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Placentophagy, Lotus Birth, and Other Placenta Practices

What Does the Evidence Tell Us?

Hart Hayes, Emily, DNP, CNM, WHNP-BC

The Journal of Perinatal & Neonatal Nursing: April/June 2019 - Volume 33 - Issue 2 - p 99–102
doi: 10.1097/JPN.0000000000000402
Departments: Expert Opinion: Perinatal
Free

Guest Columnist, Nurse Midwifery, Intermountain Health care, Adjunct Assistant Professor, University of Utah, College of Nursing, Salt Lake City, Utah

Disclosure: The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Each author has indicated that he or she has met the journal's requirements for Authorship.

Will you be taking your placenta home with you?

Many labor and delivery nurses speak these words to women when they are admitted to the hospital for the birth of their child. Although placentas are still considered medical waste by most and treated as such by hospitals, more and more families are requesting to take their placenta home rather than have it disposed of at the hospital. Common alternative practices surrounding the placenta include burial at home, consuming the placenta, and having a lotus birth. This column aims to review these practices and discusses the evidence regarding their potential benefits and risks.

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PLACENTOPHAGY

Placentophagy is the practice of consuming the placenta. Although still relatively rare, it is a growing practice and has been gaining attention in recent years.1–6 Encapsulation is a popular method of consumption, which involves steaming and drying the placenta, then placing it into capsules that are consumed by the new mother over the course of the postpartum period.6 Women often hire encapsulation specialists who provide the service for a fee. Proponents of placenta consumption report benefits such as improved mood and energy, decreased postpartum depression, and improved milk supply. In a qualitative study, some women who consumed their placenta reported self-perceived benefits.6

Some have proposed that placenta capsules work by replenishing of nutrients or hormones.7–9 A series of articles by researchers at the University of Nevada, Las Vegas, investigated the hormone, nutrient, and toxicant concentrations in placenta capsules.9–13 Young and colleagues11 analyzed hormone and melatonin levels in encapsulated placentas and found detectable concentrations that could possibly yield physiologic effects. In a related study, the researchers measured salivary hormones of women taking placenta capsules and compared them with hormones in women who took a placebo and found no differences between groups; however, they did measure a significant dose response relationship in women in the placenta capsule group.12 In a separate investigation, Johnson and colleagues14 reported that preparation via steaming and dehydration reduced the concentrations of hormones and bacteria in the prepared placenta.

While there may be evidence that placenta capsules contain biological active concentrations of hormones, and there is a measurable increase in hormones of women who consume placenta capsules, this dose-response relationship had not yet been shown to result in therapeutic effects. Young and colleagues13 also investigated placenta capsules’ effect on mood, bonding, and fatigue and found no differences between women who consumed placenta capsules and those who consumed a placebo. Gryder and colleagues9 found no significant difference in iron status between women who consumed placental capsules and those who consumed a placebo, indicating that replenishment of iron stores from consumption of placenta capsules is not likely.

Kristal and colleagues15–22 conducted a series of studies utilizing animal models that demonstrate an analgesic effect from placenta and amniotic fluid consumption. Placenta tissue contains a compound called “placental opioid-enhancing factor” that acts by enhancing the pain-relieving effects of endogenous opioids released during labor and birth. This enhancing effect is not present in nonopioid analgesics, such as aspirin or nicotine.18 It has not been determined whether an analgesic effect may continue into the postpartum period, when most women are consuming placentas as capsules.

While the body of evidence about the effects of placenta consumption is growing, the science is still emerging. The sample sizes on human subjects are small and others are relegated to animal models. Thus far, these studies do not substantiate claims by proponents that consumption of encapsulated placenta can enhance postpartum recovery by increasing energy, improving mood, and increasing milk production. Evidence regarding possible pain relief for postpartum women is still lacking.

Research on potential risks from placenta consumption is also sparse. Potential risks include the possibility for a thromboembolic event from exposure to exogenous estrogen, exposure to environmental toxins that may accumulate in placental tissue, exposure to infectious agents, and exposure of breastfed infants to these substances.1,23–25 To date, there have not been any studies regarding thromboembolic events from placenta consumption; therefore, the question of whether this is anything more than a theoretical risk remains unanswered. Recent studies have not found elevated concentrations of heavy metals in placenta capsules that are likely to cause harmful effects.10,14,26

Two recently published case reviews investigated the possible exposures of breastfed infants to harmful substances in encapsulated placenta. A 2017 Morbidity and Mortality Weekly Report27 chronicled a case report of a breastfed infant with late-onset group B Streptococcus (GBS) bacteremia who had previously been treated for early-onset GBS bacteremia. The mother of the infant had been ingesting placenta capsules, and a culture of the mother's capsules found GBS. The final diagnosis was late-onset GBS bacteremia due to high maternal colonization from consumption of GBS-infected placenta tissue.

A second case study recently published in the literature reported on a 3-month-old breastfed infant with breast budding and vaginal bleeding whose mother was consuming her placenta.28 The infant's symptoms resolved after her mother discontinued her placenta capsules. These case studies must be interpreted with caution, as they represent the lowest level of evidence. However, they do reveal a potential connection between placenta encapsulation and possible harmful effects on the breastfed infants, and additional investigations on placenta consumption must include potential impacts on breastfed infants.

Placenta consumption is becoming increasingly common among women in North America, Europe, and Australia. Little evidence exists to determine whether there are potential benefits and risks associated with the practice, although several recent publications have begun to shed light on the topic. These studies do not substantiate claims for benefits and highlight potential harms, especially to breastfed infants of mothers who consume their placenta.9–14

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LOTUS BIRTH

Lotus birth is the practice of umbilical nonseverance, leaving the umbilical cord and the placenta intact and attached to the infant until it detaches spontaneously, usually within the first week of life. Lotus birth focuses on the principle of nonviolence, with the idea that avoiding cord cutting is meant to allow the infant to be born into the world without violence.29 First introduced into Western cultures in the 1970s, the practice is quite rare and relatively new, but there are reports that lotus birth has long been practiced in some cultures.30 Lim31 describes a lotus birth in Indonesia, where the placenta was prepared by gently washing and patting dry and applying herbs and salt to it before wrapping it in a clean diaper. Over the course of the infant's first week of life, the cord gradually dried. The dressing on the placenta was replaced daily until it eventually detached.31

There is ample evidence that delayed cord clamping can result in benefits to the newborn, including increased hemoglobin levels and iron stores in term infants.32 The American Academy of Pediatrics and the American Heart Association revised the neonatal resuscitation guidelines to include a recommendation to delay cord clamping in vigorous infants for this reason.33 Beyond the benefits of delayed cord clamping in the first minutes of life, however, there is a paucity of research on possible benefits of umbilical nonseverance.

In addition, very little research is available regarding the safety of umbilical nonseverance. Hanel and Ahmed34 describe a case study of a 2-day-old newborn with his umbilical cord and placenta still attached. The infant had been removed from his home and brought to the emergency department for a Department of Child and Family Services evaluation. There was little known about the infant's birth history other than that he had been born at home without medical assistance and his mother had not received prenatal, perinatal, or postnatal care. With the exception of clinical dehydration, the infant was otherwise in good health with no signs of infection. His cord was cut upon admission to the hospital, he was treated for dehydration, given routine newborn vaccines and treatments, and discharged 2 days later to a foster care family. Zinsser29 describes case reports of 3 lotus births by women who chose to deliver at home, giving newborn attachment and spiritual reasons for choosing lotus birth. In this case report, 1 infant had a granuloma present; otherwise, none showed any signs of infection or problems. Monroe et al35 reported on 6 lotus births over a 33-month period between 2014 and 2017. Of the 6 cases, 3 opted to cut the umbilical cord prior to hospital discharge. None of the infants had infections and 2 of the 6 received photo therapy for jaundice. Uptake of recommended newborn cares (eg, vaccinations, vitamin K administration, erythromycin eye ointment) was lower among the families who elected for lotus birth compared with the typical newborn service; only 1 family opted for hepatitis B vaccine and all others declined. One case report by Tricarico and colleagues36 describes a lotus birth in which the infant developed persistent jaundice because of idiopathic neonatal hepatitis that the authors determined was likely related to an infection based on clinical and laboratory data. The infant's condition resolved spontaneously after the first months of life.

The Royal College of Obstetricians and Gynaecologists statement on umbilical nonseverance37 highlights the lack of evidence regarding the safety of the practice and states that women must be fully informed about the potential risk of infection and families that choose lotus birth should monitor their infants closely for signs of infection. As the available evidence currently consists of case reports, additional research is needed to determine whether risks of infection or other risks are present with this practice.

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PLACENTA BURIAL

Many cultures dictate that the placenta should be buried after the birth of a child. In an ethnographic survey of placenta practices across 179 societies, Young and Benyshek38 found that the majority of societies contained references to specific methods for properly disposing of the placenta, and burial was the most common of these methods. Many cultures have a specific location where the placenta must be buried, such as behind the house, at the place of birth, or in a “special place.” In a qualitative study of the practices of a Hmong American Community, Helsel and Mochel39 reported that Hmong people believe that the placenta must be buried at home and that the placenta is needed for travel by the soul into the spirit world to rejoin ancestors. Central Thai culture contains references that the growth of the tree under which the placenta is buried will predict the child's health.38 In Western culture, burial of the placenta beneath a special tree has also become more common. Risks from placenta burial include exposure to possible pathogens during handling. As long as handwashing precautions are followed and the placenta is buried at a sufficient depth to prevent it from being scavenged by animals or accidentally unburied during yard work, the risks from this practice are low.

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CONCLUSION

Although still considered medical waste by most, many women are now requesting to take their placentas home as an alternative to disposing of it at the hospital. A common practice is to bury the placenta beneath a special shrub or tree, but a growing number of women are choosing placenta encapsulation or lotus birth. The evidence surrounding risks and benefits of these practices is still in its infancy, consisting mostly of small studies or case reports. Women must be counseled that there is no strong evidence to support placenta consumption to improve postpartum recovery, breastfeeding, or preventing postpartum depression, and that potential risks include possible exposure of breastfed infants to pathogens and hormones. Other than the known benefits of delayed cord clamping, there is no evidence that lotus birth (umbilical nonseverance) has any clinical benefits. However, families may choose lotus birth due to cultural or spiritual reasons. Families that choose this practice must be counseled to watch closely for signs of infection. For all families planning to take the placenta home, information must be provided regarding safe handling and handwashing to prevent infection.

—Emily Hart Hayes, DNP, CNM, WHNP-BC

Guest Columnist, Nurse Midwifery, Intermountain Health care,

Adjunct Assistant Professor, University of Utah,

College of Nursing, Salt Lake City, Utah

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