Safe deposit

How often do you have a once-in-a-lifetime opportunity? If you’re currently expecting, you have one right on the horizon. When your baby is born, the umbilical cord attaching him to you will also make its arrival in the world—and you’ll have the option to either save the valuable cells inside or allow them to be disposed of as medical waste.

Parenting isn’t a one-size-fits-all endeavor (think breast versus bottle, co-sleeping versus sleep training), and neither is cord blood banking. Different families will do the same research and come to different conclusions about what’s “right.” No matter where your opinion falls at the end of the day, what’s important is that you make an informed decision. Read on for an easy-to-understand breakdown of what cord blood is, how it might be able to help your family or another’s, and what options you have come delivery day. When your opportunity arises, you’ll know just what to do.

Pure gold
To get started, let’s brush up on the basics of cord blood. As you might have surmised from the name, it’s simply the blood found in the umbilical cord at birth. What makes it so special is what it’s composed of. Cord blood is rich in stem cells—specifically hematopoietic progenitor cells (HPCs), which are precursors to blood cells (and are admittedly a mouthful to pronounce). In a nutshell, all you need to know is that they have the ability to transform into many types of blood-forming cells. If a person’s blood supply or immune system is compromised, these HPCs can be transplanted into the body, where they will hopefully begin producing new, healthy cells.

For many, this process makes the most sense when applied to a disease like leukemia. Leukemia is a cancer of the blood cells—specifically the white blood cells, which are responsible for fighting off infection in the body. The abnormal white blood cells found in leukemia patients are produced in the bone marrow, and once they’ve started forming, they pretty much take over, crowding out the healthy blood cells and making the person who is hosting these nasty cells very, very sick. Once leukemia has been diagnosed, chemotherapy and/or radiation will be used to destroy the diseased cells. And that’s where stem cells—often derived from cord blood—come into play.

Those immature cells pulled from the umbilical cord can be transplanted into the blood supply of the sick patient (assuming the provider and recipient are a genetic match), and if things go the way they should, the new cells will become exactly what the body needs them to be—in this case, healthy white blood cells.

It’s worth noting that HPCs aren’t found only in cord blood. They can also be found in bone marrow. In fact, bone marrow transplants are a bit more common. But transplants from cord blood tend to be slightly more successful. Because cord blood cells are less mature than cells from an adult’s bone marrow, the recipient’s body is less likely to reject them. It’s also easier and less painful to collect cord blood than bone marrow.

Leukemia isn’t the only condition that can be improved with a cord blood transplant. Hodgkin’s and non-Hodgkin’s lymphoma, sickle cell disease, Wiskott-Aldrich syndrome and many other diseases have been successfully treated with stem cells, too, either from cord blood or bone marrow. (For a full list of stem-cell treatable diseases, go to parentsguidecordblood.org/diseases.php.)

All in the family
There’s one caveat to cord blood banking that should be acknowledged up front: As it stands today, it’s unlikely a child could benefit from his own cord blood. If he has a genetic disorder—as most stem cell treatable conditions are—the same genetic flaws that caused the disease in the first place will be present in the collected cells, which means they would effectively reintroduce the illness into the body. Although research is ongoing—and promising—with conditions such as cerebral palsy and type 1 diabetes currently in phase II clinical trials, until further progress is made, the odds aren’t high that your child will benefit from his own store of cells.

The person most likely to benefit from your child’s cord blood is a brother or sister. There’s about a 25 percent chance that a sibling will be a match. If you have a family history of diseases that might benefit from cord blood, private banking is almost a no-brainer. If there’s even a small chance that one of your children might need that blood down the road, you’ll never regret having saved it. However, keep in mind that many stem cell treatable conditions won’t have any prior family history. They’re often fluke occurrences, and things you certainly can’t plan ahead or prepare for.

Going public
Some companies try to sell private cord blood banking as a form of insurance, and to be objective, they aren’t far off. Much like that flood insurance you pay for, you hope like crazy that won’t ever need it, but you’re willing to pay the price just in case.

However, others suggest that it’s not fair to make that comparison. In fact, the American Academy of Pediatrics disagrees and states, “The American Academy of Pediatrics discourages storing cord blood at private banks for later personal or family use as a general ‘insurance policy.’ Rather, they encourage families to donate their newborn’s cord blood … to cord blood banks (if accessible in their area) for other individuals in need.”

Unfortunately, that “if accessible in their area” stipulation is a huge factor. Public donation is not an option for everyone. Donation centers work only with select hospitals in certain areas, and they can be few and far between; your odds of making a public donation in New York City are much better than they are in rural Arkansas. If you’re interested in finding out more about your public donation options, the best place to find details is BeTheMatch.org. There are questions you’ll need to answer beforehand, and if you deliver early or have complications, it might not be a go. The public bank will not charge you for their role in the collection, but your doctor or hospital might; you’ll need to look into that ahead of time.

One other thing to note about public storage: If you need your donation five years down the road, and it’s still there, you’ll most likely be able to get it back. It might sound like a long shot, but it could happen. Of course, there is also the possibility that the cells will have been used, either to help someone in need or for research.

Although public banking is a great option, it isn’t viable for everyone, and some people want a more dependable alternative. In other words, they want to know that their stem cells are going to be there if they need them.

Private matters
Private or “family” banks store cord blood at a cost, so it’s guaranteed to be there if a need arises. These locations are where cord blood collections most commonly go. There are a handful of reputable family banks in the U.S., which can make it hard to figure out which one is best. As before, the same decision won’t be right for everyone; you’ll need to do a little research into the different companies and their costs before making a decision. Here are a few things to ask when considering banks:

• How long have you been in business?
• How many units do you currently have in storage?
• How many successful transplants has your bank participated in?
• What kind of research are you participating in for future stem cell use?
• How can I be sure that my collection will be properly collected, transported and stored?
• How can you guarantee that the cord blood will be available and viable if my family needs it?
• Is blood screened for defects before storage? What happens if one is found?
• What accreditations does your bank hold? (Look for FDA certification and AABB accreditation, at a minimum.)
• What contingency plans do you have in place for a natural disaster?
• Are you affiliated with any hospitals or research institutions?

Of course, cost will also be a factor. Prices vary from bank to bank, but many institutions offer ways to make the financial burden less cumbersome: payment plans, family discounts, gift registries and upfront payment reductions might all be options. Before writing it off as too expensive, explore what the different banks you’re interested in offer to help lessen the cost. (And don’t automatically assume the cheapest option is the best. Sometimes, a bank costs more because its processes and procedures are more involved—and therefore, more reliable.)

If you have an immediate need for the cells—such as a sick child at home who might benefit from a transplant—some banks are willing to collect, process and store the cord blood for free or at a considerable discount while arrangements for the procedure are being made.

Time it right
Big decisions take time to mull over, so it’s important for parents to begin the cord blood conversation early in pregnancy. In fact, it’s advisable to make your decision—not only whether to store, but also where to store—before the third trimester.

“Ideally, making a choice at least six weeks prior to the due date allows adequate time for paperwork and shipment of the kit,” says Nancy L. Sapanara, MD, medical director at LifebankUSA. “This also gives a cushion of time in case of an unexpected early delivery.” (It’s possible to sign up for private banking in the third trimester, but you might incur late enrollment fees.)

You should ensure early on that the place where you plan to deliver is on board with your cord blood plans and that your doctor is capable of handling his end of the procedure. When you arrive at the hospital for delivery, let your nurses know right away that you plan to collect baby’s cord blood.

Easy does it
Once the decision has been made, the process of collecting baby’s cord blood will be simple. You’ll bring your collection kit to the hospital, and after baby’s delivery, the blood in the umbilical cord will be collected—either by syringe or by draining it into a bag—and sealed up in the container provided by the bank. There is a brief window during which cord blood can be collected, but it won’t interrupt the time you have to bond with your baby after birth. “The cord blood being collected is blood that would normally be discarded after birth,” shares Heather Brown, MS, LCGC, vice president, scientific and medical affairs at Cord Blood Registry. “Your physician or midwife will not alter the normal birthing process in any way, except to collect your baby’s cord blood [after delivery].”

Brown also notes that delayed cord clamping isn’t off the table if you’re interested in banking. “Collection can still be performed after delayed clamping,” she notes, so discuss the specifics with your doctor (and your bank) if that’s your plan.

The entire process takes between two and four minutes and is completely painless for both you and baby. It can be performed whether you have a vaginal or cesarean delivery.

The sample might seem small—most are around 60 milliliters (or ¼ cup)—but there are about 1.8 million cells that test positive for stem cell markers in there. That’s a lot of potential in one tiny package!

Make the call
As you can see, there’s a lot to be considered when it comes to cord blood banking. We can’t look into the future and see what will happen with stem cell research, but we do know that research in the field continues to expand and that new uses are being investigated every day. There’s a good chance that this liquid gold we used to throw away will become a huge player in treating an assortment of maladies in the future.

But that’s just it—a good chance, not a guarantee. It’s not a cost everyone is willing to incur for an unknown. If you fall into that category, take a little time to see if public donation is an option in your area. It might not be, but if it is, your child’s cells could literally save the life of someone else—and that’s worth a couple hours of your time.

Whether to bank baby’s cord blood is just one hard decision of many you’ll have to make as a parent. But do what’s right for you. Don’t fall victim to scare tactics or listen to folks who tell you you’re wasting your money. Maybe you’ll go public, maybe you’ll go private or maybe you’ll just let it go … no matter what camp you end up in, if you made an informed decision based on what you think is best for your family, you made the right call.