Bank on it

As an expectant mom, you are constantly making decisions that will affect your babe-to-be’s future. One question that could potentially have the greatest impact on the health of your newborn—and family members—is whether to bank baby’s cord blood.

This choice is one that has been afforded to parents only in the past 25 years, and more and more mamas are weighing their cord blood options. Wherever you are in your decision process, we’re here to help. From breaking down what cord blood is and why it’s important to explaining how things will go on delivery day, here’s everything you need to know about saving, storing and using umbilical cord blood, so you can decide what’s right for your family.

What’s the big deal?
As you might have guessed, cord blood is the blood that remains in the umbilical cord and placenta after birth. Unless you choose otherwise, it’s usually discarded as medical waste.

This blood happens to be an ample source of stem cells, which is where its value lies. Stem cells are the body’s building blocks. These master adapters have the ability to transform into other types of cells to further new growth. They contribute to the development of tissue, organs, blood and the immune system.

Stem cells can also be found in bone marrow; however, the collection process is significantly more challenging—not to mention painful for the donor. Research also suggests that cord blood stem cells don’t need to match as closely as those from bone marrow for a transplant to be successful. For all of their benefits, cord blood stem cells can only be collected during one brief window: right after birth. The cells are then processed, frozen and stored.

The umbilical cord contains blood- forming cells that have been used in more than 30,000 transplants to treat nearly 80 serious diseases, including blood, immune system and metabolic disorders. These stem cells are also used to offset the effects of cancer treatments on the immune system. Most of the treatment options are for genetic disorders and typically require a transplant to infuse new stem cells into a patient’s bloodstream. Like any other transplant, the patient is literally carrying around the donor’s blood and immune system.

The stem cells from your baby’s cord blood are special in that they are genetically unique to him and his immediate family members. This means that, now or years later, these same cells could be effective in treating that child or a close relative. However, it’s worth noting that using his own cord blood, your baby can be treated for only a small number of non-genetic diseases, such as brain tumors or severe aplastic anemia, because any genetic defect in the patient is also present in his cord blood stem cells.

A sibling’s cord blood is often the best match. In fact, according to ViaCord, one of the largest private cord blood banks in the country, more than 90 percent of its transplants have been used for a matched sibling. “Cord blood stem cells are doing amazing things right now—treating serious diseases, improving lives and helping families more and more each year,” reports Kate Girard, RN, MSN, principal clinical affairs specialist at ViaCord. “We recommend cord blood banking for any family that believes in the potential of medicine and wants to provide for the future health of their children.”

greatly improving a family member’s chance of finding a match, cord blood banking—though never a complete guarantee—acts as a kind of insurance. You hope that you’ll never need your baby’s stem cells, but it can be reassuring for parents to know that they’re there.

How has it helped?
When Traci and Kevin Mercer of Oxford, Massachusetts, first learned their 2-year- old son Nicholas had leukemia in March 2005, they prepared their family as best they could for the 18-month course of chemotherapy that the doctors were recommending. Cord blood banking was something Traci, then pregnant with her second child, had seen articles about, but it was Nick’s oncologist who urged her to look into it.

Nick was in the middle of chemotherapy, but Traci and her husband decided that the cord blood would be worth saving should Nick ever need a transplant. Thanks to Sibling Connection, a partnership between ViaCord and the Children’s Hospital Oakland Research Institute, expectant mothers who have a child who might be in need of a stem cell transplant can have their newborn’s cord blood collected and stored for five years at no cost. Traci enrolled in the program, and when baby Brayden was born in August 2006, she sent the sample to ViaCord just in case.

Nick’s chemotherapy was successful, but unfortunately, when he was 5 years old, his leukemia returned. The doctors gave Traci and Kevin two options: commit to another 18 months of chemo or test Brayden’s cord blood to see if it was a suitable match.

While they waited for the results, Nick’s health rapidly declined. He was put back on chemotherapy, and three weeks later his appendix ruptured. The infection ran rampant through his body because his immune system was suppressed. Traci and Kevin were sitting with him in intensive care when Nick’s oncologist gave them the good news—Brayden’s cord blood was a perfect match.

“It was unbelievable,” Traci says. “Every day they came in with worse news, and when they came in that day they were smiling.” Two years after collecting Brayden’s cord blood, those same stem cells were transplanted into his big brother. Although the boys were too young to fully understand what happened, Traci and Kevin did their best to explain it to Nick in the simplest terms. “Several times after the transplant, [Nick] would ask the nurse whose blood they were drawing—his or Brayden’s,” Traci recalls with a laugh.

Nick, now 12, is an active, sports-loving sixth-grader who, aside from some residual effects of chemo, is healthy and cancer-free. When August rolls around each year, the family takes time to celebrate Nick’s trans- plant much like a birthday—and, in a way, it was one. “[Nick and Brayden] know that they have that connection,” Traci says. “I think as they grow older and understand more about it, they’ll realize how special of a gift that was.”

Who’s it for?
While choosing to bank your newborn’s umbilical cord blood can be a life-changing decision for families like the Mercers, there is a long list of factors to consider. Parents with a baby on the way have three options:

• Pay to privately bank baby’s cord blood for personal use.
• Donate the cord blood to a public bank.
• Let the cord blood be disposed of as medical waste.

When you’re deciding whether cord blood banking is for you, start by taking a look at your family’s medical history. Ask your medical provider to weigh in if you have any concerns.

“I would certainly recommend cord blood banking if anyone in the immediate family has, or has had, any type of leukemia or lymphoma,” says Nancy Sapanara, MD, JD, medical director at LifebankUSA. “However, many conditions for which cord blood can be used often arise without any family history of the disease. For this reason, cord blood banking is a reasonable choice for any family that would like the peace of mind of knowing that their child’s stem cells are available.”

The American College of Obstetricians and Gynecologists (ACOG) estimates the likelihood that cord blood stem cells will be needed to treat your child or a close relative is roughly 1 in 2,700. Therefore, ACOG recommends saving cord blood only if an immediate family member has been diagnosed with a disease for which stem cells are currently being used for treatment.
The American Academy of Pediatrics (AAP), on the other hand, advocates for cord blood banking among all families—with the distinction that blood be stored in public banks for use by the general population.

“As a cord blood bank medical director, obstetrician and mother, it is my goal that cord blood not be thrown away,” says Karen E. Taylor, MD, FACOG, medical director at StemCyte, Inc. “I would encourage families to look into donating or saving their new baby’s cord blood.” Taylor points out that if private banking is an affordable option for you, it is particularly important for races that are not as well represented in the national public inventory, such as African Americans and Asians, because those patients will have a more difficult time finding a match. This also makes those donors all the more vital.

Should you find that private banking isn’t for you, your tot’s valuable stem cells don’t have to go to waste. You can donate cord blood to a number of public banks at no cost to you, and possibly help save or improve someone else’s life. Expectant mothers must meet basic donor require- ments, but the largest obstacle to donating is that many delivery hospitals don’t have a program in place. (Find out if yours does at BeTheMatch.org.)

Dina J. Levin, MD, an OB/GYN in Bellingham, Washington, has seen this firsthand. “When I was a resident, we had [a public donation program] in St. Louis, but there has not been one in any of the cities that I have practiced at since—it’s a shame,” says Levin, who has practiced for 17 years in three different states. If your hospital doesn’t offer this option, some public banks provide mail-in collection kits, but check with your doctor to make sure she has the required training.

Not all donated units are viable or large enough to be placed on the list for transplant. Those that are too small are used to investigate new uses for stem cells and improve banking processes.

One thing doctors and all banks agree on is that the future of stem cells looks bright. “The future is unkown, but aging and cell mutation is a given,” says Jared Ehrhart, PhD, lead researcher at Cryo-Cell International. “The only thing I can say with certainty about the future is that the research, use and benefits of stem cells will expand and increase exponentially.”

“We believe stem cells are built of possibilities and optimism, and through continuous progress in medicine we believe we’ve just begun to scratch the surface of what stem cells can offer families,” says Heather Brown, vice president of scientific and medical affairs at Cord Blood Registry. “It’s only up from here.”

How does it work?
Finding the right bank for you, be it public or private, will take some time and research. Moms- and dads-to-be who are considering banking cord blood should start looking into their options as early as the first trimester. Before you sign up, make sure the bank you choose is accredited by the American Association of Blood Banks (AABB).

As far as what happens between the umbilical cord and the bank, rest assured the process of saving baby’s cord blood is safe, painless and simple, so you can leave the stem cells to the pros and focus on that new little love in your life.

The process of collecting cord blood, whether you have a vaginal or cesarean delivery, takes about two to four minutes. Neither you nor your babe will feel a thing because it all happens after the umbilical cord has been clamped and cut, which means deciding to bank will in no way alter your birth plan.

Depending on your hospital’s and chosen bank’s collection proce- dures, your health care provider will either use a syringe or bag method to store the remaining blood. Most samples are about 60 milliliters (or 1⁄4 cup), but in that seemingly small amount there are 1.8 million cells that test positive for stem cell markers.

The syringe or bag will be labeled with an identification number assigned to your baby. There is a brief window following birth during which cord blood can be collected, and then it must be sent to the designated laboratory for processing within 48 hours. Once the sample arrives, the number of viable stem cells will be counted, and the blood will be tested for any diseases or contamination before it’s stored. Depending on the bank, the stem cells might be frozen in the blood and later removed if they are ever needed, or they might be separated from the red blood cells and plasma prior to freezing.

Parents who choose to privately bank can expect to pay two fees: The initial fee covers the cost of enrollment, collection, processing and typically storage for the first year. The second is a smaller annual storage fee.

Costs vary by bank, so the first payment can range from $1,400 to $2,200. There are potential add-ons, as well: Expect about $150 for a medical courier if transport isn’t included and anywhere from $150 to $500 for physician’s fees. Once the first (and biggest) hurdle is out of the way, parents will need to pay the subsequent yearly fees, which usually fall around $130. Even if you pick one of the cheaper options, you could be spending upwards of $2,000 out of pocket in the first five years.

The price of cord blood banking can be a major expense for some families, which is why many facilities offer payment plans to make the costs more feasible. ViaCord took affordability a step further and recently lowered its upfront price of banking by 40 percent. “There are 4 million births a year,” says Girard. “There’s not a lack of cord blood or cord tissue out there, and our goal is to make that resource more affordable and available.”

Having a baby is expensive without the added cost of cord blood banking, but some parents still see the benefits outweighing the hefty price tag. “It’s life-saving. I mean, it’s a choice—and if it’s a money issue, I get that, but you can’t put a price on life,” says Mercer, who knows firsthand how valuable those stem cells can be.

Sapanara’s advice for any mom still deciding is clear: “I would tell her to gather as much information as she could about her choices as this is a very personal decision. But I would emphasize that it is also a once- in-a-lifetime opportunity. If the cord blood is not collected at birth, it is gone forever.”