Q: I had not discussed cord blood banking with my midwife, but after my
daughter had been delivered, I looked down to see my midwife taking some in
a syringe. Was it ethical for her to take the stem-cell blood from my cord
without my consent, (and also it would have been without my knowledge had I
not looked) or is this normal practice?
-Anon.
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A: It depends on where you give birth. Some facilities just throw away the
cord blood with the placenta but most only collect the cord blood from the
placenta if the mother is O+ or Rh negative. In the facility I currently
work in, we collect cord blood on all babies and send it to the lab. If a
client wants to keep her cord blood she needs to let her practitioner know
about it before the baby is born and she needs to make arrangements to have
her cord blood stored well in advance of labor.
-Tora Spigner RN MSN
====
I suspect that your midwife was collecting cord blood to test your baby's
blood type and Rh factor. The pediatricians at my hospital want this
information on every baby, so they can screen for incompatibilities with
the mother. By drawing blood from the umbilical cord, the baby is spared
having the blood drawn from its foot or arm vein. Cord blood banking is
expensive and requires special collection equipment for proper storage of
the blood (not just a syringe). I strongly doubt that this is what your
midwife was doing. Did you ask her?
-Jeanne Preston, CNM, Ohio
====
...Some parents want the baby's blood typed, so taking cord blood at birth
saves the baby a heel poke! Some midwives just want to be on the cautious
side.
If cord blood was needed for any kind of testing after birth, they would
have it. Ask your midwife why she took your baby's cord blood. If this is
routine for her, she might not have thought to ask you. I agree that you
should have been
informed, for I imagine it could be disconcerting.
-Jenny Johnson
====
...It should always be explained why cord blood samples are being taken,
and usually the woman is well aware antenatally that cord blood will be
taken after the birth, especially if this is not her first birth, if she is
rhesus negative. I think that there was practice to take cord blood samples
in the UK due to the high levels of haemaglobin that would help some blood
disorders, but I am sure that this practice has ceased--I may be wrong.
Your consent should have been gained if it was for banking as for any
procedure as a matter of informed choice and consent....
-Helen
====
How do you know your midwife took "stem cells"? It may have been that she
is required by law to take a cord blood sample (which is universal) for
syphilis and HIV. It is law in Texas that we send cord blood to the state
lab for these tests, even at homebirths. When we do not, we have broken the
law. Also, this is universally done in all settings. No one asks any
birthing mothers' permission in the hospital to do that. No one informs the
mother at any of the prenatal visits or hospital tours that it will be
done. It is done, it is not questioned, it is considered a standard, and
mothers have no idea it is being routinely done. Stem cell saving is
expensive, and I can guarantee your midwife did not spend $600 or $1800 to
save your baby's stem cells.
The next question you must ask is why did your midwife not discuss the law
with you for your state? Why did she not discuss routine cord blood testing
on your baby and then offer permission to refuse these routine tests if you
do not believe in them?
I'm sorry that your midwife did not discuss this with you prior to your
baby's birth and delivery, because communication and honesty are the
hallmarks of the midwifery-client relationship. Most midwives respect your
feelings about certain issues, and then allow you to refuse tests that you
do not want simply by your signing a waiver after the test or procedure has
been explained to you and you fully understand the benefits or consequences
of refusing the test.
-Sandra Stine, CNM
midwife@lcc.net
Reprinted from Midwifery Today E-News (Vol 2 Issue 21 May 26, 2000)
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