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Hilary's Desk

The ethics of Cord clamping and stem cell collection

Hilary Butler - Tuesday, July 22, 2008

This afternoon Radio New Zealand, Jim Mora interviewed Professor Bob Williamson (download mp3 here)
about research on stem cells which come from cord blood.  Jim asked Professor Williamson whether there are any ethical issues surrounding cord blood stem cells.  He replied that there weren’t. 

The key to harvesting cord blood is when you clamp the cord.  There are various terms relating to cord cutting.  The first term is “immediate clamping” which means that a clamp is put on the cord, the minute a baby comes out of the mother.  The second is “delayed clamping” which to doctors means that the clamp is put on any time after “immediate” but to homebirth midwives, means that the cord isn’t clamped until all the blood has been pumped by the uterus into the baby and the cord has gone white.

In terms of obstetrics history “immediate” cord clamping is a relatively new “routine” procedure, and is now pretty much standard practice in hospitals. 

That immediate cord clamping is inherently wrong and potentially dangerous to babies, isn’t talked about much. 
 
Immediate cord clamping has its roots in the mid 20th century following an observation that babies appeared to be getting more jaundiced. This “problem” had suddenly become more severe, after it became fashionable for obstetricians to routinely knock out labouring mothers with various drugs.  These drugs got into babies.  Babies started to get more jaundiced.  Obstetricians rationalized that perhaps babies were getting too much blood, so they decided to routinely clamp the cord immediately, to stop the jaundice. 

Doctors didn’t realise was that the drugs were taking up the bilirubin sites on the red blood cells, preventing it’s excretion in the “normal” timely manner, building up dangerous levels of bilirubin. 

The obstetricians compounded their first monumental error of incorrect diagnosis, with a second, even worse error.  While clamping the cord, sometimes stopped the jaundice, it deprived the baby of two thirds of its own blood, which has nasty effects such as:

Hypoxic ischemic encephalopathy, (HIE) cerebral palsy (CP) and IVH.

Respiratory distress syndrome and hyaline membrane disease

Infant anemia, mental deficiency, cognitive and behavioral disorders, ADD, ADHD, autism and ASD

Hypotension, oliguria, hypothermia, metabolic acidosis, pallor, persistent fetal circulation, PPH, PFO
(List provided to me by Professor George Morley.)

There are Obstetric Professors to this day, who think immediate clamping is "normal". 

Perhaps you are reading this wondering, “What is the big deal?”

The deal is that immediate cord clamping deprives babies of 200 mls of blood.  You look at 200 mls, and think that’s not much.  What if you knew that without that 200 mls of blood, the baby only has 400 mls, instead of a total of 600 mls? 

Immediate cord clamping is the equivalent of removing one third of an adults total blood supply (10 pints), or three and one third pints.  That is classified as a severe haemorrhage.

But in babies, immediately cord clamping is worse than a haemorrhage.  The blood in the cord and the placenta is what has “breathed” for the baby, as well as circulating food in, and waste out.  the baby needs that full quota of blood for correct intracranial pressure, lower blood volume, and to decrease the risk of anaemia in later life.  Furthermore, there are unanswered questions about whether depriving the baby of that "abundant" supply of the stem cells which Professor Williamson considers have such wonderful medicinal prospects when 'harvested', may contribute to the development of serious diseases later in life as a result.

So here is where I have an ethical about cord blood collection.  After a baby is born, 150 mls of blood is collected with a needle and vial from the umbilical cord.  In order to be ABLE to collect 150 mls, the cord has to be clamped almost immediately after birth, and that last 50 mls stays in the placenta. 

If you left the cord until it’s gone white, and shrivelled, the whole 200 mls which is rightfully the baby’s, has gone into the baby, so there is very little cord blood to collect.  Stem cell harvesting can only be achieved by depriving the baby of one third of it's blood. 

It is my belief that nothing should be done to the cord until the baby has been breathing for some time, and blood equilibrium has been achieved.  Balance is achieved in the baby, through the cord.  Blood is pumped into the baby by uterine contractions, and in the unlikely event that there is too much, it will go back down the “outflow” pipe of the cord.
  
The practical realities are, that blood hardly every comes back out.  The cord shrivels to white and hard, and the baby automatically shuts off the cord itself.

Every doctor involved with stem cell harvesting from cord blood, will tell you:  There is absolutely no risk to you or your baby.  That is simply not true. The risks to your baby must be identical to the risks of immediate cord clamping. Why would you want to do that?  The only reason you are told that there is no risk to your baby, is that most doctors still think any blood NOT in the baby at the point of birth is superfluous.

Here to me is the ethical dilemma.  That 150 mls collected blood, so rich in stem cells that doctors want them isn’t superfluous.  It is rightfully the baby’s, and to deprive the baby of 150 mls is the same as immediate cord clamping.

The possible immediate results of that are seen here:

http://www.cordclamp.com/ 
http://www.cordclamp.com/ZICCthe%20PrimeInjury.htm
http://web.archive.org/web/19960101000000-20061015225030/http://cordclamping.com/braindamage.htm

Professor Bob Williamson pointed out that as we get older the numbers of stem cells in our bodies drop markedly.  The question that appears to never have been asked, or answered, as far as I know is:  “Are the stem cells, that cord blood is so rich in, actually vital to laying down a really good foundation for a person’s health from birth to death?”

In other words, “Does stem cell harvesting rob James to cure John”?

While we are at it, let’s deal with another bugbear of mine.  Let’s stop the unscientific, incorrect use inverted phrasing, which send the wrong messages to parents.
  
Immediate cord clamping should be called “unethical premature cord clamping”.  Delayed cord clamping should be renamed “normal” or “appropriate cord clamping”.  

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