Ask HN: Would you use a cord bank?

Before I read the summary, I thought a cord bank was a co-op where you could share all those electronics cables and cords you rarely need with others. I have so many cords the manufacturer included that I can't get rid of. Yes, yes I would use that. You should start a company on that model.

I'm not planning on having kids any time soon, if you couldn't tell. ;-)

What this guy said!

I tend to open a few HN topics at once in different tabs, and in the time it was taking me to work through the chafe I was thinking about the arbitrage between downtown real-estate and the ULTIMATE FLEXIBILITY OF ANY CORD AT ANY TIME!!!11OMG

My wife and I had considered storing cord blood for our second child (now 1 year old). We ordered the kit and in the delivery room the nurse had begun unpacking and asked us to sign a form authorizing it. She briefly explained the process where, after delivery, she would cut the cord immediately in order to "capture" as much as possible for storage. I guess we hadn't thought the whole thing through because this concerned us. It is my understanding that it is recommended that the new born be left with the cord intact for as long as possible, until the cord goes white (empty) because that blood makes up a large percentage of all the blood the baby has, which provides the baby with what s/he needs for the first part of his/her life. So by not letting this blood flow back into the baby we were essentially jeopardizing it's health from the get go. My wife and I are not doctors and this is only my opinion but we decided to not store the cord blood and let the baby have all of it, hopefully giving her a head start to a happy, healthy life. I would suggest reading up on what possible problems may arise when the cord is cut too early. Just something to take into consideration.

After the cord is clamped, how is the blood on the other side expected to get into the baby?

You don't clamp it. You wait (IIRC) 15-30 minutes before doing anything to it, to give it enough time to drain. The immediacy with which the cord is routinely clamped and cut rose quite a bit in the 80's and 90's. It only makes sense that you shouldn't tamper with nature so much as to cut off the cord from the baby immediately after birth, while there's still blood flowing through it.

I'm not really sure why doctors started doing that, but it reminds me of our society's pressure towards having everything natural seem perfect and sort of sterile, like when our grocery stores reject all but the most flawless produce. We wouldn't want our babies to be handed to us with all sorts of icky, biological stuff like still-intact umbilical cords attached.

Are you saying they are supposed to leave the baby attached to the placenta while the afterbirth is delivered? I would imagine that remaining attached to the afterbirth as it is delivered is an infection and antigen exposure risk for both the baby and the mother.

There seem to be differing opinions on that. A bit of a Googling suggests that you wait until the cord has stopped pulsing, which might be as soon as a few minutes.

I'm not sure why the risk of infection would increase with the cord intact versus it being cut (where germs could potentially get in anyway). The baby's and mother's blood don't mix, so even if there were a "wound" on the placenta where it came unattached, that would be on the mother's side.

My second child was born about a week ago. I kept both their cord blood in sepearate banks in separate cities in case of a disaster or an emergency.

I paid 20 years of storage for both of them also. I believe in the future their stem cells will be beneficial to them in at least one area of their lives, and I hope never to need the cord bloods for health reasons.

But there is one crucial point you should be aware of, make sure they are not sharing personal information or genetic profile with international third parties make sure the service agreement between you and the bank covers this explicitly, banks that I stored my children's bloods had no such clear points in their agreements and i made them add my own no third parties article for me.

How much was it?

It varies depending on the bank. Public banks cost far less than private banks. Once you figure out which type of bank you want to use you really have to look closely at individual banks. Where do they store the tissue? What is their financial situation? How many successful transplants have been done with tissue that they've stored? Even the collection kit varies, with CBR claiming to be able to collect up to 30% more stem cells.

We ended up choosing CBR because if the collection doesn't meet a certain threshold you have the option to get a refund or store it anyway. They also guarantee a successful transplant or your money back plus $50000. It cost us just under $2000. We hope it's money thrown away, but if we ever need it it's a small price to pay.

Some banks can also store cord tissue. The way it was explained to me is that the tissue can be used for all the things the blood can be used for, but there's a much better chance it will be a match for the father. Apparently, the chances of the stem cells from the blood being a match for the father are quite low.

That said, I'm having some second thoughts based on some of the things I'm reading here. We have a few more weeks before delivery.

Here's a table of banks and estimated costs: http://parentsguidecordblood.org/content/usa/banklists/summa...

I think the best option right now would be to donate the cord blood to a public blood bank if that option is available in your area. That doesn't cost you, and it benefits a child more immediately and helps to advance the research. I think there is a chance of benefit to storing it yourself, but the marketing from these companies seemed to be preying on parents' sense of guilt so much that it was off-putting to me. I can put those thousands of dollars to better use to benefit my children. Of course, if the money isn't a meaningful amount to you, your decision process may be different.

You might be interested in ask.metafilter's discussion on the practice: http://ask.metafilter.com/15638/Whats-the-deal-with-cord-blo...

We didn't for our daughter who is two and a half now. It's expensive and provides dubious benefits. We're hoping to have a child next year and we won't do it then either. There's a lot to worry about when you're expecting your first child but this isn't really a big deal. I'd spend more time worrying about other things.

Congrats by the way! This is a very exciting time. My daughter is an absolute joy and I'm sure your child will be for you too. Good luck!

I work with people who do iPS (induced pluripotent stem cell) work. The technology is quite promising: take a skin punch biopsy, add Yamanaka factors, and obtain iPS cells. They have not supplanted embryonic stem cells for most purposes but someday they may (there are various scientific advantages and disadvantages to both).

I think the most honest answer is that even those of us in this field don't yet know if storage of cord blood will prove to offer something that iPS can't. Perhaps there is someone even closer to the intersection of those topics than I on HN who can weigh in.

What does your obstetrician say?

She was frustratingly noncommittal to be honest, but I only thought of phrasing the question in the "would you do this for your children" way after our last appointment - I'll probably ask her that next time we meet.

I learned a few years ago that that was the best way to ask any doctor any question.

Ditto. Especially after one made a glib comment in front of his intern how a simple procedure (a nerve test) could potentially puncture my lung but it was my decision whether I wanted it.

"What would you recommend for a family member" gets a noticeable change of demeanor/gravity.

Personally I've found, "Assume that I'm paying you in cash, not with insurance" as a prefix to a question is very, very helpful with doctors.

Before I tried this approach, I would get "you might want to consider having your tonsils removed. Have a nice day" over and over again for about 8 years.

After I tried this approach it was, "Go see an ENT and have them removed immediately!". From the same doctor who was otherwise afraid of insurance related referral paperwork.

Our OB/GYN, who does stem cell research, said she doesn't really recommend it since there isn't a high probability of using it (weighed against the cost). But my father-in-law who's also an OB/GYN only wanted the best for his granddaughter so he foot the bill :)

Here's my blog post on it: http://athomedad.justinchen.net/storing-cord-blood

I wouldn't -- your baby can use that blood TODAY.

For more info, Google: benefits of delayed cord cutting

Also, ask your doctor about it, as medical professionals they should be able to help make sense of everything you're reading on the internet :-)

Cord blood can today save the life of someone with leukemia or other diseases that require bone marrow transplants. While other cord blood stem cell therapies may be speculative, this one is real and already works to save lives. My sister has leukemia and we just found out that some kind person donated cord blood which matches her tissue type...I can't describe how grateful I feel now. Thank you, whoever you are.

In my case, for my children, I would certainly make sure the blood is saved. The only question is whether to do private cord blood banking or to donate the blood to the public blood bank. I would find out how rare is my child's human leukocyte antigen (HLA) tissue type as part of making the decision. If it's rare then it becomes much, much more important to bank known compatible blood.

One confounding factor: if your child turns out to have a blood disease later in life, it's not clear to me whether there is a risk in using your child's own stem cells. For example we know little about the causes of leukemia, it could be that even the cord blood cells are potentially cancerous. I'd suggest reading up on this and reaching out to researchers in the area on this front, since it's unlikely your OB/GYN would know the most recent results.

Our first child is 11 weeks old now and we asked the same question to our pediatrician. Her answer was that "neither she nor any other pediatrician she knows would do private banking at the moment". I agree that public banking is the best idea and we were going to do that, but our child came 5 weeks early before we had a chance to set it up.

The thing that became clear during this whole thing is there were going to be MANY times in the coming years when spending "only $3K just in case" was going to be offered and this seemed like a bad precedent to set. The vast majority of children will never benefit from private banking, so go public!

The chances of your child needing it are vanishingly small, but their is a chance it could help a child. So it's a great idea to donate to a bank but paying money to store it for your own use is probably a waste of money.

http://www.marrow.org/HELP/Donate_Cord_Blood_Share_Life/How_...

I feel like a lot of the arguments here boil down to the same fact: There is very little chance that this will be useful. Most of the time this is a waste of money, but on the small minuscule off-chance that this might help people put money into it. Its like snake-oil, can't hurt but can't quite prove that it can help, but people take it on the off-chance that it might.

When I hear "stem cells" my first thought is "scam."

A lot of people want more from medicine than it is ever going to deliver. Just say no to another expensive procedure that has no demonstrable value.

My sister's cord blood was stored. I cant remember details but just recently I read an article in the news about a child who was saved due to the doctors being able to use her cord blood to do something or other.

I have a friend who said his friend heard that his girlfriend's dad's mom thinks that your comment is pretty vague.

Probably the most polite way of expression I’ve seen on HN

Thanks. I thought the comment I was replying to had some value, but would have been better if the OP looked up a bit more information before posting. Saying that would have been boring though :)

If it's inexpensive enough, why not? My sister just had her first baby about 7 months ago. They were talking about using a cord bank but didn't follow through with it. More out of distraction than anything else.

At this point in time you can't know whether or not it will be used later on. But if you don't save it now, if the event happens you won't have it to use. There is also the perspective that if your child never needs it, there might be other kids that it could help years down the road.

You are looking at long term storage of cells, so make sure whoever you go with is legitimate and has a long established history.

I did this with my daughter.

Would not do that. Currently they take YOUR skin cells and turn them into stem cells. A couple of years ago the process was discovered/perfected. I have a friend who has a degenerative eye condition and this was discussed with him very recently. Basically babies are not needed for stem cells anymore. Its why the stem cell research was allowed again in the US provided that the cells are retrieved using the skin -> stem cell method not the aborted fetus -> stem cell method.

That is not the reason stem cell research is allowed again.

http://www.cbsnews.com/stories/2009/03/09/politics/100days/d...

http://www.washingtonpost.com/wp-dyn/content/article/2005/08...

Its an old post, but the point is you use your cells for this. I guess I was a misinformed in the reasons for the Obama bill. Nevertheless I don't see why there is no big push to show that you don't need to kill babies to get stem cells!