Friday, March 21, 2008

ACOG Revises Opinion on Cord Blood Banking

It is refreshing to see that ACOG can make some improvements in judgment, albeit small ones. While they still won't take a stance for or against it, their revised opinion on the scam that is private cord blood banking is a small nudge in the right direction.

I especially like the statement, "ACOG also advises physicians who recruit patients for for-profit cord blood banking to disclose their financial interests or other potential conflicts of interest to pregnant women and their families."

It's nice to see that ACOG has some interest in letting families know when they're being solicited for personal physician profit. The majority of mothers accept their OB's advice as research-based fact (in their defense, they should be able to depend on the information they receive as accurate and unbiased - sadly, this isn't the case). When their OB recommends cord blood banking to them as the responsible decision, they shell out thousands of dollars firmly believing their actions are in the best interest of their child. They have no idea that the doctor's recommendation may be colored with personal incentive to make a profit.

What is most upsetting to me is that the chances of the cord blood being usable to treat an illness is so unlikely. Again, their statement reveals, "there is no reliable estimate of a child's likelihood of actually using his or her own saved cord blood later. Some experts estimate this likelihood at 1 in 2,700, while others argue the rate is even lower. Physicians should also disclose to their patients that it is unknown how long cord blood can successfully be stored."

The chances are very slim that the child could benefit from their cord blood or that it would even be viable when needed.

The true kicker is that, "Pregnant women should be aware that stem cells from cord blood cannot currently be used to treat inborn errors of metabolism or other genetic diseases in the same individual from which they were collected because the cord blood would have the same genetic mutation."

One of the most-cited arguments I hear from mothers for private cord blood banking is that, "if my child got leukemia, the stem cells could cure him/her." This is a straw man argument. It's based on a fundamental lack of information that gives families of children with life-threatening diseases false hope.

That, in my opinion, is morally reprehensible. The odds are better that a donor's cord blood stem cells could treat the disease. However, the idea of donating my cord blood to a public bank, where it could be used for purposes to which I am ethically and morally opposed, is enough to stop me from considering it. Again, the other caveats of usability and viability are also present.

**Sigh** With more technology comes more responsibility for the ethical and moral implications. Some days, it's exhausting to contemplate....


Ruth Phy said...

What I wonder is what goes on between the second and third stage of labor when a family wants to bank the cord blood. Do they clamp the cord as soon as they see it in order to keep as much blood in the cord to bank? If so, would it be better for you baby to allow all of those nutrients to go to them at the time of birth, so that they CAN use them and it not be a "just in case you need them"?

My point is, you shouldn't clamp the cord too soon because the baby is still using it to obtain oxygen. When you clamp it too soon, it's cuts off his/her supply and causes them to gasp and scream for oxygen in the air. Let the baby acclimate a little. He/She is in a whole new world.

Catherine said...

Delayed cord clamping is still possible, even when banking cord blood.

There is still enough blood left in the placenta to donate.

I completely agree that giving your baby the best start possible is the preferred route, especially when both procedures can be safely combined for the optimal results.

Why compromise their immediate health and acclimation to the outside world on the basis of conjecture?

Elizabeth Allemann said...

Yes, cord blood collection for banking is possible with delayed clamping, but it's not easy. What is not possible is a physiologic third stage. What a mother needs during third stage is peace and calm and privacy. She does not need to climb half out of her birth tub or to have a midwife or doctor between her legs trying to milk blood out of the umbilical cord. Disturbing the mother puts her at increased risk of post partum hemorrhage.
Elizabeth Allemann, MD Former home birth physician

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