Valerie Gommon Midwife’s Blog

Archive for the ‘placenta’ Category

Another guest blog by Sarah Ward … thanks Sarah.

The placenta is the fetal life support system, but can also become more than this, and is a powerful symbol that many believe deserves some respect when it has fulfilled its main aim. 

A new TV programme on Channel 4 called ‘How to be a Good Mum’ made me decide to do a topic on placentas. I tend to hate programs like this because they always portray what can be reasonably sensible well thought out ideas, throw them all together and turn them into a program designed to shock and mock anything mildly different from the perceived ‘norm’.

The first episode showed a lady making a print from her placenta in quite gory horror style detail. Each to their own maybe, but here are some ideas I found on the internet!

1. Plant It! 

The most obvious and common thing to do with a placenta (after throwing it out that is) is to plant it in the garden or a pot.  Sometimes this is done as part of a ceremony, naming day, with friends, family or just a personal thing done without announcement, just to show respect to the thing that nourished and fed your unborn baby for all those months.  Maybe to throw it out seems in some way disrespectful after all its hard work?

2. Print From It!

This is easier than it sounds.  It can be frozen for some time, defrosted, washed, dried and the side closest to the baby including the cord can be inked and printed to look like a tree, with all the veins looking like branches.  They can be quite beautiful.  They can also be printed from soon after birth using the blood left within it to make the print.

3.  Encapsulate It!

There are many practitioners that will encapsulate your placenta for you.  This basically involves mulching it up, drying it out and turning it into a powder form that’s put into tablet capsules for you to take.  The benefits are said to be that it can balance your hormones in the weeks and months after birth, increase your milk supply and quality, and increase energy.  Its been reported to decrease the risks of developing post natal depression also. In fact it’s not a new idea, its been a traditional Chinese medicine practise for centuries.  This needs to be done within 48 hours after birth.

4.  Ingest It!

Ok, I mean Eat IT! The benefits are the same as above but you could do this yourself at home and not need anyone to help you. I think most people are generally aghast at this idea, but it’s not so uncommon in other parts of the world. In fact there are many rituals and ceremonies that involve this, and are a way of welcoming the new baby into the community and celebrating its safe arrival. If you google this subject you can find many recipes and ideas from simple smoothies to bolognaise!

In fact MOST mammals eat their own placenta and the benefits are said to be that it encourages milk production, and encourages the uterus to shrink down after birth. 

5.  Burn it!

Some cultures burn the placenta in a clay pot and then bury the ashes.

6. Make a Teddy!

Artist Alex Green set off a media storm after his Placenta Bear went on display at the ‘Doing it for the Kids’ exhibition.  He explained:

“The goal of the exhibition is to inspire designers, educators and parents to be more critical of the toys that shape a child’s values and the impact toy making has on the environment.”

7. Other Cultures Do This!

In Yemen the placenta is placed on the family’s roof for the birds to eat, in the hope that it will guarantee the love between the parents.

In Malaysia the placenta is seen as the child’s older sibling and thought that the two are reunited at death. The midwife carefully washes the placenta, cord and membranes and wraps them in a white cloth to be buried.

In Nepal, the placenta is given the name ‘bucha-co-satthi’ – meaning ‘baby’s friend’

The Tanala people of Madagascar observe strict silence throughout the labour and birth and as the placenta is being delivered. When the placenta comes, everyone present claps and shouts “Vita! Vita!” – meaning ‘finished’.

Philipino women often bury their placentas with books with the hope that this will ensure an intellectual child!

To Conclude:

Whether you choose to eat it, paint with it, throw it out or whatever, there’s no denying that the placenta is a beautiful thing. It is the connection between mother and child and can be a very spiritual symbol. Whatever we decide we should not judge other people’s choices even if they appear alien to us. Being different is what makes the world an interesting place.

This is a guest blog written by Sarah Ward.

 Homebirth & PPH

Women often worry about what would happen if a woman bled heavily after a home birth. Throughout history, severe blood loss has been one of the main causes of women dying in childbirth, and it remains the most common cause of maternal death in the world [WHO, 1994].

Efficient management of postpartum haemorrhage is one of the wonders of modern obstetrics. The key is the availability of oxytocic drugs, which make the uterus contract down and normally stop bleeding.

You can choose to have either a ‘managed’ or a ‘physiological’ third stage, at home or in hospital. A ‘managed’ third stage means you have an injection of syntometrine as a precautionary measure. A ‘physiological’ third stage means you take a ‘wait and see’ approach to the delivery of the placenta, and only have drugs if you are worried about bleeding or if the placenta is taking longer than you want to wait for it to turn up

Sometimes one hears of doctors trying to dissuade women from home birth because of the risk of postpartum haemorrhage yet in fact severe bleeding after a home birth in the UK is rare, and postpartum haemorrhage is usually managed at home or by transfer to hospital. Despite the fears of some doctors, you would be very unlikely to bleed to death after a planned home birth in a developed country.

A famous review of quality studies of home birth (Olsen, 1997) looked at outcomes for over 24,000 women and found no maternal deaths. The National Birthday Trust Fund study looked at around 6,000 planned home births in the UK, and found no maternal deaths.

Where treatment for postpartum haemorrhage is needed, there are two elements. Emergency treatment focuses on stopping the bleeding, and in severe cases, keeping blood volume up while the bleeding is stopped. The other element of treatment is helping you to recover from blood loss, by administering a blood transfusion or iron supplements, this usually occurs several days after the bleed after blood tests have been performed.

What can a midwife do about heavy bleeding at a home birth?

Your midwife would follow exactly the same steps that she would take in hospital. Oxytocic drugs to manage blood loss are part of the basic kit that midwives take to every home birth.

If these did not bring the situation under control quickly then an ambulance would be called, and the midwife would take other steps if necessary, such as manually compressing your womb to stop bleeding.

In the UK most midwives can put an intravenous drip in at home while they are waiting for an ambulance to arrive.

What if the midwife isn’t there?

In the rare circumstances that a baby is born so quickly the midwife has not arrived yet, or the bleed has occurred after the midwife has left (also extremely rare), then you can do the following:-

  • ·       Call 999 if you can’t get hold of your midwife immediately
  • ·       Massage the uterus firmly – this often stops the bleeding immediately
  • ·       Pass urine
  • ·       Bi-manual compression – only if bleeding is extreme – involves someone continually massaging uterus externally and internally until help arrives

When the midwife arrives…

  • ·       She considers what we call the 4 T’s: Tone, Trauma, Tissue and Thrombin (clotting) factors.
  • ·       She can make sure the woman has passed urine and does not have a full bladder.
  • ·       She can use massage of the uterus, syntometrine or ergometrine medication to try stem bleeding. These medications induce a sustained uterine contraction. The massage of the uterus will sometimes expel any tissue obstructing good uterine clamp-down.
  • ·       The midwife can check for a tear, sometimes we can tear internally and it be less obvious
  • ·       Bi-manual compression will be used and transfer to hospital will happen as soon as an ambulance arrives if bleeding is not slowing.
  • ·       If bleeding has been easily stopped and woman feels fine then she may end up declining transfer to hospital. However in hospital they can offer a number of extra helpful interventions for anyone who has experienced or is experiencing a life-threatening PPH.

Placental Problems

  • ·       Occasionally the placenta doesn’t separate properly and obstructs, the midwife can manually remove it allowing the uterus to contract down and stem the bleeding

Can more be done in hospital than at home?

  • ·       The answer is yes, but only because there are more staff on hand, however the chances of having a life threatening PPH are far far greater in a hospital than at home in the first place.
  • ·       The most common reason for PPH is to do with atonic uterus, where the womb fails to contract down properly. At home, this is dealt with in the same way and with mostly the same drugs that would be used in hospital.
  • ·       It’s important to mention that PPH at home is reasonably rare, by the very nature of the fact that the major risk factors for PPH are things which only happen in hospital (instrumental deliveries, long hours on syntocinon drips, caesarean section etc).
  • ·       The last confidential enquiry into maternal deaths listed approx 5 deaths from PPH, all of which were in hospital, four of them were following instrumental deliveries and one following caesarean.

 How likely is post-partum haemorrhage after a home birth?

  • ·       PPH is significantly less likely to happen after a home birth than after a hospital birth.. This is probably because home birth reduces the risk of interventions which can contribute to PPH
  • ·       For more info, see the National Birthday Trust Fund study in the first instance, but numerous other studies have also found a reduced PPH rate in planned home births.
  • ·       Part of the reason for higher rates of blood loss after hospital birth is that PPH is statistically more likely to occur after intervention such as caesarean section, assisted delivery (forceps or ventouse), or medical induction or augmentation of labour (having a drip to speed labour up). None of these things will be happening at home. If you were to have any of these interventions, you would already be in hospital.
  • ·       There are some ways in which planning a home birth actually reduces your chances of having a PPH. Simply planning a home birth significantly reduces your chances of ending up with a caesarean or an assisted delivery – labour just seems to progress more smoothly at home, leading to less call for intervention. As these interventions increase the risk of PPH, by reducing the risk of the intervention, you are reducing the risk of PPH.

Can you have a home birth after having had a PPH with a previous baby?

  • ·       To try to work out the chances of a PPH recurring, and whether this is ‘safe’ for a home birth, you’d need to know why the PPH occurred, and if the same circumstances were likely to recur.
  • ·       Much depends on how you felt after the PPH.  Some women feel great even after losing a considerable amount of blood whereas others may feel terrible only losing 300ml.
  • ·       Its often hard to accurately measure the amount of blood loss. In the UK we call a loss of 500ml a PPH, but Europe don’t record a PPH unless over 1000ml.
  • ·       What were the circumstances the PPH occurred in? Were there known risk factors for PPH which would not apply this time? For instance, PPH is more common after assisted deliveries, first babies, large babies, induction or augmentation of labour.

o      If she needed an assisted delivery this time she would transfer to hospital, so that shouldn’t affect her status as regards home birth.

o      Likewise, her labour is not going to be induced with prostaglandins or augmented with syntocinon.

  • ·       Was the PPH a ‘true’ PPH in terms of being blood loss from her uterus, or was it associated with perineal tearing or episiotomy? Blood from both sources ends up in the same measuring jug, but the difference is significant.
  • ·       Did she have a retained placenta, or did the bleeding occur after the placenta was delivered – some ‘uterine atony’ involved?

Conclusion

All in all the risks of a PPH are lower in a planned homebirth than in a planned hospital birth.

However if one should occur, there are many ways it can be treated successfully at home, or by transfer to hospital.

It’s also important to realise that a negative outcome from a PPH can also occur in a hospital situation as well as at home.

Having experienced a PPH following a birth is not an automatic barrier to home birth in the future, it would depend on the reasons why it occurred. In fact planning a home birth may significantly reduce the chances of having a PPH in the future.

 

The stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and here’s a high level summary of its overall blog health:

Healthy blog!

The Blog-Health-o-Meter™ reads This blog is on fire!.

Crunchy numbers

Featured image

A helper monkey made this abstract painting, inspired by your stats.

A Boeing 747-400 passenger jet can hold 416 passengers. This blog was viewed about 3,900 times in 2010. That’s about 9 full 747s.

 

In 2010, there were 53 new posts, growing the total archive of this blog to 172 posts. There were 2 pictures uploaded, taking up a total of 2mb.

The busiest day of the year was April 7th with 144 views. The most popular post that day was Birth before the arrival of a midwife.

Where did they come from?

The top referring sites in 2010 were 3shiresmidwife.co.uk, facebook.com, en.wordpress.com, twitter.com, and studentmidwife.net.

Some visitors came searching, mostly for midwife blog, valerie gommon, skinny women and pregnancy, albany midwives suspended, and placentophagy research.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

1

Birth before the arrival of a midwife May 2009

2

“Super skinny pregnancies” March 2009
6 comments

3

Independent Midwifery and snow Part II January 2010
4 comments

4

Eating the placenta (placentophagy)? October 2009
3 comments

5

Freebirthing / Unassisted birth May 2009
5 comments

Homebirth

Posted on: July 17, 2010

There are many benefits to be gained by giving birth at home.  The woman is in familiar surroundings and is therefore more relaxed allowing the birthing hormones to work properly.  Labour is usually shorter, less painful and the mother is more likely to have a normal birth (so less need for ventouse, forceps or caesareans), she is more likely to breastfeed and less likely to suffer postnatal depression and she is more likely to report that she is satisfied with her experience.  These claims are backed up by research and evidence can be found at www.nct.org.uk/about-us/what-we-do/research/roepregnancy-birth

The British Government policy is to encourage homebirth www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073312) and in the Netherlands 30% of babies are born at home – would they really be supportive of homebirth if it were so dangerous?  A large retrospective cohort study from the Netherlands in 2009 http://www.welbornbaby.com/images/Home%20Birth%20Netherlands.pdf confirmed that the planned place of birth was not the main factor in contributing to perinatal morbidity and Low-risk women should be encouraged to “plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women’s choice”.  Furthermore, also published in 2009 was another study, from Canada http://www.sciencedaily.com/releases/2009/08/090831130043.htm which showed that planned home birth in low risk women were comparable to hospital births.  Both these studies concur with the latest US study http://www.sciencedaily.com/releases/2010/07/100701072730.htm demonstrating that women who plan home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and caesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, haemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birth weight infants.

This same American study is often quoted by obstetric practitioners because a conclusion read that infant mortality was trebled by planning a home birth, but suggested “it was because of an increased need for resuscitation among home births and therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births.”  The methodology of this study has also been severely criticised www.nct.org.uk/about-us/what-we-do/policy/choiceofplaceofbirth.

In conclusion, planned home births are very safe.  It is the presence of trained midwives with correct and necessary equipment that is most important factor, rather than location, in regards to safety of mother and baby.

A client who has previously suffered with postnatal depression has asked me to research placenta eating (or placentophagy).  Apparently it is traditionally practiced in many cultures, including Mexico, China, and the Pacific Islands, however British consultant obstetrician Maggie Blott dismisses prospect that eating the placenta helps with post-natal depression however there remain a number of women who are convinced that eating their placenta was helpful, indeed it is rich in iron and this alone will be beneficial.  Some women chop it into tablet size pieces, freeze them then swallow them!

Read more: http://www.brighthub.com/health/alternative-medicine/articles/43315.aspx#ixzz0UHDBQjT5

http://havingapoo.blogspot.com/2007/07/placenta-party.html

These are from ‘Mothering Magazine‘ – September 1983:

Work on the basis that each placenta weighs approximately 1/6 of the baby’s weight. To prepare a placenta, cut the meat away from the membranes with a sharp knife. Discard the membranes.


Roast Placenta

1-3lb fresh placenta (must be no more than 3 days old)
1 onion
1 green or red pepper (green will add colour)
1 cup tomato sauce
1 sleeve saltine crackers
1 tspn bay leaves
1 tspn black pepper
1 tspn white pepper
1 clove garlic (roasted and minced)

Method

(Preheat oven to 350 degrees)

1. Chop the onion and the pepper & crush the saltines into crumbs.
2. Combine the placenta, onion, pepper, saltines, bay leaves, white and black pepper, garlic and tomato sauce.
3. Place in a loaf pan, cover then bake for one and a half hours, occasionally pouring off excess liquid.
4. Serve and enjoy!


Placenta Cocktail

Ingredients:

1/4 cup fresh, raw placenta
8oz V-8 juice
2 ice cubes
1/2 cup carrot

Method: blend at high speed for 10 seconds. Serve. A tasty thirst quencher!


Placenta Lasagne

Ingredients:

1 fresh, ground, or minced placenta, prepared as above
2 tblspns olive oil
2 sliced cloves garlic
1/2 tspn oregano
1/2 diced onion
2 tblspns tomato paste, or 1 whole tomato

Method: use a recipe for lasagne and substitute this mixture for one layer of cheese. Quickly saut� all the ingredients in olive oil. Serve. Enjoy!


Placenta Spaghetti Bolognaise

Ingredients:

1 fresh placenta, prepared as above
1 tblspn butter
1 large can tomato puree
2 cans crushed pear tomatoes
1 onion
2 cloves garlic
1 tblspn molasses
1 bay leaf
1 tblspn rosemary
1 tspn each of: salt, honey, oregano, basil, and fennel

Method: cut the placenta meat into bite-sized pieces, then brown quickly in the butter and olive oil. Add the rest of the ingredients and simmer for 1-1.5 hours. Serve. Yummy!


Dehydrating your placenta

Instead of cooking your placenta whole, you can dehydrate it and then add it to meals! The following method is extracted from an article entitled “Thinking About Eating Your Placenta?” by Susan James, which appeared in the winter 1996 issue of “The Compleat Mother”. It was discovered posted on a newsgroup noticeboard, so we cannot absolutely guarantee its authenticity, or that it is an actual verbatim account of the magazine article.

Method:

Cut off the cord and membranes.

Steam the placenta, adding lemon grass, pepper and ginger to the steaming water. The placenta is “done” when no blood comes out when you pierce it with a fork.

Cut the placenta into thin slices (like making jerky) and bake in a low-heat oven (200-250 degrees F), until it is dry and crumbly (several hours).

Crush the placenta into a powder – using a food processor, blender, mortar and pestle, or by putting it in a bag and grinding it with rocks.

Put the powder into empty gel caps (available at drug and health food stores) or just add a spoonful to your cereal, blender drink, etc.

The recommended doses vary, some suggest up to 4 capsules a day, others just one. Perhaps the best advice is to take what makes you feel good.

It is also possible to have your placenta made into a homoepathic preparation contact www.ainsworths.com

A birth plan is optional – it enables you to devise your own personal plan of care if this is your wish, and can be helpful to health professionals in knowing your thoughts.

It is also an opportunity to make a decision about your care on the basis of informed choice.  By compiling a birth plan, it does not imply that you want a ‘natural’ or ‘alternative’ labour and a birth plan can be changed at any point, it is just an indication of your wishes.

Whether you decide to make a birth plan or not, your care should be discussed with you and no treatment or procedures performed without a full explanation and your consent.

The following are some suggestions of things you might like to include in your birth plan:

Who you want with you for the birth (e.g your partner, a friend or both)

Pain relief (you may be keen to manage without drugs or keen to have as pain free a labour as possible, do you plan a waterbirth)

Positions for labour and birth (you may wish to be able to move around during labour and encouraged to try different positions for the birth)

Monitoring of the baby’s heartbeat (e.g. using a hand-held sonicaid to monitor the baby intermittently or being monitored continuously)

Students (whether you are happy for students to participate in, or witness your birth)

After the birth (do you want pick up the baby yourself/be given the baby or do you want the baby wrapped, do you want to discover the baby’s sex yourself, would your partner (or you) like to cut the cord)

Management of the third stage or placenta (do you want a ‘natural’ third stage or to be given the drug syntometrine

Vitamin K (do you wish your baby to receive Vitamin K either by injection/orally/not at all)

A Birth Plan is just that – a plan, it can be deviated from according to your wishes at the time!

It is obviously a scarey thought that your baby could be born before the midwife arrives; but it can *occasionally* happen.  It usually happens when a woman has had several babies before – first babies rarely come quickly.  But here are a few pointers and considerations *just* in case it should happen to you.

1.         Don’t panic!  If things are happening quickly the baby will usually be born easily.

2.         Call an ambulance (inform them what is happening).  If you have time also:

3.         Phone Labour Ward/your midwife to let them know what is happening.  They are also able to talk you through a birth should the need arise.

4.         Put a clean towel/item underneath the mother.

5.         Have a clean, dry towel ready to dry and wrap the baby.  (You make like to warm them on a radiator, or up your jumper).  Babies are born from a warm, wet environment into air and they can loose heat quickly.

6.         Where possible, help the mother to concentrate on not pushing, even if she is having strong urges by encouraging her to pant (like a dog) through the peak of the contraction, and is possible get her into an all-fours position with her bottom slightly raised.

7.         Wash your hands in case the baby is born.

8.         If the head is visible, encourage the mother to pant and not to push, she can also put her hands down to slow the birth of the head.

9.         Once born, the head may turn to one side or another, with the next contraction or as the baby is born try to support (or catch) the baby to prevent it falling to the floor.

10.       Ensure the baby has clear airways (if necessary wipe the mouth and nose with a clean handkerchief or towel), dry the baby and place directly onto the mother’s abdomen and cover carefully with several towels.  (Remember not to lift the baby too far as it will still be attached to the mother.)

11.       Do not cut the cord or try to deliver the placenta.  Receive it only if the mother has a desire to push it out within an hour of the birth, in this case wrap the placenta with the baby.  Still do not cut the cord.

12.       Try to encourage the mother to breastfeed.

13.       Keep baby warm.  If baby is slow to start breathing, dry it briskly, wipe mouth and nose free from mucus.

REMEMBER

Don’t panic.  Most babies do wait until help arrives – if they don’t they usually are born easily on their own.

Don’t be tempted to cut or tie off the cord or deliver the placenta.

Most importantly keep the baby and mother warm until help arrives.


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