamping for two minutes in elective, term caesarean deliveries does not increase the risk of excessive blood loss in the mother. However, as there may be a slight delay in stitching and hence arresting bleeding from the uterine incision, some obstetricians may not be keen to wait. An alternative is to milk the cord such that the blood that is in the cord is massaged towards the direction of the baby and this aids in hastening flow of blood to the baby before clamping.
Delayed Cord Clamping and Jaundice
There are small studies which show that DCC can slightly increase the likelihood of babies having a higher level of jaundice. This is yellowing of the skin and eyes due to the presence of too much bilirubin (a byproduct of the breakdown of red blood cells) in the baby’s blood. However, there is also strong evidence which shows that the benefits of DCC outweigh it.
Jaundice is common in newborns and it usually doesn’t need treatment. However, some babies may need phototherapy to help them get rid of jaundice regardless of when the cord was clamped. It is the responsibility of the paediatrician and other neonatal care providers to ensure that mechanisms are in place to monitor and treat neonatal jaundice.
Cord Blood Banking
We know that the value of cord blood goes far beyond the timing of clamping of the cord. Storing it for future use is also a beneficial practice in certain circumstances and has since been adapted in Singapore since 2001.
Cord blood is a rich source of regenerative factors which can be collected, preserved, and stored for potential future medical uses. After collection, cord blood is frozen and can be safely stored for many years. This method of freezing is called cryopreservation, and it is crucial in maintaining the integrity of the cells. Cord Blood Banking came about because cord blood must be stored carefully.
Many are willing to shell money for storage because cord blood can be used to treat over 80 medical conditions. However, most of these conditions are very rare. The main predominant use currently for cord blood is for treatment of blood cancers. Treatment for autism, cerebral palsy and degenerative diseases in later adult life are still conducted in experimental settings. There have been more than 35,000 cellular transplants worldwide using stem cells collected from cord blood and stored in both public and private family cord blood banks.
The reason why these cells hold therapeutic benefits is that they are too immature to know that they want to be “when they grow up,” which means that they are adaptable. Hence, they can be used for several functions.
If you have plans to preserve cord blood, you have the option to go for either private or public cord blood banking. Private banking offers storage that is exclusively for their family’s potential future use, or you may choose to donate to a public bank so you can also save a patient in need.
Delay Cord Clamping or Bank Cord Blood?
So, is it really possible to get the best of both worlds?
One of the commonly asked questions relating to delayed cord clamping is if you can have it done even when you are doing a cord blood collection.
Delayed cord clamping is usually not advised if a couple would opt for blood banking as there may not be enough cord blood available and hence, minimal regenerative factors to store.
When considering delayed cord clamping or cord blood collection, families should discuss their birth plan in advance with their OB-GYN. If families are interested in public donation, it’s important to know that public banks have different requirements compared to family banks.
Public cord blood banks will only accept cord blood donations with higher collection volumes. The reason for this is that high regenerative cell counts are needed in current transplant procedures and hence storing low amounts would not be beneficial for subsequent use. Private banks are motivated by commercial reasons and would more likely bank lower amounts for clients.
Cord Blood Banking: Covering the Cost
While cord blood banking offers a gamut of benefits, some shy away from it due to the cost. Storing it in a private facility can be costly in the long run, but it is free if you donate it to a public bank.
In families where there is a known genetic problem that puts them at risk of developing an illness that could be treated with cord blood, it makes sense to keep it for family use. In such cases, you can use the Baby Bonus Scheme for cord blood banking.
If you’re not familiar with it, the Baby Bonus Scheme has two components – a Cash Gift and the Child Development Account (CDA). The CDA is a special savings account which you can use for your child’s educational and healthcare expenses. You can apply online at any OCBC, DBS/POSB or UOB bank for your child who is eligible for CDA.
Under the Scheme, the savings you contributed to your child’s CDA will be matched dollar-for-dollar by the Government. Recently, the CDA First Step Grant is given a boost in the form of $3,000 for eligible Singaporean children—that’s on top of the existing Baby Bonus cash gift.
Another less expensive option is to store it in the Singapore Cord Blood Bank, which is the lone public institution in Singapore established for this purpose. At present, they already offer private cord blood banking, granted that you give birth in a government hospital. But it will also cost you around $5,000 for processing and 21-year storage.
If you choose to go with private cord blood banking (i.e. Cordlife, StemCord, Cryoviva) you can check if they are an approved institution under the Baby Bonus Scheme. As such, you will be able to use your Baby Bonus to pay for all your cord blood banking fees (enrollment fee & annual storage fee).
Why Should Parents Consider Donating Cord Blood?
There has been growing evidence which supports the fact the cord blood offers precious benefits that makes it definitely worth keeping. This is why many physicians advise towards cord blood donation.
It’s always your family’s discretion if you want to go for private blood banking instead of donation. But it’s not hard to miss the wealth of benefits a contribution can do. However, if a family has a known genetic problem that puts them at risk of developing certain illnesses that can be treated with cord blood, then storing it for private use is sensible. However, if there is none, donating just might help save a life.
Blood banking, although good, may not be affordable for some families. So the ones who need it the most won’t have their own supply. Take note that cord blood is not a cure-all. The identified diseases that it can treat are not too common, so the chances that a child may develop them are low, but such conditions affect millions worldwide. This explains why public blood banks are used 30 times more than private ones.
Imagine the amount of precious material that slipped through our hands by simply discarding cord blood. So think about it. Better yet, consider saving a life today!
If you’re interested in delayed cord clamping or cord blood banking, talk this through with your attending physician. You may also book a consultation with Dr Pamela Tan today.
All attempts to publish accurate information were made but no responsibility can be claimed if facts/costs change.
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.