E11: 7 Domains of the Placenta

Well, listen ladies. So before we get deep into the placenta project, I want to talk about dispassionate kindness. So the Buddha tells us that we need to be compassionate and kind, but the Buddhist tells us that we need to be dispassionate. We can't bring our kindness with the whole load of sadness or happiness or fear. We are supposed to step back from those emotions so that we can be truly dispassionately kind.

And as women, we carry our hearts on our sleeves and we carry our family inside our bodies. More on that when we talk about the placenta. But to be truly kind, we have to be able to step back a little and offer our kindness without all of our load of stuff that we bring to our kindness.

So I am working personally on dispassionate kindness, and in these days of hard times, I'm really trying to be dispassionately kind. So that's the thought for the day as we jump into the placenta project.

Now, here's a riddle. What critically important organ belongs to the newborn baby that most mothers never even see, but it is cut off? It's evilly cut off and thrown away. It serves as a kidney, a liver, a brain, and the lungs for the baby. What is it? Anybody get it? It's the placenta.

The origins of the word come from the Greek Latin meaning "round and flat," like a flat cake. If the ancients had known how critically important it is to the developing child, they would have given it a better name. But now it's increasingly viewed as critical to understanding the health and the course of pregnancy and some brand new information about how it lets our cells commingle so we become one with our child and our child becomes one with us.

So the placenta forms when cells from a fertilized egg secure a beachhead in the uterine lining. A few cells reach out, they take over the arteries to the mom's uterus lining, and they start invading. And it turns out that 90% of the placenta is made up of cells not from the mother, but from the fetus.

When the placenta evolved, it was really the beginning of maternal-fetal conflict. What does that mean? It means that the placenta ends up being very important in considering what is the best for the baby and what's the best for the mother, because the placenta is the epicenter of this conflict. And the development of the placenta was a huge evolutionary advantage for the offspring, not for the mom.

Non-placental mammals can lay a bunch of relatively low-energy eggs, and many species hang around to take care of them. Some just leave them behind. In some, the male does the egg caretaking and in some species they share it. But if the going gets rough, if it gets too cold or too hot, or there's no food, or a predator is running around, the mother can bail and the offspring will die. In the case of placental mammals, the mom can run away with the babies in her, so the babies are more likely to survive.

Now, the babies aren't born usually able to take care of themselves, so along with the placenta, breasts and milk evolved. So we're called mammals instead of placentals, because they kind of go hand in hand.

Now, the placenta belonged to the fetus, and at term 25%, one-quarter of the blood flow coming out of the mom's heart goes through the placenta. And when the baby is born, the cord is cut, or in the case of many mammals, is chewed apart, and the placenta's job is over and it needs to come out pretty darn quick, or the mom will die.

This can be the riskiest time of pregnancy. The placenta has to separate from the uterus completely and pretty quickly and then come out so the uterus can contract and stop that blood flow, or the woman will bleed to death.

Around the world, the most common cause of maternal death is hemorrhage from the placental site when the placenta isn't fully delivered or the uterus doesn't contract to shut it off.

Now, here's a story, and listeners beware, it's kind of a sad story. But it's the most compelling memory from my OB/GYN residency.

I was a chief resident at a very prestigious hospital, and they called me immediately to come down to the emergency room. This is kind of "ER," "Grey's Anatomy," or something before those all existed.

So I went running down to the emergency room and there was a young woman, she was in her early 20s, who had given birth alone in her room in her family's home. She had not disclosed her pregnancy. She'd hidden her pregnancy. She worked in a bank. She was an upstanding young Catholic woman and she did not tell her parents that she was pregnant.

They heard a noise from her bedroom that sounded like a baby, and they found a baby. The cord had been cut, but the mother was unconscious and had blood everywhere. And they called the EMTs who came and they quickly started an IV line, they didn't have blood with them, and tried to resuscitate her and brought her in to the emergency room.

Our job was to see if we could bring this woman . . . who literally had bled to death because her placenta didn't separate. My job was to put on a big long glove and reach inside this sweet young woman's body and take out the placenta from her uterus in hopes that the uterus could contract and she then would stop bleeding. And I got the placenta out, but the team couldn't bring her back. She had bled to death.

This is one of the enduring memories of how dangerous the placenta is for moms. If it doesn't come out pretty quick and completely, women can die.

In fact, this isn't the only dangerous time, right at the birth. Sometimes the placenta separates too early. This is called a placental abruption.

And another compelling memory from my training was a woman whose placenta had completely separated inside -- she had not been in labor -- inside the uterus. The baby, of course, then bled to death. The baby died inside her and the uterus turned into a rock filled with blood, and our job was to empty the uterus, which we did by cesarean, but we didn't save the baby and the placenta had separated too soon.

The Physical Domain of the Placenta

So the placenta ends up being a little window on the future life of the mom and the baby. So this business about invading the mom's blood supply so that we can get really good mixture of blood and nutrients and oxygen between the mom and the baby, if that doesn't go right, and it doesn't go really right about 20% of the time, then either the mom will miscarry, the fetus will not survive, or the placenta doesn't grow very well. And when the placenta doesn't grow very well, it's at risk for making toxins.

We don't know exactly what the toxins are, but there's the disease called toxemia or pre-eclampsia, which causes malignant hypertension in the mom, which can cause, if untreated, stroke and hemorrhage and death in the mom. So a placenta needs its good blood supply.

The placenta also during pregnancy makes a certain hormone called human placental lactogen, or hPL, that acts kind of like insulin. So many women sort of become insulin resistant during pregnancy and they become diabetic, and it's a window on their future health. So women who are diabetic in pregnancy are at much greater risk of developing diabetes later in life.

The question is women who get pre-eclampsia, women who have small babies, women who have preterm birth, women who get diabetes, all those conditions are more likely to be reflected in diseases in moms when they get to be 40.

So women in midlife who had babies that were premature, too small, have high blood pressure or diabetes need to be extra aware that that event that they had in pregnancy is a little signal that they may be more likely to have heart disease, hypertension, and diabetes as they get older. So this is really a critical fact.

Now, is it the placenta itself that sets up the disease like a little grenade to be exploded later when you're 40, or is the placenta kind of a stress test, an early stress test, and when the placenta doesn't work right and you get hypertension or you get diabetes or other kidney problems, that actually those were going to happen anyway and you just had it revealed early? We're not exactly sure.

The Intellectual Domain of the Placenta

But the Human Placenta Project, a very highly funded NIH project is looking carefully at how the placenta predicts moms' future health. But the placenta also predicts the kids' future health.

It turns out that the placenta is different. Male placentas are different than female placentas. And there are about 56 genes in the placenta that are different in boy placentas than girl placentas. And boy placentas are a little bit bigger and they're more at risk for stress. So hypertension and other things are more likely to make a placenta that doesn't work so well, and that stress actually can be put forth to the baby.

That's why boy babies are more likely to be born prematurely, they're more likely to be stillborn, and they're more likely to have cognitive-behavioral problems, like schizophrenia, like autism, and ADHD. And many people are beginning to think that the origins of those three conditions happen with what's happening in utero to the baby, and they may be caused by the placenta.

So the placenta itself can also be a predictor of how the baby is going to do. So the placenta is not just something to throw away, although we do. It's really something that predicts the mom's future health and the baby's future health.

The Emotional Domain of the Placenta

Let's talk about what happens. The baby comes out and is born and hasn't taken its first breath yet really because you need to cut the cord for the baby to sort of take its first deep breath. Otherwise, the baby still thinks it's inside and it's getting oxygen from the placenta. So usually, what happens is somebody cuts the cord. Now, sometimes the baby makes noises before then and that's all well and good.

Now, what I've never understood is relatively contemporary fashion of the obstetrician offering scissors to the dad to cut the cord. I don't get it. First of all, a lot of men don't want to spend any more time down there watching that part of their wife be exploded, literally sometimes, figuratively in others.

So some men don't want to go down there and see that, but I'm not quite sure what cutting the cord does for the guy. Does it make him feel like he was part of the whole event? Really, all the work was done by the woman, a little bit by the obstetrician. And although the guy caused it, I don't get why cutting the cord is such a big deal.

And it's really a brand new thing. It never happened when I was training. We didn't ask the dads if they wanted to cut the cord. In fact, in most cultures, dads aren't even in the delivery room.

It's not good for them to watch this, they aren't very helpful, and indeed they probably need to go get a cigar and go someplace else and do their own little thing. And that's a very retro and regressive thinking on my part. Many husbands want to be there and wives want them there for the whole experience.

But the cutting the cord thing is kind of a relatively new American/European thing, because in most other cultures, the dads just aren't there.

It's maybe helpful for the emotional bonding. The guy gets to now separate his very pregnant wife from her baby by cutting the cord, so now maybe the baby is partly his. I don't get it.

Some guys want to do it. Some guys kind of get talked into it by the obstetrician. The guy really never wanted to get down that end of things anyway, but there you go, cutting the cord.

The Financial Domain of the Placenta

So you cut the cord, and then if all goes well, the placenta comes right out. Aren't we lucky? The uterus contracts, and bleeding stops, and then you have this one-pound blob that looks like hamburger sitting in the bowl. It really looks like hamburger. Yeah, uncooked. Uncooked hamburger. Kind of red, maroon-y, yucky stuff. Here in the studio, my producer just cringed, but something that looks like hamburger.

So sometimes the cord, which is very special and interesting . . . but this isn't a podcast on the cord. It's on placenta. But normally, it's just put in a bucket, stuck in the freezer, and unless there's something special, like the baby is pre-term or there's been problems with the baby chromosomally or there are some questions about placental flow or the placenta tore away early, it just gets thrown away. But we used to think that it was put in a big bucket of many placentas and sold for face cream and shampoo and stuff like that.

And indeed, placentas and placental stuff was put in face creams for a while, and it's maybe thought to be good for your skin. I don't think people are doing that as much anymore because of the concern that some women who were giving birth may have infectious viruses, like HIV and hepatitis B and hepatitis C, and putting other people's viruses on your face may be gross. And now I'm totally grossing out my producer here. I don't think they do that so much anymore.

The Social Domain of the Placenta

But then there is the whole thing about eating the placenta. And in fact, in contemporary United States cultures and the way we give birth in the U.S., women rarely ever see their placentas. They give birth to the baby, the baby is handed off to the mom or the dad or somebody in the room, or unfortunately whisked away if the baby is premature. But then what happens after that with the placentas all happens down there and women can't really see it. So I'd say most American women have never seen their placenta.

Now, there have been certainly women who have cultural or fantasy ideas about what the placenta does and they may take it home and bury it. And there are recipes on the web if you want to add a little placenta to your stew. But around the world, the concept of what we do with the placenta is a little different.

 

Dr. Jones: And here in the studio, we have Polly Wiessner, a professor of anthropology, who's worked for 20, 30, 40 years with cultures that are different from ours, and she's going to give you a little idea about placentas from what she's seen in other lifeways. Polly?

Polly: Yes. Well, with the Kalahari Bushmen, it's interesting because the first time a woman gives birth, she goes out with her mother and her mother instructs her. But after that, it's a high cultural value to give birth alone and not to cry, not to scream, not do anything. I know one woman who went out to the bush, built a fire to give birth, and wild dogs attacked her, and she gave birth while fighting off wild dogs.

Dr. Jones: Oh, no.

Polly: Yes, incredible story.

Dr. Jones: So the first time, which is the riskiest time, she has someone to help her, and after that, she's all alone.

Polly: You're supposed to go alone. I think a lot of that is because sometimes if your [inaudible 00:17:02] was too close, you had to let one die and then no one would know.

But for the placenta, when the placenta comes out, it's something to be dealt with and it's regarded as something powerful. And the mother cuts the cord, leaving about seven inches, and then she takes a stick other than her digging stick, because nothing she uses can touch the placenta, which is powerful, and she buries it deeply under a bush. She picks up her baby, she puts it on her back, and she comes back into the camp proud and radiant. So that's with the Bushmen.

With the Enga, the women . . .

Dr. Jones: This is in New Guinea.

Polly: Yeah, sorry, Highland, New Guinea. They give birth in the center of the house and the pig stalls, and they usually have other women to support them. And if things are difficult, their husband is outside killing pigs for the spirits to help them.

And then when the baby is delivered, the placenta is taken in some cases and burned so that men will have no contact with it because it's powerful. Also, that the dogs will not get it.

But in other areas of where I work, it's very interesting. They take the placenta and the umbilical cord and they put them up in the trees for the birds to carry away.

Dr. Jones: Oh. Well, the idea is that placenta is something important.

Polly: Important.

Dr. Jones: And powerful.

Polly: Yes.

Dr. Jones: And we need to do something with it.

Polly: It needs to be dealt with. Yes.

Dr. Jones: So in the U.S., we get the placenta and we put it in a plastic container and we stick it in the fridge. And maybe there's somebody doing research on placentas.

More and more we're realizing the placenta is a very, very important part of development in the newborn. What happens in the placenta really can affect what's happening in the baby. But mostly in our culture, we don't think of the placenta as anything except garbage without any power.

Polly: I know. So I think in most traditional cultures, it's regarded as something highly powerful, but it has to be disposed of. So it has to be disposed of properly. I don't know of any culture that just kind of tosses it out.

Dr. Jones: Well, in our culture, we consider it just as waste, although we're getting more information about how powerful it is biologically, but certainly not spiritually. Polly, what do you think, that you've seen?

Polly: Well, in the cultures that I know, it's regarded as something with great powers because it grew the baby, of course. And so it has to be disposed of in some way ritually, but it also has to be disposed of because it can attract dogs, it can attract rats, and things like that. So it has to be disposed of. There are usual ritual means of doing that.

Dr. Jones: Well, we're getting to have more and more understanding of how powerful the placenta is in our culture. Probably not that it's going to destroy or damage men, but our ritual of putting it in a plastic container and putting it in the fridge in the non-labor and delivery is not really . . . I think we need another ritual. We need brand new rituals here in the United States. Thank you.

 

So what about eating your placenta here in the U.S.? I know it's called placentophagy, and it's not recommended. Although many women maybe want to eat their placenta, I suggest, ladies, that you boil it well because the placenta is always infected with its own bacteria.

And then, of course, the placentas come through the vagina and some women have had other body excrements that have been all mixed up with it. And so the placenta is never sterile, so you better cook it really well, but we don't recommend it.

Some people desiccate it and put it in little placenta pills, and women are convinced that they feel better because there is lots of iron in it. But in fact, it's not recommended by the American Academy of OB/GYN or the British Royal College. So, in general, we're not a fan.

So you can't really sell it. We don't recommend eating it. If the guys want to bury it in the garden and use it as fertilizer, it's up to you, and that's it.

The Environmental Domain of the Placenta

Well, the placenta was thought to be this perfect barrier between all bad things and the baby. In fact, it's really not a perfect barrier. A lot of things get through, and it turns out that the placenta is profoundly and adversely affected by poor air quality.

So not only does the placenta let through chemicals that might be in your sunscreen, your fingernail polish, your hand lotion, plastics that you might be eating, pesticides on your fruit, the placenta lets those chemicals through and the babies then can be exposed.

Specifically, with respect to bad air quality, we know that the placenta is adversely affected by poor air quality. PM 2.5, the little particulates that we measure, that we know are bad for lungs and the brain, get lodged in the placenta and cause inflammation. Inflammation is bad for the placenta, and inflamed and stressed out placentas make inflamed babies. And in fact, worse for boy babies than girl babies.

And so inflamed placentas increase the risk of preterm birth and stillbirth and small babies and learning deficits like ADHD and maybe autism. So we're concerned about environmental qualities and how it affects the placenta and then potentially how it affects the baby.

Ozone, which is a problem around the country, especially in the summer, high ozone levels are associated with an increased risk of stillbirth, which is related to placental function. So we like to think that our environment is excluded from the baby by this wall of the placenta, but it isn't really true. The placenta lets stuff through.

The Spiritual Domain of the Placenta

Well, back to thinking about the magic of the placenta. The placenta actually lets cells from the baby and the placenta through to the mom. So women who are pregnant have stem cells from the baby wandering through their bloodstream. And these stem cells can wander around. They may find themselves in the liver or in cartilage or even in the brain, and stem cells actually can be a source of brand new, healthy cells.

And these fetal cells can stay in your body for decades reproducing, and not only the cells of this baby, but maybe also the previous baby and the previous baby. So moms of babies may have cells buried in their liver, their brain, in collagen, and other parts of their body that are actually still active. They become what we call microchimeras, meaning they have DNA from different creatures inside them.

We always think that we carry our children around with us forever and, in fact, we do. And our children may carry some of our cells back toward them. So our cells . . . the placenta allows this shuttle in very small amounts of cells from the mom to the baby and from the baby to the mom.

Now, we don't know if this is a good thing or a bad thing. It's suggested that it may be why women have more autoimmune disease, because they have cells that aren't themselves, they're DNA-different, in their bodies and may increase the risk of diseases called lupus and scleroderma and rheumatoid arthritis. So there may be more autoimmune disease in women than men because we are carrying around the DNA of our children in our bodies.

On the other hand, some people believe in mouse studies that these stem cells may actually go to areas of hurt and may help repair areas of stroke or areas of a heart attack. At least in mouse models, they seem to work that way. So it could be that these baby cells are an advantage, or a disadvantage, or more likely a little bit of both.

But in fact, we do carry around DNA of our children for decades. And that makes me stop to think about who I really am. The fact that I think of myself as an autonomous human being, I'm a person with my very own DNA everywhere, but in fact, although it's been many, many years, three decades and a half now, since my baby boy sprinkled his DNA into my body, the fact that I carried him and his DNA in my body for those years makes me think about what it means to get back to this dispassionate kindness.

I'd like to say I'm dispassionate in my care and my kindness of my kid, but I'm not because he is alive inside me either emotionally, spiritually, and maybe biologically. But I'm trying to step back a little bit more, and as I have fewer and fewer of his cells inside me, maybe I can be more calm about him and more kind.

Oh, we're going to end this episode with something that's a little fun, and we're going to create a health haiku. Now, haikus are a very structured, poetic form from Japanese, but they usually have something in them. They have usually a color, they have something about nature, and they have a certain number of syllables. And the number of syllables are five/seven/five.

 

New baby cries loud
Red blood rushing to the floor
Bleeding stops, mom smiles

 

So that's the placenta, that's about the placenta. That's the magic of the placenta. That's the placenta letting our cells intermingle for decades after the birth. And for those of you who are working on dispassionate kindness, understand it's okay if you still feel like your kid is inside you because, in fact, they are.

Thanks for joining us on the placenta project with the "7 Domains of Women's Health."