Pondering placentophagy

What’s the deal with eating placenta?

I am by now used to the kind of spin that internet discussion can put on birth-related stories. And I’m not usually too surprised when, upon reading the actual research article which has inspired a headline or discussion, I find that it doesn’t bear much relationship to the dialogue that has been knitted from it. So when I went searching for the research paper behind the debates which included an article entitled, ‘What to Expect When You’re Expecting to Eat Your Placenta. A new review of the literature finds no evidence that “placentophagy” is good for mothers. It could even be harmful’ (Beck 2015), I’d like to think I was pretty open-minded about what it might contain.

That is, I wasn’t really expecting to find any solid evidence of harm or benefit but, I thought, it’s entirely possible that I had missed a significantly sized research study that had been carried out in this area.

The systematic review

That wasn’t the case, though. The original article which had inspired the debates was a systematic review, led by a psychiatrist. According to a media story adapted from the researchers’ press release (MNT 2015), the lead author’s interest stemmed from conversations with women who wanted to know if eating their placenta would interfere with antidepressant medication. Reduction of depression is one of the key alleged benefits of placentophagy, along with (and according to the various websites which promote it, rather than solid research evidence) improved hormonal balance, increased breastmilk production, faster postpartum recovery, reduction of postnatal bleeding, faster perineal healing and replenishing iron stores. If even half of these alleged benefits are true, this would be the best postpartum tonic ever.

The systematic review included ten articles; only four of which involved humans, with the other six being animal studies. The authors emphasised that placentophagy is an activity undertaken by only a minority of women and they summarised their findings thus,

“Experimental animal research in support of pain reduction has not been applied in humans. Studies investigating placenta consumption for facilitating uterine contraction, resumption of normal cyclic estrogen cycle, and milk production are inconclusive. The health benefits and risks of placentophagy require further investigation of the retained contents of raw, cooked, and encapsulated placenta and its effects on the postpartum woman.” (Coyle et al 2015:1)

Personal and public views of the placenta

I will put my cards on the table and admit that I don’t have strong views about the consumption of placentas. Which is slightly strange, as I have strong views on lots of things, but not that. I have strong views that women should be able to engage in placentophagy in the comfort of their own homes and without being hassled if they want to, and strong views about the general fabulousness of the placenta, but as far as consuming it is concerned? Meh, not really bothered either way, sorry. I have cared for women who have consumed, printed, buried, encapsulated and slow cooked their babies’ afterbirths, and I even know of a woman who took a big bite out of her newly born placenta because she instinctively felt that was a good thing to do. And all power to her. I’ve still never developed a strong view on the question of whether doing so carries special benefits.

But even though I’m somewhat ambivalent on this topic and wearily used to the disdain in which many people hold women’s bodies and the reality of birth, I’m still saddened by the level of vehemence that they use to share that, especially online, and especially when they start wielding power that threatens women’s rights to do what they like with their own bodies. Ask me privately what I think about placentophagy and you’ll get the equivalent of that aforementioned ‘meh’. Show me a headline which sparks discussion about it being yukky or dangerous or needing intense regulation to be imposed upon women, though? Now I’m paying attention, although perhaps not for the reasons that were intended, and I start reflecting on my own experiences of encountering placentophagy and pondering the state of the evidence in this area.

Are there benefits?

In the early years of my midwifery career, which were spent mostly in the USA, women who wanted to consume their placenta tended to sort this out themselves. There were no paid placenta encapsulation services, though there was a bit of trading and sharing of capsule-making machines, expertise and tips amongst women. Those were different days, and the infection control disaster scenarios that some people might imagine when contemplating such ideas just weren’t a part of the mindset in that area at that time. My role was mainly in helping the family to store their placenta appropriately, especially if they gave birth in a birth centre and needed to borrow a shelf in the clinical fridge while they availed themselves of the bathing or snoozing facilities before going home.

Having cared for women who ate placenta capsules, or fried their afterbirth into a casserole, have I observed any benefits of placentophagy? I truly don’t know. I need to acknowledge that, on the whole, the women who consume their placentas tend to already be on the health-conscious, nutritionally well-informed and well-nourished end of the spectrum. The kind of women who, if they find out they have low iron levels postnatally, will eat brilliantly and send their partner across town to get really good iron supplements, raw organic dark chocolate and good orange juice to mix into their placenta smoothie. So it is hard to separate those elements out from any benefits of placenta consumption, especially when observing a small number of women in practice rather than looking at data gathered via randomised controlled trials.

A part of me would like to think there are benefits to placentophagy, because I do like all that circle of life stuff and I’m rather partial to admiring placentas. But another part of me can see the point of the sceptics who argue that placentophagy is probably more of a cultural trend than a tradition passed down the ages and that the placenta – which is marvellous and beautiful and all that other good stuff – also acts as a barrier and waste recycling facility for the baby. So because of all of those points I cannot completely dismiss the concerns merely as inappropriate and fear-based scaremongering. That doesn’t stop me from wishing that people could express themselves and their views in less misogynistic, patriarchal words and actions, though.

As my pondering continued, I chatted with colleagues about whether placentophagy is an ancient practice. Our conversation turned to bone broth, which is seen in some (non-vegetarian) circles as a health-giving food. I’ll admit that I like making bone broth, because it reminds me of the generations of women before me who made stocks and stews to nourish their families, but can we claim that this art is natural or traditional? What about before early humans learned to control fire? I’m aware that our understanding of ancient history is sketchy, but if we could go back far enough to meet ancestors who didn’t know how to control fire or make pots, then bone broth might look like a very new-fangled fad.

I share this to illustrate how our views on what is natural, ancient or new are culturally and temporally relative. I don’t wish to cut off a line of interesting discussion, but just because humans did something thirty or a hundred thousand years ago or because animals do it doesn’t necessarily make it a good idea now. None of which is intended to deny placentophagy’s potential benefits, but we don’t necessarily need to prove (or counter arguments refuting) that something is an ancient activity in order to validate its use nowadays. I don’t know of any evidence suggesting that ancient Egyptians made placenta print papyruses, but that doesn’t mean that printing placentas can’t be a fun, healing and treasured memory-making activity for families today.

So is there any evidence?

There is, however, no good research evidence either way on this topic. Placentophagy might confer all the benefits that have been attributed to it and more, or it might not confer any. It might be completely safe as a practice, or not, or it might be somewhere in between all of these possibilities. As Beacock’s (2012) review of the evidence confirmed, we can speculate, but we don’t know.

I am going to argue that, in the context of being a health worker in a culture that purports to be evidence-based, the appropriate response to not knowing something is to be honest and say that we don’t have any research evidence either way. One really big problem it is so easy to confuse situations where we have no evidence of efficacy (despite having looked, though we might not have looked hard or well enough yet), situations where we have evidence of non-efficacy (where we think we’ve looked hard enough and can see that it doesn’t seem to make a difference) and situations where we have no evidence either way. We all need to take care not to claim that things are something that they are not, and not to completely dismiss something without good evidence to support this. With placentophagy, we have no good trial evidence either way. Surely we should be able to say that and perhaps then add that we do have some knowledge from other sources, and then move into an open and honest discussion of other knowledge which is well seasoned with humility?

What do women think?

I think it is important to note that some of the strongest proponents of placentophagy are those women who have consumed their own placentas and felt like the proverbial million dollars after doing so. Some of these women acknowledge that they can’t be sure that it was the placenta stew that made the difference, but they’re happy to do it again next time in the hope that they feel as good again. Others are convinced that their placenta smoothies were a panacea, and some of these women spend a lot of time promoting this idea to others. It’s impossible to know, of course, how many women have tried this, felt it didn’t make much difference and have moved on in their lives without feeling the need to write their story up. It might be that, just as some people process their bad hotel experience by writing a scathing online review, everyone who felt that their time (and possibly money) was wasted has already shared their experience, in which case they are probably outnumbered by those who feel they have benefitted. Or it might be that the women who weren’t sure that consuming their placenta helped them have just moved on in their lives without documenting their experience. Our inability to know how representative and common such viewpoints are is one of the downsides of experiential knowledge.

That said, I really don’t want to underestimate the value of women’s knowledge, especially in areas like this where we have so little evidence. This is particularly important in situations where the likelihood of gathering good evidence is negatively affected by the complexity of the intervention and the slim chance that adequate funding will be secured in the absence of a patentable product and in the presence of controversy. Yes, the positive effect may well be because it acts as a placebo, but if it makes a difference to new mums, for whatever reason, then who are we to say no? Some people want to point out potential risks, but we don’t have evidence about those either.

Reclaiming power?

While I was writing these articles, I had a conversation with a friend and midwifery colleague, Caroline Baddiley, who has also cared for a number of women who have consumed their placentas.

Caroline has reflected on whether one of the reasons that some women are attracted to this is because the act of placentophagy is one of the very few elements of childbirth that women themselves can still own without interference from the medical establishment.

The act of claiming, owning, preparing or consuming one’s placenta may, then, be about a sense of ownership and self-efficacy. These things would be even harder to measure than the speed of perineal healing or the volume of postnatal blood loss, but that doesn’t make them any less important to the women who undertake these acts.

We do need to tell women that, honestly, science can’t yet tell us whether placentophagy makes any difference or not, but perhaps we should encourage those women to follow their own instincts and heart. In fact, I can think of far worse things to do than encourage women than follow their hearts, but there’s no systematic review to prove the value of that either.

A postscript

The lively discussion that followed the publication of the above articles highlighted one key thing: there really isn’t that much evidence out there on this topic, and there is a lot that we don’t know about this area.

Now available! A guide to the different approaches to birthing the placenta. Includes discussion of evidence, experience and the wider issues. For women and birth workers alike!

Which is great for stimulating conversation and debate among midwives and birth folk, but not so helpful for those wanting to get to grips with the possible pros and cons of this practice.

Since I wrote the articles though, I spotted a really interesting literature review written by a midwife and published in the Journal of Obstetric, Gynecologic & Neonatal Nursing.

In Consumption of the Placenta in the Postpartum Period, Emily Hart Hayes looked at this area in depth and included articles and research on this topic that I hadn’t previously seen. Here’s the abstract:

Postpartum women are consuming their placentas to achieve claimed health benefits, including improved mood, energy, and lactation. Strong scientific evidence to substantiate these claims is lacking. Self-reported benefits from some women include improved mood and lactation; animal models suggest there may be an analgesic effect. Possible risks include infection, thromboembolism from estrogens in placental tissue, and accumulation of environmental toxins. Women’s health care providers should be aware of this practice to help women make informed decisions. (Hayes 2016: 78)

One of the things that I found really interesting in here was a summary of the research looking at what animals and humans do:

Almost all mammalian species consume their placentas. Exceptions to this rule include humans, marine mammals, and possibly camels (Kristal et al., 2012; Young & Benyshek, 2010). Theories about why mammals consume the placenta include efforts to keep the nest area clean and reduce odors that may attract predators, to replenish nutrients and hormones in the mother, to satiate hunger in the mother after not eating during labor and birth, and because of temporary carnivorous behavior (Kristal et al.2012). Although placentophagy is common among nonhuman mammals, the practice has not been common in humans (Kristal et al., 2012). Young and Benyshek (2010) conducted a systematic review of the ethnographic literature of 179 cultures across the globe to document human practices dealing with consumption, disposal rituals and practices, and cultural beliefs associated with the placenta. They identified only one account in which a White woman in the U.S.–Mexico border region consumed her placenta. (Hayes 2016: 79)

But others pointed to this article which raised concern about the downsides of consuming encapsulated placenta over a period of weeks, and whether it may affect milk supply in some women.

I recall that Nadine Edwards and I went looking for evidence on this topic when we were writing Birthing Your Placenta, but we finished that book just before these papers were published, so it was fascinating to read about the systematic review.

It goes to show how useful it is that people from different disciplines (including, in this case, biochemistry, ecology and anthropology) are interested in these issues, as they bring a different perspective and often the ability to access and analyse different kinds of knowledge.

Placental birth resources

Hart Hayes E (2016). Consumption of the Placenta in the Postpartum Period. Journal of Obstetric, Gynecologic & Neonatal Nursing 45(1): 78-89.

photo credit: Stir Fry & Milk via photopin (license)

References

Beacock M (2012). Does eating placenta offer postpartum health benefits? BJM 20(7):464-69.

Beck J (2015). What to Expect When You’re Expecting to Eat Your Placenta. http://www.theatlantic.com/health/archive/2015/06/eating-placenta/394910/

Coyle CW, Hulse KE, Wisner KL et al (2015). Placentophagy: therapeutic miracle or myth? Archives of Women’s Mental Health. DOI: 10.1007/s00737-015-0538-8

MNT (2015). Eating the placenta: trendy but no proven health benefits and unknown risks. http://www.medicalnewstoday.com/releases/294917.php