• The Fit Midwife

Your Placenta: You want to do what with it??

Your placenta is an amazing albeit odd looking thing. It is what sustains the life of your unborn baby. Most of you will have heard about it. But not many people know what it actually does, how it works, what it looks like or that you have to deliver it after the baby.

To put this in to context here are some questions that I have had in past antenatal classes from both mums and dads….

‘The placenta stays inside for the next baby right?’

‘ It just comes out attached to the baby doesn’t it?’

‘Does the placenta contain the baby?’

I am not going to lie, I may have had a little giggle with colleagues at some of these. Because sometimes I find it strange that people don’t know these things, then I remember not everyone is actually interested in vaginas and babies and womens health things. So here is what you need to know about your placenta…..

What is the placenta?

Well, basically the placenta is an organ attached to the lining of your womb during pregnancy. It is quite a clever organ, keeping your blood supply and baby’s blood supply separate whilst nuturing the development of your baby.

It looks like a bit of liver and kinds has the same texture. As a general rule of thumb it is about 1/6th the weight of your baby and a generic healthy placenta is the size of a side plate. Here is a lovely picture of one…..

What does the placenta do?

Your placenta is doing the things for your baby they cannot so themselves yet such as breathing, eating, building immunity. It is responsible for providing oxygen, nutrients, hormones and antibodies to nourish and grow your baby. The placenta allows the passage antibodies from you to your baby, giving them immunity for about 3 months after birth. However, it only passes on antibodies that you already have.

It also removes waste products from baby’s blood stream and returns them to yours for you to dispose of.

Remember alcohol, nicotine and other drugs can also cross the placenta and can cause harm to your unborn baby. Which is why we advise the cutting down or stopping (if possible) of any unecessary substances. Sometimes your Doctor may advise you change some medication (such as anti seizures or anti psychotics) to avoid them crossing the placenta to baby. If you are concerned about this, please please see your doctor before deciding to stop them yourself. That often can cause a whole different set of problems.

How is the placenta attached to me and baby?

The placenta is connected to the wall of your womb. One side adheres to the wall and the other side has the umbilical cord and the amniotic sac (the membranes) which houses baby. This is where the waters are. The umbilical cord has 3 blood vessels going between you and baby. 2 veins and 1 artery.

See in that sac of membranes? That is what surrounds your baby.

How does it come out?

There are a couple of ways really. Firstly you can push it out. You just pushed a baby out so you certainly paved the way for a squishy organ. The good thing to mention here is that unlike your baby, there are no bones in the placenta! There are 2 ways of managing this stage (which we call 3rd stage):

  1. Physiological Management: Can be up to 60 minutes long, allow the placenta to separate from the wall of the womb and uterus to contract naturally. Then when this happens you push the placenta out. You will feel pressure, like you do when there is a head there, or you need a really big poo, same same but different. If you are doing this management then get up on the bedpan or toilet or on all4s…. gravity is your friend! There is evidence to suggest that haemorrhage is associated with physiological management but I would anecdotally say that there are many factors that generally lead women to bleed, not just the delivery of their placenta. And good staff manage these situations. That is literally our job!

  2. Active Management: This is when the Midwife gives you an injection (usually syntocinon or syntometrine) in to your thigh or it is given in your IV. This encourages the placenta to separate and the uterus to contract down. This usually happens within 2-3 minutes of delivery of your baby. Instead of pushing, the midwife will pull on the cord slowly, with one hand on your tummy and deliver your placenta. This is generally the preferred method with Doctors, the evidence and guidelines we follow advocate this management, associating it with lower risk of post party haemorrhage. It is also generally quicker which a lot of women prefer.

Your placenta is removed at caesarean section, manually and you are always given a uterotonic drug (usually the syntocinon). But you be so busy watching your new baby that you won’t even think about it.

Can a placenta get stuck?

In a word….. Yes. Sometimes they do not detach from the wall of the womb. Even with the medication. So what happens then? Well there are many things that can be done. Firstly if you can then get up and sit on the toilet. This can shift it. Secondly, have a pee. This can help your uterus contract that little bit more and get that placenta moving. If you are breastfeeding, try and put baby to the breast. That also encourages the uterus to contract.

If it still isn’t moving, there is a procedure called a Manual Removal. And it is exactly what it sounds like….. Have you ever seen a vet put one of those long gloves to birth a cow?? Yeah, it is the removal of a placenta with the Doctors hand. This should ALWAYS be done under a spinal block or very very good epidural in an operating theatre because you do not need to feel them rummaging around more than they have done already! If this is ever suggested to be done in the room without adequate pain anaesthesia then absolutely do not say yes. To be honest if your midwife allows this to happen i’d consider kicking her in the vagina and seeing how she feels about it.

What happens to the placenta after it is delivered?

After the placenta has delivered then your midwife will check the placenta and membranes, to make sure that they're complete and nothing has been left behind and there is nothing unusual about it. If any bits have been left behind then it can increase the risk of you bleeding. So we have the lovely job of checking it. And cold placenta is the single worst thing to check. It smells and feels like raw meat…. But it’s all part of the glamorous job of a Midwife.

Then you can either take it home with you or you can leave in the hospital where we happily throw it in the incinerator!

Should I eat my placenta?

As with everything childbirth related I am absolutely all for choice! If you want to eat it then there are many ways of doing it. I saw a YouTube video of a guy making bolognese out of his wife’s minced up placenta. Some people put it in a smoothie. Some people pay a small fortune to have it encapsulated and take them post pregnancy as supplements (I heard a Kardashian did it, which is as solid a reason to do anything right). There are many sources online that claim consuming your placenta will increase your milk supply, lower your risk of postpartum depression or baby blues, improve your mood and can even increase your iron supply.

Would I do it?? Nope I wouldn’t. I can’t lie, the whole idea makes me want to heave. The evidence of the nutritional value, the effect of the hormones or the supposed increase in iron levels is sketchy as hell, the studies are small and not of great quality. There is nothing to suggest it is beneficial. I am confident that the same benefits can be achieved through a healthy balanced diet. Animals in the wild do eat their placenta yes. I know. But that isn’t really as a supplement. It is because a placenta can attract prey that could kill their young. Thankfully humans do not have that problem. I cannot stress this last part enough, if there is any hint of infection in labour, even the smallest signs, then I would suggest just chucking it in the bin.

So as a Midwife I do not actually advocate it but I can direct women to people who can give them more information on it. So if it makes you feel good and you are happy then bloody go for it, who cares what anyone else thinks! We don't have to eat it so crack on!

If you don’t want to bin it or eat it you can always take it home and bury it….. although not sure how that would work in the desert. But I know back in the UK people used to plant a tree on top of it. I mean I have heard of people not thinking it through and planting placentas in the water table and contaminating water supplies. And I had one woman who called up crying because her dog had dug up the buried and now decomposing placenta and was at that point dragging it through the house.

I think there are people who do placenta prints now too. It’s like a finger painting. Some people like a memory of what nourished their baby.

So there you have it. A few bits about the placenta. So that you don’t get a shock when your Midwife tells you have to push out something else. And you don't get a shock when you get charged a small fortune to make some supposed magic pills from your own flesh! Or use it to make a print to stick on your wall!

Nikki xx

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