Today’s parents have more private options regarding how to preserve their baby’s umbilical cord. For over a year now, expectant parents have had the option to privately store more than their just the baby’s cord blood. Leading banking companies now offer the option of banking the cord tissue, commonly referred to as the Wharton’s jelly. According to experts, about 30% of parents who privately bank are choosing this option as well.
Why should parents bank cord tissue?
The cord tissue, from the Wharton's jelly, is an abundant source of a different type of stem cell, mesenchymal stem cells (MSCs). MSCs have the ability to regenerate into other types of cells. Currently, there are no medical treatments, or human clinical studies, available using MSC, but experts feel they hold great potential. In fact, preclinical lab studies using MSCs from cord tissue have shown the potential to shrink tumors from lung cancer, slow the progression of Parkinson’s disease, and reduce the joint damage caused by arthritis. Additionally, MSCs could possibly help increase the number of engrafted cells in a transplant when used in conjunction with the other stem cells from the cord blood. Going forward, experts feel that MSCs will play a critical role in the treatment of diseases such as:
• Parkinson’s Disease
• Rheumatoid Arthritis
• Liver Fibrois
• Lung Cancer
• Sports Injuries
• Juvenile Diabetes
What is the collection process?
After the cord blood is collected, the practitioner wipes the cord with an antiseptic wipe and then places the cord in the container supplied with the cord blood kit. The collection and processing of cord tissue differs from company to company, so practitioners need to read the directions in each kit. Some companies require only a segment of the cord, generally a 4-6 “section of the cord. Other companies request the entire cord, to maximize the amount of cells captured (as much of the cord as the practitioner can fit into the specimen cup). The processing of the cord tissue also varies from company to company so this requires a little more homework on the part of the parents. Many companies cryopreserve the entire cord segment without extracting the stem cells before freezing. Currently, there is only one company that extracts the cells prior to storage and freezing, as well as accessing a patented stem cell source from the perivascular region of the cord. This later method has been proven to yield higher cell counts.
What is the cost?
There is an additional fee to bank the tissue, along with the cost associated with the collection of the cord blood, approximately$1000. Yearly storage fees are also applicable, around $125.00 per year. Many companies offer 6 or 12 month payment plans, with very minimal interest fees. The cord tissue can only be banked as an ‘add on’ to the cord blood. Many companies run frequent promotional offers through the OB offices, their websites, Facebook, or corporate partners, like parenting magazines. Public banks are not accepting donated cord tissue at this point.
Liu Y, Mu R, Wang S, et al. Therapeutic potential of human umbilical cord mesenchymal stem cells in the treatment of rheumatoid arthritis. Arthritis Res Ther. 2010;12(6):R210.
Maurya DK, Doi C, Kawabata A, et al. Therapy with un-engineered naïve rat
umbilical cord matrix stem cells markedly inhibits growth of murine lung
adenocarcinoma. BMC Cancer. 2010;10:590.
Davies JE, Baksh D, Sarugaser R, Hosseini M, Lickorish ADS, inventors;
Tissue Regeneration Therapeutics Inc, assignee. Progenitor cells from
Wharton’s jelly of human umbilical cord. US patent 7,547,546. June 16, 2009.
When it comes to delivering babies, there’s a new kid on the block - the Obstetric (OB) hospitalist. Many Labor and Delivery units around the country are embracing a new model of care.
What is an OB Hospitalist? A hospitalist, in the general sense, is a physician who specializes in the care of patients in the hospital setting. Most often, a hospitalist does not have a private practice or see patients in the office setting but instead focuses his or her medical practice on inpatient, hospital-based care. An OB hospitalist, specifically, is a board-certified obstetrician who, while on duty, remains physically present at the hospital to provide immediate care to pregnant patients whenever it is needed. The OB hospitalist works collaboratively with a patient’s obstetrician to deliver highquality care in a timely and efficient manner.
Evolution of the Hospitalist Model The hospitalist concept was first introduced in the 1990s and grew in response to various pressures - hospitals faced increasing economic pressure to provide quality care at lower costs, many physicians found it increasingly challenging to balance busy office practices while managing complex hospitalized patients, and consumers of healthcare, patients themselves, became empowered to choose their hospital and healthcare providers based on outcomes, performance, and services. Born out of the need to address each of these issues, the Internal Medicine hospitalist became a new specialized physician in many hospitals. Within a decade, the specialty grew dramatically. In the mid-1990s, 6% of all internists were practicing as hospitalists but by 2006, that number grew to almost 20%. Hospital Medicine is now a thriving subspecialty of Internal Medicine and a recent 2012 survey showed that there are currently more than 35,000 physicians working as hospitalists. Following in the footsteps of the successful internists, almost every other medical specialty has embraced its own version of a hospitalist, including Pediatrics, Orthopedics, General Surgery, Neurology, and Obstetrics.
The OB Hospitalist’s Role - Safety First
Just as medicine hospitalists offer many advantages for hospitals and their patients, OB hospitalists offer many benefits as well. Arguably, the most significant benefit is enhanced patient safety. In the busy and often unpredictable world of obstetrics, laboring patients sometimes need immediate care when their physicians have other commitments, such as a scheduled surgery or office patients. Having an obstetrician on-site 24/7 means there’s always a physician in-house to respond immediately to obstetrical emergencies. The hospitalist can administer care, such as attend a precipitous delivery or prepare for an emergency C-section, while the patient’s physician is en route. As most of us know, in obstetrics those minutes can be vitally important.
Beyond Emergencies – Other Benefits of OB Hospitalist Programs OB hospitalist programs can impact patient safety in many ways beyond their role as first responders to emergencies. OB hospitalists in many Labor and Delivery units are becoming increasingly involved in OB triage. Until recently, “nurse-only triage” has been a common practice in the care of obstetrical patients. Patients who present to Labor and Delivery Triage with complaints such as preterm contractions or decreased fetal movement may be evaluated by a nurse who then communicates with the patient’s physician who is often off-site. While this has been an acceptable standard in the past, many suggest that a safer model for OB triage is one that includes bedside evaluation not only by a nurse but a physician as well. In many hospitals, the in-house OB hospitalist is the obstetrician who can provide that higher level of care. Working collaboratively, the nurse, the OB hospitalist, the patient, and the patient’s physician can then determine the best plan of care.
Hospitalists are also impacting care by becoming increasingly involved in the quality and safety initiatives in their hospitals. In many facilities, hospitalists participate in the development of hospital policies and protocols. Hospitalists’ input regarding evidence-based medicine and best practice can be an invaluable asset to these processes. Additionally, team training and simulation programs are proving to be very beneficial for patient safety, and hospitalists can be the physician champions for the implementation of these programs in the hospital setting. As hospitalists and other staff members become increasingly engaged in these activities, we can create a safer environment for patients and providers alike.
OB Hospitalist Programs Grow in Popularity
As the benefits of OB Hospitalists become more apparent, more and more OB hospitalist programs are developing around the country. Because the specialty is in its infancy, it is difficult to know just how widespread this model is but a popular website, www.obgynhospitalist.com, currently has over 1160 registered members and more than 180 programs listed on its site. In an effort to organize and promote the specialty, a few motivated and passionate physicians established the Society of OB/GYN Hospitalists (“SOGH”) in 2010. After holding annual meetings in 2011 and 2012, membership in this organization is expanding and its members are working diligently to collect data on the impact of hospitalist programs on patient care. While enhancing patient safety and quality of care is the common motivation for starting most OB Hospitalist programs, a recent survey by the SOGH showed that there are variations in hospitalist responsibilities from program to program. Some programs are designed to provide coverage for OB and gynecology patients (“OB/GYN Hospitalists”). Others focus on the care of pregnant patients (“OB Hospitalists”), while others are even more specific in their coverage, focusing on the care of laboring patients (“Laborists”). In any case, all programs are developed to enhance patient safety in women’s health, improve quality, and improve satisfaction for the benefit of patients, hospital staff and practicing physicians.
The Patient-Physician Relationship
Pregnancy and the delivery of a baby is no doubt one of the most significant events in a woman’s life, and the relationship between a pregnant patient and her obstetrician is a sacred one. Many OB hospitalists recognize this because most have worked as general obstetrician/gynecologists in a practice setting before they became hospitalists. As this model becomes more widespread in obstetrics, some caution that OB hospitalist programs might negatively impact patient satisfaction because patients receive care from a physician who is new to them during one of the most intimate and important events in their lives. Certainly OB Hospitalists must have insight into patients’ emotions and expectations and must respect the bonds that patients feel with their primary OB. OB Hospitalists must have exemplary communication skills and a bedside manner that enables them to establish a rapport in even the briefest patient encounters. In doing so, proponents anticipate that OB Hospitalist programs will positively impact patient satisfaction because hospitalists may be more readily available and may be able to spend more time at the bedside than general obstetricians who are often under tighter time constraints due to multiple commitments. To be successful, OB Hospitalists must not only possess knowledge, experience and skill, but must also exhibit humility, compassion and a commitment to patient-centered care. With these attributes, the OB Hospitalist, along with the nursing staff, the patient’s physician, and the rest of the Labor and Delivery team, can deliver something very special to obstetrical patients - exceptional patient care.
Tanner Colegrove, MD, FACOG, is the Medical Director of the Northwestern Memorial Physicians Group (NMPG) OB Hospitalist program at Northwestern Lake Forest Hospital in Lake Forest, Illinois. She is a member of the Society of OB/GYN Hospitalists. For more information on OB hospitalist programs, visit www.societyofobgynhospitalists.com or www.obgynhospitalist.com.