Expectant parents must make several important medical decisions. Among them: whether to have prenatal genetic testing, request pain medication during labor, strive for a natural birth or circumcise a male baby?
Perhaps one of the most overlooked parts of childbirth preparation is whether to save or donate the infant's umbilical cord blood.
Umbilical cords are usually discarded as medical waste. But the potential uses for cord blood are growing, making it imperative that families understand their options, including whether to pay to have the blood stored for possible use in the event of their child's illness or to donate it to a public bank so it's available to any child who may need it.
"I think every couple who is pregnant should look into this and make a decision for themselves about what to do," says Dr. Charles Sims, co-founder of the California Cryobank, which offers private storage. "Every doctor treating them should also be informed."
The treatment of Sacramento toddler Dallas Hextell, profiled in a recent Times story, has been used to highlight the promise of private cord blood banking, even as researchers caution against putting too much stock in still-preliminary research.
After being diagnosed with cerebral palsy, Dallas was given an infusion of his own cord blood that his parents say greatly reduced his symptoms.
Umbilical cord blood contains stem cells, a coveted commodity in medicine. Stem cells from cord blood -- particularly blood supplied by unrelated donors -- have been used to treat diseases such as cancer and some genetic conditions. Those cells can be used to treat many of the same illnesses (multiple myeloma or leukemia, for example) as stem cells found in bone marrow, but they're easier to use because they're already banked and the tissue types of the donor and recipient don't have to be as closely matched. Such treatments appear to be as successful as bone marrow transplants in some cases.
Moreover, the emergence of regenerative medicine has created potential new uses for cord blood. Some researchers are working to coax cord blood stem cells into becoming a range of tissues that might one day be used to treat an array of diseases or to repair injuries.
Viewing the promise of cord blood stem cells as a form of health insurance, about 5% of parents now bank their newborn's cord blood, with about 80% of that going to private banks for the child's own possible use and about 20% going to public banks.
Private vs. public
The possibility that more families may choose to save cord blood for their own future use has created tension between proponents of private banking and public banking.
"There isn't nearly enough awareness about cord blood banking. And pregnant mothers tend to get only one side of the story from private banks," says Susan Stewart, director of the Blood and Marrow Transplant Information Network, an organization that publishes books and newsletters on bone marrow, stem cell and cord blood transfusion.
The number of privately stored units of cord blood, estimated at 500,000 nationwide, far exceeds those in public banks even though cord blood in public banks is much more likely to be used. An estimated 300,000 units of donor cord blood are available worldwide.
For that reason, several major medical associations have urged families to donate their baby's cord blood to public banks.
"The beauty of harvesting these cells via the public banking system is that the chances of someone else using it are relatively great," says Dr. William Shearer, a professor of pediatrics at Baylor College who helped write guidelines on cord blood banking for the American Academy of Pediatrics. "In the private system, the chances of using it are actually very low."
Unrelated cord-blood transplants are increasing. An estimated 7,000 unrelated-donor transplants have been completed in the U.S., many of them in children. Cord blood is often used when someone who needs bone marrow cannot find a match among relatives or in the National Marrow Donor Program; success rates range from 40% to 80%.
"Cord blood is desperately needed," says Dr. Karen Ballen, an oncologist at Massachusetts General Hospital who helped write cord-blood banking guidelines for the American Society for Blood and Marrow Transplantation. "We have thousands of patients nationwide who need a transplant for leukemia or lymphoma. Only about 30% have a donor in their family. They need to look for adult bone-marrow donors and only about 50% will find that. There is an urgent need to donate cord blood to help those patients. If we bank cord blood privately we are taking the opportunity away from someone who might really need it."
A bill to increase donor cord blood collection in California has been introduced by Assemblyman Anthony J. Portantino (D-La Canada Flintridge).