

Ask HN: Would you use a cord bank? - abstractbill

We are expecting our first child in August and have seen a lot of adverts for cord blood banking - the idea is that the blood in your baby's umbilical cord contains stem cells that might be useful for curing diseases later in life and so you should bank the blood as a form of insurance.  The ads and marketing literature are very compelling, but of course that's what they're designed for!  We've done a little basic research, and it looks like not everyone agrees that banking cord blood is desirable (e.g. see http://en.wikipedia.org/wiki/Cord_blood_bank).  However, as my wife pointed out, while the organizations in that wikipedia article who
recommend against banking are the kinds of people who should know what's best for mothers and babies, they don't necessarily seem like the best people to judge the potential effectiveness of stem cell therapies.<p>I'm posting this in the hope that there are some biotech folks reading Hacker News who can cut through the marketing spin and give us a straight answer - would you do this yourself, for your own children?
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aphyr
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. ;-)

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peteforde
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

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uptownben
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.

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johSho7w
After the cord is clamped, how is the blood on the other side expected to get
into the baby?

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alaithea
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.

~~~
johSho7w
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.

~~~
alaithea
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.

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mindcreek
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.

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louislouis
How much was it?

~~~
jm4
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...](http://parentsguidecordblood.org/content/usa/banklists/summary.shtml?navid=17)

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babar
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.

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fragmede
You might be interested in ask.metafilter's discussion on the practice:
[http://ask.metafilter.com/15638/Whats-the-deal-with-cord-
blo...](http://ask.metafilter.com/15638/Whats-the-deal-with-cord-blood-and-
farming-your-own-stem-cells)

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jswinghammer
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!

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carbocation
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.

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pg
What does your obstetrician say?

~~~
abstractbill
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.

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

~~~
dschobel
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.

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

For more info, Google: benefits of delayed cord cutting

~~~
megamark16
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 :-)

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ephermata
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.

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maineldc
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!

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asmithmd1
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_...](http://www.marrow.org/HELP/Donate_Cord_Blood_Share_Life/How_to_Donate_Cord_Blood/index.html)

~~~
GrandMasterBirt
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.

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terra_t
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.

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dzlobin
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.

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

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

~~~
jrockway
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 :)

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geuis
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.

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dnsworks
I did this with my daughter.

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GrandMasterBirt
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.

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

[http://www.cbsnews.com/stories/2009/03/09/politics/100days/d...](http://www.cbsnews.com/stories/2009/03/09/politics/100days/domesticissues/main4853385.shtml)

~~~
GrandMasterBirt
[http://www.washingtonpost.com/wp-
dyn/content/article/2005/08...](http://www.washingtonpost.com/wp-
dyn/content/article/2005/08/21/AR2005082101180.html)

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!

