Whether you’re thinking about having a baby down the road, have made the decision to start trying, or are currently pregnant, the thought of expanding your family can be exhilarating and frightening (yup — all at the same time). There are so many things to consider: What kind of parent do I want to be? Should I cut back on the lattes? When should I go off birth control?
We’re here to help you think through one of these choices: Deciding whether or not to bank your baby’s umbilical cord blood. It may be the furthest thing from your mind, or heck, you may not even know what cord blood banking is. Even if you’re months or years away from trying to conceive, it never hurts to learn about the advantages and disadvantages of cord blood banking so you can make an informed decision when that day finally comes.
Cord blood banking 101
Let’s start with the basics: An umbilical cord is the cord that connects your baby to your placenta — it’s the thing that often gets clamped or cut after birth (ya know, the commonly used phrase “cutting the cord”). A placenta is a temporary organ inside your uterus that only exists during pregnancy. It transfers the nutrients and oxygen you take in to your baby via the umbilical cord. The umbilical cord is a critical bridge and carrier between the placenta and the baby — it’s vital for the baby to receive nourishment.
After giving birth, you and your baby will still be connected via the umbilical cord. Often, cord clamping is delayed for at least 30 to 60 seconds after birth which can provide great benefits to your baby like increasing their blood volume, improved blood circulation, and reducing the need for a blood transfusion. Cord cutting is the final step transitioning your baby from womb life, to life outside in the big, bright world.
Usually, cord blood is thrown away after birth, but some families choose to 1) pay to store it with a private bank for later use by your baby or immediate family, 2) donate it to a public bank, where the cord blood may be used to treat unrelated individuals with serious health conditions, or 2) save the blood for direct-donation to a biological sibling.
Hold up — I heard this whole thing’s a scam
Cord blood — what’s the big deal? And is it for real? The blood inside the umbilical cord blood contains stem cells that is currently being used in the treatment of over 80 diseases like childhood cancers, leukemias, lymphoma, and sickle cell disease. This is because stem cells have the ability to grow into a number of different healthy cell types your body, thus heal the body and treat different conditions — they’re the body’s little wonders. This is why stem cells could provide life-saving treatment to someone.
We turned to leading experts at the American College of Obstetrics and Gynecology (ACOG) and the American Academy of Pediatrics (AAP) to dig into whether this is actually the case. Their opinions are outlined in this overview published in the Journal of Perinatal Education. According to ACOG, the chance of a child or family member needing a stem cell transplant is about 1 in 2,700 — pretty low odds. Therefore, ACOG recommends the collection and banking of cord blood only when an immediate family member has a known diagnosis for which stem cells are currently being used for treatment, and not for potential future uses. In other words, they suggest not banking as a form of insurance.
Similarly, the AAP says the use of banked umbilical cord blood as “biologic insurance” is unwarranted. But unlike ACOG, the AAP recommends public cord blood collection and banking for all families for use by the general population. The AAP recommends private cord blood banking only if a full sibling has a medical diagnosis for which stem cells are currently being used for treatment.
Planning for cord blood banking or donation
Between your 28th and 34th week of pregnancy, talk with your healthcare provider about umbilical cord blood banking or donation, if this is something you’re interested in. This gives you enough time to get your questions answered by a professional and take the necessary steps, depending on your preferred method of cord blood banking (hang tight re: method).
First thing’s first: Cord blood banking isn't routine in hospital or home births, so you will have to plan ahead. For private banking you will have to contact a firm to enroll. You will then receive a kit from your bank ahead of time. Keep this in your hospital bag, since it will have everything you need to collect the blood and return it to the bank.
For public donations, you will need to contact your birthing hospital to check if they actually collect cord blood for public donation onsite. If this is important to you, select a hospital that has these programs. Next, you will want to contact the public cord blood bank that works with your hospital. They will ask you a few questions about your health, pregnancy, and your family’s health to see if you meet the basic guidelines for cord blood donation. Your delivery hospital will guide you through the entire collection, banking, a donation process.
Of course, there’s paperwork involved. If you decide to bank your babe’s blood, you will either sign a contract and pay a private bank, or you’ll sign a consent form in your last trimester to donate the blood to a public bank. We’ll talk about private and public banks and the pros and cons of each in a bit.
How is cord blood actually collected?
Regardless of where you choose to bank, many patients report that it’s relatively easy and painless to collect the blood and the collection process only takes about 10 minutes from to start to finish. There are two main methods used to collect cord blood, regardless of whether you’re banking privately or publicly:
In utero collection: Before birthing your placenta (yes — the placenta is typically delivered, too, after the baby is delivered), a small area of the umbilical cord is clamped to stop the blood flow and cleaned. Blood is removed from a vein inside the cord with a needle connected to blood collection bag. (This doesn’t hurt the baby because there aren’t any nerves in the cord.) In utero collection can be done during a vaginal delivery or cesarean section (C-section). This is called in “utero collection” because the placenta is still “in utero” during collection.
Ex utero collection: Some banks collect cord blood after the placenta is delivered. A technician will take the placenta to another room where it is cleaned and placed on a high stand, so that all of the blood in the umbilical cord and some from the placenta can be drained. As you probably guessed, this is called in “ex utero collection” because the placenta is out and in the world during collection.
Ideally, cord blood collection happens right after giving birth to maximize the amount of blood saved. Usually, about 50 to 20 ml of blood is collected. A 2002 study found that no differences were found in the collected blood volume when either collection method was used. Researchers did find, however, that when blood was collected in utero it was more likely to be rejected by public banks because of issues of contamination, clotting, and processing delays when compared to ex utero collection.
These banks aren’t the ones with ATMs
After collection, cord blood can be stored in one of three banking options:
Private banks: These are also known as commercial banks. Private banks will store cord blood specifically for your baby and family members to possibly use sometime in the future. These banks charge a fee to collect, process, and store the blood. Private storing costs about $1,000 to $2,000, and there is an additional yearly maintenance fee.
Public banks: Unlike private banks, it will not cost you a penny to donate to a public bank. Your donation is not reserved for your family but instead, it is made available to the public or used for research.
Direct-donation banks: If a biological family member has a medical need that may be treatable with cord blood, parents can choose to save the baby's cord blood for directed donation. Oftentimes, there is little to no cost involved.
Quick recap: You have two options when it comes to cord blood collection: in utero or ex utero. You have three options when it comes to banking: private banks, public banks, or direct donation banks. Always good to have options, right? Since we’ve already covered the pros and cons of collecting cord blood in utero and ex utero, let’s turn to the choices you have when it comes to banking.
What are the advantages of private cord blood banking:
Here's one reason you might consider private cord banking: Privately-stored cord blood is set aside specifically for your family. If your baby or someone in your family, like your uncle or aunt, has a higher risk for a disease like leukemia or lymphoma, it’s may be helpful to have access to this valuable resource that could be a treatment option to your family — and only your family — whenever you need it.
And the disadvantages of this method?
While reassurance is one reason you may choose to store your baby’s blood in a private bank, there are some cons to consider. First, private storage for cord blood is expensive. UptoDate notes that companies may charge $2000 dollars for processing the initial specimen. A recent study suggests that initial storage fees may range from $1,200 to $2,500, plus annual storage dues. You also might pay another fee for the blood collection kit, courier service to the blood bank, and processing. While some companies offer short and long-term payment plans for storing your baby’s blood for a period of 18 years, this can still really add up over time.
UptoDate also reports that private blood banks have less government oversight than public banks. Less regulation may impact the quality of the handling and storing of the blood which may decrease the chance of a successful stem cell transplant if your cord blood is ever needed.
Pros of public cord blood donation
If private cord blood banking is not the right fit for your family or wallet, you always have the option of donating your little one’s blood to a public bank. The aforementioned consent form gives a public bank like The National Cord Blood Program or San Diego Blood Bank permission to collect and list your donation in its database.
Supporters of cord blood donations believe that it increases the diversity of cord blood available across the county. In 2017, only 28 percent of transplants involving umbilical cord blood were conducted on patients of color. Donating to a public bank makes it possible for more people of diverse backgrounds to have access to this potentially life-saving resource. Generally, successful stem cell transplants happen when genes know as human leukocyte antigens (HLA) in both the donor and patient are closely matched. This match is more likely to happen within the same ethnic group. For example, African Americans have a greater variation of HLA types than any other group, which often makes it difficult to find a donor.
Another benefit to public donation is that it costs you nothing. Yep, it’s completely free.
Lastly, the cons of public cord blood donations
While donating to public cord blood banks is incredibly generous, there are a few drawbacks. Although it’s free, you will give up all rights at the time of donation and unlike organ donation, your initial donation will not get you priority treatment or waived fees if your little one needs a donor later in life. It is very unlikely to get your cord blood back once it is publicly donated. (AKA: Donating cord blood is not a way of banking for your family for free.) In other words, when considering donation, think about the long-term possibilities.
The decision to bank your baby’s umbilical cord blood privately or publicly — or bank at all — is a personal choice and totally up to you, mama (or future mama). Understanding the ins and outs of the whole process can help you make the best decision for you and your family. No matter where you are on your family planning path, we got you.