Happy New Year everyone!

Yes, Kathy D, the cord blood is the baby's not the mother'.  (Watch out,
I just found my lecturer's platform)

What is the concern about how much cord blood the infant gets?
Primarily one that there may be too much.  Can that really be?  Yes,
because the closed system of baby, cord and placenta together hold more
blood than baby needs in his/her system when the cord and placenta are
removed.  If extra blood is drawn away from baby and the cord cut the
baby will be anemic, not a good thing.  But if extra blood is drained
into baby, ie, baby held below the level of the uterus, or cord "milked"
to give baby "a little extra"  other problems can develop.

How could extra blood be a problem?  Well when the hematocrit ( measure
of the red blood cells (RBC"S) as a % of blood volume) becomes greater
than 60% the chance of tiny blood clots forming in body organs
increases.  Also the heavy load of immature RBC's increases the
bilirubin load which must be processed by the liver.  Prior to delivery
the infant has many RBC's with what is called fetal hemoglobin designed
to attract oxygen from the mother's circulation across the membrane
which separates baby's blood from mother's.  After deliver, when the
infant is receiving oxygen via the lung, fetal hemoglobin is not needed,
so is broken down by the liver, saving the iron content of these cells
for later needs and removing other products from the blood, via the gut
as bile and via the kidneys as urobilinogen.

As an example, daughter #2 was delivered using a "birthing chair" back
in 82.  As she delivered very rapidly, coming out "sunny side up", head,
shoulders and rump (much to the surprise of the MD who had just told me
to "give one more big push and we'ld get this posterior baby to turn"),
there was not time for him to suction (considered absolutely necessary
in those days) her nose and mouth before delivery of the shoulders.  So
he held her in his lap, about 18 inches below the level of the uterus,
suctioned her and then cut the cord, and handed her to my husband.

Three days later, after probably two dozen very soaked diapers,
transitional stools nearly every hour, weight still at birth weight, so
no question of dehydration, she had a bilirubin of 18 and a hematocrit
of 58%.  We did the 48 hours of phototherapy and they checked her bili
every four hours.  I was told by the ped to think of the blood draws as
mini phlebotomies to decrease her hematocrit, which was probably causing
the problem! We nursed every 1.5 hours and kept her under the lights the
rest of the time.  She never did lose much weight, as a matter of fact
doubled birth weight by 3 months and tripled it by six.

In trying to answer why she had this bili problem, hubby and I both did
a lot of reading regarding cord blood, etc.  Seems as though the events
surrounding delivery best explained the elevated hematocrit and the
bilirubin.
Seems a lot of other folks were concerned about delivery practices too
at that time, but I haven't read much lately, not having ready access to
OB literature where we are now.

Melinda Hoskins, MS, RN
Northern Nevada, USA