The recent Guardian and Medium article by Matilda Battersby on cord blood, placenta and amniotic membrane donation is premised on inaccurate medical information and troubling assumptions about how to fix inequities in our healthcare system.
Although the article is titled “Should US mothers be paid to donate placentas?”, Battersby focuses on cord blood, as the more valuable “byproduct” of birth.
Battersby argues that selling cord blood could provide a source of revenue to offset costs of prenatal care for uninsured or underinsured parents. She cites the high costs of maternity care in the United States and the seemingly untapped reservoir of cord blood that could be sold to research or other medical uses.
Battersby quotes a parent promoting cord blood donation because it's "really of little to no consequence for the donor". She earlier writes that “collection is painless, and there’s no risk to either mother or baby”.
Unfortunately for researchers who would benefit from access to it, cord blood already has a natural home - in the baby that it came from. The donor is in fact the baby, not the person who gave birth, because it is the baby’s blood circulating in the cord and the placenta.
When the baby is born, a third or more of its blood volume is circulating in the cord and the placenta, where it goes to oxygenate and receive the nutrients that grow the baby. If you clamp and cut the cord right away, the baby loses that blood, rich in oxygen, stem cells, immunoglobulins, and iron. If you wait, much or all of it will end up in the baby.
Early cord clamping robs babies of blood that they need to optimally perfuse their lungs and other organs, bank iron stores, and build their immune system.
Battersby is right that the vast majority of cord blood in the United States is currently wasted, as physicians increasingly took over and medicalized birth over the course of the 20th century and early cord clamping became the norm. However, the tide is shifting.
Delayed cord clamping is like climate change: there's a mountain of scientific evidence and consensus among the research community for decades, and a stalwart bunch of non-believers. Or at least non-practicers. Most babies around the world also have their cord clamped immediately, thanks to our global exporting of the medical-industrial model of childbirth.
Thankfully, recommendations are slowly starting to catch up with this research, and in 2017 the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion recommending delayed cord clamping.
The World Health Organization has also recommended delayed cord clamping since 2012 "for improved maternal and infant health and nutrition outcomes”.
Battersby fails to acknowledge any of this information, and only tosses out a one sentence nod to the disturbing aspects of her proposal: “Naturally, there are considerable ethical ramifications, and nobody wants to start a baby farm where placentas are manufactured and women are treated like chattel”.
The ethics are clear when it comes to the idea that cord blood could be a band-aid fix for the gaping wound of our healthcare system. As more and more parents educate themselves and request delayed cord clamping, how could it possibly be ethical to pay some parents to deny their babies cord blood in order to pay their bill?
There are a few relatively simple interventions that could cut the exorbitant maternity care costs that Battersby cites. First, a universal, single payer healthcare system would eliminate most of the insurance company overhead.
Second, the United States could also follow the model of most of Europe, where midwives are the first line providers for normal birth and costly obstetricians are reserved for high-risk situations that demand their level of specialized expertise. In many countries, home birth is actively encouraged by the government for low-risk pregnancies as a safe and cheaper option.
Selling cord blood is not the answer. It’s an either/or: either that blood is harvested in an interruption of the normal physiologic process for all mammals or the baby receives its full placental transfusion that is every child’s birthright.