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.
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.
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.