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Wednesday
Jul052006

What Makes Placentas Healthy (or not)

When I worked with inner-city teens, I loved teaching them how to dip their own pee (a matter of course as a midwife) - how they could see the direct impact of their diet in the little paper cup. I thought it was great when I taught them to take each others' blood pressure - they finally understood what I was listening for and why each number had an importance in the first place. Weighing each other, they would encourage weight gain and question large amounts of weight gain without being judgemental and cruel. Not something you'd always see in the 13-17 year-old age range.

Care in this style now has a name - Centering - and many practices are moving towards this type of prenatal and postpartum care.

It took awhile, but when I figured out how to demonstrate the obvious results of their self-care and the health of their babies, I had that wonderful A-HA! moment so delicious in birth work.

Placentas.

I knew placentas could be great looking or not-so-great looking and I knew what could make them so, but one in particular brought that moment home hard.

A client who weighed 400+ pounds had quite uncontrolled gestational diabetes even with insulin usage. In a 14 year old, it was really challenging to acquire any sort of compliance. Her mother was non-existent, so the pregnant girl was pretty much on her own in her care.

We all know that diabetes in pregnancy can make for enormous babies, but I didn't know it could also make for some ultra-small ones, too. IntraUterine Growth Restriction (IUGR) can be a side effect in women like my client.

She was post-dates and fetal testing showed the baby would probably be better outside than in, so an induction brought a really long, slow labor to a forceps end and I blinked looking at the tiny, skinny, wrinkly man-baby under the warmer. The baby weighed just under 4 pounds! All the other signs of maturity were there, but the baby was wearing some other newborn's skin.

Wow.

When the placenta was born, it was a the size of a pancake served on a kid's plate. The size, however, corresponded to the baby's size (something I've seen over and over through the years). So, if extra large babies make extra large placentas, why wouldn't under-sized babies create little tiny placentas?

The other aspect about the placenta was how white it was. Having always described placentas as "liver-like" and "an organ," it was strange seeing this piece of light-colored, pebble-speckled placenta.

It was in that moment that I realized I could show my teen moms what healthy and un-healthy placentas look like and perhaps... just maybe... it could make an impact.

And so I began my showing-off-placentas career.

I take pictures of many placentas and try to have something in the picture to offer scale, but the ones I think are the most interesting are the sickly ones. There are many times it's easy to point out why they have had a problem, but occasionally, there doesn't seem to be any cause.

Nutrition - This is the most common reason I have found for a placenta to have problems. Interestingly, placentas of migrant women looked much better than most of the teen mom's placentas I saw. Diet? I think so. A minimal diet of beans and rice with corn tortillas far surpasses a hefty diet of McDonald's and Wendy's. Who knew?

I'm not a pathologist, but the nutrient-deprived placentas seem to have rings of calcifications around the periphery of the maternal and fetal connection. The hard areas tend to be large and flat as opposed to grainy like an older-placenta's calcifications. I've seen this flat calcification spread about 4 inches into the organ, all the way around.

Age - Not the woman's age, but the age of the placenta. I don't understand all the mechanisms behind what makes placentas begin to deteriorate or remain lusciously alive, but when a mom goes post-term (her OWN internal timing mechanism in motion), the further she goes, the more calcifications and spongy white areas appear. For some women, post-term is post-dates; for others, post-dates and post-mature are not the same thing.

In many natural birth circles, the belief that a placenta has a shelf-life is heresy. I expend a lot of energy explaining the realities of nutrition, blood flow and time and their effects on the sustainer of the fetus. I still butt up against disbelievers, but (and I'll use the line so many in the natural birth community hate to hear from medical folks) - they just haven't seen enough births to see that placentas really can - and do - die. If the placenta dies, the baby suffers.

Age spots in a placenta look (to my non-pathological eye) like tiny pebbles or large grains of sand, but really white - like from a North Florida beach. Sprinkled randomly around the placenta, the older the placenta, the more concentrated the patches of "sand" - calcifications - I've seen.

Random reasons - These would include congenital issues, cigarettes, drugs, and other random things mom might inhale or injest or be injected with. She might have some illness or disease that is either known or unknown such as clotting problems or vascular issues.

Smoking placentas look much like the food-deprived placentas, with the added touch of pale-pink sponginess - the way lungs are supposed to look... not a placenta.

Did you know that smoking placentas smell like nicotine? They reek of tobacco.

Did you know that some placentas smell horrid? Those placentas must head off to pathology to be checked for infection.

Most placentas smell beautiful and heavy-fleshy.

My Belief - If a mom eats well and has another variation at play - such as post-term or a partner who smokes - then the placenta can sustain the baby longer than nutrition was also poor. When a mom heads over the "due date" space on the calendar, I really encourage my moms to continue (or begin) eating extremely well to offer the baby every benefit the placenta can give.

There is, absolutely, a cause and effect that can be seen and felt (and smelt!) when it comes to placentas.

I am so humbled when I touch and see the only regenerative organ the human body can make - it fascinates me - even as I hardly understand the inner workings of such an amazing part of our creation.

References (3)

References allow you to track sources for this article, as well as articles that were written in response to this article.
  • Response
    - Navelgazing Midwife Blog - What Makes Placentas Healthy (or not)
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    - Navelgazing Midwife Blog - What Makes Placentas Healthy (or not)
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    Response: coffee research
    - Navelgazing Midwife Blog - What Makes Placentas Healthy (or not)

Reader Comments (18)

Thanks so much for the clarification! Here's hoping that I have a healthy placenta in there; I'm certainly trying to take care of myself. (And the little tiny guy is certainly squirmy already!) In all my reading about pregnancy (a LOT) I have never before seen any reference at all to an unhealthy placenta, so this is an eye opener.

July 6, 2006 | Unregistered CommenterAnonymous

When you say the placenta starts to age once the Mom goes post-dates, what do you consider post-dates to be? Some doctors start to induce at 40 weeks for an "overdue" baby, but I have read that it is usually safe to go to 42 weeks, and we shouldn't consider anything earlier than that to be overdue. At what point do you generally see aging, or does it vary by woman?

July 6, 2006 | Unregistered CommenterJennifer Z.

I continue to learn so much from you.

You are an educator at heart. Something we share...and I admire the way you do it.

Hh

some of this must have to do with micro-circulation so infection and fibroids and where the placenta implants and how deeply/well it implants.

July 6, 2006 | Unregistered CommenterAnonymous

I've done some group prenatals that are similar to that Centering style. They're fun and it's great to pair up women so they can palpate each other's babies, etc. :)

July 6, 2006 | Unregistered CommenterSage Femme

Anon: Thanks! Just keep eating well and smoking down to a minumum (*wink*) - soda? probably not.

Let us know what your placenta looks like afterwards, eh?

Jennifer: I need to revise my verbage in the piece... the term I should have used was "post-term" not "post-dates." I apologize for using the proper term. Thank you for reminding me. By changing the term, it allows the dates to be what they are and more ambiguous than what is on a calendar. Does that make sense?

It definitely depends on each woman and her nutrition. Aging happens earlier with crappy nutrition... the placenta can be sustained longer by better nutrition. Perhaps I should add that, too?

Hannah: Thank you, as always. :)

Anon 2: Oh to understand scientifically what you are saying! On the surface, what you say makes sense, but trying to explain it in lay language would take me a week. Thank you so much for bringing in more of the variables that are possibilities.

Sage Femme: How great! It really is wonderful for the women to touch each others' bellies and babies, isn't it. They can learn so much about the safety of the baby deep inside (that palpating doesn't hurt the baby physically), that each woman can learn to feel fetal parts and fosters intimate friendships that can be so, so important postpartum.

I'm glad you are doing something similar to Centering. I have yet to begin with the clientele I have now. Soon, though, soon.

July 6, 2006 | Unregistered CommenterNavelgazing Midwife

Seeingmy own placentas with my untrained eye, I had no idea what I was looking at. They just looked red and bloody to me. Seeing the last few placentas at births, and seeing a stained placenta, a healthy one, and then one with lots of calicfications, I have somewhat of an understanding of how much information a placenta carries.
Simply incredible.
I am so blessed to have you as my teacher.

July 7, 2006 | Unregistered CommenterAnonymous

I can't wait to0 get these started. What I would have done for such an experience when I had my first baby.....or even the last 7!

July 7, 2006 | Unregistered CommenterAnonymous

some visual analogy would be velcro- almost all of us have now had the experience of velcro not working- because the pieces cannot mesh- too shallow because of interference
things that cause interference in people would be scar tissue- or a fibroid or diabetes, smoking, infection ( infections are probably understandable if someone has had even a zit they know the swelling and tissue changes) -
I don't know how else to describe- when placentas implant they and the uterine lining have spiral arteries- that relax a bit and twine near each other-
smoking causes the stuff that relaxes the arteries (nitric oxide) to be used up so they don't intertwine well -- and diabetes does this too- longer standing diabetes has oxidized off many of the little bits of circulation and they don't exist anymore- I guess it would be like walking into an afternoon matinee and all the soda has been spilled on the floor the you have syrup hanging on to maternal nutrients- well not exactly but... I will think on this more- sorry - anon s

July 7, 2006 | Unregistered CommenterAnonymous

It was a funny twist of fate that moved my husband to take close up pictures of both my placentas after they were discarded after cursury inspections by boh OB's. He said he did so because he thought the color looked beautiful (and they do!). Now I find myself digging them out and examining the photos! Funny how life works! Thankyou!

July 7, 2006 | Unregistered CommenterLouisa

here you go something very tech not at all the beautiful piece you wrote but a bit of info any way

http://info.med.yale.edu/obgyn/kliman/placenta/articles/AJP%20Commentary.html


anon s

July 7, 2006 | Unregistered CommenterAnonymous

Thanks. I asked the question because I once attended the delivery of a client whose placenta looked like it had been sprinkled with white peas..the calcification was so bad. She was 4 days post "date". The dr announced to all the residents in the hall that when placentas look like that - that it means the woman has been on drugs and the placenta caught the bad stuff. I knew this was hog wash because I had a slight calcification on my last placenta (15 days post date but she still had vernix and was fine) and I didn't do any drugs.
Besides, that particular doc was known to be an a$$hole.

July 9, 2006 | Unregistered CommenterWash Lady

WL: How big was that baby with the calcifications, but vernix?

July 9, 2006 | Unregistered CommenterNavelgazing Midwife

You talking about *my* baby that was post date with vernix AND calcifications?
She weighed 9#6oz. Due date (based on US at 9 weeks) was Oct 1st, she arrived on morning of the 15th (just the day that I told them from the beginning that she would come)
She had vernix in the creases and along the trunk.
What significance, if any, do you think the fact that I had LOTS of fluid played in the whole situation?
It was not a good pregnancy for me - certainly not the utopia from the previous pregnancy (where I felt like a gazillion bucks, 4 hour labor, 22 minute 2nd stage and an 11 pound baby). I just remember looking at that placenta and thinking, "You're done, honey."

July 9, 2006 | Unregistered CommenterWash Lady

I have no idea what my placenta looked like. I wish I did. I wish I could have seen it, smelt it, touched it. I can still remember the smell of my baby and hope that sweet smell on her was a similar smell to the placenta.

I was told my placenta was "HUGE!" but my bubba was only 7 pound 4 ounces. She did have a two vessel cord though...

Next time I hope I can see my placenta. The thing about emergencies, there is always a lot of hindsite.

July 11, 2006 | Unregistered CommenterKristie

Soooo, I read your post and found it very interesting but when I looked at placentas on Google I realized that its not clear to me which side would have the calcifications. Would they be found on the mom's side, or the baby's side, or throughout the tissues?

I mean, I had my last at 41.5 weeks, 10lbs 5oz, and what I saw was a placenta that filled the tub they use, and it looked like a fluffy liver to me, no white spots and no light colors, except the baby side for the sack. Do remember the doc looking at it with me and her remarking it looked good, but at that point I didn't know what to look for.

And thank you for the post, what I remember seeing and what you wrote tells me that it was a very healthy pregnancy - as I tried to make it.

January 16, 2008 | Unregistered CommenterEthel

I've been reading your blog and just had to comment on this post. My son was born at 39.4 based on LMP, though 39.6 based on when I think I ovulated. He was 7 lbs 13 oz with no vernix to speak of (a little bit in creases, but that's it) and the skin on his hands and feet were peeling. My midwife said his placenta was quite calcified. I think she said it looked term or post-term, I don't remember. I didn't actually look at it though, I was too busy loving on my little boy.

My diet could have been healthier, I'll admit, but it wasn't THAT bad. No cigarettes but I did pop TUMS like no tomorrow and took loratadine every day for allergies. I tried quitting that a couple of times but my husband talked sense into me after a week (maybe something to do with my moaning and whining that my face was falling off?) This next time I'm going to try more natural remedies for heartburn and see if I can avoid the TUMS at least.

And I see no way that I mistook implantation bleeding for menses given 1) my period is always heavy and 2) that cycle was the first cycle we didn't use protection.

Anyhow, I just want to say how much I love your blog. I'm still reading through all the posts -- only 3 years to go!

September 29, 2009 | Unregistered CommenterKimberly

I have nine children. I didn't see the placenta for the first one born by C section ; I hardly got to see the baby, just a glimpse and then 12 hours before I saw him.

Of all the rest, there was only one whose placenta didn't look good, my third. It was very large, much larger than the standard size of placentas that they showed us in nursing school. But it was the wrong color, kind of grey white and looking as if it was falling apart. This baby wasn't post dates or post term at all; he was born three days before my due date, and I had calculated the due date from an exact known date of conception. But he weighed 11 pounds and had some of the newborn problems associated with gestational diabetes. They weren't so diligent in looking for that in those days. After my first was 9-6 I did have testing with my second pregnancy, which met the normal criteria.
However, I flunked the two hour post prandial, and with the GTT, my one hour values were too high, but the two hour and three hour values were OK, and this counted as a normal test. But if you eat all the time and you are high an hour, or two hours, after you eat, then your sugars are going to be high, right?
In the pregnancy that produced the 11lb baby and the funny looking placenta I had no testing at all. That baby's blood sugar dropped after birth so that the pediatrician, who had promised me no separation from the baby, told me she had to stretch it a bit to say it was above 30, because below 30 they had to start an IV. He had to be given soy formula right in the recovery room to get his sugar up. I let her give it to him and turned my face away because I didn't want to see my baby getting a bottle. They wound up giving him soy formula the whole time I was there because they were giving me methergine and my milk didn't come in. They would weigh him before and after I nursed him and say he only gained half an ounce. I "forgot" the formula in the car of the person who drove me home, and that was the end of that! He also had polycythemia. I had insisted on no separation from the baby, and the pediatrician had agreed, writing for the nurses to do one hour checks. She also said my husband could stay in the room and "observe" while I slept. Well, the nurses gave him a recliner and he went right to sleep. I didn't sleep so much, but the lights were out. We got to the room around 11 or midnight, and no one came in until about 5 am. As a nurse now I understand this; she came to see us because pretty soon she was going to have to give report to the day shift, but she expected us to be just fine in there and she had all kinds of tasks in the nursery and paperwork to do. So when she turned on the light and looked at the baby she started scolding me "Don't you see how red this baby is?" (He was pretty close to beet red.) Don't you see those retractions? I wasn't a nurse then, and had no idea what retractions were. She pushed some kind of button, it seemed to me, and suddenly the room was full of people, and they were handing me something to sign. I thought my baby was going to die. Later they told me that they used the umbilical stump and took out some of his blood and put in plasma. They said they used stored plasma; in the old days, they said, they would spin down the baby's own blood and put his plasma back in. I wished they had used his own. They told me this condition is life threatening, that having the blood that thick can cause strokes or heart attacks. They told me that the exact cause wasn't known, but it is associated with large babies and diabetes. They also told me I shouldn't have any more children, that if I did they would only get bigger and have the same problems only worse. Well, I had six more, and one was bigger, but he didn't have the same problem, although I think his blood sugar might have gotten low after birth; I had a friend nurse him. I always thought that the reason why I went into labor 3 days early and had a fast and furious labor was that the placenta was falling apart and it was time for him to be out of there.
Before I had the next one at home my family practice doctor researched polycythemia for me, giving me copies of the articles he found. He said he thought there would be plenty of time to get the baby to the hospital if there was a problem. He came right away after the birth and did both blood sugar testing and a hematocrit on the baby, and came back some hours later to repeat the hematocrit, which was fine. I never have found out what causes polycythemia; do they know any more about it now?

So that's the story which accompanies my one yucky looking placenta.

Susan Peterson

August 14, 2010 | Unregistered CommenterSusan Peterson

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