THE COLLEGE HILL INDEPENDENT


My Finest Jacket

Reimagining the placenta’s place in our birth narrative

by Mia Pattillo

Illustration by Mariel Solomon

published November 30, 2018


Though addressing the experience of all placenta-bearing folks, I refer to mothers in this piece using she/her pronouns for the sake of continuity, to address histories of misogyny, and because the majority of placenta-bearers are cis-women. However, it is necessary to acknowledge that those who do not identify as women and/or use she/her pronouns are equally, if not more, affected by the issues and discourses of reproductive justice.

Minutes after a child is born, the mother’s body must act as a vehicle of expulsion for one final entity: the placenta. It is likely that no one has prepared her for this process, sometimes referred to as the “afterbirth”; no one has told her the contractions don’t stop quite yet, that she needs to push out a disc about the size of a pizza. It exits with a gush of blood, splattered with pulpy crimson blobs on one side, shimmering with a thin membrane on the other, crawling with a network of blue and red veins that flower from a stalky umbilical cord. She may be shocked by its size; some parents faint at the sight of it. The placenta is a Shirley Jackson novel in organ form: formidable, enigmatic, raw and meaty, smelling of liver, oozing pulp and power.

The placenta is the organ that precedes all other organs before the fetus develops a stomach, lungs, or kidneys. The organ that grows alongside the fetus and filters blood, removes waste, and provides oxygen—all simultaneously. The organ that keeps out bacteria, while letting in glucose and antibodies. The only organ that mother and child ever share and ever will share, linking her air to child’s air, her nutrients to child’s nutrients, and her heart—filling and contracting and ejecting and relaxing—to that of child. A jack-of-all-trades kind of organ, but also a transient kind of organ—the only transient organ to exist in the human body. Expelled from the mother’s body and severed from child with one swift snip of the gelatinous umbilical cord.

The placenta is neither secreted by the mother herself, as blood is, nor does it exist as its own organism, as her child does, but rather straddles the space between mother and child, between the developed and undeveloped, between what is fully human and what is not. Sustaining a child for months only to often be forgotten immediately, it possesses the power of ownership, the weakness of ephemerality. But above all, the placenta is a mystery. According to the National Institute of Child Health and Human Development, the placenta is “the least understood human organ and arguably one of the more important, not only for the health of a woman and her fetus during pregnancy but also for the lifelong health of both.” As a result of the fact that medicine has historically been and continues to be run primarily by cisgender men, the actual bodies that carry placentas are disproportionately understudied—those of both cisgender women and anatomically female trans folks. We simply accept the existence of this individually-paired organ that once developed alongside us in our mother’s body like a sibling, spoon-fed us what we needed to flourish in the uterus, and then obligatorily left us post-womb, never to be seen again, save for the times it is crushed into pills, blended into smoothies, or fried and eaten. Thus, it continues to maintain its enigmatic identity—who can fully comprehend the inner machinations of the placenta, other than the placenta itself?

The ominous pucker of our belly button teases us: the only wrinkly relic of the critical connection to our placenta, our mother, our lifeline.

 

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My infatuation with the placenta began with an interview on NPR’s Fresh Air podcast with Angela Garbes, author of  Like a Mother: A Feminist Journey Through the Science and Culture of Pregnancy. As she described the “double-sided hybrid interface,” the “conduit connecting present, past, and future,” I paused in my hike in the middle of the woods and frantically scrambled to take notes in my phone, spending the next few days obsessing over what I had learned, shocked at how little I had previously heard about it. Why wasn’t the entire world talking about this?

“If my body is doing something, I want to know,” Garbes said when I spoke with her over the phone. “I think that when you learn something about how you’re able to nurture a fetus…that’s something that makes pregnant people feel empowered, that makes them admire their body, and I think as a culture we can also admire the work of pregnant people and what they’re contributing.” But the placenta is difficult to study: it’s complex, it’s temporary, it’s one entity connected to two people. It also has a finite lifespan, growing for around thirty-four weeks within the womb before it begins deteriorating. Upon expulsion, its time is already complete; the window for studying its function has elapsed.

As Garbes pointed out, the placenta is also a part of female reproductive health, which has been systematically undervalued—scientifically, financially, and culturally—for centuries. In response to pregnant women’s negative reactions to several sedative drugs, the FDA issued a ban in 1977 preventing all women who could become pregnant from participating in early-stage clinical trials, including women who were not sexually active, women who used contraception, or lesbian women. Thus, all clinical research in the period following was done primarily on, by, and for men. It was only in 1993 that the the National Institute of Health mandated that women and minorities be included in any government-funded health research. And yet the scope of our scientific knowledge still remains disproportionately skewed toward those with male anatomy, as evidenced by a survey of studies published in 2004 revealing that only 37 percent of the participants were women. Pregnant women, specifically, continue to be routinely excluded from clinical trials under the guise of protecting fetuses from the potential harm of an intervention.

But studying the placenta would have impacts far beyond understanding a fascinating organ—it could save lives of all genders, Garbes explained. A lack of blood supply in the placenta can lead to disastrous results, such as stillbirths, miscarriages, and long-standing post-delivery health problems in both mother and child. Pre-eclampsia, a potentially fatal disease caused by an abnormally small and weak placenta, affects two to five percent of pregnant women in the United States. And yet, exactly how and why this problem occurs has yet to be completely understood.

According to a New York Times article from July 14, 2014, the perturbing word that scientists repeatedly use to describe the placenta is “invasive.” The placenta forms along the uterine lining beside the implanted egg, burrowing deep into the mother's tissue and leeching off of her nutrients. It is an entirely new organ within the mother’s body, “50 percent originating within the fetus, 50 percent somebody’s DNA—yet a mother’s body tolerates it,” Garbes explains. Indeed, it taps into a mother’s body with a ruthless yet welcome aggression, a process that many researchers have parallelled with cancer. But describing the placenta as “invasive” implies that it is unwanted, an encroachment on the womb. Though this adjective may be applicable to a disease like cancer, these negative connotations do a disservice to the placenta, whose “invasion” is critical to sustaining the life of a human being.

On a scientific level, both placenta cells and cancer cells share the same secret: the mastery of mimicry. In early pregnancy, cells called trophoblasts on the outside of embryos swarm over the uterine walls like ants, destroying cells that stand in the way through digestive enzymes or inducing cells to kill themselves. They then imitate the very vessels they invaded, as the arteries lining the uterus become “remodeled” with trophoblasts instead of the mother’s cells. This remodeling in order to convince the mother to accept the placenta may also open up avenues to a better understanding of organ transplants. When a foreign organ enters a body, the natural inclination is to reject it without extreme pharmacological suppression, Garbes said to the Indy. The placenta serves as a stark counter-example to this bodily rejection. Thus, it is critical to study the placenta not only for maternal and female reproductive health, but for overall adult health: a fuller knowledge of the placenta could offer realms of understanding in cancer cells and organ transplants. The Human Placenta Project, a collaborative research effort launched by the National Institute of Health in 2014, is working to fill this critical gap in our knowledge. But a long road still remains ahead in tapping into the workings of this extraordinary organ to help us better tend to and make sense of our own bodies—regardless of whether they carry placentas or not.

 

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Tabloids blew up when Kim Kardashian ate her placenta last year, groundup and encapsulated in pill form. “I had great results and felt so energized and didn't have any signs of depression! I definitely had to do it again. Every time I take a pill, I feel a surge of energy and feel really healthy and good. I totally recommend it for anyone considering it!” Kardashian wrote on her blog. The placenta certainly challenges our definition of what we consider food, what we consider human, and what we consider our own body: is placentophagy—the act of eating one’s own placenta—vegetarian? Vegan? Cannibalism?

Most mammals, even domesticated pets, eat their placentas immediately after birth, a trend that is catching on among women in the United States. A small study published in 2013 in Ecology of Food and Nutrition suggested that a majority of women who ate their placentas were white, wealthy, and married, perhaps reflecting the economic barrier of $200-400 for encapsulation services or a sense of status in consuming “delicacies.” If one hopes to incorporate a little culinary creativity, a quick Google search provides entire placenta cookbooks, chock-full of placenta recipes including placenta lasagna, placenta chili, placenta truffles, placenta tacos, and placenta smoothies. The common theory holds that placentophagy will prevent postpartum depression and help the uterus heal more quickly, although there is currently no scientific proof of any health benefits. In fact, a 2016 literature review published in the Journal of Obstetric, Gynecologic & Neonatal Nursing “did not find strong scientific evidence to support the mood, energy, and lactation-enhancing claims of placenta-eaters.” Furthermore, the June 2017 issue of the CDC’s Morbidity and Mortality Weekly Report warned against it, citing an Oregon woman’s baby who was diagnosed with late-onset group B strep in 2016, a disease whose bacteria were found in the mother’s post-delivery placental pills. With no standards for how a placenta is encapsulated, it can be done in the home or sent to outside facilities, where the placenta is placed into foreign hands to be dehydrated, put into pills, returned, and ingested.

Garbes ate placenta pills with her first pregnancy, but not with her second. She attributes the increasing interest in placentophagy partially to the fact that female reproductive health continues to be undervalued. “I think a lot of people turn to the placenta as another way of helping them, because they don’t really have the support that they need post-partum,” she said. “People are like sure, I’ll eat my organ, because I only have one six-week check-up and I’m feeling overwhelmed. Someone’s telling me that this might make me feel better.” But at the same time, she also finds the intuition and testimonies of mothers who attribute health benefits to the placenta to be compelling. She doesn’t find it at all extreme to believe that something a woman grew, that is hers, that her body created, is beneficial to her. “We need to take it seriously and study it better,” she added.

In some cultures, the placenta is spiritually revered, carrying symbolism of life and individuality. Among New Zealand’s Maoris, who use the same term for placenta and land, as well as among the Navajo nation, the placenta is buried within a sacred area of soil. Filipina mothers may bury their placenta with books in hopes of a smart child, while the Igbo of Nigeria perform full burial rites for the placenta, treating it as a dead twin. Many Vietnamese and Chinese mothers prepare the placenta for consumption by boiling it and making it into a broth. Among the Hmong, the word for placenta can be translated as “jacket”—an infant’s first and finest item of clothing. Burying it outside, they believe that after death, the soul must retrace its journeys until it returns to its original placenta jacket. Without it, the soul is doomed to wander eternally coat-less, cold, alone.

 

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I often think about how women are taught that their bodies are vehicles of expulsion: the expulsion of blood, every month; the expulsion of human life, for childbearers. Both of these carry an incredibly heavy weight in the lives of women and mothers. The former implies puberty and growing up, the possibility of childbearing, but it also can consume a woman’s life for up to seven days of pain, bloating, and mood swings. The latter often entails intense pain too, while simultaneously bringing about new life, perhaps a future of love and warmth and growth. So why do we ignore this third, huge, life-dependent expulsion that occurs in the lives of many mothers? This undertaking that also carries an incredibly heavy weight, of pain, of birth, of sustenance?

“I see [the placenta] as this place where mother and child are first communicating to each other, but it’s also a place where there’s invading, altering, and doing things to the mother’s body, so it’s a site of conflict as well,” Garbes told the Indy. Indeed, the placenta serves not only a multi-functional purpose, but one whose multiple functions span two sides of the same coin of pregnancy: cooperation and conflict. That juxtaposition, perhaps, extends beyond the arteries and veins of biology—isn’t so much of any relationship between mother and child a deep grappling with cooperation and conflict?

In one of my favorite parts of Garbes’ book, she likens the placenta to Janus, the two-faced god of beginnings and endings, transitions and passageways, who looks both to the past and to the future and after whom the gates of a building in Rome were named after. The placenta, too, is our past and our future, a transition from our mother, to us, to (potentially) our child. It is a beginning—our first connection to life, and it is an end—snipped away with scissors, likely never to be seen again. It is a passageway stretching back into past generations, and a hallway extending down future generations. And ultimately, the placenta stands at the gate of human life, carrying all of the power to breathe (literally, through its respiratory system) a being into existence.

I ask my mother about my own moment of expulsion. Where is that lifeline now, the pizza-shaped veiny blob with which I formed a physical relationship closer than that with any human being? “I have no idea,” she replies. “All I remember is being in the most terrible pain. I was pushing, stuff was coming out, no one told me what was going on. Then I had a baby.” I imagine my mom’s placenta, disposed of in some waste freezer, incinerated in a landfill, or perhaps sold on an online placenta black market (which is apparently thriving in Japan, where I was born). I think about the time awaiting me in my future, when the life-span of my body comes to an end. And I picture my soul, wandering, scouring the Earth like a character from Spirited Away, hoping for a glorious reunion with my finest jacket.

 

MIA PATTILLO B’20 wants to try placenta sushi but is having vegetarian qualms.