And the parents are supposed to do all that?

N1:  Well  they  are,  yeah.  And  some  nurses  will  say,  “Oh  I  don’t  know  anything  

about  that.  That’s  yours.”  And  just  kinda  leave  it  at  that,  even  though  they  do   because  we’ve  done  so  many  of  them.  But  it  becomes  a  hassle  because  you’re   kinda  doing  so  many  other  things  once  the  delivery  has  happened.  You’re   trying  to  clean  up  the  mom,  you’re  checking  on  the  baby,  they’re  usually   really  interested  in  breast  feeding  right  away  so  you’re  trying  to  get  all  these   other  things  done,  trying  to,  um,  catch  up  on  your  charting  a  little  bit  if  you   weren’t  able  to  chart  those  last  fetal  heart  rates  at  the  end,  um,  you’re  trying   to  check  on  her,  check  her  blood  pressure,  check  her  fundus,  make  sure  the,   er,  oxy-­‐,  oxytocin  is  infusing  afterwards.  Um,  so  there’s  a  bunch  of  different   things  you’re  trying  to  do  and  they’re  trying  to  get  this  cord  blood  together   and  you’re  kinda  saying,  “That’s  your  job.”  But  the  dads  are  always  kinda   look-­‐,  scratching  their  head,  ‘cause  they  know  it’s  an  expensive  thing  for  them   to  purchase  and  I  know  that  they  don’t  want  to  screw  it  up,  um,  so  I  normally   help  them,  but  I  know  a  lot  of  other  nurses  don’t.  They  say,  “That’s  yours.   Read  the  instructions.”  

The  nurse’s  quote  paints  a  compelling  picture  of  the  collection  and  post-­‐collection   activities  in  a  hospital  birthing  room  and  the  work  that  many  nurses  do  to  ensure  a   successful  cord  blood  collection  and  transport.    She  describes  the  unrecognized,  but   crucial  work  of  informing  the  doctor  that  there  is  a  cord  blood  collection,  of  

arranging  the  materials  in  the  kit  on  the  sterile  delivery  tray  for  the  physician,  and  of   assisting  partners  with  labeling  and  packing  up  the  cord  blood  unit.    Nurses  who   assist  with  the  post-­‐collection  work  do  so  in  addition  to  their  clinical  work  of  

managing  women’s  recovery  post-­‐birth  and  managing  the  third  phase  of  delivery  in   which  a  woman’s  uterus  must  be  monitored  for  hemorrhaging.    Clearly,  successful   cord  blood  collections  by  physicians  in  hospitals  depend  on  the  work  of  nurses,   extra  work  that  private  banks  and  hospitals  do  not  recognize  or  remunerate.       Another  important  step  in  cord  blood  collection  is  the  proper  packing  and   labeling  of  the  cord  blood  unit  for  transport  to  the  private  bank.    The  labels  require   identifying  information  such  as  the  names  of  the  woman  and  physician,  the  date  and   time  of  birth  and  cord  blood  collection.    Nurses  often  assist  partners  with  these   labels  since  s/he  may  miss  details  such  as  the  name  of  the  attending  physician   and/or  the  specific  time  of  birth  given  the  excitement  and  circumstances  of  the  

birthing  experience.    Packing  the  cord  blood  collection  involves  placing  the  cord   blood  in  specific  biohazard  bags  and  sealing  them  for  transport.    Each  private  bank   has  its  own  specific  labeling  and  packing  instructions  requiring  partners  and  nurses   to  follow  instructions  specific  to  each  bank.    N1  described  one  collection  for  a  bank   that  required  the  cord  blood  collection  tube  be  flushed  prior  to  packing  and  sealing.     She  explained  that  the  partner  who  was  charged  with  this  responsibility  was  

confused  with  this  technical  requirement  and  so  she  assisted  with  flushing  the  tube.     Nurses  straddle  both  clinical  practice  and  the  commercial  requirements  of  the   private  banks  and  do  much  of  the  unrecognized,  yet  necessary  work  required  for  a   successful  cord  blood  collection.  

Once  the  cord  blood  is  labeled  and  packaged,  most  often  with  the  assistance   of  a  nurse  or  midwife,  partners  often  called  a  courier  or  a  family  member,  to  pick  up   the  cord  blood  unit  and  take  it  to  the  private  bank’s  laboratory.    Some  private  banks   require  women  and  couples  to  use  specific  medical  couriers  to  transport  the  cord   blood,  while  other  banks  allow  women  to  choose  their  mode  of  transport.    In  the   case  of  one  private  bank,  the  medical  courier  they  require  transports  the  cord  blood   in  a  bag  that  contains  a  computer  chip  that  monitors  the  temperature  of  the  bag   from  the  time  it  picks  up  the  cord  blood  unit  to  the  moment  it  drops  it  off  at  the   laboratory.    The  information  on  this  computer  chip  is  downloaded  onto  a  computer   and  the  bank  maintains  a  record  of  the  specific  temperature  and  temperature   variation  of  the  cord  blood  from  the  moment  of  pick  up.    Thus  begins  the  highly   technical  process  of  transforming  the  cord  blood  unit  to  a  bankable  product.      

Conclusion  

  In  her  book,  More  Work  for  Mother,  Ruth  Cowan  (1983)  shows  how  

industrialization  of  the  home  and  the  introduction  of  new  “time  saving”  appliances,   such  as  the  microwave,  actually  increased,  not  decreased,  women’s  domestic  work.     Private  banks  market  cord  blood  banking  as  requiring  very  little,  if  any,  work  by   women.    However,  unlike  the  marketing  rhetoric  of  private  banks  that  erase  

women’s  work  in  banking,  I  show  in  this  chapter  how  women  are  crucial  to  the   successful  collection  of  a  cord  blood  unit.    Moreover,  I  argue  that  women  actively   engage  in  coordinating  work  between  the  clinical  practices  and  logics  of  the  hospital   and  the  commercial  practices  and  logics  of  the  private  bank.    I  show  how  the  

insertion  of  commercial  practices  into  a  clinical  space  produces  tensions  and   potential  confusion  among  the  various  social  actors  and  most  often  women  and   nurses  step  in  to  do  the  work  needed  to  collect  cord  blood.    I  also  suggest  that   private  cord  blood  banking  is  another  example  of  the  domestication  of  health   technologies  or  tools  (Childerhose  &  MacDonald  2013)  in  which  the  work  and   responsibility  for  the  use,  or  production,  of  the  health  tool  is  shifted  from  clinicians   to  laypeople  and  from  exclusively  inside  the  clinic  to  outside  or  multiple  sites.     Ironically,  at  the  most  crucial  point  of  cord  blood  collection  post-­‐birth,  women  feel   the  height  of  responsibility  and  yet  are  least  able  to  intervene  physically.    In  spite  of   this  physical  challenge,  they  were  actively  engaged  in  ensuring  the  cord  blood  had   been  collected.    Even  when  women  were  lying  on  a  hospital  bed,  many  having  had   their  bodies  surgically  opened  up  to  deliver  their  child,  they  spoke  about  asking   about  the  cord  blood  and  worrying  about  whether  or  not  enough  had  been  collected.         Science  and  technology  scholars  have  studied  the  production  of  biological   materials  as  research  tools  or  objects  for  scientific  research.    Scholars  have   examined  the  cultural  and  scientific  production  of  specific  cell  lines,  such  as  the   HeLa  cell  line,  as  scientific  tools  to  study  specific  diseases  (Landecker  2007),  the   procurement  and  use  of  female  reproductive  tissues  for  use  in  stem  cell  science   (Waldby  &  Cooper  2008),  and  the  transformation  and  standardization  of  entire   organisms,  such  as  the  OncoMouseTM_{,  into  research  tools  (Haraway  1997).    In  this}  

Chapter,  I  have  foregrounded  the  experiences  of  women  to  analyze  their  work  in   banking  cord  blood.    In  addition  to  the  work  of  experts  and  technicians,  I  argue  that   women  are  key  actors  in  transforming  biological  materials  into  valuable  objects  that   are  implicated  in  contemporary  bioeconomies.    In  the  next  chapter,  I  follow  the  cord   blood  unit  once  it  has  been  received  at  the  private  bank’s  laboratory  and  turn  to  a  

detailed  analysis  of  the  socio-­‐technical  process  of  transforming  the  collected   cord  blood  to  blood  stem  cells  that  are  cryopreserved  for  future  use.    I  focus  my   analysis  on  the  production,  and  loss,  of  value  in  the  cord  blood  stem  cells  as  it  is   produced  into  a  potential  therapeutic  object.      

Chapter  4:     From  “Waste”  to  (Fool’s)  “Gold”:  The  Unstable  Biovalue  of