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Thursday
Dec312009

The Placenta (& Amniotic Sac)

This is a lovely placenta, the maternal side... the side that is attached to the mother's uterus. The baby does not come in contact with this side. It's made up of cotyledons, veins, arteries and many more parts I am not familiar with; I haven't studied the placenta as much as midwifery.

The amniotic sac is rumpled around the edges.

Right at the bottom of the picture (5:00-6:00), the placenta has broken apart somewhat. The baby was born by cesarean, so I didn't see how the placenta was born, although the doctor delivering has a wonderful respect of the birth process and, I am sure, wouldn't have handled the placenta harshly. I still don't know why it broke apart in some areas. I did want to point out the lovely color, the deep purple/red coloration that demonstrates perfusion and health.

We can learn so much from a woman's placenta. It is more tangible than, say, the effects of a posterior labor. I believe the placenta is a powerful tool. My midwife friend Marla says the placenta tells tales on you; you cannot lie to the placenta.

This is the fetal side of a healthy placenta. Deep purple, lovely veins and arteries can easily be seen. When the placenta is in use, those vessels are plump and operating.

 

The baby lies against this side, tucked inside the amniotic sac; a soft pillow of a precious organ for the baby to live next to for about eight months (the placenta does not form immediately after conception). 

Talking about the placenta cannot be had without discussing the spiritual aspects of the organ. There are folks who feel the placenta, including the cord and the amniotic sac, belong to the baby. I've had numerous discussions about this, mainly because the mother is who creates these things and, to me, loans them to the baby. They begin in her, by her and remain with her until it has finished its job for the baby and then she releases it. Those who believe otherwise say they have research/proof that shows the baby is affected by what happens to the placenta and umbilical cord. that they wince, cry or show signs of an emotional disconnecting to the organ. It is this belief that leads some to choose to Lotus Birth, leaving the placenta attached to the baby via the cord until the umbilical cord falls off the baby. However you believe, I feel the placenta deserves a great deal of respect. It's an amazing organ... the only organ that is created, disposed of and a new one re-created when needed. Touching it lovingly demonstrates to the family your reverence for the mother's and baby's creative abilities.

Here is a placenta that is extremely unhealthy.

  

The mom who made this placenta had a very poor diet, fast food being the majority of her intake. The baby, over 11 pounds, demonstrated the mother's over-nourishment (she gained over 60 pounds).

Care providers who have seen this picture believe this was a Circumvallate Placenta, a variation (many believe not a normal one) whereas there is a double fold of amniotic sac forming a circle around the edges (simplistic explanation). Initially, I wondered if it wasn't a deposit of fat, but I think I was wrong in this thinking.

Healthy placentas allow free-flow of nutrients and oxygen. Said in extremely simplistic terms, when the placenta is compromised, parts of it die, leaving dead spots, whole places/sections that no longer provide health and well-being to the baby. I tell women we never know if what part has died, the part that goes to the fingernails - or the place that goes to the baby's brain. While not technically accurate, it brings home the point that what goes in - food, tobacco, marijuana - affects the baby directly.

I've seen similar placentas with teen moms who also didn't eat so well. Or with smokers or women who couldn't quit drugs during the pregnancy.

Some women have yucky placentas even though they ate meticulously and didn't smoke or do drugs. There are unknown reasons why placentas deteriorate and we might not know it until the placenta is born. However, placental insufficiency can also cause fetal growth restriction (used to be called fetal growth retardation, but that term was changed in the early 90's) or babies that are small for gestational age (SGA). We can suspect an SGA baby by monitoring a mother's fundal height throughout the pregnancy. Sometimes the fundal height doesn't grow and, less commonly, actually goes down (and it isn't because of a change in the baby's position, which needs to be ruled out), especially if it shows a trend of a lowering fundal height. The fundus is the top of the mother's uterus. We measure, in centimeters, from the top of the pubic bone to the fundus. After 12 weeks or so pregnant, the centimeters equal the weeks of a mother's pregnancy. Who discovered that? A great discovery, whoever it was.

One reason for serial measuring is the subjectivity of what the fundal height is. When women have different care providers at each visit, an SGA baby can go undetected for a couple three months. However, when there is one midwife measuring, the likelihood of missing a shrinking baby is much less since she should be measuring the same each time.

Women being told they have an SGA baby will be sent for an ultrasound, and often a couple more within the next month or two to keep tabs on the fetal growth. Again, an ultrasound can be a subjective measurement, but much less so than fundal height. Plus, if you have the same ultrasonographer each time, the results are more accurate.

Often, the amniotic sac, or membranes, are seen as separate when they are, quite intertwined physically. The sac is connected to the edges of the placenta and form a protective barrier between the baby and the mother's uterus. Amniotic fluid fills the space, allowing the baby to "swim" in a sterile ocean of saline water.

The amniotic sac is made of two individual membranes connected by friction; the amnion and the chorion. In this picture, you can't tell which is which, but you can see that one of the two has slid down, some air even getting between the two, making that bubble.

Each membrane has a function. The amnion is closest to the baby and is responsible for making the amniotic fluid (easy to remember that the amniotic fluid is around the baby, so the amnion is next to the baby). The chorion, among other things, helps change the mom's nutrition into a form the baby can absorb via his blood. When there is chorionic villi sampling early in pregnancy, it is the chorion they are taking the sample from.

While I knew hospitals "donated" (sold) placentas to a variety of places from cosmetic companies to (rumored) dog food makers, I hadn't ever considered the medical use of this amazing part of the birthing process. Until Sarah got ocular lymphoma - eye cancer.

Quick aside is that when they removed the cancer, they had to use something to cover the open wound in her eye. The membrane was also going to act as scaffolding so the eye cells could grow across and meet each other, the 40 very tiny sutures falling out, thereby losing the membrane. The whole piece removed was smaller than the eraser on a pencil. When we were sitting with the surgeons, they were talking around us, thinking we didn't know what they were saying - even though I'd told them more than once I was a midwife. "Blah blah blah... a graft will go over the wound... blah blah blah." Our ears perked up and asked what the graft was going to be made of. Monotone, they said it would be one of two things, either the foreskin of a newborn's penis.... WHAT?!? We were horrified. Although... Sarah had to make a joke about it saying she couldn't possibly use the foreskin, then she'd be cock-eyed. We laughed our heads off. They were stone-faced. She then said she wouldn't allow the foreskin to be put in her eye... what was the other choice.

Amnion. I perked up and said, "Amnion? Like amnion and chorion?" And they said yes, that they only use the amnion (not sure why they only use that side). Joking, I told them I could bring in many samples, we could try and match the best one to the color of her eyes. They didn't think it was funny and droned on about pathology and sterility, blah blah. We thought it was funny.

The day of surgery, we gave thanks to the mother and baby for their gift of the amnion that would protect Sarah's eye from the surgery insult.

I'll talk more about placental situations in another post.

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Reader Comments (9)

Why did all these comments repost on the same day and what happened to all of the comments that were on them?

December 31, 2009 | Unregistered CommenterJen

Women asked me to split the posts up and I thought it was a great idea because if someone searches for something, they wouldn't find it if it were buried in an ambiguous post.

I will grab the comments and put them with the posts they belong to. Probably tomorrow.

January 1, 2010 | Registered CommenterNavelgazing Midwife

Hey Barbara... in my embryology studies I thought I learned that the placenta was primarily an embryonic creation, not a maternal creation... thus the reason there is no HCG in the maternal blood stream until the embryo implants, begins to grow a placenta which excretes HCG.

http://www.merck.com/mmhe/sec22/ch257/ch257c.html.

While I like the idea that the placenta is on loan from mom... and yes would be made primarily with the molecules from her body... anatomically it (in my mind) belongs to the baby. If you were to sample the genetic material of the tissue of the placenta it would match baby, not mom.

January 1, 2010 | Unregistered CommenterBrenna

awesome, gross, fabulous! Thanks for keeping this blog up!

January 24, 2010 | Unregistered CommenterClaire

Barbara- very interesting post. I was told 2 things about my placenta when I was pregnant with my second (my VBAC baby) 1. I had scar tissue attached to it (most likely a result of my previous c-section) and 2. It was calcified (grade 3) at 37 weeks. The perinatologist I saw told me not to go a DAY over my EDD, it was too risky. They weren't sure how quickly my placenta was aging and told me my daughter was measuring in the 8th percentile foe her gestational age. NST's showed she was doing great and I felt she was healthy.
But, I won't lie. I was TERRIFIED. Not knowing 100% what was going on with the placenta was scary.
I went into labor (SROM) 3 days before my due date, 2 days before my scheduled repeat c-section. SHe was 6 lbs, 5 oz. We have pictures of the scar tissue attached to the placenta.

April 5, 2010 | Unregistered CommenterAndrea Owen

Hi - I just have a quick question. I'm currently 7 wks, 3 days pg & this is my 4th pregnancy. I have 1 daughter (4) & had an ectopic miscarriage in March. As a result, I had an ultrasound Tuesday. The baby has a strong heartbeat, but they also said there is a gap between the placenta & sac. What does this mean? Any idea what the chances are of the pregnancy being ok? Thanks for your help!

July 8, 2010 | Unregistered CommenterJulie A

Hi! Great post! I do really love the picture and the contents explaining the placenta,the amniotic sac and many more, Keep it up!

April 5, 2011 | Unregistered CommenterHCG Drops

I have a question and no one has been able to answer it. When I was in my mothers stomach she said three days before birth she kept telling the doctors that she hadn't felt me move. The day my mom went in to have the hospital check me and they said that my heart wasn't beating. so they did an emergency c-section. and my placenta was black and dead I was 6 days over due and I looked like a pre mature baby and they never understood why I and i have been looking for answers ever since. like why was my placenta black? Why didn't anyone see that I was dying in my moms stomach and what birth defects could have cause? if anyone could help me out that would be amazing!

June 23, 2011 | Unregistered CommenterJackie

I have a question and no one has been able to answer it. When I was in my mothers stomach she said three days before birth she kept telling the doctors that she hadn't felt me move. The day my mom went in to have the hospital check me and they said that my heart wasn't beating. so they did an emergency c-section. and my placenta was black and dead I was 6 days over due and I looked like a pre mature baby and they never understood why I and i have been looking for answers ever since. like why was my placenta black? Why didn't anyone see that I was dying in my moms stomach and what birth defects could have cause? if anyone could help me out that would be amazing!

August 4, 2012 | Unregistered CommenterJackie

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