The noble placenta

While admittedly not easy on the eye, the noble placenta perhaps deserves a little more respect than it typically receives. Sarah Tennant champions the cause of this remarkable organ.

One of my favourite scenes in the vastly underrated Bridget Jones: The Edge of Reason (the book, the film’s rubbish) has Bridget’s freshly postpartum friend Magda horrifying her childless girlfriends by mentioning lochia and mastitis. Writes Bridget: “Gah. Why do Smug Married girls do this, why? Casually launching into anecdotes about slashings, stitchings and effusions of blood, poison, newts and God knows what as if making light and delightful social chitchat.”

Oh, so true. I’ve chatted with new mothers about their second-degree tears before we’ve even exchanged names. Worse, I’ve found myself enthusiastically educating civilians – for instance, my single male friends – on the causes of reverse dilation and the barbarity of routine episiotomies. So it is from a position of some experience that I dare to define the one thing about childbirth which causes grown men to shudder most: the placenta.

Makes sense, I suppose. You can poeticise birth to an extent – tactfully soft-focus it with concepts about life and transformation. You can’t poeticise a placenta. It’s just there, lurking in the kidney dish – a bloody half-deflated balloon with a liverish smell and a severed umbilical cord plugged into the middle. It’s the slightly grotesque interruption to bonding with your newborn; an insulting postscript to labour pain, which I’ve always felt should cease immediately and completely at the moment of birth. It’s not something that shows up in the average movie birth scene, or in the newborn photos; more often than not, it’s bundled off to the hospital incinerator and never thought of again.

Which is hardly fair because placentas are pretty awesome. They’re the only organ grown by committee – a placenta has maternal and fetal components – and the only temporary, disposable organ. Plus, Jennifer Lopez smears them on her face to combat the ageing process (in a collagen mask form, not straight out of the delivery room).

In pre-scientific cultures, this mysterious organ is given a lot more respect. Among the Ibo of Nigeria and Ghana, the placenta is considered to be the stillborn twin of the living child; other tribal groups believe it to be an older or younger sibling of the baby, with the power to protect and communicate with the child. Another widespread belief links the placenta with the baby’s native land; the Maori word for placenta, ‘whenua’, also means ‘land’. (‘Placenta’ itself is Greek and means ‘flat cake’).

On closer inspection
While Western medicine has pretty much nixed the twin theory, the placenta is still something of a mystery. Here’s what we do know:

The placenta starts forming very early on in pregnancy —at around six days after fertilisation. The placenta will gradually spread over the surface of the uterine wall as it grows. Most locations are okay, but placenta previa (where the placenta grows over the cervix, blocking the baby’s exit route) and placenta accreta (where the placenta imbeds too deeply into the uterine wall, usually at the site of scarring from a C-section or D&C) are both problematic and looked out for in prenatal scans.

By the fifth week of pregnancy the umbilical cord has formed and the placenta can begin nourishing the baby by transferring nutrients, as well as oxygen, from the mother’s blood supply. From 14 weeks onwards the placenta also provides the baby with immunoglobulins to protect against disease. Additionally, it secretes prostaglandin and estrogenic hormones, which help maintain the pregnancy and prepare the mother’s body for lactation.

The placenta has a delicate job – it must allow nutrients and oxygen to pass from mother to baby (and waste products to pass the other way) while ideally preventing harmful substances from entering the baby’s system. In fact, though people often talk about the ‘placental barrier’, the placenta allows all sorts of nasties through including alcohol, lead and nicotine. The term placental barrier more correctly refers to the fact that the maternal and foetal blood supplies do not mix – fortunately, as mother and baby may have different blood types!

Research about placentas is still ongoing. At one time the placenta was thought to be sterile. A recent study has shown that in fact, it contains a ton of good bacteria, possibly originating from the mother’s mouth, which colonise the baby’s gut with (hopefully) the correct flora. As these flora were previously thought to colonise the baby from the birth canal – meaning C-section babies lost out – this is good news for babies who never made it that far down. The downside is that ‘bad’ bacteria from periodontal disease or UTIs can also show up in the placenta, and are linked to premature and underweight babies.

Best before
Another area of controversy is placental ageing. Conventional wisdom is that the placenta, like a cheap dishwasher, has ‘planned obsolescence’; that is, it’s not built to last forever. As a pregnancy nears completion the placenta begins to degenerate, slowly calcifying and becoming less efficient; hence the higher mortality rate among newborns born after 42 weeks.

However, Harold Fox, a professor of pathology, argued that the placenta in fact remains efficient throughout its lifespan; that low amniotic fluid and macrosomia (large babies) are responsible for the increase in post-term mortality, not the placenta; and that so-called old placentas are not in fact any more calcified than their younger counterparts.

Mission complete
When a baby is born, the placenta pumps the foetal blood supply down the umbilical cord for the final time, ceasing to oxygenate the blood as the baby’s lungs take over. This takes a few minutes; New Zealand’s policy of delayed cord clamping ensures the baby gets all her rightful blood. The placenta also pushes the maternal blood supply back into the mother’s body; minus all this blood, it shrinks considerably. Under the influence of oxytocin a clot forms on the uterine wall behind the placenta as it shears off, usually from the centre outwards. A few pushes, and the placenta should ‘goosh’ out. Most mothers find this minimally painful – a placenta’s fairly large, but it’s squishy and has no shoulders.

With an expectant third stage of labour – that is, waiting around – the placenta usually births within around 30 minutes. Oxytocin can be stimulated by breastfeeding the newborn and massaging the mother’s abdomen. A managed third stage encourages the placenta out with a shot of synthetic oxytocin, and is slightly lower-risk in terms of excessive bleeding. Once out, the placenta will be examined to make sure it’s all there and looks healthy.

And what then?
Socially acceptable uses of the placenta include burying it, possibly under a tree, and keeping it in the freezer for years until a power cut prompts you to toss it out with the gravy beef and frozen peas.

Non-socially acceptable uses are beginning to creep in though. Some mothers make placenta prints, inking the placenta like a giant rubber stamp to capture the ‘tree of life’ blood vessels on the foetal side. Admittedly, they do look a lot prettier in silhouette – perhaps you can poeticise a placenta after all.

Or, of course you can eat it. There’s the poetry out the window again.

A few facts about placentophagy. It’s practiced by most mammals; some say to get rid of the blood-scented placenta before it attracts predators, some say to replenish the mother’s vitamins and hormones. In humans, the jury is out on whether or not it constitutes cannibalism – the placenta is a human organ, but not a human being, placing it on the extreme dark side of the same grey area that houses biting your fingernails. And oddly enough, because it’s an organ which can be freely given by a creature who was not exploited in the harvesting, a placenta is technically vegan. Feel free to bring up this fact at parties; I do.

Truly committed mothers consume the placenta raw, often in smoothies. It can also be stir-fried, stewed or roasted, attaining a flavour and texture similar to liver. For the squeamish (including, incidentally, January Jones, Betty Draper off Mad Men) the placenta can be steamed, sliced, dried like jerky and pulverised into an innocuous greyish powder, to be poured into capsules and taken over time as pills.

Full disclosure: that’s what I did. Or more accurately, got my husband to do – poor thinking on my part, as he’s never been at ease in the kitchen and managed to burn Placenta #2 to cinders. “It took me NINE MONTHS to grow that!” wailed my postpartum self. (Googling now, I see I could have gotten Baby Tree Placenta Services NZ to do it for $250, including placenta prints and a ‘cord keepsake in a beautiful organza bag.’ What might have been.)

Did Placenta #1, the non-burned version, do me any good? Maybe. It did seem to stave off post-partum depression while I was taking the pills – I got it shortly after finishing them – but that’s not exactly hard evidence.

Peer-reviewed-studies-wise, there’s not much to go on. A 1954 study showed that placenta pills increased lactation in new mothers, but that’s about as recent as the research gets. As far as negative effects go, there’s no evidence one way or another. No-one has been recorded as perishing from placenta-borne scrapie or e.coli, though gagging on the smoothies is a legitimate concern.

One last point about placentophagy? In some cultures, it’s not just the mother who partakes, but her friends and family. Try mentioning that one to your single male friends while sharing a casserole.

Sarah Tennant is a Hamilton-based freelance writer. She is pregnant with her third child but undecided as to the eventual fate of the placenta once it has completed the good work of nourishing her baby.