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Collecting Cord Blood for Typing

Guide for Student Midwives

By Gloria Lemay

This is a detailed instruction on how to collect cord blood that I wrote for my students some time ago.  I hope it's helpful to you.

When the mother of the baby is Rh negative and the father is Rh positive, there is a good chance that the baby will be a positive blood type.  Blood in the umbilical cord  and the placenta will be the baby's blood.  To obtain a sample:

1. At the time of birth do not rush the clamping and cutting of the cord.  I like to see the placenta birthed (this will take approximately 30 minutes) before clamping and cutting of the cord.

2. Take the bowl with the placenta to the kitchen and get everything together before starting to get your blood sample.  What you'll need.  Two pairs of non-sterile gloves to protect yourself from body fluids, a container with a lid to put the placenta after, a blue waterproof 17" X 21" underpad, a 3cc syringe and needle, a purple stoppered test tube (check with your local hospital to determine what color stopper they prefer). The purple stopper tube has an anti-clotting chemical in it to prevent the blood from clumping. The blood must be gently rocked back and forth after collection to disperse the material evenly through the sample.

3. Before putting on your gloves, write the necessary info on the label of the test tube in very tiny printing.  Remember, it is very important that blood samples not get mixed up at the hospital. You will get along well with the blood bank if you mark your samples carefully.  In my area we put on   Mother's full name and date of birth, "cord blood", baby's date of birth, and mother's personal health number.  When you get to the blood bank they will also want you to fill out a requisition.  On that form, I put my name, pager no., the physician's name, the mother's date of birth and PHN no. and write for the order "type infant cord blood for screening of rh negative mother."

4. Now that you have all your supplies together and the tube labeled, take the cord blood before inspecting the placenta.  Pull the placenta out of the bowl and put it on the blue pad so that it is sitting on the counter and the cord can be draped over the edge of the counter with the clamp on the end of the cord. You want to keep the label of the tube clean and legible so you may want to change your gloves or wipe blood off them on the blue pad edge at this point. Take the lid off the tube and hold it at the clamped end of the cord, take off the clamp and allow the blood to run in to the test tube.  When you have 1/2 inch of blood in the bottom of the tube, close the tube and rock the blood back and forth.  If you can't get enough blood you may have to squeeze the blood down from higher up in the cord and, occasionally, you may have to take the 3 cc needle and run it into one of the vessels on the fetal side of the placenta, draw back on the plunger to extract the blood and then squirt it into the test tube.

4a.) Now you can do a complete inspection of the placenta and then put it away with a lid on it in the fridge.

5.  Take the test tube in and ask the lab tech to page you with the results asap.  They'll phone and say "Baby Smith is negative (or positive)."

6.  If baby is negative ask them to fax a copy of the record for your records.  If baby is positive, they require a blood draw from the mother
of blood from her arm.  This is not difficult to do but you need to practice on other student midwives and get some instruction from a friendly midwife..
The maternal sample is taken in and checked by the lab for baby cells in  the blood.  If there are no baby cells in mom's blood, a low dose of WinRho (Rhogam in the U.S.) is given (120 micrograms) and if there are baby cells, I have had up to 900 micrograms prescribed.  There are instructions on how to give the injection intramuscularly in the package.  It is given into the large muscle on the upper outer quadrant of the thigh.  If you have to give over 300 micrograms, you have to give it in multiple sites.
Injecting anything under the skin can cause harm so be very careful that you are sure of what you are doing and that you've had good instruction.

Gloria Lemay, Vancouver BC