Hold the Placenta, Please

Last week, I wrote a post about maternal placentophagy. While it's not a routine practice in America, I know of a few midwives and mothers here in Portland, Oregon who have begun to practice it. Portland Placenta Services claims that Traditional Chinese Medicine (TCM) has been using placenta for "thousands of years" and that the encapsulated placenta can be used to "increase scanty lactation and tonify Qi, life energy, after the birth. Today, many women look to placenta encapsulation as a natural way to even their hormones after birth and avoid postpartum depression." PPS says that they "use traditional methods to gently steam, dehydrate, powder and encapsulate the placenta."

In Aviva Jill Romm's book,Natural Health after Birth: The Complete Guide to Postpartum Wellness, she states that:

In Chinese medicine, the placenta is traditionally made into a medicine to be taken by the mother in the days postnatally. Bob Flaws, in his book The Path of Pregnancy, writes: 'Postpartum discharge and tonification can be facilitated through the use of the placenta.... The placenta is full of hormones and other biologically powerful substances. it is very potent and powerful medicine and should not be wasted.'

Although taking the placenta as medicine may not be everyone's cup of tea, many of my clients over the years have done this and found it very tonifying. The following instructions allow you to dry and preserve the placenta as a powder, which, kept in a dark, cool environment, will keep for years. However the recommendation is to take it during the first week or 10 days postpartum until it is entirely used up.

My other post on placentophagy talked about how researchers can find no history (i.e. tradition) of human mothers eating their own placentas prior to the 1970's. And, the only "traditional preparation methods" I can think of would be those listed by Li Shizhen in the Renbu chapter of the Bencao Gangmu. The late 16th Century text would be the oldest mention in a Chinese source. In most cases, the placenta is soaked for many days and drained of all blood with needles, then dehydrated and ground to a powder that is usually mixed with herbs. Even so, Mark Kristal has shown that the delicate amino acids and other constituents in the placenta will not retain their integrity once heated over 104 degrees F.

Ultimately, if the practice is positive or even neutral/placebo, that's great! However, with the number of heavy metals and chemicals humans are exposed to on a daily basis, I worry that this may actually be a harmful practice for a mother (and her breastfeeding infant).  I have to ask:

What is the goal/thinking behind the modern use of placenta during the postpartum and what might be a better or safer choice?

Since there are no proven benefits of maternal placentophagy, nor a reliable account of traditional use in any world medicine (that I can find so far), I am compiling a list based on what I've read and heard. I think this covers the attributes given to placenta as a postpartum medicine:

• Helps with "postpartum discharge" (retention of lochia)
• Slowing and stopping hemorrhaging after childbirth
• Balancing postpartum hormones
• Increasing postpartum energy (replenishing iron levels)
• Increasing milk supply for breastfeeding
• Avoiding postpartum depression
• Helping the uterus regain its pre-pregnancy state

For a healthy, well-nourished woman, many of these issues do not require medication after giving birth. Certainly, a woman who has social support as well as access to bone broths, organic well-prepared grains, nutrient-rich vegetables and healing fats should have the bulk of what she needs to replenish herself during the postpartum month. A spokesperson from the Royal College of Obstetricians and Gynecologists in England told the BBC that:

Animals eat their placenta to get nutrition - but when people are already well-nourished, there is no benefit, there is no reason to do it.

Obviously, Mark Kristal has shown that animals eat their placenta for more than just nutrition - it helps with pain relief and maternal bonding. But, humans (and camels) do not participate in this mammalian practice and researchers are working to determine why.

Social support is paramount in helping a postpartum women in understanding her new role as a mother, how to breastfeed her child, assisting with routine work done, etc. When there is support/education combined with nutrition, the new mother will be at lowered risk for postpartum depression and her body should heal well after a normal birth.

Taking placenta pills is not only unproven, but it's simply not enough to address issues that go above and beyond normal levels for postpartum recovery. In addition, the postpartum placenta pill can satisfy our cultural urges for a quick-fix. For instance, numerous studies have shown that breastfed babies do not necessarily benefits over formula fed babies, due to a lack of nutrition in the mother's diet. Western mothers often feel pressure to return to their pre-pregnancy weight quickly and end up avoiding a number of foods that would be nourishing for them. If these mothers think that they can get the same benefits by taking a low-calorie placenta wonder pill, they are even less likely to invest in the thinking and lifestyle changes needed to accommodate healthy breastfeeding.

Someday soon, I can go into more specifics about the postpartum recovery period, what each week after birth entails. For now, what do we do with these issues above?

Retention of Lochia/Stopping the Bleeding

In his 17th Century text, Fu Qingzhu Nuke, Dr. Fu recommended the use of Shenghua Tang in the postpartum. The Paojiang stops the bleeding while the other herbs move the blood and help to clear the uterus/lochia and any swelling. (Benson Huang, L.Ac, recommended that this formula can be used right away after a natural birth (no interventions), but that we need to wait for three days after a hospital birth so that any drugs are cleared from the system. If there has been a cesarean, it is best to wait seven days before the woman starts the formula.)

Another teacher recommends using SHT but said that for a more classical approach, a practitioner could look at Danggui Jianzhong Tang plus Taoren and Mudanpi. The DGJZT is going to help tonify the Earth and relieve pain. The Taoren and Mudanpi will move any blood that is stagnating in the uterus and reduce the swelling. I would probably add Paojiang as well - though I have tended to stick with the Shenghua Tang. Western herbalists use postpartum combinations of Capsella bursa-pastoris (Shepherd's Purse) and achillea millefolium (Yarrow) to staunch bleeding and clear the uterus and the idea behind the combination is similar. If I were to go that route, I would likely add a bit of licorice to harmonize the formula and the Earth.

For the first week, the mother should be eating relatively light foods and avoiding heavy foods. Before tonification, the uterus must be cleared and the Earth organs allowed to rest. Putting undue stress on her digestion will result in delayed healing, fatigue, lowered production of blood and breastmilk, insomnia and many of the other disorders that placenta can supposedly treat. The body just went through a huge ordeal and it needs a little time to breath before supplementation can begin. This is really, really important, but it seems to get lost in the conversation sometimes. Here, think about highly nutritive bone broths with some very overcooked grains and possibly some easily digested and well cooked vegetable soups. I have used simple congees, miyuk gook, peanut jujube soup and warming fish or chicken soups. The mother should avoid hard-to-digest foods such as muscle meats, raw vegetables and overly fatty substances. The foods chosen are going to be different depending on the season, the constitution of the mother and how she's doing afterwards. 

If the mother shows a more severe yang deficiency that cannot wait, consider Danggui Shengjiang Yangrou Tang.

This is a time of rest and the mother needs to concentrate on keeping a quiet mind (guarding the Shen), nurturing her baby and making sure she is getting plenty of sleep and fluids.

Lactation/Building Blood

This is a huge topic that will require it's own post. However, as noted above, it's not simply the quantity of breast milk, but the quality, that matters. I love the way that Hilary Jacobson breaks it down in Motherfood, though it's based on Ayurveda and not East Asian medicine. She identifies the three Ayuvedic constitutions and the issues they tend towards (people can be a mix of any of these types). It helps me think about the three main problems with the blood like this:

• The more Earth-Water type (earth in Ayurveda, kapha) tends to be able to produce enough milk and high quality milk, but if social support is lacking, this type can run into problems with apathy and depression. The blood needs to be light enough to house the Shen. Laughter and joy give lightness to the blood, social connection and support are highly important here.
• The Wood-Fire type (fiery in Ayurveda, pitta) person tends to be highly active (sometimes excessively), drinks a fair amount of alcohol, craves spicy foods, etc. This type may have issues with the quantity of blood but more defining is the toxicity/quality of the blood. Babies breastfed from these mothers can tend towards colic. The blood needs to be high-quality and free from toxins. The Spleen and Stomach need to be functioning well to make this happen. The liver is a major player in the quality of the blood. 
• The Fire-Metal type (airy in Ayuveda, vata) person tends to be more intellectual and reliant on thinking. This person is the "least vital" of all the types. They are very changeable, with bursts of energy and sudden bouts of fatigue. The nervous exhaustion that can come on in the postpartum is a characteristic of this type. The milk supply for this constitution can be quite low. The vessels need to be filled with high-quality blood so that they can overflow to make milk. Again, the digestive organs need to be functioning well to make sure this happens. The person needs to avoid over-thinking and reserve their energy.  

Placenta pills are just not enough to cut it for some of these issues. A woman needs to modify her behavior, her lifestyle and her diet to include foods that are replenishing for the digestive organs. Depending on her nature, other recommendations to build the blood or clean the blood can follow, as well as meditations, exercises and social recommendations.

Building the blood can be as simple as a couple of cups of blackstrap molasses "coffee" each day, or it can require complex herbal formulas in addition to dietary and lifestyle changes. As stated above, a healthy woman would do well to eat only light foods the first week after birth (to allow the digestive organs to rest and regenerate) and to follow that with traditional food recommendations. These continue to include bone broths, fish congees, miyuk gook and warming chicken soups as well as Sangjisheng egg, lotus soup and red yeast rice cakes.

An avoidance of things that deplete and toxify the blood is very important. This includes alcohol, overly spicy foods, GMO foods, sugar, fried foods, meat imitations, highly processed foods and commonly allergenic foods until it is known that the baby can tolerate them (eggs, soy, dairy, etc.)

Iron

Once the mother's spleen function is looking good and the baby has shown that she can tolerate some of the more allergenic foods, boost the iron with eggs, dark leafy greens, prunes, meat, chickpeas, lentils, fish, pumpkin seeds, quinoa, etc. Tofu is made with shigao and can be considered too cold for a newly postpartum woman. However, tofu skin (the film that rises to the top while the milk is boiling) is neutral in flavor, high in protein and delicious in soup, while being much easier to digest than tofu itself.

All of these foods work well for replenishing the mother's energy, but more must be done. The mother must have a good social support network. If she is estranged from her family, this can be difficult, especially if she has a hard time asking for help and doesn't have the money to pay for services. A new mother needs at least a month off from house work and worries other than her new baby. Worrying and overworking herself will further deplete the spleen, resulting in blood deficiency and toxicity.

In our modern world, it's easy to become overstimulated by technology. A new mother might post pictures of her new baby on Facebook and then check in often through the social network, especially if she isn't getting a lot of "real life" support. The stomach channel begins at the eye and we can think about the myriad of ways in which we drain ourselves through the eye - television, reading, social media, playing on our Smartphones, etc. In addition, some of us tend to overthink or become really passionate about ideas or possibilities. All of these things take energy from our digestive function and draw on the resources in our blood in order to feed the overworked brain. A new mother can work to find a meditative state that is more heart-centered and heart-feeding, that builds the blood while it allows her to slow down and focus on her baby and her own healing. Our modern lives are fast-paced, and we tend to sleep too little and think too much. Taking placenta pills three times a day won't remedy this. We have to change our behavior to keep our reserves strong and add to our energetic bank accounts.

Hormonal Imbalances

Taking care of the digestive function is foremost in every condition listed here, including hormonal imbalances. During pregnancy, the placenta is producing high levels of progesterone. Once the placenta is delivered, the progesterone levels drop and a woman is left in a state of estrogen dominance. Progesterone tends to elevate the mood, while estrogen dominance can result in fluid retention and mood related symptoms. If a woman is following a healthy postpartum diet (good fats, organic fruits, veggies, whole grains and high quality protein) with plenty of fiber, drinking plenty of water and avoiding caffeine, sugar and alcohol, her hormone levels should regulate themselves. Estrogen is excreted through the bowel when it attaches to fiber.

Kombu and kelp can be used to relieve hormone imbalances, if a safe source can be found and they are prepared in a way that warms them for a postpartum mother (like miyuk gook). Soups made with angelica sinensis (danggui) root are very effective for regulating hormones and Danggui Shengjiang Yangrou Tang can be considered if there are signs that an imbalance is not righting itself.

Postpartum Depression

Again, a number of posts can be dedicated to the topic of postpartum depression. There are too many formulas that are too varied and individualized for me to list them here - though ultimately the idea is typically to calm the Shen, smooth the liver, tonify the digestion and kidney, promote sleep and build blood and energy. A Western combination of herbs could be used to do this as well. If postpartum depression is an issue, it's going to take more than placenta pills to remedy - as it requires individualized treatment and social support.

It seems to me that there are a considerable number of options for us, as EAM providers, that do not rely on placenta. In fact, after typing just this small percentage of remedies out, I realize that placenta pales in comparison to the other resources that we have!