The ethical responsibility of childbirth educators

I’ve just returned from Sydney where I taught a Lamaze Childbirth Educator training program. Part of the course is to explore the Code of Ethics for Lamaze Childbirth Educators. Quite ironically,  I received the following email while I was away;

I was thrilled to come across your website today!
I work as a midwife and with cryosite in raising awareness of cord blood and tissue collection and storage. So as to have an exact stem cell match if their child ever needed it for a medical treatment. Treatments include: leukaemia, lymphoma and anaemias just to name a few. There are over 80 approved treatments and 100’s of trials being conducted here in Australia. 1000’s world wide.

Our aim is to get as much information out to parents to be as possible so we can ensure that everyone knows that this is an option!

I’d love to speak to you further about the possibility of presenting at your classes, or having some of our brochures available for your clients. I also love to set up a referral system where your clients can get exclusive discounts by mentioning that they picked up the brochure from your class. This also links you to receiving referral bonuses also!

I really look forward to speaking further,

Kind regards,

(name withheld)

The first thing I found myself doing after reading this email was to take a very long, deep breath. Anyone who knows me personally would know that optimal cord clamping is a topic I am extremely passionate about. I also get very upset when parents-to-be are fed a load of marketing crap, passing itself off as “scientific evidence”.

The Royal Women’s Hospital in Melbourne have produced a very informative guide to cord blood and clearly states their reasons for not allowing private collection of cord blood at the hospital:

• Currently, the Women’s does not agree with all of the claims made by private storage companies about the future health benefits of blood storage. In our view, there is still not enough proof that cord blood will offer a solution
to everything that some organisations claim it will
• Although preliminary data shows encouraging results in cord blood stem cell transplantation for a variety of diseases, the procedure at this time is considered experimental
• There is not enough reliable evidence to suggest that family members are the best donors for cord blood transplants
• Philanthropic donation of cord blood for banking at no cost is to be encouraged by public health services.

The Women’s policy is not to collect cord blood for private companies because:
• It is not always possible to collect blood from the cord so we cannot guarantee blood will be collected
• We cannot guarantee the condition of the blood after it leaves the hospital
• We do not want to endorse commercial services or products particularly when all the advertised benefits for patients are not guaranteed or scientifically established

Delayed cord clamping is not a new idea. In 1801, Erasmus Darwin wrote, ‘Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be.’

We’ve known for over 200 years that the best place to store a baby’s blood is IN THE BABY’S OWN BODY. And now we have the science to prove it.  With all that we know about the benefits of optimal cord clamping, I could not, in good faith, ignore this person’s email. Pregnant women are already getting the short end of the stick when it comes to evidence-based healthcare. They are told they must be tested for gestational diabetes and Group B strep, when in fact the evidence to support routine testing is far from conclusive. We induce labours at a frightening rate – often for no medical reason, and our Caesarean section rates are amongst the highest in the world. Sometimes, delayed cord clamping is the ONLY physiological part of the labour and birth that a woman can control, and as a childbirth educator I have a responsibility to let women and their partners know the clear benefits of this practice.
So all this being said, this was my reply;

Thank you for contacting me regarding Cryosite. As a Lamaze Certified Childbirth Educator, I abide by a very rigorous code of conduct and ethics which absolutely prohibits me from financially benefiting through something like a referral system. In addition, Lamaze educators are committed to teaching the most up-to-date, evidence-based research in maternity care, and as a result, this means that I cannot promote the use of private cord blood banks. To be honest, as a midwife, I am both surprised and somewhat disappointed that you are actively promoting a service that is neither evidence-based or supported by RANZCOG. Presenting yourself to potential customers acts as a very public legitimization of Cryosite’s services, in the same way someone wearing a “white coat” in a TV ad is inferred by those watching to be a medical authority on whatever it is they are promoting/selling.

Private cord blood banks prey on vulnerable parents who are desperate to “do the right thing” and who are usually completely unaware of the fact that autologous use of their baby’s cord blood almost never happens – and yet, they are sold the promise of being “the ultimate life insurance policy.”

Given the highly aggressive marketing techniques adopted by your company – and others – many, many parents are aware of your services. What saddens me is that most people have not heard of the incredible benefits of optimal (delayed) cord clamping, which has been supported irrefutably by Level 1 research worldwide. The truth is, there is no money to be made by a baby receiving their own cord blood and stem cells, and that’s probably why most people haven’t heard of it.

I wrote about private cord blood banks on my blog – you are welcome to read the article by clicking here. You might also be interested to read an article that appeared in the prestigious Journal of Perinatal Education on private cord blood banks.

So, in summary, thank you, but I will not be taking you up on your offer to promote your company’s services. It is also my personal hope that as a midwife, you will consider your own duty of care to provide women and their families with evidence-based information, free of commercial bias.



I highly doubt that I will receive a reply from this person, but I didn’t write it with the intention of receiving a reply and I could have just deleted it and ignored it. For me, it was the fact that it was written by a midwife that upset me the most. Midwives are the guardians of normal birth. They are trained to support normal, physiological birth and to do everything they can to ensure a healthy mother and a healthy baby. The evidence supporting delayed cord clamping cannot be ignored – especially by a trained midwife.
Midwives also abide by a very stringent code of ethics. According to The Nursing and Midwifery Board of Australia; “The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to each woman’s health, sexual or reproductive health and child care.”
Source: A midwife’s guide to professional boundaries (Nursing & Midwifery Board of Australia – Updated June 2013)
Clearly using her position as a registered midwife to promote a private, for-profit service with dubious scientific claims, contradicts the Code of Ethics for a midwife.
On a final note, if you have a few minutes, please take the time to watch this wonderful TEDx Talk on the benefits of optimal cord clamping by Dr Alan Greene

Tanya Strusberg is the founder of birthwell birthright. She is a Melbourne-based Lamaze Certified Childbirth Educator, doula and a Fellow of the Association of Certified Childbirth Educators (FACCE). She is a passionate advocate for women’s maternity care and her articles have appeared in The Journal of Perinatal Education, Australian Midwifery News, Science & Sensibility, Interaction – the journal of the Childbirth and Parenting Educators Association of Australia (CAPEA), International Doula, Empowering Birth Magazine and Rockstar Birth Magazine. Through her internationally-accredited Lamaze Educator Training program, she is very excited to be training a new generation of Australian Lamaze educators. Last, but absolutely not least, she is also the mum of two beautiful children, her son Liev and daughter Amalia.