Parents who make the decision to store their baby’s cord blood and cord tissue are thinking ahead, wanting to do right from the start (even before the start) and taking steps to do whatever they can to protect their baby down the road. Today, many conscientious parents are also considering delayed cord clamping.
Delayed cord clamping (DCC) is the practice of not clamping the umbilical cord immediately following delivery but rather clamping after it continues to pulse for an average of 30 seconds to 180 seconds. Although the ideal time for clamping of the cord has not been definitively established, DCC is most effective in cases of pre-term infants as well as in births in underdeveloped countries where iron-deficiency anemia is commonplace; however, support for delaying the clamping in all healthy births is growing. For instance, in January 2017, the American College of Obstetricians and Gynecologists (ACOG) recommended delaying the clamping of the umbilical cord for 30–60 seconds for all healthy infants. This was an update to similar guidelines it established in 2012. Those guidelines recommended delayed clamping in pre-term and "vigorous-term" babies. The latter being defined as a baby who is breathing and has good muscle tone and a heart rate above 100 beats per minute.
History of delayed clamping
People started clamping and cutting the cord early during the '50s
For delayers, it isn’t delaying; everyone else is prematurely clamping—and history is on their side. Today, it is common for the cord to be clamped within 15–20 seconds, but up until the mid-20th century, the cord was often cut anywhere between one minute and five minutes after the birth of the child. It wasn't until after the 1950s that early clamping became more commonplace because a number of scientific studies during the time failed to demonstrate a need to wait and more and more people were going to a hospital for delivery instead of using a mid-wife.
In a study published in JAMA Pediatrics, 263 children were followed from birth to four years of age. Half had undergone delayed clamping and the other half had immediate cord clamping. At age four, the children who had undergone delayed CC, compared with early CC, were rated higher in their fine-motor and social skills, especially in boys. The study results suggest that even children born into a low-risk, high-income population may benefit in neuro-development from delayed clamping.
How DCC can affect banking
Some circumstances will clearly dictate when cord blood banking for future therapeutic needs (e.g., family history of disorders) is preferable to infusing additional red blood cells to the infant at birth through DCC. A prolonged delay will allow the blood in the cord to clot, and the opportunity to collect the blood for stem cells will be lost; therefore, if clamping is delayed, it should not be more than two minutes. Cord tissue collected after cutting the cord is in no way impacted by delayed cord clamping. (Umbilical cord tissue, able to be collected at the same time as umbilical cord blood, contains another type of stem cell.)
It’s a delicate balance, but what many consciousness parents don’t realize is that they can do both. Growing evidence supports the fact that parents can both delay clamping and bank their cord blood, without choosing one over the other.
One study from a private cord blood bank using data from 2,000 cord blood collections showed that delaying for one minute or more resulted in only a 6%–21% decrease in the total volume of cord blood collected and a 9%–31% decrease in the pre-processed total nucleated cell (i.e., white blood cell) count. In another study from a public cord blood bank, delayed cord clamping was found to have a small effect on the number of total nucleated cells, with 60% of collections that had underwent delayed cord clamping still meeting a high threshold for the number of total nucleated cells.
Best way to delay clamping and still cord blood bank
Not all cord blood processing methods are the same, and how a baby’s cord blood is processed is essential to being able to both delay cord clamping and bank the cord blood. In order to be able to take both steps, the manner in which the cord blood is processed becomes extremely important. Because of the delay in clamping, a smaller quantity of cord blood will be collected. The quality of that cord blood needs to make up for the decrease in quantity.
A defining study published in the International Journal of Stem Cells examined the different processing methods, (i.e., the means by which the stem cells are separated out from the blood). It found PrepaCyte®-CB processing to be the best method to ensure that parents can collect their baby’s cord blood stem cells and delay cord clamping. According to the study, PrepaCyte CB is “the only processing type unaffected by volume.” The implications of this on delayed cord clamping are significant: When the cord blood collection is processed through the PrepaCyte-CB method, even if the volume of the collection is diminished (lower than the average volume collected with immediate cord clamping), it won’t have a negative impact on the percentage of the stem cell volume. PrepaCyte-CB yields the highest number of colony-forming units (CFUs), which currently is the number used to determine stem cell potency and the potential for stem cell engraftment.
Conscientiousness is about making informed, well-thought-out decisions. It’s about foresight. “Knowing the decisions we are making in each moment (because everything is a decision whether active or passive) helps us to guide our lives.” And it helps us make wise choices. We embrace conscientiousness, always thinking ahead on how best to protect the stem cells we collect, rather than following suit.
We are the first cord blood bank to adopt PrepaCyte-CB processing and are the only private cord blood bank that can offer the technology to the public. For the conscientious parent, the choice of cord blood banks is clear. Parents can both delay clamping and store stem cells from cord blood without choosing one over the other, but to get the best cord blood specimen, parents need to choose the best processing method: PrepaCyte-CB.