What did you expect?

We have become obligate avoiders, dwellers in the middle of the field well away from boundaries –the just-right-baby-bears of the Goldilocks tale. We seek to protect ourselves from edges, no matter how pervasive, how common, how important they may be. It was for a very good reason that the American folk hero, John Wayne, felt he had to remind us that ‘Courage is being scared to death… and saddling up anyway.’

Most of us seek to insulate ourselves from every extreme: we read about our lives from the safety of a middle page while dreaming of the youth in early chapters –as if there were no beginning or conclusion to the book. I suppose it reads as well in the center as at either end, but that misses the point; the book is a story –our story- and to ignore the epilogue or, for that matter, the introduction is to miss the context in which it is written -the gestalt.

The end of life, is an example –until recent times, most people in Western civilizations died where they lived: in their own homes. Family and friends were usually there to provide comfort and support; it was not treated as an event that necessitated separation, but rather as a communal passage –something that invited witness and provided solace for all involved.  Dying, especially of advanced age, was not something to be hidden away or delegated to strangers, however skilled. Death was visible and inevitable; death was a known, if unwelcome guest in each home.

Birth, the beginning of the story, has also had a somewhat chequered history. It, too, was once relegated to the home, but with sometimes unfavourable results for both mother and baby. This led to it being assigned to areas –or assistants- with more training and facilities in case unexpected -or anticipated- problems arose. And while, as an obstetrician, I feel more comfortable in an institutional setting, there is no reason why a well-trained midwife should not be able to pick and choose the appropriate venue for the birth depending upon her assessment of the risk involved. And there is no reason, either, why family or friends should not be able to witness and support the event.

I was surprised, therefore, to come across an article in the BBC news that treated as, well, unusual, the idea of a mother’s children being present to witness the birth: http://www.bbc.com/news/uk-37020059

Clearly, some vetting might be required in terms of the children’s age and behaviour, but as long as they are prepared beforehand, and there is someone else in the room who could supervise and help them understand what is happening, I think it could be a positive experience. Birth and Death should be presented as they are: natural events –not secrets whispered behind closed doors.

*

I kind of suspected birth was no secret to Loretta’s kids. A third-time mother of six and  nine-year-old daughters, she brought them to every antenatal visit. I asked her one day while her older daughter played doctor with my stethoscope, how she managed to get them out of school each time.

She pointed to her watch. “Ever notice that I always book my appointments around noon?”

I nodded. We’d often joked about our stomachs rumbling each time we met. “But they don’t mind leaving their friends to come here?”

“McDonald’s,” she said and then shrugged. “It’s their reward for agreeing to come with me.” She was silent for a moment and then stared at me, her eyes twinkling. “Don’t look at me like that, doctor. Remember Bill Clinton?”

I nodded, puzzled by the non sequitur.

“I never inhale,” she whispered conspiratorially.

The girls were always on their best behaviour in the examining room –full of questions and wanting to try my equipment on themselves. I suspect that the visits sometimes even cut into McDonald time, but they seldom complained –they were much too curious about the growing baby. They never seemed to tire of asking me how much it weighed, and whether it could hear them through their mother’s tummy –apparently they would sing to it at home. The moment they both waited for, however, was when I would place the Doppler device on the uterine wall so they could hear the heart. Janice, the older one, would even time it with her watch to make sure my device was counting correctly. They were both as involved in the pregnancy as their mother.

One day, towards the end of the pregnancy, Loretta phoned me. “I’ve been thinking of letting my girls see the birth,” she said. I could hear a little hesitancy in her words as she spoke. “Will the hospital allow that? My mother will make sure they don’t get in the way,” she added, almost too quickly.

I smiled into the phone –I’d been expecting her to ask. “As long as they know what to expect Loretta. There’s sometimes a lot of… well, yelling as you push… and a lot of blood –especially when the placenta comes out.” I paused for a second. “They have to be told that none of that means there is anything wrong. I wouldn’t want them to become scared.”

She chuckled into her phone. “They watch deliveries all the time now on YouTube, doctor –complicated ones, scary ones, and even ones that end up in Caesarian Sections. I think they’ll be all right.”

“Then it’s fine with me.” I reminded her that I may not be on call when she delivered, but she merely laughed.

“You didn’t make it for the first two either…”

*

Obstetrical practice nowadays is a hectic melange of joy and crisis, each delivery unique and exhilarating to be sure, and yet strangely merged into the one a few minutes before and blended into the one a few minutes later when on call at the hospital. So I have to admit that I was pleasantly surprised one evening as I was rushing to yet another delivery further down the hall when a nurse informed me that Loretta had just been admitted in labour.

“She’s almost fully dilated and it’s her third baby; she won’t be long…” she yelled as I ran past her to the accompaniment of screams from the room where I was originally heading.

Obstetrics is sometimes an exercise in ad hoc triage, and the screams were becoming louder and more compelling from that room, so I had little choice in the matter. I arrived just in time to exchange the mother’s for the baby’s screams, and allow a placenta to jump suddenly into my lap while she snuggled her precious baby against her abdomen.

In the warmth of smiles and congratulations that followed, I almost forgot about Loretta until the nurse’s face appeared in the door. “They want you in Room 8, doctor,” she said, almost casually.

I removed the placenta from my lap and stood up ready to run from the room.

The nurse shook her head sternly. “Better not show up like that,” she said, pointing to my gown. “You’ll scare the girls…”

I grinned sheepishly from behind my mask. I’d forgotten about the girls.

Loretta’s room was strangely calm when I arrived. Everybody was smiling, the baby already snuggled skin to skin on Loretta’s abdomen, and the girls were standing beside their mother enthralled and staring wide-eyed at the crying baby.

Maria, another nurse, who’d been with Loretta since her admission, was just removing her gloves after making sure the newly-delivered placenta was in its little metal bowl. Even though trained as midwives, the obstetrical nurses rarely get a chance to exhibit their skills except at times like this, and she was smiling from ear to ear. Things had obviously gone well.

“Congratulations, Loretta,” I said and immediately blushed. “Looks like I missed number three as well. I’m sorry…”

“Don’t be sorry, doctor. Maria did a fabulous job.”

Maria glanced at Janice who hadn’t even noticed that I’d finally come into the room then focussed her attention on me. “Actually, I was a bit rusty,” she said with a mischievous smile and winked at me. “Janice kept reminding me what to do next…”

Janice turned her head and stared at me. “Maria did a good job,” she said approvingly, “But she dropped the placenta,” she added, her face turning serious like a teacher unwilling to overlook a mistake. “I told her it’d be slippery…”

 

Placentaphilia

Finally! Somebody has had the courage to think the unthinkable and say what most of us have been too shocked to verbalize, too nauseated to contemplate: that eating your baby’s placenta is not a plus. My risen gorge has been vindicated.

An article in the BBC news http://www.bbc.com/news/health-33006384 reports on a review article on placentaphagy (the practice of eating placentas) from Northwestern University http://link.springer.com/article/10.1007/s00737-015-0538-8#page-1 (published in the Archives of Women’s Mental Health) that suggests that there are no proven benefits and no research on the potential risks.

Uhmm… Well, okay, no blinding epiphany there. I mean even if you saute it and hide it under a leaf of lettuce between two slices of toast, you would think it would still lack that magic je ne sais quoi. But, alas, you would be wrong. There has long been a fascination with the placenta and its powers, no doubt rooted in its dual role in both sustenance and connection. It is, after all, neither baby nor mother, and yet an essential workshop serving the two worlds. A mythological creature, its function does not cease with the accident of birth.

Name the culture, and there’s probably a tradition. Some of the aboriginal peoples of the Pacific Northwest of Canada, for example, have the belief that if the placenta is placed in a tree and then carried off by a raven, the child will travel. The New Zealand Maori suggest that the placenta has a link with the earth and should be returned to it when it is no longer needed. There are even those who believe it was alive and functioned as a companion for the baby but then sacrificed itself so the child could be born –I like that one.

My point, I suppose, is that given the magic surrounding the placenta, it should not come as a total surprise that some might feel that the power it wielded might be transferrable if it were consumed. Or, perhaps, that some of its constituents may be beneficial. But I wonder if it’s the same kind of logic that Macbeth’s three witches used. It’s certainly a stretch to suggest that the placenta offers something that isn’t more readily and efficiently available in some other more acceptable format. The fact that it came from within the body and has served as a treatment plant in utero does little to recommend it in my opinion.

But I am more than a little disappointed with my own Medical culture’s lack of imagination. Its lack of narrrative. We are a society of stories –it’s not only how we impart information, its how we value it. Evaluate it. Surely we could have made something up as well… Tradition wrapped in metaphor is far more meaningful than facts trapped in lists. Sometimes facts must wear scratchy and uncomfortable clothes to attract attention. Gather adherents.

Once upon a time when I was young and still wore a stethoscope around my neck, I found myself in the midst of nothing less than an epidemic of placenta-eaters. Wave after wave of them swept into the case room, teeth sharpened, and bread sliced. They couldn’t wait to enter the Kingdom of the Enriched –some even partaking before they left the delivery suite. Usually they were discreet and waited until we had left them alone in the room to bond; sometimes they seemed in a rush.

I’m not certain what started the practice –it was, as I recall, before the days of social media- but start it did. Suddenly, and with an enthusiasm I had never witnessed, it was upon us. But until I saw my first bite, it was a horror that lived in legend alone.

*

The hospital nurse assigned to the couple was an English-trained midwife and she shooed us out of the room as soon as we doctors had congratulated them and put away our instruments. I should have known something was up when I was even led away from the little window in their door.

“They need some privacy, doctor,” the nurse informed me as she grabbed my elbow and steered me away. “This is a really important time for them,” she added, winking at me cheekily and then hobbling into the lounge to get a coffee.

I wandered over to the ward desk and pulled out the chart to enter the usual description of the delivery and write some orders when I discovered I didn’t have a pen. I checked the counter and even riffled through some drawers, but to no avail. It was around two-thirty in the morning, and no one else was around. I decided I must have left mine in the delivery room, so I walked down the corridor to their room and pushed open the door.

Mistake. The father was lying on the narrow bed beside his wife who was holding the swaddled baby on her chest. Three things struck me: the baby was preternaturally quiet; the parents both had silly, embarrassed smiles on their faces; and he looked like he had been practicing with bright red lipstick. He’d even got it on his teeth.

I quickly looked away so I wouldn’t embarrass them in their intimacy. “Sorry to disturb you like this,” I said, a bit uncomfortable that I had maybe caught them in flagrante delicto as it were. “I left my pen in here,” I mumbled and searched around on the floor for it. It was then I noticed the umbilical cord suspended from the edge of a blood-tinged sheet on the bed. I was horrified; I thought perhaps the placenta had somehow gotten mixed up with the blankets after the delivery.

I stood up suddenly beside the bed. “I’m so sorry,” I said, in my most apologetic voice. “Did we forget to clean up your bed after everything?”

He looked up at me sheepishly, still holding a fragment of placenta in one hand. “I’m afraid it was us…” His voiced trailed off as his wife looked at him with hooded eyes. A profound silence blanketed the room suddenly. No one spoke; the baby snortled; and I could hear all four of us breathing. Labouriously. Expectantly.

The husband broke the tryst. “Not what I expected, actually,” he mumbled cryptically. I could see his wife giving him a poke under the covers. “Wouldn’t recommend it to anybody, that’s for sure…” She sighed loudly and glared at him over their still sleeping baby.

I thought it was unusual for the baby to be so quiet –they usually cry a fair amount after delivery to fully open their lungs and adapt to life outside the womb. I reached over and vigorously rubbed its back through the blankets he’d been swaddled in –at that time the parents weren’t taught the importance of skin-to-skin contact for mom and baby like they are nowadays, so it would have been difficult to spot breathing problems in the infant through all of the layers.

The baby made a weak attempt to cry while mother sat up immediately and demanded to know why I had attacked her baby. She pushed the bell for the nurse at the same time. By the time the midwife had arrived with angry eyes, I had transferred it to the bassinet and was fiddling with a suction tube preparing to suction out the baby’s mouth.

When the nurse heard the grunting of the infant and saw what I was attempting she smiled at me and took over.

The mother, in the meantime, was distraught. “Why did he wake my baby up?” she screamed. “We were having a little quiet time when he barged in here and grabbed my baby.”

The nurse handed a screaming infant back to the mother and touched her gently on the arm. “You should be glad that Doctor came in, Emily. Your baby was having trouble breathing with all that mucous in its mouth.”

The husband looked embarrassed. “I think we were too focussed on that weird placenta stuff,” he said and smiled at Emily to sooth things over. She blushed and cast a loving glance at her screaming baby.

“It wasn’t very tasty was it, honey?” she whispered. “Not at all like that book promised…” She reached over and kissed him warmly on his cheek.

He returned the blush. “I… I spit mine out into this,” he admitted and pulled out a little plastic K basin he’d hidden under his pillow. “Couldn’t swallow it,” he said and shrugged. “How about you, sweetheart?”

“Terrible heartburn, dear…” She glanced at the midwife, in case she had transgressed on some sort of midwiffic tradition. “But maybe it just needed more salt, or something,” she added quickly to try to make the best of a bad situation.

The room filled with the cries of the baby. “Maybe it just needed to stay in the metal bowl where the doctor put it,” he said in a brief lull as the baby sucked in a lungful of air and he returned his wife’s kiss.

The midwife was all smiles. “I couldn’t eat mine, either,”she said, winked, and cast a knowing shrug towards them. Then she walked slowly over to a sink in the room, picked up a couple of towels and, ever the nurse, dampened one edge of each.  “Anybody want to clean up a little?”