Understanding Cord Blood

If you're pregnant, you've no doubt begun to hear a lot about cord blood. Here are the basics. First, the facts. After a baby is born and the umbilical cord is cut, some blood remains in the vessels of the baby's placenta and the cord attached to it. This is known as cord, or placental, blood. Cord blood has all the elements of normal blood, plus a rich supply of hematopoietic, or blood-forming, stem cells. These are similar to the cells found in bone marrow. For this reason, cord blood is increasingly replacing bone marrow in stem cell experimentation. In addition, cord blood transfers can be used to treat and improve some pediatric cancers and blood disorders. Today, cord blood can only be transplanted from a donor into a recipient who is a match. This is similar to how a bone marrow transplant works, although cord blood transplants use less stringent matching criteria. The cord blood from a baby will also have a high likelihood of matching with the baby's parents and any of the baby's siblings, so the benefits of familial cord blood extend beyond the donor. As of today, only a few illnesses can be treated with cord blood, so it is statistically unlikely that any individual will need the use of his or her cord blood. But because stem cell research is always evolving, many people believe that cord blood will have even more uses in the future.

If you're pregnant, you may be wondering if you should store your baby's cord blood. There are actually two decisions which you'll need to make in regard to your baby's cord blood. First, whether you'd like it harvested, and second, whether to donate it or store it in a private facility. The American Medical Association urges everyone to harvest their cord blood - most objections to this procedure are made on religious grounds, not medical ones. The more controversial decision is whether to store your cord blood at a cord blood bank or to donate it to a public bank. A publicly owned bank stows this blood for the general public, much like when you donate your own blood to the Red Cross. Whether you donate or not, the assumption is that if you or your baby should need cord blood that it will be available to you from a similar public bank. Meanwhile, a privately owned bank stores your cord blood for a fee, allowing it to be used solely by your own family. A private cord blood bank is not cheap. The average rate is a $2,000 collection fee with a $125 fee for annual storage. Proponents of this system say storing your cord blood privately is the best way to ensure that your family will have access to matching cord blood if it is needed. This debate will continue long after you have your baby. Make the choice that works for you and your family and feel good about it.

If using an obstetrician sounds too clinical for your delivery, a midwife may be an excellent alternative. Although midwives deliver less than 10% of all babies born in America, the percentage has been steadily growing since the 1970s. Midwives have the philosophy that pregnancy and birth are natural events, and typically do not make use of pain medications or advanced monitoring technologies. Instead, they focus on supporting the mother-to-be as nature takes its course. There are many different types of midwives who can assist with labor and delivering your baby, either at a hospital or in your home. Most midwives can also perform gynecological exams and provide prenatal care. Perhaps the most educated of this set are certified nurse-midwives, or CNMs. CNMs are trained as both midwives and nurses and have to pass a licensing exam from the American College of Nurse-Midwives. Certified professional midwives are similar to CNMs, but without the nursing training, and are certified by the North American Registry of Midwives... Direct entry midwives, on the other hand, largely attain their education through an apprenticeship. While a midwife can be a good choice in many cases, there are some situations in which a mom-to-be should opt for a doctor instead. For example, most midwives are not qualified to handle multiple births or high-risk pregnancies. They also cannot deliver pain medications and are unable to perform C-sections or administer emergency services. For this reason, choosing to have a midwife-assisted birth should only be done after careful consideration.

Are you giving birth as a single mother? Do you worry that your partner may not be able to offer enough support during delivery? If you answered yes to either of these questions, then a doula-the Greek word for "women's servant"-may be for you. A doula is a non-medical assistant who is trained to provide emotional, mental and physical support during labor and delivery, but who does not replace your doctor. Some doulas also offer breastfeeding consulting, newborn care assistance, and further support postpartum. During labor and delivery, your doctor and nurses will be concerned with both your baby's health and your well being, a doula will focus entirely on you. Having this kind of personal, undivided support during labor can be a great relief to some women. Generally, the doula/patient relationship begins a few months before the birth, as the doula helps to devise a birth plan. While doulas do not provide medical care, they are knowledgeable in the medical aspects of birth, allowing them to help patients understand the process. During delivery, a doula can provide comfort and pain relief using any number of methods, like massage and breathing exercises. Note that a doula will never replace your partner if you have one, but she will help him or her to participate and soothe you. The most important thing to know about a doula, though, is to make sure you choose one with whom you feel comfortable and confident

You've given a ton of thought to your new baby. But do you know what to expect on delivery day? Once you arrive at the hospital to give birth, you will check into the labor and delivery unit. After you change into a hospital gown, your nurse will hook you up to a monitor that tracks your contractions and your baby's heart beat. will then start an IV, draw blood, and request a urine sample for testing. At this time, you'll want to tell the nurse about your delivery plan, whether you intend to breastfeed, and if you plan to participate in cord blood banking. Throughout early labor, the nurse or doctor will perform regular checks of your cervix to see how far it has dilated. If you choose, a doctor or anesthesiologist can also give you pain medication during the labor and delivery. Your partner can stay with you throughout the process, except if and when you receive an epidural, or if and when you are prepped for a C-section. Now you know what to expect from your hospital stay, so you can arrive there feeling confident.

So now that you've delivered your little one, what can you expect from the remainder of your hospital stay? Congratulations! You're now ready to begin getting to know your new addition, and bonding with your baby. If you plan to breastfeed, you will usually start doing so within one hour of delivery. To help you get the hang of nursing, the hospital will send a lactation consultant to your room. Post-delivery, your doctor will come to check on you at least once, while nurses will monitor you around the clock. Provided your baby is healthy, you will be able to keep her with you for the rest of your stay. You'll also have the option of sending the baby to the nursery when you need a rest. Within 48 hours of a healthy vaginal delivery, and 96 hours of a healthy C-section, you and your new family will be able to leave the hospital. Remember, you need to install an appropriate car seat IN ADVANCE, as some states require this before you can drive home!

You expected to lose weight after your baby was born, but not your hair... After you give birth, you'll notice a lot of changes! For starters, even though you won't lose all your pregnancy weight immediately, your body will get you off to a good start. Immediately following the birth, on average, you will shed a seven-pound baby, two pounds of placenta, and two pounds of amniotic fluid. Plus, all the extra water that you retained during your pregnancy will now be looking for a way out. For this reason, you'll produce a HUGE three quarts of urine a day, causing more weight loss. Because you're producing so much urine, you'll probably urinate more often than you're used to, although this won't last for long. Post baby, you may also notice that you're losing a lot of hair-even handfuls of it! Rest assured, however, that this temporary side effect is just the result of your decreasing pregnancy hormones. The first couple of months with your new baby can require a real adjustment. Hang in there though -most of the post partum effects will subside within the first year.

No part of your body is harder hit by giving birth than your vagina and breasts. In the several days following birth, your breasts will produce a yellowish fluid called colostrum. In the several days following birth, your breasts will produce a yellowish fluid called colostrum. When your infant suckles, it will cause the release of hormones that trigger your milk. However, even if you choose not to nurse, your breasts will produce milk for several days to a week. If you want the milk to stop flowing, you shouldn't allow your baby to nurse, nor should you remove the milk in any other manner. However, these drugs come with additional health risks to the mother, so they are not commonly prescribed. You will notice discharge known as lochia from your vagina. This occurs as cells from the lining of your uterus slough off. Lochia starts out as bright red blood, then tapers off before finally stopping. After you give birth, your uterus is 15 times heavier than it was when you got pregnant! For this reason, you'll be able to feel it a few finger widths below the top of your belly button. But by six weeks after delivery, your uterus will return to its old size. Having a baby definitely changes your body, but take comfort in the fact that most alterations are only temporary.

"Being a mother is incredibly rewarding, but it can also be a bit scary at first. Dr. Mom is a physician and has also raised two children. Here are Dr. Mom's top three tips for new mothers:First of all, she should take a deep breath and relax. Babies are not fragile, they get sick, they have rashes, they have earaches, they cry. All of which can be handled usually at home, with no unusual measures. You need to be aware that a doctor may be needed, but don't jump to the worst conclusions. Breastfeeding is really good it's nice for the mom and for the baby, but it's not absolutely the only way to feed your baby. Even if you breastfeed, it's very important to get your baby ready to take a bottle. You need the time and the flexibility that having somebody else feed your baby occasionally will allow you. The most important advice I can give new mothers is: remember you are your baby's lifeline and you need to take care of yourself. That means taking some downtime, getting some rest, getting proper nutrition, occasionally leaving the baby and entertaining yourself with a movie or a book or friends. You're still a partner, you're still a member of the social world, and you still have interests outside the house. Take care of yourself and be good to your baby."

If you're expecting two...or more!...babies, you're not alone. Three percent of pregnant women in the United States carry twins. This growing community of mothers of multiples means that you'll be able to reach out for support and advice during your pregnancy. Perhaps your first consideration when pregnant with multiples will be how much you should eat. The good news? It's more than your singularly pregnant sisters! Most doctors recommend eating 300 extra calories per fetus per day. That means that moms-to-be of twins get 600 extra, and moms expecting triplets get 900! But before you reach for the candy bars, remember that those extra calories should come from foods that will nourish your babies. Try to get additional servings of lean protein and dairy. You'll also need plenty of iron and magnesium when you're carrying multiples. Get iron from red meat and spinach, and try whole grains and green leafy veggies for your magnesium. You need that iron to prevent anemia, or your red blood cell count from falling, which is a common problem in multiple pregnancies. Magnesium will help build your babies' strong bones and regulate your blood sugar. Round out that healthy diet by drinking at least eight glasses of water a day. This will prevent dehydration, which can lead to dangerous preterm labor. A final hint on bulking up for your babies: You'll probably want to gain between 35 and 45 pounds, nearly twice as much as singleton moms! Most of this weight gain will occur during your second and third trimesters, when you're (hopefully) past that morning sickness phase! When you're pregnant with more than one baby, you need to take a careful approach to exercise. It is VITAL to get the green light from your OB-GYN before working-out. Then, it's okay to engage in gentle exercise, preferably the kind where you're off your feet and your body temperature doesn't raise significantly. Try prenatal yoga or swimming. While you're working out, know when to stop...now is NOT the time to push yourself too hard! If you begin to experience even mild discomfort, stop exercising immediately. A final consideration when you're pregnant with multiples is where and how your babies will be born. Some mothers will have a planned C-section, while others will aim for a vaginal birth. When birthing multiples, most doctors require an epidural, in case an emergency C-section becomes necessary. Most multiple births will take place in an operating room, rather than a standard labor-and-delivery room. This is normal and not cause for alarm! When you're pregnant with more than one, your doctor will want to see you regularly and will take frequent sonograms of your babies. While preparing for more than one baby may seem like twice as much work, keep in mind that the results will be twice as wonderful when they do arrive!

Pregnancy complications are rare, but they DO happen. And when you consider all the parts that contribute to a pregnancy...fetus, amniotic fluid, placenta, umbilical cord...it's amazing that they don't happen more often! One group of complications stems from the amniotic fluid. Oligohydramnios, which occurs in four to eight percent of pregnancies, is a condition in which there isn't enough fluid surrounding the baby. On the other hand, when there is TOO MUCH fluid in the amniotic sac, the condition is called hydramnios or polyhydramnios. Both rarely have symptoms, and will be discovered during a standard prenatal exam. While many women with oligohydramnios or hydramnios will go on to have healthy babies, both CAN lead to difficult births or even birth defects. For this reason, women with oligohydramnios should drink plenty of water. Moms-to-be with extreme hydramnios may need to undergo a procedure called therapeutic amniocentesis, whereby fluid is withdrawn from the amniotic sac. In one to two percent of pregnancies, the amniotic sac may become infected with bacteria. The main symptoms of chorioamnionitis, as this is known, are a fever in labor and vaginal leaking of odorous amniotic-fluid. Generally, women diagnosed with chorioamnionitis are given antibiotics. Once born, the baby will also likely take a course of medication. Another pregnancy complication is pre-eclampsia, which is a sudden onset of high blood pressure and swelling. Five to ten percent of pregnant moms experience pre-eclampsia. Once pre-eclampsia is diagnosed, bed rest may be able to prolong the pregnancy if the baby is premature. If left untreated, this condition can lead to pregnancy seizures called eclampsia, a serious condition which occurs in one of 2,000 pregnancies. Eclampsia can be life threatening to the mother and requires immediate delivery of the baby. Gestational diabetes affects four to seven percent of moms-to-be. This condition occurs when a woman's body doesn't produce enough insulin to keep up with higher demand, resulting in increased blood sugar. Generally, gestational diabetes can be controlled with diet, exercise and blood sugar monitoring, but if left untreated, the baby can grow too large and cause delivery difficulties. In about one in 300 labors, the umbilical cord will jump the gun and slip through the cervix before the baby. Known as cord prolapse, this can have serious consequences, because the cord is the baby's breathing supply. After a cord prolapse, a baby will generally need to be delivered very quickly, typically via emergency C-section. Another complication, which strikes one in 200 pregnancies, is placenta previa, whereby the placenta partially or completely covers the cervix. Placenta previa is diagnosed in routine ultrasounds and can manifest as bleeding late in a pregnancy. The condition is managed with a scheduled C-section prior to the onset of labor. While these and other complications CAN occur, they are rare, and not something to worry about. With monitoring and healthy habits, there is every likelihood that you will deliver a healthy baby!

A word of comfort to new moms and dads: You WILL figure this out! Newborns are a lot of work, but knowing some baby basics will help. Of course, one of your more unpleasant (and frequent!) jobs will be diaper duty. This isn't hard and will become second nature in no time. Before you start, be sure that you have everything you need at your fingertips. That means diapers, baby wipes, diaper rash ointment, and a change of clothes (just in case!) Lie your baby down and open the diaper. Parents with boys, watch out for that penis! Keep it covered with a cloth when he's undressed to avoid a spray surprise. Now fold over the diaper so that the clean side touches your baby's bottom. Lift your baby's legs and wipe the area well. If you have a girl, wipe her from front to back to keep her vagina bacteria-free. If you have a boy, prevent leaks by quickly fastening his diaper. As you replace the dirty diaper with a clean one, remember that disposables have tabs that go in the back and wrap around to the front. So what if your baby's made a REALLY big mess in his or her diaper? Bath time! Once again, have everything you'll need handy before you begin. Ensure that the room is between 75 and 80 degrees. Because babies lose body heat very quickly, this keeps them comfortable. Use an infant tub, or the sink, until your baby can sit up unassisted. Once the sink is filled with enough water to cover your baby's bottom half, slide him or her into the tub. When washing a newborn, use soap sparingly and stick to the hands, bottom and genitals. The rest of your baby's body can be washed with water alone. If you want to shampoo, use a drop of tear-free product once a week. If you have an uncircumcised boy, it's fine to wash his penis with soap and warm water. But a circumcised boy shouldn't be bathed until his penis is healed, so stick to sponge baths for now. It seems like when babies aren't dirtying diapers, they're nursing, and feeding babies need to be burped. Burp your baby when you switch breasts, or halfway through a bottle. Remember to have a burp cloth handy in case the baby spits up! The classic burping position is to hold your baby upright, with his or head on your shoulder. Support the bottom with one hand and use the other to pat the back firmly. If this doesn't work, try placing your baby stomach side down across your lap, turning him or her sideways. Or hold your baby in a seated position, supporting the neck and chest with one hand, and patting with the other. A newborn baby is a lot of work. But take heart in knowing that every couple DOES get the hang of burping, bathing, diapers, and everything in between!