Third Stage of Labor: The Cord Blood Donation Decision

During birth preparation, many parents-to-be are surprised to learn that labor doesn’t end when the baby is born. In fact, there’s a (gasp) third stage of labor. But don’t worry, this third stage is usually the shortest, starting after the birth of the baby and ending with delivery of the placenta and fetal membranes.

If you weren’t thinking about the third stage of labor when making your birth plan, that’s totally fine. Your labor preferences can end here if you want.

But if you’re interested, one thing you might want to consider in advance is what you’d like to do with your baby’s extra umbilical cord blood. As an obstetrician, I get a lot of questions about umbilical cord blood donation and banking. If you have been thinking about this option, hopefully this summary helps clear up the different types of donation so that you can make the best decision for you and your family. If this is the first time you have ever heard about umbilical cord blood, this article should help you understand the process of cord blood donation and how to choose whether or not it’s right for you and your family. And if you want to know more about delayed umbilical cord clamping, you can read about it here.  

What is umbilical cord blood banking, anyway?

Umbilical cord blood banking involves collecting the excess fetal blood in the umbilical cord and placenta for storage in a cord blood bank. Fetal blood from the umbilical cord contains a large concentration of hematopoietic stem cells, which are the types of cells used in hematopoietic stem cell transplants (more commonly referred to as bone marrow transplants).

Why would I want to bank my baby’s cord blood?

Simply put, the main reason parents choose to bank cord blood is to help others with health conditions requiring treatment with a hematopoietic stem cell transplant (e.g. cancer or severe hematologic and immunologic diseases). Babies are born with lots of these stem cells to prepare them for growth and development in their first year of life. In fact, the umbilical cord blood contains more stem cells per unit volume than what can be obtained from a regular adult stem cell donor. Often, there is a significant amount of extra fetal blood that the baby does not need or require, and this can be collected, preserved, and stored for use in a life-saving transplant serving either a related individual (private donation), or an individual matched through the national donor registry (public donation).

What is the difference between public and private donation?

Before I get to that question, the most important thing to understand before you donate your baby’s cord blood is that it cannot generally be used for autologous transplants (meaning it must be used in a transplant for another individual, called an allogeneic transplant). The reason for this is that the stem cells harvested at the time of birth already contain the genetic mutations that led to the cancer or another disorder treatable with a hematopoietic stem cell transplant.

There are two types of umbilical cord blood banks, public and private. Private banks are intended for families to store cord blood for use in stem cell transplants for other family members with a known illness or for future children in the event they develop an illness. In the absence of a known condition in your family, guidelines do not currently support storing your baby’s cord blood in a private bank, as this is both costly (due to upfront kit costs and yearly storage fees), and unlikely to be of benefit (the estimated chance that your baby’s cord blood is used for a transplant is one in several thousand). 

If you don’t have a family member with cancer or another condition requiring stem cell transplant, almost all professional medical societies recommend that cord blood donation be to a public bank. These public banks determine the genetic makeup of the cells and anonymously list the genetics in a searchable public registry. Public donation is free for the family and the blood is much more likely to be used in a transplant than privately banked blood. 

How does donating work?

The general donation process requires obtaining a collection kit from the bank before your delivery and bringing it to the hospital or birth center when you come in for delivery.

Your delivering provider will use the kit to collect the remaining blood from the umbilical cord and placental circulation after the baby’s cord has been clamped and before delivery of the placenta.

Are there reasons I wouldn’t be able to donate?

In general, most women over the age of 18 who are healthy, have no personal history of cancer, and haven’t had any exposure to (or history of) diseases like HIV or hepatitis can donate cord blood to a public bank.

Women who are pregnant with multiples are not eligible. For a full list of conditions that would disqualify you from donation, you can check the Be the Match website.

https://bethematch.org/support-the-cause/donate-cord-blood/learn-if-you-can-donate-cord-blood/

Private banks each have their own set of criteria.

If I choose to donate my baby’s cord blood can I still do delayed cord clamping?

The simple answer is yes, but the real answer is more complicated.

In general, ACOG recommends delayed cord clamping in all circumstances and specifically states that “umbilical cord blood banking should not compromise…or alter routine practice of delayed umbilical cord clamping with the rare exception of medical indications for directed donation.”

So, your provider should be routinely performing delayed cord clamping even when you are donating cord blood. The issue with this is that in order to be considered an “adequate” cord blood unit with enough cells for transplantation, at least 40 mL of blood need to be collected. This can be difficult in the setting of delayed cord clamping or an emergency. I can’t speak for all providers, but what I tend to do in my own practice is delay cord clamping for 30 seconds (since the recommendation is 30-60 seconds), and then hope that I can collect enough leftover blood for cord blood donation. If you are choosing cord blood donation, talk to your provider about his or her practices, and your preferences.

What would you recommend doing? Should I donate the cord blood or just maximize the benefit to my baby with delayed cord clamping?

My personal opinion is that absent emergencies or medical issues, all babies should receive the benefit of delayed cord clamping.

However, I also feel that if all patients donated cord blood,  we would have a large public stockpile that could serve most (if not all) our transplant needs. Currently, the bone marrow transplant registry (bethematch.org) is in need of more registrants from ethnically diverse backgrounds to be able to serve all patients equally and increasing the diversity and number of cord blood donations would help this situation significantly.

When it comes down to it, I believe that every family should choose what works for them in the third stage of labor. The whole point of this article is to go through the options available, but also reassure you that no matter what happens at your delivery, you will still have a beautiful new baby. The cord blood is something to think about, but when it comes to preparing for your birth, it shouldn’t be the top concern.

Ok I want to donate cord blood! But how?

If you choose to donate to a public bank there is an up-to-date list available of participating banks and hospitals at  bethematch.org.  

 

Helpful Links:

1. Be the Match - information on cord blood donation: https://bethematch.org/support-the-cause/donate-cord-blood/
2. American College of Obstetricians and Gynecologists frequently asked questions (FAQs) on Cord Blood Banking: https://www.acog.org/patient-resources/faqs/pregnancy/cord-blood-banking
3. Parents Guide to Cord Blood Foundation https://parentsguidecordblood.org/en

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This article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The views expressed in this article are the views of the expert and do not necessarily represent the views of Kudos.