Midwifery Today > Issue 147 > Wonders of Third Stage Labor: The Placenta

Photo by Caroline Brown

Wonders of Third Stage Labor: The Placenta

by | September 9, 2023

Midwifery Today, Issue 147, Autumn 2023.
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When I was sixteen, I attended my first birth: the birth of my baby brother, David. After he was born, my mama delivered the placenta, which was placed in a bowl. My father brought me over to look at it, and he normalized the experience of third stage by observing to me how beautiful the placenta was: “Doesn’t it look like glazed clay?” It did look that way: purplish-red and shining. The future midwife in me was fascinated.

About a year later, I attended my second birth: the birth of my godson, Zachary. My closest friend gave birth quickly and easily, being, at 17 years old, remarkably healthy and unafraid. After her placenta was delivered, I put my hands on the placenta in the bowl and made blood-prints on a white piece of paper as a memento for us. I know my friend’s mom was surprised when I did! But for me, knowing the placenta would be taken away by the hospital, I wanted to keep the memory of such a beautiful part of my friend and her baby for the future.

The Sacred Placenta

My instinct to recognize the beauty and the sacred nature of the placenta is not unusual in other cultures. Our hospital systems often dispose of the placentas as “medical waste,” or recycle them for “medical research,” sometimes with (and sometimes without) parental permission. However, other cultures treat the placenta with a certain amount of reverence. Cross-cultural traditions of burying the placenta under a tree with some ceremony is one example of reverence for the placenta (Enning with Smith 2007).

Reading the work of childbirth anthropologist Sheila Kitzinger some time ago, I learned of another example of reverence for the placenta. On the island of Bali, native people say that a baby has four brothers: the amniotic fluid, birth blood, umbilical cord, and the placenta. The dried cord is placed in a tiny box and hung on a necklace around the baby as a form of protection while the placenta is considered to have the power to protect the bodies of the dead and to guard the living from illness. It is placed in one half of a coconut lined with leaves and pebbles. When both halves of the coconut are brought back together, bound by the father, prayers are prayed and offerings made, as the placenta-within-the-coconut is buried. The “baby’s brothers” are considered to save his life at sunset (Kitzinger 2000; Tedder 2013).

Placentophagy

While this kind of sacred ceremony from Bali is foreign to most Americans, some birthing parents have begun to see greater value in the placenta. Some assert ownership of it and request to take it home from the hospital. Or, if they are in the minority of parents who give birth at home, they do not simply dispose of it. Increasingly different kinds of “placentophagy”—or the eating of the placenta—are being practiced by some parents. This is not as strange as it may sound at first.

In nature, as Michel Odent has observed, all mammals eat their placentas: it is an immediately available source of protein and nutrients for the mother, who cannot hunt or forage immediately after birth, but must rest and be available to nurse her young (2014). Like other mammals, human mothers can eat their placentas: raw, cooked, or encapsulated. There are actually recipes from preparing the placenta in smoothies or in ice-cubes, like steak in breakfast burritos or chili, to name only a few possibilities (Daly 2015).

Doulas sometimes offer “placental encapsulation” services. They take the placenta home, dry it in a dehydrator, grind it up in a (coffee) grinder, and encapsulate it in pills. Mothers then take the “placenta” pills daily with their meals during their postpartum period. Many believe this helps prevent postpartum mood disorders, increases the production of oxytocin, decreases the production of cortisol, restores iron levels, and increases milk supply (Daly 2015; Dekker 2017; Enning with Smith 2007).

The Centers for Disease Control and Prevention (CDC) cautions against placentophagy, believing that in at least one case, Group B Strep was transmitted from mother to newborn through placenta pills (Marnach 2021). So Group B Strep-positive moms might want to bypass this option. Nevertheless, placentophagy—made possible by the wondrous existence of the placenta and its being brought forth during third stage—is at least one way in which some families are recognizing the placenta’s value in postpartum healing.

Placental Research

Despite the CDC’s nominal objection to placentophagy, the scientific value of the placenta is beginning to be widely acknowledged. Placental tissue and cord blood stem cells are the subject of many different kinds of research today. For example, one of these studies (in animals) has shown that mesenchymal stem cells (MSCs) “can be differentiated into beta-pancreatic islet cells and MSCs administration result in beta-pancreatic islet regeneration and prevent renal damage in diabetic animals (Wang and Zhao 2010). New stem cell research also shows that MSCT stem cells can help to effectively treat liver disease (Cona 2023). Right Now, late-stage problems with the liver and kidneys require major surgeries and transplants that come with lifelong medical management. Imagine a world in which the human pancreas, liver, and kidneys could be healed by donated stem cells from healthy placentas and umbilical cords!

Placental Wisdom

A few years ago, I was assisting a pregnant woman who had an unusual obstetric history. She became pregnant while taking hormonal birth control pills and did not realize that she was pregnant until she experienced a miscarriage. She had the emotional experience of realizing she had been pregnant at the same time she was miscarrying the baby. As she grieved that loss and recuperated from the initial hemorrhage in the hospital, she recovered—only to the learn that she was still pregnant. She had been carrying twins. While one of the twins had died and passed from her body, the other stayed and continued to grow to full term.

She had conceived in Viequez, Puerto Rico, but decided to return to Chicago, Illinois, to give birth. It was there that she asked me to assist her, and I did. She gave birth in a hospital, in the care of midwives, to her firstborn son after an induction. Third stage was protracted (by hospital standards) because the placenta was retained. Suspecting a possible placenta accreta, my sister nurse-midwife opted for a manual removal of the placenta, which was agonizing for the mother—even with the epidural in place. I remember how fiercely the mother squeezed my hand as she arched her back while the placenta was taken out. Fortunately, her bleeding afterward was well-controlled.

I remember reflecting on this third stage and what it might mean: in order for this woman to become pregnant while on the pill, and to maintain the pregnancy of this child when her other child miscarried, perhaps this placenta had had to attach very firmly to the uterine wall. Perhaps it was very hard for the placenta to let go when it was time. Of course, perhaps it would have come on its own given a little more time.

Sometimes birth attendants put an artificial time limit on the time between birth and the delivery of the placenta. I understand the concern—a fear of a massive postpartum hemorrhage if the placenta is not delivered soon after the baby’s birth—but that doesn’t always happen, even when the placenta comes out four or more hours later. In the case of this woman and her baby, the placenta was safely removed manually, blood loss was controlled, and eventually, mother and son formed a close bond that continues to grow and develop beautifully to this day.

I am a witness to it. This mother, who didn’t plan to conceive at all, lost one twin and didn’t know immediately that the other lived, went on to give birth to a son who is extremely precious to her. She was an orphan, with no family, and the wisdom demonstrated through this placenta—resisting the influence of the hormonal birth control, resisting miscarriage —helped to give to her a family of her own.

Placenta Memories as Narrative Medicine

I will always remember the first two placentas that I saw with my own eyes—my mama’s/ brother’s and my best friend’s/godson’s—with a sense of wonder and awe. They led me to explore how the placenta is treated in other cultures as sacred. They led me to appreciate the scientific research being done with placental tissue, cord blood, and stem cells. Today, I find it impossible to forget the extraordinary placenta of the woman I helped to labor in Chicago years ago. I wrote a poem (Beal 2011) about it because I think these are the types of experiences that we, as midwives, need to remember and hold onto: they are narrative medicine. They teach us the wonders of the third stage of labor.

References

ISLAND LOVE-CHILD

Your mother, pure of heart, and
your father, at peace like a prince,
met in Viequez and at once
went walking on the hot, white sand,
making love in a distant land.
Island love-child, you were conceived!
The Maker of All Things just breathed
and your life, and your tiny twin’s,
came into being, though hidden,
between the waves and the palm trees.

Your soul was secreted inside,
your body took root in the blood
and when life flowed out like a flood,
you stayed, but your twin went outside,
and was lost in the half-moonlight.
He whispered in your mother’s ear
that you, little one, were still there—
so her pure heart cherished your life
and to protect you from all strife,
she journeyed north for the next year.

In snowy Chicago, she made
a sure way for you to be born,
a home on Honoré Street, warmed
by her hard work and heaters placed
near frozen pipes on icy days.
She put a map of the glacier,
the Emmons route up Mount Rainier,
on her bedroom wall and named you
for the power in the earth, true
against the blue sky—without fear.

Your father came north to be close
to you as nine-month’s time came on—
your heartbeat asked for air and dawn,
so eager midwives asked almost
too much, yet you glided down, on
the power of your mother’s push
from womb to world—you, naked truth,
first in your father’s arms, a great trust,
then at rest on your mother’s breast—
of life and love, you are the proof!

This decima I sing for you,
a Puerto Rican island song,
so you will know your beginning
and rejoice in it your whole life long!

jb

About Author: Jane Beal

Jane Beal, PhD, is a writer, educator, and midwife. She holds a Certificate in Midwifery Mercy in Action College of Midwifery and a graduate Certificate in Narrative Medicine from Bay Path University. She has served with homebirth practices in the Chicago, Denver, and San Francisco metro areas and in birth centers in the US, Uganda, and the Philippine Islands. She is the author of Epiphany: Birth Poems and Transfiguration: A Midwife’s Birth Poems. She teaches at UC Davis and the University of La Verne in California. To learn more, please visit janebeal.wordpress.com and christianmidwife.wordpress.com.

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