Did you know that those first moments after the birth of your baby offer incredible opportunities to promote health and long-term development? In this episode, Shazi discusses the birth of her daughter Asha with her OBGYN, Dr. Katherine Kohari – and why she made the decision to bank Asha’s cord blood privately. She also speaks with midwife McKenna Eldh, who explains the benefits of delayed cord clamping – which midwives have always traditionally practiced and The American College of Obstetricians and Gynecologists (ACOG) now also recommends. We also hear from biomedical engineer and CEO of Epibone, Nina Tandon, on the incredible ways that stem cells are being used to repair diseased or damaged tissue later in life.
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Episode Transcript
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Speaker 1 (00:01):
The Healthy Baby Show is a production of My Heart
podcast Network and Healthy baby dot Com. Cored blood banking
is a really interesting topic, I think because it's one
of those things that we're sort of discovering more and
more along the way. And bilcal core bloody used to
just be thought of as nothing special and would be discarded,
and now we know the value that there are actually
(00:22):
stem cells in the umbilical cord blood that could be
used instead of a bone marrow transplant, which is pretty cool.
There's so much about having a baby that I wasn't
prepared for and I feel like I've learned a lot.
I want to let you in on what I've discovered
(00:44):
and save you the time and effort, give you a
shortcut through the hours of research, correspondence with experts, the
roller coaster of it all, so that you can walk
away with new knowledge that you can act upon. Every episode,
this is The Healthy Baby Show. I'm Chassis from that
(01:10):
voice you heard at the top is Dr Catherine Cohari.
She's an O B G. Y N specializing in maternal
fetal medicine and high risk pregnancies. We actually met back
in two thousands sixteen when I was pregnant with my
daughter Asha, and my pregnancy was deemed high risk. It's
a scary sounding umbrella term that covers everything from an
expectant mother with a pre existing condition, to a child
(01:32):
with a genetic or anatomic abnormality, to a complicated delivery
like the C section I ended up having at thirty
eight weeks. Age can also be a factor. Pregnancies are
treated as higher risk for women over the age of
thirty five. I love caring for pregnant women, and I
really love the fact that there's so many unanswered questions
(01:53):
from a scientific perspective about even the most basic questions
related to pregnancy. Related to lay her where the logical
go to people to be advocates for our patients, For
our patients children were kind of on the front lines
of a lot of the social issues that are going
on in our country. Dr Kohari was a rock for
(02:14):
me and my husband during our pregnancy. She was also
supportive of our decision to bank our daughter ash has
cord blood, something we didn't do when our son's Saying
was born. There's a concept of banking or storing your
umbilical cord blood or parts of the placenta or a
bilical cord with the idea that at some point in
the future you could access that blood and maybe use
(02:34):
those stem cells for other members of the family who
may be facing a medical condition where it would be
useful to have. And the way we actually collect that
is we do delay cord clamping, so that is to say,
after baby is born, keep the baby connected for at
least thirty seconds, if not longer, and that's been shown
to improve outcomes, especially in pre term babies. And then
(02:54):
we clamped the cord and we let the partner typically
cut the cord and then we passed babies some mom
and then take it basically a needle and stick it
in the cord and just collect the rest and that
can be stored for future use. Right now, cord blood
is being used to treat certain types of cancer and
immune deficiencies. In the future, researchers hope stem cells can
(03:16):
be used for much more, including mitigating symptoms for people
with autism like my son Sane. The process is expensive
several thousand dollars up front to collect the blood and
then a few dar annually to store it, and for
many parents it's out of the question. I asked Dr
Kohari whether she thought it was worth it. The tricky
part is it can't always be used for the baby
(03:36):
that donated it, because if there's a genetic issue, well
then that cord blood has the same genetic issues. So
it's maybe not always as valuable in that regard. But
the thing that's sort of interesting is that we're learning
more and more every day about what those stem cells
can be used for. So although right now the likelihood
of ever having to access your own cord blood is
pretty low, we don't know what the future may hold,
(03:58):
and so having that bank to weigh is sort of
something that could be relied on in the future. So
when I was pregnant with saying we were really tight
on funds, I mean, I think between me and Joe
together we made less than sixty tho dollars a year,
and we lived in New York City, and I knew
about cord blood banking at the time, and I literally
(04:19):
thought we couldn't afford it because I knew that we
would have to sign up for the subscription of a
monthlier annual cost to bank the chord blood. Moving forward,
there's also actually public cord blood banks which do the
same processes, which is collecting cord blood from the umbilical
cord after the baby is disconnected, and then it goes
to a public bank where other people could access that
(04:42):
cord blood, and it's more likely to be used because
you have more people having issues that can access that.
So that's another alternative that is typically free, whereas private
cord blood banking you pay a fee for that. But
I wasn't sure that we would find a match because
my husband and are genetically so different. I mean, he's
like as New Jersey white American as you can get
(05:04):
super Caucasian, and I'm you know, in the end, but
from Tanzania and Pakistan. In any case, with saying we
just couldn't afford it, but I really actually wanted to
do it, and in retrospect, I really wish that we
had because we could have participated in a stem cell
research study if we had autolegous chord blood for Zane's autism.
And in fact we have Asha's cord blood and Asha's
(05:28):
five and we did have money and I knew about it.
So we did chord blood, cord tissue, and placental tissue.
Because there are different things you can do, and I've
seen how science is just so incredibly fast moving. I
wanted to have all the options. Well it is and
it isn't. They had a sibling study and so if
you had the sibling chord blood you could participate. And
(05:50):
so I went through this whole process. It was like
two years of emails and labs and finally we get
to the point where it's like, okay, Zane is getting
to be big areas like pounds, and you know, their
recommendation is a certain number of cells per kilogram body weight,
and we're actually hitting the max of If we don't
(06:10):
use Asha's cord blood, now it might not be a
possibility for Zane. And so we finally did the cheek
swap just to make sure it's a match, and ironically
it wasn't a match. So are more and more parents
opting for cord blood banking at birth. I think it's
still mixed. In Connecticut. We don't really have a great
public cord blood options, so those that do do the
(06:34):
private banking through various companies. Again, I think, you know,
part of the issue is some of the financial considerations.
There are still many many uses for stem cells that
we have yet to learn about, and science will soon unleash,
and because the umbilical cord is such a rich source
of those stem cells, to me, it makes sense for
(06:56):
us to have access to a store just in case
something happens with our child in the future, and just
in case there's a new therapy that can actually address
it with those stem cells. And because parents who have
children with chronic issues want to be on the forefront
of that. I think it's nice to have as many
tools in your toolbox as possible to address challenges. We'll
(07:21):
be back after a quick break. Welcome back to the
Healthy Baby Show. If you've had a baby in recent years,
there's a good chance you've heard of delayed chord clamping.
The practice has been used by midwives for years, and
as Dr Kohari alluded to, she believes it should become
(07:42):
a standard of care for all O b G y
n's as it is at Yale. There is really significant
benefit in delaying work clamping, and specifically the benefits to baby.
Most of our exposure or two birth is from media,
and oftentimes the baby comes out and it's clean and
(08:05):
happy and has a belly button already, and there's like
absolutely no mention of umbilical cord or placenta, but like, really,
it's a super important part of birth, that voice he hears.
Midwife McKenna eld I am a licensed midwife in the
state of New York. I currently worked for and have
worked for for the last six years and all midwife
(08:25):
practice that is based in Brooklyn. We are affiliated with
a larger hospital system and have a really wonderful network
of obs and high risk doctors that we co manage
with as necessary, but within the practice ourselves, we offer
full scope prenatal care, labor care and support postpartum, as
well as full scope well woman gynecological care. We talked
(08:46):
to her about delayed chord clamping, which she says midwives
have traditionally practiced for centuries. What we have known for
literal millennia is that coor it should not be cut
until they stop pulsing. That last transion of blood, which
is to a third of the baby's blood volume, increases
heem of globin levels, there are increased iron stores, there's
(09:08):
an establishment of red blood cell volume that wouldn't otherwise be.
There decreased need for blood transfusions, which can be a
common thing in pre term babies, and a lot of cultures,
there's ceremony and ritual around the cutting of the cord,
and it's a recognition of the baby's autonomy and also
welcoming a baby into the communities. There are writings from
(09:30):
like the seventeen hundreds where people were debating, you know,
do you clamp the cord or do you not? And
really like the justification for early clamping was to like
not dirty the bed sheets. There was otherwise general recognition
that babies fared better and transition better if you didn't
cut the cord or clamp the cord until that pulsing
was done. Even though not all hospitals are practicing delayed
(09:54):
chord clamping, ACOG has now just started to recommend a
delay in umbilical cord clamping for least thirty to sixty
seconds after birth. This is because recent medical research backs
up McKenna just told us the delayed chord clamping reduces
the risks of iron deficiency, anemia and infants, and the
need for blood transfusions in premature babies. Additionally, studies have
(10:15):
shown that delayed chord clamping results in higher assessment of
fine motor skills and social skills. So baby is born
most babies transition very well. You know, nine out of
ten babies transition very well, and they cry within the
first minute, and they turn pink, and they got get
after scores, and they transition well. And every once in
a while there's a baby that doesn't transition well. Those
(10:38):
breaths allow the babies mature circulatory system or extra uter
in circulatory system to kick in, so it's able to
deliver blood to the brain, to the intestines, and kind
of deliver blood to where it needs to go in
the newborn. But if the baby hasn't breathed, the placenta
is still doing that job. It's still acting as the
baby's lungs. So if you're cutting the cord but for
(11:00):
good breath has been established, essentially the oxygen supply has
been cut off to the baby. There are instances in
which delayed chord clamping should be weighed against possible risks,
like mom is experiencing a hemorrhage, for example, or you know,
if there is evidence that the baby is really going
(11:20):
to experience some respiratory distress. I asked McKenna what she
tells women who come to her with questions about delayed
chord clamping. And chord blood banking. When it does come up,
that is usually the number one question. The first question
is like should I bank chord blood? And then the
second question is, but I also really want to do
(11:41):
delayed chord clamping? Can I do both? You know, I
talked about physiologic word clamping, which is waiting for the
entirety of the blood volume to transfer to the baby,
in which case those two cannot be done together. There
is usually like some confusion and also some disappointment as
well when people hear that they can't have the best
of both worlds. But we have demonstrated that there is
(12:04):
still benefit to be gained for thirty to sixty seconds
of delayed cord clamping, so that if people did want
to do both, kind of do less delayed cord clamping,
shorter delayed cord clamping and take whatever is left in
the cord for private banking. But with public banking you
generally cannot do both because the likelihood that there will
be usable numbers themselves within that blood is significantly decreased
(12:28):
by any kind of delayed cord lamping. So you look
at w h O, I think they recommend waiting one
to two minutes before clamping the cord American College of
Obsections in Gynecology a COG, they recommend at least thirty
seconds to one minute, and then you look at American
College of Nurse midwise and they say two to five minutes,
and that kind of generally tends to ensure that the
(12:49):
large amount of the baby's blood volume has been transfused
to the baby. A COG discusses that with immediate cord
clamping there's um like thirty nine in enough blood and
enough stem cells to be banked, and then if you
wait even the thirty to sixty seconds, that drops down
to about However, that's okay for private banks which don't
(13:12):
have a strict volume limit to store the chord blood,
and it's also okay for therapies that don't require high
stem cell counts, for example cerebral palsy or new autism therapies.
The American Medical Association especially recommends chord blood banking if
there's a family history of genetic conditions or if the
baby has a sibling with a disease that may require
(13:33):
a stem cell transplant. So I think it's really important
for all moms to understand what's happening and make those
decisions with your doctor beforehand, and to remember how important
all those first moments are after birth and how they
affect your child's development, from delayed chord clamping to simple
actions like skin to skin contact, which can really have
(13:54):
a huge impact on your baby's development. When you do that,
you stimulate your baby's brain. You're encouraging physical development, you're
encouraging emotional and social development, and that skin to skin
contact helps moms too, improving your own connection to your
child as well as your milk production during this key time.
It actually stimulates your milk production. One of the things
(14:18):
that I've seen over the years in my experience is
kind of a greater respect for the return to simplicity,
which is to say, you know, physicians and midwives sharing
their expertise and realizing that maybe something like delay core clamping,
which midwiffery has practiced for years, maybe it is in
fact better that physician practice should listen to some of
(14:41):
the things that our midwife colleagues have always been proponents of.
So I think, you know, a more collaborative care model
of combined types of providers for women I think is
really the future as well as incorporation of DOULA programs.
I'd really like to see more of that additional bedside
support through their labor process. It's time for a quick break,
(15:06):
but we'll be back in a minute. Welcome back to
the show. M there's certainly promised beyond what the science
knows to be true at the moment in stem cells,
and that's part of what makes it so exciting to
be in as a field. That's Dr Nina Tannon. She's
(15:29):
a biomedical engineer and CEO and co founder of EpiBone,
a startup that uses stem cells from a patient's fat
to grow human bones. It's an incredible feat of bioengineering
and full disclosure, I'm proud to be one of the
company's investors. I asked Nina to join the show because
I wanted to know more about the future of stem cells,
(15:51):
specifically how stem cells can be used to repair diseased
or damage tissue later in life. I mean, we all
started out life as one cell, big, okay, and when
we were that one cell, that one cell had the
most potency of any cell in humanity. There's two properties
of stem cells. They can self renew so they can proliferate,
(16:13):
and they can differentiate. So when we were one cell big,
that one cell became everything that we are, so it
had what's called tody potency, full potency to become any
part of the body. And then that cell divided, became two,
divided became four, and the cells differentiated and became our brain, heart, tissue, liver.
(16:34):
So the stem cells that we use for making bone
and cartilage are called mezanchimal stem cells. They come from
like the middle layer of the embryo in our embryonic development,
and they end up living in our bone marrow and
in our fat and other parts of our body. But
they can become bone, cartilage, connective tissue like ligaments and
tendons and fat, So those are pretty useful tissues. I
(16:57):
would love for you as a mom, knowing everything you
know about the power of stem cells. I'm assuming you
did chord blood banking. I did not, interestingly enough, so
I didn't do banking of my kids stem cells because
I guess what I did was delayed clamping of the cord.
(17:17):
You know, I thought to myself, what's the probability that
I will need my daughter's own cells to heal her
versus what is the benefit that my daughter might get
if I asked the nurses to do this delayed chord clamping,
which allowed all of those stem cells to go back
(17:37):
into her right then. So that's what I did with
both kids, and I basically told myself, well, I'm going
to take the risk that if they were to ever
need them, by the time they would need them, there
would be a match with a donor available. And I
don't know if that calculation was correct. I mean, I
hope so, because I actually have very plex genetics, and
(18:01):
so finding an h L a match is actually not
the easiest thing to do if you have a very
complicated ethnic background, as my kids do. They're like ashkenaz A,
South Asia, potential European, Eastern European, like they're complicated. And
that's actually part of why I became a bone marrow
donor pretty early in life, is because it's just harder
to find the matches. I did that the second time
(18:21):
with Asha, but we did kind of a duel. We
also took placental tissue, cord tissue, and the stem cells
because it was an option, and you know, I've seen
that it could be a possibility that you need autologous
stem cells, but I think also on your end, we
can drive stem cells from fat and from bone marrow. Yeah,
like if for Zane, he may not be an h
(18:43):
l A match to Asha, but you can find really
similar cells to those cord blood stem cells in his
own fat. So maybe there's an option if there is
a stem cell study you'd like to do that would
involve proliferating his own cells. There's conflicting search, but I've
seen something there that I know there's something to it.
(19:04):
But it's just like throwing a bunch of stuff at
the wall and hoping something kind of goes where it
needs to go to help prepare something that needs repairing,
versus being very objective and having a target. I mean,
that is not entirely crazy considering how much is known
and especially how much is unknown about autism genetic factors.
Only best measurements account for of cases you'll find identical twins,
(19:29):
and they only are correlated se percent of the time
in terms of autism prevalence. So it's such a mystery
that it's really I think pioneering families that have the
fluency and the agency and the resources to help discovery
for other families to what you're doing is not just
for you, but also for so many other families. Nina
(19:52):
uses a type of stem cell found in adults to
create their own bone. She doesn't rely on bank to
chord blood for the particular work she's doing. What we
do is we take stemselves that live in our body
and we coax them into living body parts that can
serve as replacements for our bodies as we age, as
(20:14):
we get injured. And we made history this past year
for being the first company to ever gain permission from
the FDA to takes themselves and grow them into bone
and replace bones in people's bodies after for patient one
injury after a car crash, Patient two congenital defect, and
Patient three congenital defect. And they're now three people living
(20:35):
with engineered bones made out of their own cells. Can
we talk about why why is it better for a
little girl who might have a congenital defect to have
a bone grown by Eppy bone using stem cell technology
versus what might be a traditional implant. Well, let's just
(20:56):
use that word traditional implant. You know it's crazy. Bonus,
the most transplanted human tissue after blood, and the only
way to get human bone is to cut it out
of a human. And so if you've got this little
girl with a congenital defect, she may be missing her
cheekbones or her job bone, maybe underdeveloped. The only way
(21:16):
to get enough phone, like the traditional implant you talk about,
is going to be cut out of her rib or
cut out of somewhere else on her head. And so
you can imagine if you're trying to spread around the
bone of this tiny little human. You know, you have
to really weigh the damage that you would do to
the person by cutting them apart versus the benefit they
(21:36):
would get from being reconstructed. And so these kids end
up going through multiple surgeries and that's just a crappy
way to heal a person. Well, number one, I'm so
proud to have been a part of it and just
get to see this. But number two, I just realized
something about stem cells that I think is so cool
(21:56):
about you. I never really thought about it, but what
you are doing is allowing the human body to heal itself.
You know, that's like my rebel side of me where
I'm like, Okay, medicine is so patriarchal, this idea of
a patient and the surgeon who's you know, the surgeon
is the one who does the work, not the patient,
(22:18):
but actually the patient's doing all the work and re
centering healing inside our own bodies and reclaiming our own
body's power to heal itself with this enabling technology that
we provide that gives those stem cells an opportunity to
do more of what they can do, but kind of
are limited in the body because basically we take the
stem cells and we put them in a new bone
(22:38):
outside the body, and we coax them and grow that
new bone and then put it back in. And that's
something that I feel like makes me pretty rebellious in
the medical community because we're re centering the power of
healing inside our own bodies. You are your own medicine.
I asked Nina about some of the controversies surrounding her work.
So we all started out life as one cell big,
(23:00):
but in my view and the view of many people,
that one cell is not a human. Now there are
some people who share the opposite view and say, if
life begins a conception, a human embryo that's one cell
big is ethically equivalent to a human. I don't think
a seed is a tree, you know, I think they're different.
(23:20):
So that's where I stand on that. Where do you
become a human is a very political question being worked
out right now in the courts. But someone who's experienced
pregnancy that leads to birth and pregnancy that is non
viable in all its shapes and forms, I don't believe
that of embryo is a human. Did I experience loss
(23:45):
when I had embryos that were non viable? Of course?
Is that the same loss of losing a human? No?
Do you see that as your biology failing you or
supporting you? I felt I had both narratives. I feel
like biology supported me because there were chromosomal abnormalities and
those embryos that meant that they self destructed. Now did
(24:07):
my body have awareness of that self destruction or did
it like hang onto the tissue for a long time
and cause lots of havoc? Going like another story for
another podcast. But you know, missed miscarriage, which is something
that I experienced more than once, is something that's really difficult.
And so because there's so much ambiguity in terms of
how people view when does life begin, there's been a
(24:28):
lot of ethical controversy about manipulation at various stages of
that developing embryo, and I believe that it should be.
But embryonic stem cells were all derived from non viable embryos.
You know, that's sort of like a corollary to the
idea of brain death and that after brain death it's
okay to harvest a body for organs, and that view
(24:49):
was applied to embryos and said, if that embryo is
brain dead, i e. Non viable, there are certain healthy cells.
Just like your heart can be alive even if your
brain is dead. There could be certain cells inside that
embryo that we're still alive and still useful. But because
there's controversy around the creation of unused embryos at all,
there was a lot of controversy about potentially harvesting cells
(25:11):
from these non viable embryos. And that is only one
of the many types of stem cells that I mentioned. Okay,
those our embryonic stem cells. There's adult stem celves, there's
induced for potent stem cells. There's lots of different types
of stem cells. But because embryonic stem cells were derived
from this source, and some of those cells were derived
under fuzzy informed consent, they kind of clouded the entire
(25:33):
industry and the entire academic science of this industry too.
So the advent of newer types of stem cells that
come from adults where you can sidestep some of these
issues of informed consent or with induced pluripotent stem cells
that side step the need for an embryo itself. I
think it's really moved the feel forward. I asked Nina
(25:56):
how she thinks the field will change in years to come.
I think we're going to see a lot of progress
in the coming years for what's called universal donor stem cells,
and so we won't have to be so reliant on
our own cells. Are the cells of our immediate family
for healing potential. I think we're going to see that
(26:17):
open up much more. You know, we talked a lot
about autism. There's a lot of correlation between certain mutations
that affect congenital heart defects and also the mind. And
this is something that I was interested in during my
PhD and I didn't make much headway with because I
was graduating soon. But I think we're going to start
(26:39):
to understand more of this nature nurture question and be
able to coax not only the cells in our own bodies,
but coax our selves outside our bodies. You know, we
may not be perfect at being able to create that
environment for our own body, but we can learn from
what those ideal conditions are and create conditions outside the
(26:59):
body that can help make new therapies. So I'm excited
for the future. I'm excited to participate in it in
my own small way, and I'm really excited to see
my little, tiny humans continue to grow. This was the
Christmas we bought my daughter her first my driscope, So
I'll land on that I believe in science. Well that's
(27:27):
it for the show this week. Next week we'll be
talking all about the magic of a baby's brain and
how it develops. I've learned from my experience and saying
from some of the top neuroscientists in the world how
a baby's brain develops, and how atypical brains develop and why.
And now that I understand these things, I've learned that
there are so many simple things that we, as totally
(27:50):
new parents can actually do to set the stage for
optimal development and create an even more resilient child by
doing so. And it's just really exciting to put some
of that knowledge to use. So tune in and learn
more about what the research says. The Healthy Baby Show
is a production of iHeart podcast Network and healthy baby
(28:11):
dot com, where you can find a new line of
the safest baby essentials. The Healthy Baby Show is hosted
by me shazivs From. Our lead producer is Jennifer Bassett.
Executive producers are Nikki Etre, Anna Stump, Shahsi vas Fraum,
and James Violette. Mastering and sound designed by Carl Katel
and Dan Bowsa, additional writing and research by Julia Weaver.
(28:32):
Our theme music is by Anna Stump and Hamilton's Lighthouser.
Additional music from Blue Dot Sessions.
The Healthy Baby Show is a production of My Heart
podcast Network and Healthy baby dot Com. Cored blood banking
is a really interesting topic, I think because it's one
of those things that we're sort of discovering more and
more along the way. And bilcal core bloody used to
just be thought of as nothing special and would be discarded,
and now we know the value that there are actually
(00:22):
stem cells in the umbilical cord blood that could be
used instead of a bone marrow transplant, which is pretty cool.
There's so much about having a baby that I wasn't
prepared for and I feel like I've learned a lot.
I want to let you in on what I've discovered
(00:44):
and save you the time and effort, give you a
shortcut through the hours of research, correspondence with experts, the
roller coaster of it all, so that you can walk
away with new knowledge that you can act upon. Every episode,
this is The Healthy Baby Show. I'm Chassis from that
(01:10):
voice you heard at the top is Dr Catherine Cohari.
She's an O B G. Y N specializing in maternal
fetal medicine and high risk pregnancies. We actually met back
in two thousands sixteen when I was pregnant with my
daughter Asha, and my pregnancy was deemed high risk. It's
a scary sounding umbrella term that covers everything from an
expectant mother with a pre existing condition, to a child
(01:32):
with a genetic or anatomic abnormality, to a complicated delivery
like the C section I ended up having at thirty
eight weeks. Age can also be a factor. Pregnancies are
treated as higher risk for women over the age of
thirty five. I love caring for pregnant women, and I
really love the fact that there's so many unanswered questions
(01:53):
from a scientific perspective about even the most basic questions
related to pregnancy. Related to lay her where the logical
go to people to be advocates for our patients, For
our patients children were kind of on the front lines
of a lot of the social issues that are going
on in our country. Dr Kohari was a rock for
(02:14):
me and my husband during our pregnancy. She was also
supportive of our decision to bank our daughter ash has
cord blood, something we didn't do when our son's Saying
was born. There's a concept of banking or storing your
umbilical cord blood or parts of the placenta or a
bilical cord with the idea that at some point in
the future you could access that blood and maybe use
(02:34):
those stem cells for other members of the family who
may be facing a medical condition where it would be
useful to have. And the way we actually collect that
is we do delay cord clamping, so that is to say,
after baby is born, keep the baby connected for at
least thirty seconds, if not longer, and that's been shown
to improve outcomes, especially in pre term babies. And then
(02:54):
we clamped the cord and we let the partner typically
cut the cord and then we passed babies some mom
and then take it basically a needle and stick it
in the cord and just collect the rest and that
can be stored for future use. Right now, cord blood
is being used to treat certain types of cancer and
immune deficiencies. In the future, researchers hope stem cells can
(03:16):
be used for much more, including mitigating symptoms for people
with autism like my son Sane. The process is expensive
several thousand dollars up front to collect the blood and
then a few dar annually to store it, and for
many parents it's out of the question. I asked Dr
Kohari whether she thought it was worth it. The tricky
part is it can't always be used for the baby
(03:36):
that donated it, because if there's a genetic issue, well
then that cord blood has the same genetic issues. So
it's maybe not always as valuable in that regard. But
the thing that's sort of interesting is that we're learning
more and more every day about what those stem cells
can be used for. So although right now the likelihood
of ever having to access your own cord blood is
pretty low, we don't know what the future may hold,
(03:58):
and so having that bank to weigh is sort of
something that could be relied on in the future. So
when I was pregnant with saying we were really tight
on funds, I mean, I think between me and Joe
together we made less than sixty tho dollars a year,
and we lived in New York City, and I knew
about cord blood banking at the time, and I literally
(04:19):
thought we couldn't afford it because I knew that we
would have to sign up for the subscription of a
monthlier annual cost to bank the chord blood. Moving forward,
there's also actually public cord blood banks which do the
same processes, which is collecting cord blood from the umbilical
cord after the baby is disconnected, and then it goes
to a public bank where other people could access that
(04:42):
cord blood, and it's more likely to be used because
you have more people having issues that can access that.
So that's another alternative that is typically free, whereas private
cord blood banking you pay a fee for that. But
I wasn't sure that we would find a match because
my husband and are genetically so different. I mean, he's
like as New Jersey white American as you can get
(05:04):
super Caucasian, and I'm you know, in the end, but
from Tanzania and Pakistan. In any case, with saying we
just couldn't afford it, but I really actually wanted to
do it, and in retrospect, I really wish that we
had because we could have participated in a stem cell
research study if we had autolegous chord blood for Zane's autism.
And in fact we have Asha's cord blood and Asha's
(05:28):
five and we did have money and I knew about it.
So we did chord blood, cord tissue, and placental tissue.
Because there are different things you can do, and I've
seen how science is just so incredibly fast moving. I
wanted to have all the options. Well it is and
it isn't. They had a sibling study and so if
you had the sibling chord blood you could participate. And
(05:50):
so I went through this whole process. It was like
two years of emails and labs and finally we get
to the point where it's like, okay, Zane is getting
to be big areas like pounds, and you know, their
recommendation is a certain number of cells per kilogram body weight,
and we're actually hitting the max of If we don't
(06:10):
use Asha's cord blood, now it might not be a
possibility for Zane. And so we finally did the cheek
swap just to make sure it's a match, and ironically
it wasn't a match. So are more and more parents
opting for cord blood banking at birth. I think it's
still mixed. In Connecticut. We don't really have a great
public cord blood options, so those that do do the
(06:34):
private banking through various companies. Again, I think, you know,
part of the issue is some of the financial considerations.
There are still many many uses for stem cells that
we have yet to learn about, and science will soon unleash,
and because the umbilical cord is such a rich source
of those stem cells, to me, it makes sense for
(06:56):
us to have access to a store just in case
something happens with our child in the future, and just
in case there's a new therapy that can actually address
it with those stem cells. And because parents who have
children with chronic issues want to be on the forefront
of that. I think it's nice to have as many
tools in your toolbox as possible to address challenges. We'll
(07:21):
be back after a quick break. Welcome back to the
Healthy Baby Show. If you've had a baby in recent years,
there's a good chance you've heard of delayed chord clamping.
The practice has been used by midwives for years, and
as Dr Kohari alluded to, she believes it should become
(07:42):
a standard of care for all O b G y
n's as it is at Yale. There is really significant
benefit in delaying work clamping, and specifically the benefits to baby.
Most of our exposure or two birth is from media,
and oftentimes the baby comes out and it's clean and
(08:05):
happy and has a belly button already, and there's like
absolutely no mention of umbilical cord or placenta, but like, really,
it's a super important part of birth, that voice he hears.
Midwife McKenna eld I am a licensed midwife in the
state of New York. I currently worked for and have
worked for for the last six years and all midwife
(08:25):
practice that is based in Brooklyn. We are affiliated with
a larger hospital system and have a really wonderful network
of obs and high risk doctors that we co manage
with as necessary, but within the practice ourselves, we offer
full scope prenatal care, labor care and support postpartum, as
well as full scope well woman gynecological care. We talked
(08:46):
to her about delayed chord clamping, which she says midwives
have traditionally practiced for centuries. What we have known for
literal millennia is that coor it should not be cut
until they stop pulsing. That last transion of blood, which
is to a third of the baby's blood volume, increases
heem of globin levels, there are increased iron stores, there's
(09:08):
an establishment of red blood cell volume that wouldn't otherwise be.
There decreased need for blood transfusions, which can be a
common thing in pre term babies, and a lot of cultures,
there's ceremony and ritual around the cutting of the cord,
and it's a recognition of the baby's autonomy and also
welcoming a baby into the communities. There are writings from
(09:30):
like the seventeen hundreds where people were debating, you know,
do you clamp the cord or do you not? And
really like the justification for early clamping was to like
not dirty the bed sheets. There was otherwise general recognition
that babies fared better and transition better if you didn't
cut the cord or clamp the cord until that pulsing
was done. Even though not all hospitals are practicing delayed
(09:54):
chord clamping, ACOG has now just started to recommend a
delay in umbilical cord clamping for least thirty to sixty
seconds after birth. This is because recent medical research backs
up McKenna just told us the delayed chord clamping reduces
the risks of iron deficiency, anemia and infants, and the
need for blood transfusions in premature babies. Additionally, studies have
(10:15):
shown that delayed chord clamping results in higher assessment of
fine motor skills and social skills. So baby is born
most babies transition very well. You know, nine out of
ten babies transition very well, and they cry within the
first minute, and they turn pink, and they got get
after scores, and they transition well. And every once in
a while there's a baby that doesn't transition well. Those
(10:38):
breaths allow the babies mature circulatory system or extra uter
in circulatory system to kick in, so it's able to
deliver blood to the brain, to the intestines, and kind
of deliver blood to where it needs to go in
the newborn. But if the baby hasn't breathed, the placenta
is still doing that job. It's still acting as the
baby's lungs. So if you're cutting the cord but for
(11:00):
good breath has been established, essentially the oxygen supply has
been cut off to the baby. There are instances in
which delayed chord clamping should be weighed against possible risks,
like mom is experiencing a hemorrhage, for example, or you know,
if there is evidence that the baby is really going
(11:20):
to experience some respiratory distress. I asked McKenna what she
tells women who come to her with questions about delayed
chord clamping. And chord blood banking. When it does come up,
that is usually the number one question. The first question
is like should I bank chord blood? And then the
second question is, but I also really want to do
(11:41):
delayed chord clamping? Can I do both? You know, I
talked about physiologic word clamping, which is waiting for the
entirety of the blood volume to transfer to the baby,
in which case those two cannot be done together. There
is usually like some confusion and also some disappointment as
well when people hear that they can't have the best
of both worlds. But we have demonstrated that there is
(12:04):
still benefit to be gained for thirty to sixty seconds
of delayed cord clamping, so that if people did want
to do both, kind of do less delayed cord clamping,
shorter delayed cord clamping and take whatever is left in
the cord for private banking. But with public banking you
generally cannot do both because the likelihood that there will
be usable numbers themselves within that blood is significantly decreased
(12:28):
by any kind of delayed cord lamping. So you look
at w h O, I think they recommend waiting one
to two minutes before clamping the cord American College of
Obsections in Gynecology a COG, they recommend at least thirty
seconds to one minute, and then you look at American
College of Nurse midwise and they say two to five minutes,
and that kind of generally tends to ensure that the
(12:49):
large amount of the baby's blood volume has been transfused
to the baby. A COG discusses that with immediate cord
clamping there's um like thirty nine in enough blood and
enough stem cells to be banked, and then if you
wait even the thirty to sixty seconds, that drops down
to about However, that's okay for private banks which don't
(13:12):
have a strict volume limit to store the chord blood,
and it's also okay for therapies that don't require high
stem cell counts, for example cerebral palsy or new autism therapies.
The American Medical Association especially recommends chord blood banking if
there's a family history of genetic conditions or if the
baby has a sibling with a disease that may require
(13:33):
a stem cell transplant. So I think it's really important
for all moms to understand what's happening and make those
decisions with your doctor beforehand, and to remember how important
all those first moments are after birth and how they
affect your child's development, from delayed chord clamping to simple
actions like skin to skin contact, which can really have
(13:54):
a huge impact on your baby's development. When you do that,
you stimulate your baby's brain. You're encouraging physical development, you're
encouraging emotional and social development, and that skin to skin
contact helps moms too, improving your own connection to your
child as well as your milk production during this key time.
It actually stimulates your milk production. One of the things
(14:18):
that I've seen over the years in my experience is
kind of a greater respect for the return to simplicity,
which is to say, you know, physicians and midwives sharing
their expertise and realizing that maybe something like delay core clamping,
which midwiffery has practiced for years, maybe it is in
fact better that physician practice should listen to some of
(14:41):
the things that our midwife colleagues have always been proponents of.
So I think, you know, a more collaborative care model
of combined types of providers for women I think is
really the future as well as incorporation of DOULA programs.
I'd really like to see more of that additional bedside
support through their labor process. It's time for a quick break,
(15:06):
but we'll be back in a minute. Welcome back to
the show. M there's certainly promised beyond what the science
knows to be true at the moment in stem cells,
and that's part of what makes it so exciting to
be in as a field. That's Dr Nina Tannon. She's
(15:29):
a biomedical engineer and CEO and co founder of EpiBone,
a startup that uses stem cells from a patient's fat
to grow human bones. It's an incredible feat of bioengineering
and full disclosure, I'm proud to be one of the
company's investors. I asked Nina to join the show because
I wanted to know more about the future of stem cells,
(15:51):
specifically how stem cells can be used to repair diseased
or damage tissue later in life. I mean, we all
started out life as one cell, big, okay, and when
we were that one cell, that one cell had the
most potency of any cell in humanity. There's two properties
of stem cells. They can self renew so they can proliferate,
(16:13):
and they can differentiate. So when we were one cell big,
that one cell became everything that we are, so it
had what's called tody potency, full potency to become any
part of the body. And then that cell divided, became two,
divided became four, and the cells differentiated and became our brain, heart, tissue, liver.
(16:34):
So the stem cells that we use for making bone
and cartilage are called mezanchimal stem cells. They come from
like the middle layer of the embryo in our embryonic development,
and they end up living in our bone marrow and
in our fat and other parts of our body. But
they can become bone, cartilage, connective tissue like ligaments and
tendons and fat, So those are pretty useful tissues. I
(16:57):
would love for you as a mom, knowing everything you
know about the power of stem cells. I'm assuming you
did chord blood banking. I did not, interestingly enough, so
I didn't do banking of my kids stem cells because
I guess what I did was delayed clamping of the cord.
(17:17):
You know, I thought to myself, what's the probability that
I will need my daughter's own cells to heal her
versus what is the benefit that my daughter might get
if I asked the nurses to do this delayed chord clamping,
which allowed all of those stem cells to go back
(17:37):
into her right then. So that's what I did with
both kids, and I basically told myself, well, I'm going
to take the risk that if they were to ever
need them, by the time they would need them, there
would be a match with a donor available. And I
don't know if that calculation was correct. I mean, I
hope so, because I actually have very plex genetics, and
(18:01):
so finding an h L a match is actually not
the easiest thing to do if you have a very
complicated ethnic background, as my kids do. They're like ashkenaz A,
South Asia, potential European, Eastern European, like they're complicated. And
that's actually part of why I became a bone marrow
donor pretty early in life, is because it's just harder
to find the matches. I did that the second time
(18:21):
with Asha, but we did kind of a duel. We
also took placental tissue, cord tissue, and the stem cells
because it was an option, and you know, I've seen
that it could be a possibility that you need autologous
stem cells, but I think also on your end, we
can drive stem cells from fat and from bone marrow. Yeah,
like if for Zane, he may not be an h
(18:43):
l A match to Asha, but you can find really
similar cells to those cord blood stem cells in his
own fat. So maybe there's an option if there is
a stem cell study you'd like to do that would
involve proliferating his own cells. There's conflicting search, but I've
seen something there that I know there's something to it.
(19:04):
But it's just like throwing a bunch of stuff at
the wall and hoping something kind of goes where it
needs to go to help prepare something that needs repairing,
versus being very objective and having a target. I mean,
that is not entirely crazy considering how much is known
and especially how much is unknown about autism genetic factors.
Only best measurements account for of cases you'll find identical twins,
(19:29):
and they only are correlated se percent of the time
in terms of autism prevalence. So it's such a mystery
that it's really I think pioneering families that have the
fluency and the agency and the resources to help discovery
for other families to what you're doing is not just
for you, but also for so many other families. Nina
(19:52):
uses a type of stem cell found in adults to
create their own bone. She doesn't rely on bank to
chord blood for the particular work she's doing. What we
do is we take stemselves that live in our body
and we coax them into living body parts that can
serve as replacements for our bodies as we age, as
(20:14):
we get injured. And we made history this past year
for being the first company to ever gain permission from
the FDA to takes themselves and grow them into bone
and replace bones in people's bodies after for patient one
injury after a car crash, Patient two congenital defect, and
Patient three congenital defect. And they're now three people living
(20:35):
with engineered bones made out of their own cells. Can
we talk about why why is it better for a
little girl who might have a congenital defect to have
a bone grown by Eppy bone using stem cell technology
versus what might be a traditional implant. Well, let's just
(20:56):
use that word traditional implant. You know it's crazy. Bonus,
the most transplanted human tissue after blood, and the only
way to get human bone is to cut it out
of a human. And so if you've got this little
girl with a congenital defect, she may be missing her
cheekbones or her job bone, maybe underdeveloped. The only way
(21:16):
to get enough phone, like the traditional implant you talk about,
is going to be cut out of her rib or
cut out of somewhere else on her head. And so
you can imagine if you're trying to spread around the
bone of this tiny little human. You know, you have
to really weigh the damage that you would do to
the person by cutting them apart versus the benefit they
(21:36):
would get from being reconstructed. And so these kids end
up going through multiple surgeries and that's just a crappy
way to heal a person. Well, number one, I'm so
proud to have been a part of it and just
get to see this. But number two, I just realized
something about stem cells that I think is so cool
(21:56):
about you. I never really thought about it, but what
you are doing is allowing the human body to heal itself.
You know, that's like my rebel side of me where
I'm like, Okay, medicine is so patriarchal, this idea of
a patient and the surgeon who's you know, the surgeon
is the one who does the work, not the patient,
(22:18):
but actually the patient's doing all the work and re
centering healing inside our own bodies and reclaiming our own
body's power to heal itself with this enabling technology that
we provide that gives those stem cells an opportunity to
do more of what they can do, but kind of
are limited in the body because basically we take the
stem cells and we put them in a new bone
(22:38):
outside the body, and we coax them and grow that
new bone and then put it back in. And that's
something that I feel like makes me pretty rebellious in
the medical community because we're re centering the power of
healing inside our own bodies. You are your own medicine.
I asked Nina about some of the controversies surrounding her work.
So we all started out life as one cell big,
(23:00):
but in my view and the view of many people,
that one cell is not a human. Now there are
some people who share the opposite view and say, if
life begins a conception, a human embryo that's one cell
big is ethically equivalent to a human. I don't think
a seed is a tree, you know, I think they're different.
(23:20):
So that's where I stand on that. Where do you
become a human is a very political question being worked
out right now in the courts. But someone who's experienced
pregnancy that leads to birth and pregnancy that is non
viable in all its shapes and forms, I don't believe
that of embryo is a human. Did I experience loss
(23:45):
when I had embryos that were non viable? Of course?
Is that the same loss of losing a human? No?
Do you see that as your biology failing you or
supporting you? I felt I had both narratives. I feel
like biology supported me because there were chromosomal abnormalities and
those embryos that meant that they self destructed. Now did
(24:07):
my body have awareness of that self destruction or did
it like hang onto the tissue for a long time
and cause lots of havoc? Going like another story for
another podcast. But you know, missed miscarriage, which is something
that I experienced more than once, is something that's really difficult.
And so because there's so much ambiguity in terms of
how people view when does life begin, there's been a
(24:28):
lot of ethical controversy about manipulation at various stages of
that developing embryo, and I believe that it should be.
But embryonic stem cells were all derived from non viable embryos.
You know, that's sort of like a corollary to the
idea of brain death and that after brain death it's
okay to harvest a body for organs, and that view
(24:49):
was applied to embryos and said, if that embryo is
brain dead, i e. Non viable, there are certain healthy cells.
Just like your heart can be alive even if your
brain is dead. There could be certain cells inside that
embryo that we're still alive and still useful. But because
there's controversy around the creation of unused embryos at all,
there was a lot of controversy about potentially harvesting cells
(25:11):
from these non viable embryos. And that is only one
of the many types of stem cells that I mentioned. Okay,
those our embryonic stem cells. There's adult stem celves, there's
induced for potent stem cells. There's lots of different types
of stem cells. But because embryonic stem cells were derived
from this source, and some of those cells were derived
under fuzzy informed consent, they kind of clouded the entire
(25:33):
industry and the entire academic science of this industry too.
So the advent of newer types of stem cells that
come from adults where you can sidestep some of these
issues of informed consent or with induced pluripotent stem cells
that side step the need for an embryo itself. I
think it's really moved the feel forward. I asked Nina
(25:56):
how she thinks the field will change in years to come.
I think we're going to see a lot of progress
in the coming years for what's called universal donor stem cells,
and so we won't have to be so reliant on
our own cells. Are the cells of our immediate family
for healing potential. I think we're going to see that
(26:17):
open up much more. You know, we talked a lot
about autism. There's a lot of correlation between certain mutations
that affect congenital heart defects and also the mind. And
this is something that I was interested in during my
PhD and I didn't make much headway with because I
was graduating soon. But I think we're going to start
(26:39):
to understand more of this nature nurture question and be
able to coax not only the cells in our own bodies,
but coax our selves outside our bodies. You know, we
may not be perfect at being able to create that
environment for our own body, but we can learn from
what those ideal conditions are and create conditions outside the
(26:59):
body that can help make new therapies. So I'm excited
for the future. I'm excited to participate in it in
my own small way, and I'm really excited to see
my little, tiny humans continue to grow. This was the
Christmas we bought my daughter her first my driscope, So
I'll land on that I believe in science. Well that's
(27:27):
it for the show this week. Next week we'll be
talking all about the magic of a baby's brain and
how it develops. I've learned from my experience and saying
from some of the top neuroscientists in the world how
a baby's brain develops, and how atypical brains develop and why.
And now that I understand these things, I've learned that
there are so many simple things that we, as totally
(27:50):
new parents can actually do to set the stage for
optimal development and create an even more resilient child by
doing so. And it's just really exciting to put some
of that knowledge to use. So tune in and learn
more about what the research says. The Healthy Baby Show
is a production of iHeart podcast Network and healthy baby
(28:11):
dot com, where you can find a new line of
the safest baby essentials. The Healthy Baby Show is hosted
by me shazivs From. Our lead producer is Jennifer Bassett.
Executive producers are Nikki Etre, Anna Stump, Shahsi vas Fraum,
and James Violette. Mastering and sound designed by Carl Katel
and Dan Bowsa, additional writing and research by Julia Weaver.
(28:32):
Our theme music is by Anna Stump and Hamilton's Lighthouser.
Additional music from Blue Dot Sessions.
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