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Friday
Jan012010

Amnion & Chorion

Below is a great picture that shows the amazing nature of the amniotic sac. Take a look and I'll explain afterwards.

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 am always amazed by the amniotic membranes.

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Reader Comments (14)

Thank you so much for this post. I lecture once a month on neonatal physical assessment, and one of the conditions I go over is amniotic band syndrome. Your post will help in the explanation.
Happy New Year!

January 1, 2010 | Unregistered CommenterReality Rounds

I am both glad and horrified at the use of foreskin in this instance. Glad that it can be used even after parents make the choice to circ and horrified that someone is profiting ($$$) from that same decision.

January 1, 2010 | Unregistered CommenterMichelle

Wow, what an amazing use of an amazing organ! I think it is wonderful that they are able to use the amnion in this way, and just amazing!

January 3, 2010 | Unregistered CommenterKelly

How could they not laugh at cockeye? That is wicked funny!

January 3, 2010 | Unregistered Commenterpinky

Thanks so much for this educational and hilarious post!

January 4, 2010 | Unregistered CommenterDoulaRina

so is it correct to assume that any woman who gives birth in a hospital or any baby boy who is circumcised in a hospital- that the amniotic sac and the foreskins are made available for such procedures without the consent of the woman/ parents?
wow...

January 9, 2010 | Unregistered Commenterjenna

Correct.

January 9, 2010 | Registered CommenterNavelgazing Midwife

This is a derail, but along with foreskin and placental parts, what about cord blood samples? (I did not give consent for cord blood to be taken, but according to my chart 2X vials were taken. No lab records included though.)

January 11, 2010 | Unregistered CommenterJanice

Those aren't cord blood samples. Those are taken to test the baby's blood type and a complete blood count, looking for anemia among other things. If you look in your chart, you will see the baby's blood type.

They don't keep that blood.

Hope that helps.

January 11, 2010 | Registered CommenterNavelgazing Midwife

Actually the baby's blood type is not in the chart or the neonatal record. Also, there is no lab work for the cord blood. And the chart specifically says "cord blood". It's weird. I hope that you are right.

January 12, 2010 | Unregistered CommenterJanice

Weird they didn't put it in the baby's chart. And yes, it is called "cord blood" - "Did you get the cord blood?" "Here're the tubes for the cord blood." Like that.

It really is weird as all get out they didn't chart the results in the baby's chart. Does the Pediatrician have the baby's blood type? (Just reaching for ideas of where to find it.)

Sorry it wasn't right there for you... I can totally understand the concern without that information. Really do hope this helps.

January 12, 2010 | Registered CommenterNavelgazing Midwife

No. There is just no documentation of blood type or gases at all. They did the heel prick & hearing test, and that's in there. I've even got the histo. records from the placenta.

Also strange is that the birthday is way, way off in the neonatal record. It's listed as 11/11/1911. My baby was born in January '07. I am suspicious that we were included in a research project w/o consent, hence the de-identification. Just a suspicion though because the hospital is refusing to answer any questions so far, and they also will not correct the baby's chart.

LOL. If it wasn't for all the ruckus I'd had never had my next child at home. I can't figure out what to do with the placenta in the freezer though. My amnion won't save the next lovely lady from being
cock-eyed.

January 12, 2010 | Unregistered CommenterJanice

Oh, to tell you all the mistakes I've seen in charts. Nurses arguing with parents that their baby was NOT a girl, it was a BOY... says so in the chart.

If you were sitting in front of me, I would chuckle with you and say, "Janice, you sound awful paranoid. And seriously, being an American, you have probably been a part of so many studies, had so much observation and been monitored so many times, you would crap if you knew them all."

The study requirements are pretty straightforward. I volunteer for any study I can get myself into because I want to give more information for whatever they are working on. I always have to sign reams of paper and get re-asked anytime there is a lag in the study. I've been in the hospital when they are doing studies and, yes, the requests can be worded so that the patient doesn't *really* seem to have a choice, but usually, they are respectful and give the person a real choice about participating or not.

Isn't it interesting how you and I have totally different views on studies and personal space? I'm a very fat woman who always allows students and residents to poke around on me because I can teach them how to work with future fat folks in their care. If I don't do it, who else is willing to let them and give them appropriate feedback from a fat chick's perspective? I do draw the line on surgery and blood draws. Only my SURGEON is allowed to do surgery. The learner can *assist*, but may not take an active role in the procedure.

Anyway, your concerns led you to (I hope) a better homebirth experience, right? We all have our walk. :)

Oh, and your placenta. Bury it in the yard (deep!) or bury it under a ficus plant if you live in an apt or move around a lot. You can also find someone to make it into capsules for you, but time doesn't treat placentas so nicely for encapsulation (from what I understand). You can also donate it to the local midwife so she can use it to teach students - or to the local student group... they always love to have placentas to study. Hope this gives you some ideas.

And, you might not be able to keep someone from being cock-eyed *har!*, but you *can* remember the gift it gave you in your child.

January 12, 2010 | Registered CommenterNavelgazing Midwife

I've been looking everywhere for information on this. I had an interesting experience that has led me to believe that my chorion broke at the onset of labor and not my amnion. When the midwife checked me after I had informed her that my water broke, she told me that I must have peed on myself. In disbelief, I told her that was the most I've ever peed my entire pregnancy. So, I went home and labored thinking that I was nuts or my midwife was mistaken. Surely, my water broke, I thought to myself. Especially since with that small gush of water, my labor started immediately and contractions were about five minutes apart and about a minute long, and with every major contraction more gushes would escape (By that point, I had put on some Depends!) So, imagine my surprise when daughter was born in the caul. I thought I must have just peed on myself.

All of that to say, I recently took my DONA certification where the instructor, Jessica Atkins shared a story very similar to mine. A woman's water breaks, she starts into labor immediately, she goes into have it checked and care provider tells her she peed. Jessica says this was most likely the chorion breaking.

I was relieved to hear this and later spoke to my midwife after I pressed her further on the issue and she agreed that, yes, it was, it could have been my chorion. Is this accurate? If so, what I don't understand is the physiology of this. Does the chorion have fluid in it as well? How is chorion attached to the amnion? You said by friction, but I'm still unclear. If you have a link that would help me better understand, or more information, I would be most grateful.

Your blog is divine! Thank you!

May 3, 2010 | Unregistered CommenterJoy

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