Corporeal Commodification and Women’s Work

Abstract

Private cord blood banking is the practice of paying to save cord blood for potential future use. Informed by the literature on corporeal commodification and feminist theories, this article analyses women’s work in banking cord blood. This article is based on in-depth interviews with 13 women who banked in a private bank in Canada. From learning about cord blood banking to collecting cord blood and transporting it to the private bank’s laboratory, women labour to ensure that cord blood is successfully banked. Private cord blood banking involves the overlap or insertion of commercial practices, and relations with clinical practices and relations that may cause tensions and confusion for women and clinical practitioners. Moreover, private banking reinforces and is reinforced by an ‘intensive mothering’ ideology. This article shows that corporeal commodification is not confined to a laboratory and the work of experts but extends into women’s everyday lives.

Keywords

biotechnology blood body parts commodification feminism

Cord blood, or the blood that remains in the umbilical cord and placenta following birth, is valued in biomedicine for its high concentration of blood stem cells and its use to treat a number of blood and immune-system diseases (Gluckman et al., 1989). Contemporary processing and cryopreservation techniques allow for the transformation of cord blood from liminal tissue shared by woman and unborn during pregnancy to a banked biological object or commodity (Santoro, 2011). As tissues are removed, kept alive, and banked, bodies are no longer always and only integral ‘wholes’ assumed to overlap non-problematically with the boundaries of the social person. Instead, bodies can be disaggregated, raising important social and economic questions of belongingness, identity, and bodily property and ownership (Dickenson, 2007; Strathern, 2005). Disaggregation of bodies also raises questions of corporeal commodification, or assetization, as parts are used, exchanged, and/or stored.

Social science literature on cord blood banking is relatively lean; however, there is an important body of scholarship that has explored various lines of inquiry. Dickenson’s (2007) work on cord blood banking and bodily property offers a feminist argument for establishing property rights in the cord blood for the women from whom cord blood is collected. In doing so, she presents an alternative to the biomedical designation of the cord blood as belonging to the child based solely on genetic match. Waldby and Mitchell (2006) and Fannin (2013) examine cord blood banking as a form of contemporary tissue economy. Waldby and Mitchell (2006) conceptualize it as a circulating tissue economy and reflect on social relations and models of exchange, whereas Fannin (2013) argues that private cord blood banking more closely resembles a hoarding economy, since the cord blood is held and does not circulate. These differing views of the cord blood economy raise thoughtful debate on tissue (non)use and (non)circulation and various forms of tissue economies. Waldby (2006) also introduces the ‘entrepreneurial subject’ as a new subject produced in private cord blood banking. For the entrepreneurial subject, private banking is a way to invest in one’s own corporeal self and in the promises of new biotechnological futures. Finally, Brown and colleagues have studied the bio-economy, expectations, and bio-politics of cord blood banking (e.g. Brown, 2005, 2013; Brown and Kraft, 2006; Brown et al., 2006, 2011; Martin et al., 2008). They examine the economization of life and demonstrate how discourses of hope and promissory expectations are key to constituting a market for private cord blood banking.

While several studies have interviewed women who have banked (or prospective clients) for their perspectives or thoughts on cord blood banking (e.g. Brown and Kraft, 2006; Fernandez et al., 2003; Geransar, 2010), none have examined what women do to bank cord blood. Informed by the literature on contemporary biotechnologies and commodification and feminist theories that make visible feminized forms of labour, in this article, I analyse women’s work in banking cord blood. This article is based on in-depth interviews with women who banked cord blood in a private bank in Canada. I begin by providing a discussion of some of the key critical work on corporeal commodification and situate private cord blood banking as a process of commodification. Next, I briefly review the feminist scholarship on women’s work and mothering ideology that informs my analysis. By foregrounding and analysing what women do to bank, women’s contribution is highlighted rather than minimized or naturalized; the interactions and tensions between commercial and clinical practices and relations are made visible; and the inseparability of private cord blood banking from women’s embodied reproductive labour and an ideology of ‘intensive mothering’ is demonstrated. Following the analysis of women’s work to bank, I conclude by considering some implications for corporeal commodification and private tissue banking.

In Canada, the first private cord blood bank opened in 1996, enabling some women and couples to save cord blood following birth. Private cord blood banks market their services to pregnant women as a safe and easy process emphasizing the speculative promises of regenerative medicine. Cord blood that is banked in a private bank is held for women and their families for their use in the future if needed. To date, in Canada, cord blood banking has largely been a private, for-profit industry. Currently, there are eight private banks across Canada. The largest private cord blood bank has approximately 39,000 units banked and, since 1996, has released under 20 units for transplant (Weeks, 2012). As these numbers indicate, the vast majority of privately banked cord blood units will not be used, raising concerns regarding the hyperbolic marketing claims made by private banks.¹

This article is part of a larger feminist, qualitative project on private cord blood banking in Canada. For this project, I interviewed women who banked in a private cord blood bank, key informants who work in private banks, and healthcare providers who have assisted with cord blood collection. In addition, I conducted site visits to four private banks in two provinces, British Columbia and Ontario. This article draws on semi-structured, in-depth interviews conducted in 2011–12 with 13 women who banked privately.² All the women interviewed ranged in age from late 20s to early 40s, lived in an urban Canadian city, are white, have completed post-secondary education (most had a graduate-level or law degree), and were married. The women all had young children (ranging from newborn to elementary-school aged) and had banked cord blood within five years of the interview, with the exception of one woman who had banked her child’s cord blood eight years prior to the interview.³ These demographic characteristics match what private bank workers described to me as the women who are most likely to bank. While private banking is ostensibly available to everyone, it is primarily women and couples who have the social and financial resources to bank who do so. Thus, my analysis presents a detailed view of a particular group of mothers who are able to bank cord blood privately.

Corporeal Commodification

Social scientists have long been concerned about the commodification of bodies and body parts (see for example, the special issue of Body & Society [2001, vol. 7, nos 2–3] on body commodification). Scholars have raised a number of concerns including: the exploitation of marginalized people for their biological organs and tissue (Cohen, 2001; Scheper-Hughes, 2001b), transgression of the Kantian distinction between ‘persons’ and ‘things’ (Dickenson, 2007), and the erosion of social solidarity (Titmuss, 1971). Commodification of bodies and parts can be understood in broader and narrower ways. Dickenson (2007: 1) defines commodification of bodies broadly ‘to include private property rights by third parties in tissue, DNA samples, umbilical cord blood and other substances derived from individuals’ bodies’.⁴ Waldby (2006: 63), on the other hand, takes a more narrow view and suggests that while a form of property relation is established between the cord blood and account holder (i.e. the person who banked), the cord blood itself is not a commodity since it does not circulate through market exchange. Recognizing the contested nature of this concept, in this article, I take the view that cord blood banked in a private bank is a form of commodification of body tissue. While cord blood does not enter circulation when stored for personal use, if an account holder fails to make storage payments, then the cord blood becomes the property of the private bank. If this were to happen, it is possible that the cord blood could enter circuits of exchange. As Appadurai (1986) argues, objects or ‘things’ can move in and out of being commodities and thus the process of commodification is not necessarily a singular event. Finally, paying to save tissue for future personal use requires a person to enter into a commercial relation with a private, for-profit company. Framing private cord blood banking as a form of commodification alerts one to the commercial market principles and relations involved in the process of private banking.

Contemporary biosciences and biotechnologies have not only made it possible for different types of body tissue to be commodified, but have also increased the need for body tissue for both scientific and clinical purposes. In particular, women’s reproductive tissues are highly sought after for use in both regenerative medicine and assisted reproductive technologies. Oocytes are necessary for stem cell science involving somatic cell nuclear transfer and in reproductive technologies aimed at assisting women and/or couples who do not have fertilizable oocytes for any number of reasons (Thompson, 2013). The expansion of body parts that can be commodified and the ways in which this is done have also opened up debate regarding body commodification. Some scholars argue that the broad prohibition against buying and selling of body tissue is not only ineffective, but does not necessarily guard against exploitation (e.g. Swanson, 2014). While some forms of commercial exchange for body parts are legally prohibited (e.g. in Canada, the buying and selling of gametes for reproduction), other forms of market exchange are allowable (e.g. buying and selling cells for research purposes).

Further complicating national regulations on commercial exchange of body parts and services, is the transnational character of the assisted reproductive industry rendering national prohibitions ineffective in many instances. While buying and selling sperm is prohibited in Canada, people living in Canada can buy and use sperm from the USA (Tober, 2001). Women and couples in the Global North can purchase surrogacy services of women in India, paying for the services of a ‘mother-worker’ in India (Pande, 2010). For these reasons, and others, some feminists question the broad legal prohibition against buying and selling body tissue. They suggest that neither is it effective in guarding against exploitation (Swanson, 2014), nor is it always in the best interest of the women providing their tissue and/or service (Thompson, 2013). Thompson (2013) argues that prohibiting payment for reproductive tissue and/or services in an effort to protect women from exploitation excludes women from a financial value chain in which all other social actors (e.g. surrogacy company, physician, etc.) are remunerated for their work. Thus, critical and feminist scholars recognize the need for more nuanced views and analyses of payment for, and commodification of, biological tissue and services. One way of providing more nuanced analyses is to better understand women’s labour and their participation in contemporary bio-economies.

Women’s Work and Mothering

Contemporary biotechnologies and bio-economies have inspired work on new and changing forms of labour. Shifts from commodity to non-commodity based bio-economies are associated with changes from material to immaterial forms of labour (such as the knowledge labour of experts) in biotechnology industries (Birch and Tyfield, 2012). In other forms of bio-economies, such as global clinical trials, people recruited to participate in trials engage in contemporary forms of clinical labour that involve following specific clinical regimens in order to satisfy the requirements of the particular clinical trial (Cooper and Waldby, 2014). Another form of contemporary bio-labour is provided by women who are targeted by the stem cell industry and research, which require access to their reproductive tissues (e.g. oocytes, fetal tissue, and cord blood). Cooper and Waldby (2014) suggest that these tissues are involved in a new form of labour, regenerative labour, based on a model of regeneration and not Fordist (re)production.

The feminist critique of the erasure of women’s work in matters of (re)production and regeneration is well established. As Cooper and Waldby (2014) outline, their concept of regenerative labour extends earlier work of Marxist feminists who re-theorized labour and production to conceptualize women’s work in the home as social (re)production and critical to capitalist and market economies. Without engaging in a detailed discussion of the effects of distinguishing some forms of work as ‘labour’ and others not, an important point worth noting is the naturalization of work not identified as labour (Smith, 1987). The naturalization of women’s reproductive work and the model of the female body as a vessel from which medical experts deliver a child or extract cord blood render women largely as passive objects. On both scales – women as embodied persons in matters of reproduction and women’s reproductive tissue as engaged in regenerative labour – feminists have intervened to foreground women’s work.

While on the one hand, women’s labour in matters of reproduction and regeneration has largely been minimized, on the other hand, socio-cultural expectations of women-as-mothers require them to be actively involved in meeting their child’s every need, intensifying their work and obligations as mothers. Sharon Hays (1996) introduced the concept of ‘intensive mothering’ to describe the prevailing contemporary ideology that mothers must be ever-present for their child. Mothers must nurture, listen, and decipher their child’s needs and desires. Although how, and to what extent, mothers of different social modalities (i.e. income, race/ethnicity, sexual orientation, etc.) are able to achieve this differs, in general, they are expected to put their child’s well-being ahead of their own (Hays, 1996). A mother’s selflessness in relation to her child is not only valorized, but expected. Moreover, the temporal range of a mother’s self-sacrifice has been extended to begin not only after the child is born, but prior to conception. For example, many women preparing for pregnancy avoid alcohol and take vitamins to ensure a healthy uterine environment for their future child. Private cord blood banking is another way in which mothers-to-be care for their child’s needs by ‘ensuring’ the future health of their yet unborn child.

Labouring to Bank

Learning about Cord Blood Banking

Women in this study learned about cord blood banking when they were pregnant and preparing for their child. Most of the women in this study explained that either they made the decision to bank and then told their partner that they were going to bank, or when they asked their partner for his thoughts, they were told that since she was having the baby, it was her decision. In a couple of cases, women made the decision to bank together with their partner. While some had heard of friends or family members banking cord blood prior to their own pregnancy, it was only after they became pregnant that women received private banks’ marketing materials through various clinical spaces and experts. For example, some women described seeing ads for private banks in their obstetrician’s waiting room and others were given pamphlets in their prenatal classes. Once alerted to the option of banking cord blood, many women sought out more information and opinions from their friends, family members, and healthcare providers. As Alexandra⁵ described it:

I guess I must have picked it up through the readings or through, when I got pregnant my doctor did discuss it with me as well. Um, nobody recommends any specific place so it just became about finding a healthcare facility that did cord blood that you were comfortable with that was accredited. So I found a lot of that, you were kind of up to your own devices. Um, but I did have some other friends who were pregnant also at the time, um, and yeah, we kind of bumped research off each other to kind of make a decision and, ah, ultimately decide on a facility. (Alexandra)

Although the Society of Obstetricians and Gynaecologists in Canada (2005) recommends against private cord blood banking because of its low likelihood of use, women in this study described their physicians as taking a ‘neutral’ position regarding banking and leaving the decision up to them. While private banks make an effort to establish formal and informal relationships with clinicians and hospitals, physicians are not necessarily experts in cord blood banking and many women are responsible for doing their own research on private banking. In addition to talking to people about cord blood banking, several women also described researching banking through online searches, attending private bank information sessions, and making site visits. This work contributed to an already heavy burden on women to prepare for motherhood through various consumer, lifestyle, and educational practices.

Women, in preparation for motherhood, are responsible for ensuring that they have all the necessary items for their child. From buying the ‘right’ crib to having the ‘best’ stroller, women described feeling overwhelmed not only with all the work involved in knowing how to prepare, but also in the amount of items they had to purchase in order to be prepared. Intensive mothering also includes caring for the health of one’s child through consumer practices that include buying non-toxic toys, organic food, and BPA-free bottles (MacKendrick, 2014). Moreover, these responsibilities do not diminish for women who work outside the home (Christopher, 2012). Private cord blood banking extends the temporal range over which ‘good mothers’ are responsible for their child’s health; that is, even before their child is born, women are encouraged to bank cord blood for their child’s future health. For two women in this study, learning about cord blood banking tied directly in with buying the ‘right’ things for their baby-to-be as they learned of banking at a large retail event geared towards expectant and new parents, the Baby Time Show:⁶

I don't remember how I first heard about cord blood banking. I think that it was probably something that I had come across in the media or whatever, but never processed it until I [was pregnant] and I went to a Baby Time Show or something and I remember seeing a lot of vendors, um, blood banks have set up booths there and so I first asked about it at the Baby Time Show. (Kara)

In addition to clinical entanglements, private cord blood banking is part of the consumer practices of parenthood. Kara learned about cord blood banking as she learned also about the many other items on the market for newborns and young children. Later in the interview she spoke about how private banking was another service she felt morally obligated to buy in order to be a ‘good mother’:

Um, I guess it’s peace of mind. Whatever that’s worth. That if something were to go wrong I would have done everything I could have to, you know, in addition to giving her organic food and feeding her breast milk and using frickin' green cleaner, you know, all these things you do, right, because you want to protect your baby’s health and ensure that they don’t get cancer when they’re 50, or when they’re 10. I'll have done that and that’s like, you know, I did as a mother. I, like, loved her enough to do everything, you know, and I thought of enough to do everything that I possibly could … (Kara)

For Kara, banking cord blood was part of her mothering work to ensure that her child would be healthy in the future. Exemplifying ideas of selflessness and sacrifice, to have banked meant that she had loved her daughter ‘enough’ to spare nothing for her future health. Thus, learning about cord blood banking and deciding to bank were part of the multiple clinical and consumer practices many women were expected to participate in to be responsible mothers.

Registering and Getting the Collection Kit

After women made the decision to bank, they spoke about selecting a bank and registering. Many explained that they chose a bank that was located in or close to the hospital in which they gave birth. Although there are no restrictions regarding which private bank can be used (i.e. as long as the cord blood collection arrives at the private bank within 48 hours of collection, the private bank will process and store the blood), most women were concerned with minimizing the various tasks involved in banking cord blood. As Kara explained, she chose a bank that is co-located in the hospital in which she gave birth because ‘it just seemed simpler’.

At the time of registration, women sign a contract with the bank, complete a medical questionnaire, and receive a collection kit. Given the biomedical determination of the cord blood as the child’s, women sign the contract on behalf of their child whose cord blood is being banked. Although the cord blood is designated as the child’s, women complete the medical questionnaire in order to satisfy Health Canada regulations intended to ensure the safety of the blood being banked. The intercorporeality of a pregnant woman and unborn (Weiss, 1999) and the deeply entangled constitution of both bodies underlies the women’s ability to stand as a proxy for their unborn. The contract that establishes a legal relation between the woman, child, cord blood, and the bank is contingent on her ability to pay the required fees. If the woman is unable to make payments, according to the contract the cord blood becomes the property of the bank.

Once registered, women either take the collection kit home with them, if they have registered in person, or have the kit delivered to them, if they have registered online or by phone. Each private bank has its own specific collection kit; however, they all contain the same basic items including all the material needed to collect the cord blood, a second medical questionnaire, and materials needed to collect maternal blood samples post-birth. Inside the collection kit are sealed packages that contain needles to insert into the umbilical vessel, plastic tubing to direct the cord blood into the collection bag, and vials for maternal blood. As one woman described it:

Um, a little bit overwhelming. Um, it looked, like I said, that it looked pretty fancy, like this, you know, styrofoam box, but it was wrapped in cardboard, like it looked like a Playstation, like a Wii, like some kind of [laughing], it looked like some fancy, it was like ‘Wow, that’s where our thousand bucks are going.’ Um, and then inside, you know, there were these various, you know, hermetically sealed things and then colour photocopies of, like, pictures of stuff, like what thing, like how to take things out in order. So I felt very like, ‘OK this is a big responsibility,’ and there’s like needles in there and stuff. (Kelly)

In addition to the unfamiliarity of the materials in the collection kit, women described the increased responsibility of coordinating the help of others in order to ensure that the kit was available and ready for collection when needed:

Kind of daunting. ’Cause it's like another thing you have to remember, like you have to bring it to the hospital and you don't know what's gonna happen, and you're nervous especially my first time around, you don't know what's gonna happen, kind of, kind of nervous about, ‘Are they gonna remember to do it? Are they gonna get enough?’ You know, a certain amount, you know, all that kind of stuff so. (Sally)

As Sally described, for many first-time mothers, cord blood collection added stress to an already stressful period. Neither the bank nor any healthcare workers who assist in collecting the cord blood are legally liable or held responsible should an inadequate amount of cord blood be collected. Successful cord blood collection requires a minimum volume of cord blood in order to be clinically useful based on current therapeutic uses of cord blood.⁷ Given that women are in labour during the most critical period of cord blood collection, they organized and enlisted the help of others:

Sure. Um, so I was also very preoccupied with making sure that the kit got to the hospital and like making sure that after it was collected, ’cause that’s one thing that they say, that it gets to the place…. But I remember telling my husband, ‘Ok we’re banking, this is one thing you have to remember, tell them to get the cord blood, tell them to, you know, blah-blah-blah.’ And you have to store the kit, that’s the other thing, we couldn’t leave it in the car so it had to be, you know, it had to be at a certain temperature, so it has to be in the house, at the last moment you have to put it in the car and take it with us. (Kara)

Women instructed spouses and family members to give the collection kit to nursing staff when they went to the hospital to give birth and, as outlined in the next section, to call the private bank, and package and label the cord blood unit appropriately. Although women were unable to do the actual work themselves since they had just laboured to birth, they continued to manage and coordinate others.

Collecting Cord Blood

Most discussions about collecting cord blood, academic and lay, separate it from the birthing process. Private banks describe it as an easy additional step during birth that is completed by a physician or midwife following birth. Women’s accounts, however, provided a different picture of cord blood collection. For women, the work of banking cord blood included moving between the clinical role of woman-as-patient and the commercial role of woman-as-consumer. As women giving birth, they were expected to defer to medical authority (most pronounced in cases of physician-assisted, hospital births) and yet, as women banking cord blood, they were responsible for ensuring that the cord blood was appropriately collected. In the first case, the physician or midwife is the clinical expert in relation to the woman, whereas in the second case, s/he is a skilled technician. For several women, the overlapping of clinical and commercial practices and relations required them to assert themselves against physician authority to have cord blood collected. As Donna explained:

Yes. I felt like I needed to. And I think I felt like I really needed to push, um, to, to have it done, um, just because ah, the baby was breech and he was supposed to be very large and I had to have a C-section and then they had to bring in the, um, another guy to actually, another physician to do the surgery, so I had to like say, ‘OK, now here’s the kit. Make sure you do this, OK?’ And like, you know, carried it with me. (Donna)

For Donna, not only did she have to bring the kit with her, she also had to insist on having her cord blood collected and make sure that the correct physician had the kit. While submitting to medical authority as a ‘patient’ undergoing a C-section, she also had to assert herself as a consumer to ‘push’ the doctors to collect cord blood for her. Other women interviewed had unexpected C-section deliveries and were trying to manage cord blood collection in the midst of clinical emergencies:

My husband did not want to see everything. At one point they said, ‘Stand up, your baby’s gonna be born.’ And he stood up and he sat right back down. He’s like, ‘No.’ ’Cause they take, like, all your insides out to get to your uterus so your, like, friggin’ organs are like sitting on your stomach. It’s really, really gross. Ah, so I guess they did it [i.e. collect cord blood]…. I think while I was in recovery [post C-section] … I asked there and I said, like, ‘Did somebody do what they needed to do?’ And they were like, ‘Yeah, yeah, yeah.’ And then I asked my husband, like, three or four times if he did what he needed to do and he was like, ‘It’s done. It’s gone there.’ Because, you know, you have to do it [i.e. call the courier to pick up the cord blood] within two hours. (Sarah)

Well I was worried. I was really worried, right? Because, you know, you have these visions, I didn’t have a vision of some like beautiful birth, I know it’s a pretty traumatic event or can be, but you don’t have visions of a C-section, you know. The recovery is harder, but I was worried, right? You want to make sure everything’s OK with the baby when things like that happen, somebody was running, they ran me down to the OR. So I kept crashing into things in the hallway, like somebody’s on top of me holding my baby up, it’s just like, ‘Oh my god, what’s going on?’ My husband’s pulled away ’cause he’s gotta get a gown on and all that kinda stuff so…. I remember saying to my husband when they were doing it [collecting cord blood], ‘Make sure they get enough.’ Whether he knew that that was enough and they said, they said they knew how much was necessary and they were able to get enough. (Sally)

Both women had complications during their pregnancies and had very difficult births. In spite of their intense and ‘traumatic’ clinical birthing experiences, both women continued to manage cord blood collection by checking with clinical staff and their husbands regarding successful collection immediately following delivery. Ironically, the most critical point of cord blood banking, when the cord blood is being collected, is also the very moment when women are least able to control what happens. Yet, they are responsible for whether or not it is done successfully.

Once the cord blood has been collected, a number of important steps must follow: the bag containing the cord blood must be labelled and placed in a package, the courier must be called to pick up the cord blood, and in some cases the bank must be called within two hours of the birth. These time-sensitive steps are necessary in order for the private bank to receive the cord blood within 48 hours of collection, a requirement for AABB industry standards.⁸ The strict technical timeline imposed on the clinical timeline of labour and birth places extra stress on women. All the women in the study relied on their spouse to assist them with this, but, as several mentioned, their partner was often distracted (for good reason) and they had to remind him/her several times about the cord blood. During cord blood collection, nurses also played a key role in helping women and their partners by packaging the cord blood, placing the appropriate labels, and instructing partners on what needed to be done. While not considered to be part of their clinical practice, many nurses did this additional work without any recognition or additional pay.⁹

Collecting a Maternal Blood Sample and Transporting the Unit

In addition to packing and labelling the cord blood bag, women must provide a post-birth blood sample for the bank. In most cases, birthing room nurses or midwives take the blood sample. However, in at least two hospitals in the Greater Toronto Area, the birth units have an explicit policy prohibiting nurses from collecting maternal blood samples for women who bank privately. This poses a challenge for women giving birth in these hospitals since private banks require women to provide a maternal blood sample 5–7 days post-birth to test for infections according to Health Canada regulations. If a woman does not have her blood taken post-birth by a nurse or a midwife, she must go to a laboratory with the vials and a requisition form provided by the private bank. Several women found it difficult to go to a laboratory, or in one case the private bank itself, to have this done. In the extended quote below, Alexandra describes all the work involved in giving a blood sample:

Which was interesting because apparently [in hospital], the nurses won’t draw your blood for the, for the cord banking, so [the private bank] sends the kit without any vials to [the hospital]. But I had a midwife so the midwife would have drawn my blood, um, so the midwife found some vials because it said we need four purple vials, she said, ‘The vials aren’t here.’ So she borrowed them. She took vials from the hospital, four purple vials and she drew my blood and then [the private bank] called me and said, ‘That wasn’t enough blood. We need you to come down now and, and give us a blood sample.’ And I’m like, ‘Are you kidding me?! I just had a C-section! I gave you blood. Why didn’t you put vials in there?’ And she said, ‘’Cause [the hospital] won’t draw the blood.’ I said, ‘But why didn’t you ask me? My midwife could have drawn the blood.’ So that was, um, that was frustrating…. You have to do it three days post-delivery, within three days post-delivery. So you’re going down when, I wasn’t even standing up straight yet. So that was a little, ah, unfortunate…. Yeah, and here you are, we’re just in [city] so we had someone, my mom stayed with my, like, who do you have to stay with your son? My mom stayed with my son, my husband pulled up on [downtown] Street, I walked up the stairs, I called him, I said, ‘I’m done,’ he pulled up on [downtown] Street. (Alexandra)

For Alexandra, giving maternal blood involved coordination of multiple people and her own efforts to go to a laboratory to provide blood. Her account exemplifies how social resources – midwife, husband, and mother – are necessary to bank cord blood in a private bank. The conditions for Alexandra’s and her midwife’s confusion over the vials for maternal blood are produced, in part, by the insertion of commercial practices in clinical spaces. In an effort to follow the private bank’s instructions, the midwife tracked down ‘purple vials’ only to be told that an insufficient amount of blood had been collected in incorrect vials. Moreover, Alexandra’s description of the challenges of going to a laboratory only days after a C-section delivery demonstrates the tensions of imposing a technical timeline on a clinical timeline of a woman’s post-birth recovery.

A second woman, Sally, also had to go to a laboratory to provide a maternal blood sample; however, in her case, she was unable to give a sample because of the grave health concerns for her child and herself during birth (see Sally’s quote above). Unfortunately, she had to make the trip to the laboratory on her own with her newborn since she had no one to watch her son:

Yeah. Um, but um, I remember going to the, the lab to get a blood test for cord blood. I think I had to get it within five days, I remember going, like he was, like, with me, my little boy was with me at the lab and I had to get it done after the baby was born. So I think they said to try to do it in the hospital, but because there was such an emergency situation with my son it was never done so I had to do, the blood work, the cord blood was done in the hospital, the nurses did not do the blood work I was supposed to get done so I had to go afterwards and get blood work done. (Sally)

The more complicated and difficult the birth, the less likely the maternal blood is to be collected; thus, women who have endured the most challenging births may be required to do the most work to give a maternal blood sample.

Once the cord blood is labelled and packaged, most often with the assistance of a nurse or midwife, women must make arrangements to have the cord blood transported to the private bank. Some banks use specific medical couriers while others do not; in several cases, women asked a friend or family member to take the cord blood collection to the bank’s laboratory. When the laboratory receives the cord blood unit, most banks call the woman to tell her that they have received it and confirm the volume of cord blood they have received. From here, the cord blood enters the private bank’s laboratory where technicians process, freeze, and store the cord blood.

Discussion and Conclusion

Through the various steps outlined above, cord blood is transformed from shared, intercorporeal material that mediates woman and baby to a cord blood unit, a biological object or commodity held in a metal cassette and stored deep inside a liquid nitrogen tank. Foregrounding women’s work in producing the cord blood unit opens up the multiple social and institutional relations involved in this specific case of corporeal commodification. Doing so demonstrates how commodification is not limited to specific ‘expert’ locations, such as a laboratory, but involves various spaces and locations including hospitals, clinics, and commercial parenting events. Moreover, examining women’s work expands the time frame of commodification such that it does not begin when the biological material is received at a laboratory (i.e. when technical expertise is applied), but well before this moment. Considering corporeal commodification in these broader terms encourages us to think more broadly about the multiple processes of commodification and our own participation in these processes. A broader conceptualization of commodification also enables broader academic and political discussion that moves beyond normative debates regarding commodification. While normative debates are important and necessary, as scholars have pointed out (e.g. Hoeyer, 2007; Swanson, 2014; Thompson, 2013), it is important to consider questions beyond whether or not corporeal commodification is ‘good’/‘bad’, or should be allowed/not be allowed.

Women’s work in cord blood banking shows how processes of corporeal commodification overlap with medicalization and commercialization of pregnancy and motherhood. In this case, commodification processes rely on clinical practices of pregnancy and childbirth, producing the conditions for confusion and challenges for women who bank. This is most evident when cord blood is being collected and women must provide a post-birth blood sample. Private cord blood collection requires the help of midwives, physicians, and nurses and it is women-as-consumer who must ensure that healthcare professionals know what to do and when, while at the same time, in a clinical setting, they are ‘patients’ giving birth. Women must navigate and respond to institutional and technical regulations – such as hospitals prohibiting nurses to assist with blood samples (clinical regulations) and regulations requiring blood samples within a short timeframe post-birth (commercial regulations) – that may conflict with each other. Women are, thus, responsible for managing the various requirements for banking and the clinical relations in order to bank cord blood. Notwithstanding the many women and couples who cannot bank cord blood privately because of financial and social resources, even those who can afford to do it may find it much more difficult than the private banks and clinicians assume.

Women’s participation in private cord blood banking is reinforced by and reinforces motherhood ideologies that require women-as-mothers to do everything they can for their child. Even for those women in this study who had concerns about for-profit enterprise in healthcare and were not entirely convinced of the uses of new biotechnologies, the feelings of maternal guilt that would arise if they did not bank trumped these concerns. Corporeal commodification, in this case, was inseparable from women’s responsibilities as ‘good mothers’. Private banking also reinforces and extends intensive mothering by expanding the temporal frame of health concerns mothers are responsible for managing (i.e. the future health of their unborn child) and the way in which these health conditions are managed (i.e. by having a biological treatment if and when it is needed). Situating commodification within broader ideologies and discourses is also an important consideration for other forms of private tissue banking, such as social egg freezing for women of reproductive age. With social egg freezing women are encouraged to freeze their eggs in a for-profit bank for their own future use (Inhorn, 2013).¹⁰ As with private cord blood banking, the ‘option’ of freezing one’s eggs situated within ideologies of exercising control and valorizing one’s own biological children may circumscribe what some women view as their ability not to choose to freeze their eggs.

In addition to the embodied reproductive labour of generating and sustaining cord blood throughout pregnancy, and the labour of bringing a child into being and expelling the afterbirth, women must work to bank cord blood. In this article, I have shown the many ways women labour to provide the necessary conditions for a successful cord blood collection. From learning about cord blood banking and registering with a bank to coordinating the collection of the cord blood and its packaging and transport, women work together with partners, family members, and healthcare professionals to bank cord blood.

Footnotes

Acknowledgements

Many thanks to the women who generously shared their time and experiences with me, and to the anonymous reviewers for their valuable feedback. This project was funded by a Social Sciences and Humanities Research Council Doctoral Fellowship.

Notes

References

Appadurai

(1986) Introduction: Commodities and the politics of value. In: Appadurai

(ed.) The Social Life of Things: Commodities in Cultural Perspective. Cambridge: Cambridge University Press.

Ballen

Barker

Stewart

Greene

Lane

(2007) Collection and preservation of cord blood for personal use. Biology of Blood and Marrow Transplantation 14: 356–363.

Birch

Tyfield

(2012) Theorizing the bioeconomy: Biovalue, biocapital, bioeconomics or … what? Science, Technology and Human Values 38(3): 299–327.

Brown

(2005) Shifting tenses: Reconnecting regimes of truth and hope. Project Muse 13(3): 331–355.

Brown

(2013) Contradictions of value: Between use and exchange in cord blood economy. Sociology of Health & Illness 35(1): 97–112.

Brown

Kraft

(2006) Blood ties: Banking the stem cell promise. Technology Analysis & Strategic Management 18(3–4): 313–328.

Brown

Kraft

Martin

(2006) The promissory pasts of blood stem cells. BioSocieties 1(3): 329–348.

Brown

Machin

McLeod

(2011) Immunitary bioeconomy: The economisation of life in the international cord blood market. Social Science & Medicine 72: 1115–1122.

Cattapan

Hammond

Haw

Tarasoff

(2014) Breaking the ice: Young feminist scholars of reproductive politics reflect on egg freezing. International Journal of Feminist Approaches to Bioethics 7(2): 236–244.

10.

Christopher

(2012) Extensive mothering: Employed mothers’ constructions of the good mother. Gender & Society 26(1): 73–96.

11.

Cohen

(2001) The other kidney: Biopolitics beyond recognition. Body & Society 7(2–3): 9–29.

12.

Cooper

Waldby

(2014) Clinical Labor: Tissue Donors and Research Subjects in the Global Bioeconomy. Durham, NC: Duke University Press.

13.

Dickenson

(2007) Property in the Body: Feminist Perspectives. New York: Cambridge University Press.

14.

Fannin

(2013) The hoarding economy of endometrial stem cell storage. Body & Society 19(4): 32–60.

15.

Fernandez

Gordon

Van den Hof

Taweel

Baylis

(2003) Knowledge and attitudes of pregnant women with regard to collection, testing and banking of cord blood stem cells. Canadian Medical Association Journal 168(6): 695–698.

16.

Flegel

(2009) Ten reasons to make cord blood stem cells a public good. Canadian Medical Association Journal 180(13): 1279.

17.

Geransar

(2010) The Meaning and Significance of Informed Consent in Tissue/Blood Donation: An Exploration of Theoretical Foundations and Donor Perspectives Through a Collective Case Study of Canadian Public Cord Blood Banks. PhD dissertation, Department of Community Health Sciences, University of Calgary, Calgary, AB.

18.

Gluckman

Broxmeyer

Auerbach

Friedman

Gordon

Devergie

. (1989) Hematopoietic reconstitution in a patient with Fanconi’s anemia by means of umbilical-cord blood from an HLA-identical sibling. New England Journal of Medicine 321(17): 1174–1178.

19.

Hammersley

Atkinson

(2007) Ethnography: Principles in Practice, 3rd edn. London: Routledge.

20.

Hays

(1996) The Cultural Contradictions of Motherhood. New Haven, CT: Yale University Press.

21.

Hoeyer

(2007) Person, patent and property: A critique of the commodification hypothesis. BioSocieties 2: 327–348.

22.

Inhorn

(2013) Women, consider freezing your eggs. CNN.com, 9 April. Available at: http://www.cnn.com/2013/04/09/opinion/inhorn-egg-freezing (accessed March 2016).

23.

Kaimal

Smith

Laros

Jr Caughey

Cheng

(2009) Cost-effectiveness of private umbilical cord blood banking. Obstetrics & Gynecology 114(4): 848–855.

24.

Katz

Mills

(2010) Cord blood banking in France: Reorganising the national network. Transfusion and Apheresis Science 42(2010): 307–316.

25.

MacKendrick

(2014) More work for mother: Chemical body burdens as a maternal responsibility. Gender & Society 28(5): 705–728.

26.

Martin

Brown

Turner

(2008) Capitalizing hope: The commercial development of umbilical cord blood stem cell banking. New Genetics and Society 27(2): 127–143.

27.

Pande

(2010) Commercial surrogacy in India: Manufacturing a perfect mother-worker. Signs: Journal of Women in Culture and Society 35(4): 969–992.

28.

Samuel

Kerridge

O’Brien

(2008) Umbilical cord blood banking: Public good or private benefit? Medical Journal of Australia 188(9): 533–535.

29.

Santoro

(2009) From (public?) waste to (private?) value: The regulation of private cord blood banking in Spain. Science Studies 22(1): 3–23.

30.

Santoro

(2011) Liminal biopolitics: Towards a political anthropology of the umbilical cord and the placenta. Body & Society 17(1): 73–93.

31.

Scheper-Hughes

(2001a) Bodies for sale – whole or in parts. Body & Society 7(2–3): 1–8.

32.

Scheper-Hughes

(2001b) Commodity fetishism in organs trafficking. Body & Society 7(2–3): 31–62.

33.

Smith

(1987) The Everyday World as Problematic. Boston, MA: Northeastern University Press.

34.

Society of Obstetricians and Gynaecologists of Canada (2005) Umbilical Cord Blood Banking: Implications for Perinatal Care Providers. SOGC Clinical Practice Guidelines 156, March 2005. Available at: http://sogc.org/wp-content/uploads/2013/01/gui156ECPG0503wDisclaimer2.pdf (accessed 26 November 2013).

35.

Strathern

(2005) Kinship, Law and the Unexpected: Relatives Are Always a Surprise. Cambridge: Cambridge University Press.

36.

Swanson

(2014) Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America. Cambridge, MA: Harvard University Press.

37.

Thompson

(2013) Good Science: The Ethical Choreography of Stem Cell Research. Cambridge, MA: The MIT Press.

38.

Titmuss

(1971) The Gift Relationship: From Human Blood to Social Policy. New York: Pantheon Books.

39.

Tober

(2001) Semen as gift, semen as goods: Reproductive workers and the market in altruism. Body & Society 7(2–3): 137–160.

40.

Wacquant

(2001) Whores, slaves, and stallions: Languages of exploitation and accommodation among boxers. Body & Society 7(2–3): 181–194.

41.

Waldby

(2006) Umbilical cord blood: From social gift to venture capital. BioSocieties 1: 55–70.

42.

Waldby

Mitchell

(2006) Tissue Economies: Blood, Organs, and Cell Lines in Late Capitalism. London: Duke University Press.

43.

Weeks

(2012) Why banking on cord blood isn’t necessarily a good idea. The Globe & Mail, 26 May. Available at: http://www.theglobeandmail.com/life/health-and-fitness/why-banking-on-cord-blood-isnt-necessarily-a-good-idea/article4209835/?page=all (accessed 11 December 2014).

44.

Weiss

(1999) Body Images: Embodiment as Intercorporeality. New York: Routledge.