Much ado about spotting, episiotomy and cord blood banking

This morning, I went for my walking exercise at the reservoir, across the road from my apartment. Both my husband and I love the place, which is great for running. I know gynae Loh told me I shouldn’t walk so much ever since he discovered I’ve a low lying placenta. But I figured since I’ve been doing fine so far I should be able to continue walking. Besides an advice coming from a couch potato gynae isn’t very convincing.

I did a slow walk for 3km as, unfortunately, I’m not able to walk fast like before. I thought 3km was ok; I was doing more than 4km during my 1st trimester. In fact I was a little disappointed with myself that I couldn’t continue with the longer distance. Ok, I admit I was a little too gung-ho, cuz last night my husband told me that Paula Radcliffe (fastest woman marathon runner in the world) continued with her training throughout her pregnancy right up to giving birth.

After the walk, I went to the restroom and found I had spotting in the panty-liner. That honestly got me a little worried, and I suspected the long walk might have triggered it. I emailed Loh immediately to ask if I should go see him for a check or monitor the situation. He replied an hour later that I should observe for the time being. I know he’s going to say ‘I told you so’ when we next meet. Even my husband thought I was overdoing it, telling me that Paula is a world class athlete, whereas I’ve never trained for a marathon. Anyway I’m relieved to say that since this morning, I’ve not experienced any more spotting. So now I’m afraid I’ve to reduce the distance further to 1km.

Yesterday, my friend told me that a lady from the expectant mommy clique reported that she gave birth smoothly without the need for episiotomy or stitching, and credited this to her patient gynae, Dr Paul Tseng. I’ve heard of his reputation; he’s known to avoid episiotomy. I told my friend that he sounds like someone whom I would get along well with. My friend and I think that this shows a Chinese woman doesn’t necessary require episiotomy. But my husband questioned the statistic of one. He also feels that Loh may not have the bedside manner of some of the other doctors, but he has very good clinical experience. Loh told my friend that lucky for him, in his 20+ years as a gynae, he has handled smooth deliveries except for one case when a woman pushed out her womb together with the placenta. he freaked out then and had to check up the textbook for reference. My husband thinks he was saying that to assure my friend, cuz he did mention another case to us of a patient who suffered from placenta previa and bled buckets, which also freaked him out.

The other day I relayed to my husband the comments from my friend on Loh’s average stitching skill and painful vaginal examinations (VE). Apparently some women in the mommy forum reported that they felt sore a week after the vaginal stitching, and the VE done by him was more painful than the stand-in gynae. My husband sarcastically said these women have pretty revealing analytical skills. He defended Loh that there was no global standard on stitching for comparison. Different women experienced different muscle tears and have different pain threshold. So he thinks there’s no rational basis for such comments. What matters is that the stitching heals well.

Recently my husband and I were approached by a private cord blood bank, CordLife, on storing our baby’s cord blood. A friend, who had a baby 6 months ago, also recommended me to go for CordLife; and my expectant friend also signed up for it at the advice of her husband’s best friend. Well my husband is not the sort who will jump into anything without proper costs and benefits analysis. So the research job lied on me, and thank God for Wikipedia I found out some interesting information on cord blood banking.

Unlike in the US where many states have passed laws that require parents to be given full information to make an informed choice, we don’t have such requirements in Singapore. There is little public knowledge of public cord blood bank. In fact my husband and I didn’t know we have one until very recently, Singapore Cord Blood Bank. But private cord blood banks particularly Cordlife promote themselves extensively. The expectant parents are told that they’re storing the cord blood for their children’s or sibling’s future use should they have illnesses that require cord blood treatments. But there was no mention of effectiveness of using one’s own cord blood, or whether it’s usable in the long term, or the chances of using it even. Many people here don’t realize issues such as the cord blood might be contaminated with cancer cells that developed later in life, or the blood contains the same genetic defects. Also it’s a question whether the blood sample is enough for treatment later in life, and concern over premature clamping of the cord to harvest more blood which could affect the baby, like depriving of placental blood transfusion.

In North America and Europe, the medical communities realize that there’s remote chance of a person using his/her own cord blood, and unless there’s high risk within the family like a sibling having an illness that requires such treatment, it’s not wise to make use of a private bank to store the cord blood. Hence they discourage parents from banking the cord blood with these private banks since it is actually a pretty expensive insurance payment, like Cordlife charges S$6,200 (US$4,910) upfront payment for 21 years of storage, though they do offer 2 installment plans which are more expensive in the long run. The medical communities realize that the private banks prey on the fears of expectant parents. However donation of cord blood to public banks is encouraged in North America, which is understandable since this benefits everybody like the national blood bank. But I also wonder if the above mentioned issues of cord blood also apply to public cord blood banks. Still I’m willing to consider donation, but I understand I’ve to check with my doctor if that’s feasible for me. Also I’ll have to provide 30ml of blood for testing before the procedure is approved.

(Update on 25 Mar)
I just briefly read through the brochure of private cord blood bank, Cordlife, and it stated that the odds of anyone undergoing stem cell transplant is 1 in 217. The number is correct and in fact you can get this fact from Wikipedia on Cord Blood Bank, but the brochure fails to mention that this is over the lifetime of 70 years and stem cell comes from various sources, not just cord blood. Also Brochure omits the fact that most cord blood stem cells collected is only enough to treat a child, not an adult (or anybody above 90 pounds or 41kg). The fact that the storage is over a period of 21 years is really disingenuous. To date there’ve not been any successful method of collecting more stem cells, thought clinical trials are being done that show promises. So it’s very likely that parents are paying a lot of money for unusable stem cells.

(Update on 27 Mar)
Cord life launched its IPO yesterday. I got a copy of the prospectus for my husband. I did a quick scan to find out who is the founder and who are in the management team. Funny thing is even though the team members are declared, nothing is mentioned about the founder or how the company was started. Honestly the company doesn’t just appear from nowhere. We find it rather fishy.

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