6 pre-parenthood questions

When the first contraction signals that your baby is on the way, the decisions you will have to make as a couple come thick and fast. Prior to that busy time, and while it's still just the two of you, you'll be gathering information and sharing your views on all kinds of topics from breast-feeding to sleeping arrangements. Along with learning the basics of baby care, answer these six questions together before B-day.

1. What should be in our birth plan and newborn-care plan?
A birth plan, written by you and your partner, describes how you want your labour and delivery to proceed -- insofar as you have control over these events. Your doctor, midwife or doula can explain which options are open to you and can help you prepare your plan. This is a good topic for your prenatal class, where other expectant parents as well as the instructor may have lots of ideas. The plan can be as simple or as detailed as you like. It should cover the medications you want or don't want, your preferences about moving around during labour, the roles your partner and support person will play and what medical intervention you would prefer.

A newborn-care plan should cover your wishes for how your infant will be treated while in the hospital, whether he will stay with you immediately after the birth and whether he'll be allowed sugar water while in the hospital nursery. Discuss your plans with your family physician or midwife and take into consideration your hospital's restrictions for birthing rooms. Even though you should be prepared to accept changes as you move through the experience, the process of working through these plans ahead of time make it much more likely that they'll occur as planned.

2. What do newborns look like?
It's not uncommon for parents to think their newborn baby looks perfect in every respect. Yet most newborns show obvious signs of the laborious journey through the birth canal. Typically, a baby born vaginally will have a large pointed head, puffy eyes and a flattened nose. She may have a full head of hair or she may be bald. She may be covered in a white, creamy protective coating, called vernix, and in fine body hair, called lanugo. Newborns often have swollen genitals and breasts. Their nipples may secrete a white or pink fluid, and girls may have some vaginal secretions. Babies born by caesarean section will look less the worse for wear.

You may wonder why every other baby in the hospital nursery is so odd looking compared to your little beauty. But chances are a few years down the road when you're looking at her birth photos, you'll be surprised to see how obvious are the marks of birthing to which you had previously been blind.

3. Should we bank the umbilical cord blood?
Because the umbilical cord blood contains a high concentration of stem cells (the basic units in the bone marrow responsible for producing all red cells, white cells and platelets), it provides a perfect match for a bone marrow transplant should the baby need it in the future. It is also more likely to provide a good match for siblings with a blood-related illness, such as childhood leukemia (one child in 1,000), or parents with another life-threatening disease. Also, because the stem cells have not yet built up antibodies, they are more compatible with a greater number of unrelated people in need of cell transplants.

However, the usefulness of cord blood is still under discussion in the medical community. Some recent studies, performed largely on related donors and recipients, have discovered that cord-blood transplants are less likely to "take" than bone-marrow transplants. Also, while both methods produce roughly the same survival rates in the long term, studies show cord-blood transplants result in more early deaths. But on the positive side, researchers have found using cord blood greatly reduces the risk of graft-versus-host disease (a potentially fatal complication, in which the donated tissue attacks the new host's body).

Once you've made the decision to collect your newborn's umbilical cord blood, you might consider either donating it to a public cord-blood bank or storing it for your child's or a family member's future use. The process of collecting the blood involves no risk or pain to mother or baby, since it's collected within 24 hours of the birth from the clamped umbilical cord that remains with the placenta. However, expectant parents who are interested in the options should obtain information and counselling early enough in the pregnancy to make arrangements for testing and for the collection and storage of the blood.

The procedure has been adopted in several centres in Canada and the United States. The Alberta Cord Blood Bank, associated with the University of Alberta in Edmonton, is a public resource that accepts cord-blood donations from hospitals across the country and makes it available to the general public. You can visit their website at www.acbb.ca or call 780-492-2673.

Other private programs for collecting and storing this blood have begun in Vancouver and Toronto, offering parents a once-in-a-lifetime opportunity to store the blood collected from their newborns for future use. Although Canadian health organizations have yet to form official policy on the collection of umbilical cord blood, other organizations around the world, such as the Royal College of Obstetricians and Gynecologists in the United Kingdom, warn that private cord-blood banks may be preying on parents' fears. But families with high incidence of diseases such as cancer may feel it is valuable insurance.

The Toronto Cord Blood Program (TCBP) at Mount Sinai Hospital (the phone number is 416-586-8818) accepts referrals from Ontario residents only. It operates on a cost-recovery basis charging fees to collect the cord blood ($600) and subsequent annual fees ($100) to store it. Your own hospital should be able to provide you with information about these programs or others that might become available in your area. Make sure to ask lots of questions and get information from a variety of sources. For example, according to the TCBP, blood can only be stored for 10 years with current technology, but Lifebank (a private cord-blood bank with offices in Vancouver and Toronto) stores cells for up to 15 years.
Either way, researchers believe the real potential of this procedure lies in the ability to use cord-blood cells in unrelated donor and recipient transplants. Depositing cord blood into a public bank allows further study, but using a private collector ensures the availability of the sample for future use by your family.