by Donna Walls, RN, BSN, ICCE, IBCLC, ANLC
In recent years, a practice has appeared which involves the preparation of a woman’s placenta for ingestion. Preparation practices vary from dehydration to heat treatments. The dried and ground placenta is then placed in capsules for ingestion over the first days or weeks after birth. Some recipes can be found for the use of the placenta for making soups, stews or smoothies to be eaten after the birth. This controversial practice has been cited as a common custom throughout history and often referred to as part of traditional medicinal systems. Many proponents of placental ingestion report the benefits of less postpartum mood disorders, enhanced breastmilk production, treatment of anemia and encouraging uterine involution. Another rationale for ingestion points to the common mammalian practice of eating placentas immediately after the animal gives birth. Most authorities agree that this practice seems to be done for protection of the offspring by removing the smell of blood which can attract predators and not for nutritional needs. This immediate consumption also allows for the normal physiologic function of lactogenesis. After the initial surge of ingested progesterone dissipates quickly over the first hours and days, the increasing levels of prolactin stimulate early milk production.
Research supporting the safety and efficacy of placental ingestion, placentophagy, has been scarce as most information is anecdotal. Suggested benefits of placental ingestion range from less postpartum depression and treatment of anemia to improving milk production. Concerns include possible low milk supply issues and unregulated, unsafe preparation practices resulting in contamination and possible infections. A case of neonatal group B Streptococcus sepsis was recently reported to the CDC . The Centers for Disease Control and Prevention then recommended that the intake of placenta capsules should be avoided owing to inadequate eradication of infectious pathogens during the encapsulation process The Association of Placenta Arts provides guidelines for patients and providers but at this time, there are no regulations for the safety in preparation or storage or standardization of amounts needed for therapeutic effects.
The low milk supply concerns can be explained by the physiology of early lactation. Placental progesterone fills and activates the receptor sites on the alveolar (milk making) cells during the pregnancy and is responsible for colostrum production in the last half of the pregnancy. At birth and with the expulsion of the placenta there is a dramatic, rapid drop in the progesterone allowing the receptor sites to empty of progesterone and fill with prolactin, the hormone responsible for milk production. Prolactin is released when the infant stimulates the nipple during feeding or nipple stimulation occurs with expression of milk.
There is no clear answer to the question of how much of the active hormone remains after the preparation process is completed. If the hormone is degraded, there may not be a negative effect on early milk production. If progesterone remains physiologically active there is a concern. Only one study (Young et al, 2016) found that hormones did remain active and in levels high enough to cause a physiologic response.
In my professional practice as a lactation consultant, I have found a connection between mothers who have low milk supply and ingestion of placenta. Many of these mothers complained that they never really felt the initial filling, and when they expressed their milk, rarely pumped adequate milk to meet their infant’s needs. They struggled with supply, even after adding extra feedings or expression sessions and often began supplementing when there was poor weight gain in the newborn period. There were enough cases noted that I added a routine question about the practice of placental ingestion to my history when working with mothers who have milk supply concerns. I have also found, within days, there was a filling of the breast and an increase in supply when the placental ingestion was discontinued.
So, how can we respond to questions? Should we be adding placental encapsulation education in our childbirth or prenatal breastfeeding classes? At this time we are still not assured of universal safety assurances or universal warnings. As ICEA childbirth educators we should encourage investigation and asking questions about the preparation process from those they are considering receiving placental products. We encourage our clients to consider risks, benefits and alternatives in many aspects of childbearing and we should also encourage then to apply the same principles to the possibility of consuming placental products.