We have just published new research findings. You can access the full journal article free here: BMC Pregnancy and Childbirth
There has been a lot of research exploring the outcomes related to interventions during the birth of the placenta. I have included this research in previous blog posts:
- An actively managed placental birth might be the best option for most women
- The Placenta: essential resuscitation equipment
However, like most research into birth, women’s voices are missing (you can read about research bias in maternity care here). This study is the first to specifically explore the birth of placenta from the perspective of women.
A huge thank you to the women who shared their experiences for this study.
Overview of findings
The quotes that illustrate these themes can be found in the journal article. I particularly like the descriptions of birthing the placenta! Here are a couple:
“The actual birth of the placenta was just weird, just because it was so soft. It felt like my insides were coming out but not in a painful way. I guess it’s like birthing a squid or something”
“Pushing it out felt like a big jelly, relief”
Lovely and important research. Thank you for sharing.
Thank you for adding women’s voices to the conversation.
A continuing error that is repeated in this study too is the totally false notion that women keep ‘their’ placenta. Their placenta was lost a long time ago. It is the baby’s placenta that is being discussed.To fully understand the placenta it is essential that we stop repeating this falsehood. The loss of our own placenta and the manner in which it was treated is a primal imprint that has left a trail of deep trauma in each of us. This is well addressed in my book Lotus Birth. Our relationship with this extraordinary organ that we grow before the rest of our body and that we cannot survive without is very deep and far reaching as is the extent of the trauma we all carry from the brutal way that it has been treated and I believe we have come to project on to other things in our lives.
This research shared women’s own voices regarding the placenta. The title of the study, refers to ‘the placenta’. However, the women themselves used the term ‘my placenta’. In keeping with qualitative research – the researcher does not alter what participants say to fit their own agenda. Instead they must represent the participant data without judgement. Therefore ‘their placenta’ was used to reflect the women’s own perspectives and words. This is not an error – it is how research findings are presented.
It is also interesting that it was largely postnatally that women referred ‘my’ placenta rather than ‘the placenta or ‘it’. Perhaps this is like referring ‘their baby’? Certainly the baby is unable to make decisions about the placenta at this time. The decisions are made by the woman. The women also referred to ‘my midwife’ and ‘my obstetrician’… but I don’t think they believe they own those people.
Perhaps our findings would have been different if we had been studying women who choose lotus birth. But this was not the focus of the study.
I also found your work enlightening, particularly revealing thoughts and attitudes surrounding placental “birthing”, most of which I related to as a father who witnessed active and rapid removal of my partner’s placenta (by a hurried midwife, in our home). Personally, I am fascinated and frustrated when dealing with medical professionals almost monthly, and your work /always/ helps me to put things into perspective. Further, I have a 3 year old daughter that will hopefully/probably/absolutely!? be prepared to navigate the WWW of opinions, including those of medical professionals. Your work (both professional and blogged) will be cited often, thank you!
I have one question that has been bugging me when it pops up in your work or in the comments, one that I answered for myself long ago: “What is an evidence-based practice?”
Anticipating your answer, I must next ask for a clarification, “Is not every single practice that has at least a single scientific citation, an “evidence-based practice”?
I promise to follow-up with my own definition which has worked well for me in setting up scientific inquiry for myself and colleagues, not as a debate, but certainly as an exchange seeking mutual benefit.
Best in your continued good works, from Tempe, Arizona.
The history of evidence based practice is interesting. Its origin (in the 80s/90s) is based on the practitioner combining research evidence with the ‘patients’ individual situation/needs and the practitioners abilities. Now it is often considered to be about doing what the research says is best (which is incorrect).
I like ‘evidence-informed’ practice. This is about taking many forms of evidence – research, experience, cultural wisdom, etc. and using that to inform practice. However, ultimately practice is based on the woman ie. woman-centred. She is the one who actually decides what is done or not done.
Oh wow, you impress me more each time! I too noticed in the 00’s exactly your words, that as I matured through grad school, I began to discover what initially was a confusing transition away from patient-centered data analysis and instead “…often considered to be about doing what the research says is best” for everyone with similar basic demographics, which I agree with you, is incorrect practice (both medically and as an industrial engineer or statistician).
Rather, one gathers evidence from the individual in order to best predict the future outcomes for that specific individual, which can only rationally be decided when knowing the options for intervention (vs. simply observing), and then one is empowered a bit more by comparing personal data (evidence) to the statistics accumulated from (hopefully thousands or millions) of other past cases… or if one is really lucky, to have a twin or close genetic relative that has gone through a similar struggle and collected data along the way for comparison.
My wife & I always walked out of our OB’s offices (we went through several until we chose an incapable but less-invasively oriented midwife) shaking our heads in disbelief of the statistics-based decision making. They had NO need for our data (all normal) because we were both over age 40. For the most shocking example spoken to us: “guess we’ll have to schedule your induction for week 39 since that’s the age that the average 40+ yr old gives birth”. To be fair though, they did not claim to use “evidence-based” approaches. 😉
You claim that ‘There is no evidence to support this notion. There is also a good physiological explanation of the development and ageing of the placenta here, which concludes that: “There is, in fact, no logical reason for believing that the placenta, which is a fetal organ, should age while the other fetal organs do not…” however this quote is from a paper dated 1997.
A web search seems to contradict this for example here https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.1999.tb08410.x
Albeit a very small sample size.
Was happy with waiting but now unsure.
Can you provide anything a bit more recent.
There are a few contradictory studies. I discuss this further in my book Why Induction Matters. Essentially it is acknowledged that the placentas changes during pregnancy. The arguments centre around the significance/meaning of these changes. There has been no research showing that poor outcomes relating to post-dates babies are due to changes in the placentas ie. no difference between live births and stillbirths re. changes in the placenta.
The link is theoretical. In terms of the research you cite. This compared pathological changes (IUGR) with physiological changes. It did not look at outcomes.