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Cloth diapers: Choosing our “stash”

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TL;DR: It’s prefolds with covers.

As a would-be first-time mother, I’m a total newbie to modern cloth diapering. Here in the Philippines, I’ve only ever seen disposable diapers, which rule supreme, and the traditional lampin (flat cloth diapers) on babies. (I myself was a lampin baby, as apparently I wouldn’t stop crying when they made me wear disposables).

As my due date grew nearer, I started researching on diapering options online, and was surprised to discover that cloth diapers are all the rage these days. They now come in all shapes and sizes, not just flats. The thought of not dumping more disposables to landfills appealed to my husband and I, so we decided to go with cloth diapers. We still plan to use disposables at night and when going out (we love the environment and all, but we’re not martyrs). Family members also gifted us with lots of Pampers Swaddlers and Baby Dry newborn diapers, so we plan to start cloth diapering at three months.

Anyone who has ever Googled cloth diapers will know that the web is strewn with mommy blogs obsessed with them. These moms have mountainous “stashes” of various cloth diapers. The wide range of choices — and opinions on which one is the best — certainly didn’t make it easy for me to settle on which type and brand of cloth diaper to buy. I did know that I wanted a one-size-fits-all one that can be used all throughout our child’s first years.

SoftBums All-in-Two (AI2) cloth diaper
Source: SoftBums

My initial choice was SoftBums, an All-in-Two (AI2) cloth diaper consisting of an outer cover and an absorbent insert. It was the only one I came across that uses an elastic drawstring (apparently their own patented invention) instead of rise snaps to adjust the size of the cover. It seemed to me that this drawstring system is more likely to provide an exact fit compared to rise snaps, which offer limited adjustment settings.

It was the cost that dissuaded me from going with SoftBums, as they are considerably more expensive than other brands. In addition, the inner lining of their covers is fleece, which I feel is too warm for the weather here. Fleece also soils easily, which means the covers aren’t that reusable. (It didn’t help matters that apparently the owner of SoftBums is a drama queen who can’t take criticism of her product and argues with reviewers online.)

Looking further for a cheaper alternative, I started to lean towards prefold cloth diapers. They seemed intimidating at first with all the folding and pinning involved, but the price can’t be beat. Besides, if my parents managed to lampin me for 2+ years, surely my husband and I could handle prefolds, right?

Now the real question was, which brand? We were actually gifted with a bunch of Gerber prefolds, but it appears that most people use them as burp cloths, and their performance as actual diapers leaves a lot to be desired.

Diaper Rite natural (unbleached) cotton prefold diapers
Source: Diaper Junction

After researching some more, I finally went with the highly-regarded yet affordable prefolds by Diaper Rite, the store brand of the diaper specialty store Diaper Junction. We bought 30 pieces of the natural (unbleached) cotton ones in the largest size, as babies grow big fast (I figured we could just fold the prefold at the back while the baby is still small). As for fasteners, I chose the Snappi over the Boingo.

Next up was the diaper cover. Mom bloggers say it’s a necessity when using prefolds, but the modern cover is a fairly recent trend, at least here in the Philippines. Before the disposable diaper became king here, Pinoy babies of yore — myself included — simply wore lampin secured with safety pins and nothing else. Before our child starts to crawl, we plan to do the same and go coverless most of the time. I feel it would be more presko that way, especially with the warm weather here.

So just a few covers for us, but which brand? I was heavily leaning towards another AI2 diaper, the popular Duo Wrap by Thirsties. Unlike SoftBums, the Duo Wrap is a PUL-only cover, which can be easily wiped for reuse. It comes in a lot of cute colors and prints, and can be used with flats, prefolds, inserts, or fitteds. The feature that attracted me the most was the leg gussets for added leak protection. The only downside is that it’s not one-size — it comes in two sizes, hence the name. While at first glance it appears cheaper than SoftBums, in the end it comes out as more expensive since you eventually have to pony up for the Size 2 when the baby gets bigger. 

I overlooked it when I bought their prefolds, but browsing through Diaper Junction again, I noticed they had their own brand of diaper cover, the Diaper Rite 3.1 One Size Diaper Cover. Like the Thirsties Duo Wrap, it’s PUL-only and comes with leg gussets. It’s basically the Duo Wrap’s cheaper cousin that comes in just one size (the description says it can fit babies up to 35 lb).

I was a bit hesitant at first, because outside the high ratings on its product page, I only found this blog review and the video feature above. The baby in the video looks happy enough wearing it, though, so we went ahead and bought six covers.

That brings our cloth diaper “stash”, which is on its way in a balikbayan box, to 30 prefolds, six covers, and five Snappis. The total cost is only about USD 130, which isn’t bad compared to disposables. As for other costs, we plan to just handwash and line-dry them (an added challenge, I know), so no extra electricity charges. Water is inexpensive here, and so is detergent.

Of course, the real test of these cloth diapers is yet to come, and we can’t wait to use them with our baby. Here’s hoping my husband and I are up for the challenge.

Private umbilical cord blood banking in the Philippines: Yea or nay?

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TL;DR: After reading many academic articles on the subject, It’s a NAY for us. Click here to jump directly to our detailed rationale. Fellow parents considering cord blood banking in the country will find it helpful. O’Connor et al (2012) sum up our sentiments:

“Currently, there are few clinical indications for autologous transplants using stored cords. Cord blood is stored privately largely on the assumption that it will eventually prove to be an important source…for regenerative medicine. Regenerative medicine remains little more than a promising possibility…and although some clinical trials are currently underway, the value of cord blood in this wider enterprise also remains uncertain. The medical utility of private cord blood banks is thus more potential than actual… [Private banks] market their services by tapping into parents’ sense of obligation towards their own children, and parents’ anxiety that they may in future regret having missed the opportunity to protect their children and feel guilty for doing so.”

My husband and I are expecting our firstborn in a few months, and one of the things we discussed was whether or not to preserve the baby’s umbilical cord blood (UCB) for potential future use. UCB is rich in hematopoietic stem cells, which are used to treat hematological disorders such as anemia and leukemia.

In several other countries like the USA, there are public cord blood banks that accept and store donations for free. Sadly we do not have such an institution in the Philippines, where only private, for-profit cord blood banking is available.

There are only two options for UCB storage here in the Philippines: Cordlife Philippines and StemCord Philippines. Both are local subsidiaries of private companies with headquarters in Singapore. Their main selling point is that saving the newborn’s UCB is invaluable health insurance, and they really hammer home the fact that the window of opportunity to avail of it is very small — it’s once-in-a-lifetime! It’s during childbirth or never!

Cordlife Philippines umbilical cord blood banking plans and rates
Source: BDO Unibank

As anxious first-time parents, our gut reaction was to bank to avoid later regrets. Between Cordlife and StemCord, the former is more transparent with the cost. Cordlife’s rates for their 18-year UCB storage plan range from PHP 184,800 (if paid up-front) to PHP 230,720 (if paid in annual installments for 18 years).

It’s expensive, but not unattainable. So I searched online for information on these two companies, and the only site with real feedback from local Pinoy parents is this GIRLTalk forum thread. The folks there who actually visited Cordlife’s facility at UP-Ayala Land TechnoHub in Quezon City are unimpressed, saying that it looks like a “kitchen” and is “kakatakot para lang silang magluluto ng kakanin.”

Their descriptions hardly inspired confidence in Cordlife, so we inquired first with StemCord through their Facebook page. Lo and behold, they never followed up after their initial reply. StemCord’s terrible customer service was actually a blessing in disguise, as it cooled our parental knee-jerk response and allowed me to research properly on the matter.

Unfortunately, the web is strewn with obviously sponsored “news” articles and blog posts promoting private cord blood banking. There is a lot of misleading information online, which are certainly not helpful in making a truly informed decision. To separate the wheat from the chaff, I narrowed my search to scholarly articles published within the last several years.

Based on these recent scientific data, we decided NOT to pursue private cord blood banking with either Cordlife Philippines or StemCord Philippines. Below are our reasons why:

  • Our family is at low risk for hematological disorders.

There is no history of blood diseases on either side of the family. The chances of our child or other relatives needing UCB for a hematopoietic stem cell transplantation (HSCT) is low. According to the UK National Health Service, “the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists do not support the commercial collection of cord blood for low-risk families due to the current lack of research evidence to support the procedure.”

Non-hematological disorders like Alzheimer’s and type 2 diabetes do run in our family, and there are clinical trials underway on the use of UCB stem cells to treat such diseases. However, I’m not holding out hope that they will arrive at a standard treatment anytime soon — clinical trials last years, even decades. Many of them are still testing on animals such as mice.

  • There are few established therapeutic indications for autologous HSCT.

If, heaven forbid, our child does need to undergo HSCT, the chances of her using her own UCB is low. There are two main types of HSCT: autologous and allogeneic. An autologous transplant uses a person’s own stem cells, while an allogeneic one uses stem cells from a donor.

Allogeneic HSCT is actually the preferred choice and considered the standard treatment for many blood diseases. According to Waller-Wise (2011), “autologous cord blood stem cells cannot be used to treat malignant cancers such as leukemia because the genetic mutations for the cancer already exist in the DNA of the cord blood. Using one’s own stem cells would be, in effect, ‘contaminating’ oneself with the same disease process.”

Based on the guidelines from the American Society for Blood and Marrow Transplantation for pediatric patients, autologous HSCT is indicated as the “Standard of Care” over allogeneic HSCT only for solid tumors such as Ewing’s sarcoma and neuroblastoma. For the rest, autologous HSCT is “Not Generally Recommended”.

  • The amount of cord blood stored is too small.

According to this mom on the GIRLTalk thread who met with agents of both companies, Cordlife and StemCord only store up to 25 ml and 40 ml of UCB, respectively. (I assume these are post-volume reduction figures after plasma and red blood cells are depleted). Another local mom shares her actual Certificate of Cord Blood Storage from Cordlife on her blog, and it states that her UCB unit has a Total Nucleated Cell (TNC) count of only 7.72 x 108.

This is lower than the storage standard of public cord blood banks. According to Ilic et al (2012), “in the majority of public banks, the criterion for an UCB unit to be considered for storage is >109 [TNC] count…Due to an insufficient number of nucleated cells, ca. 60% of collected UCB is discarded.”

Basically, a public cord blood bank would have thrown out the UCB unit collected by Cordlife. A high TNC count is important, because according to Karasu et al (2014), “approximately 30% of cell loss is expectable in cord blood transplantation because of either cryopreservation or thawing. It should be kept in mind while assessing acceptability of cord blood units with limited cell counts.”

  • A single UCB unit is only enough for one transplant to a child or small adult.

Still, even with the requisite >109 TNC count, Ilic et al (2012) state that “the minimum threshold for an optimal UCB transplant is 2.5 – 5.0 x 107 TNCs/kg of recipient’s body weight…one UCB unit can be sufficient for a [recipient] of 20 – 40 kg.”

Basically, the chances of our kid using her own UCB when she weighs beyond 40 kg are slim. As for adult family members, the likelihood of them using her UCB for an allogeneic HSCT is pretty much zero.

Cordlife even admits it in their own newsletter: “the patient would have to be only 40 kg or less to realize the maximum benefit of these stem cells. This limits the average use of an umbilical cord blood sample to a pediatric setting.”

But what about the possibility of stem cell expansion, you ask? Yes, there are clinical trials underway aimed at increasing the cell dose of UCB. Again, the keyword here is “trial” — I’m not holding out hope that a UCB expansion technique will be available outside the research laboratory anytime soon.

Let’s not forget that even without UCB, all hope is not lost — it’s not the only source of hematopoietic stem cells in the body. There’s still the bone marrow and peripheral blood. That being said, I totally support public cord blood banking. It’s a shame we don’t have such a system here in the Philippines, because I would gladly donate. (Miriam Defensor Santiago actually filed a Senate bill proposing it in 2010, but nothing happened.)