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?”

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Perchance to Dream

There’s something about complexity that I find intimidating; impressive as it may be, I don’t crave the complicated. I don’t even understand it. Of course, that may be part of its fascination for some: a facet of the instinct that leads to worship of that which is mysterious. Unknowable to the uninitiated. The awe of a dark night full of stars.

Perhaps it’s the structural intricacy, or maybe the number of parts and their varying relationship to each to each other that I find confusing, but not compelling. Inexplicable, but not awesome.

I sometimes think that complexity is a necessary first attempt at something –a way we initially endeavor to solve a problem: throw all our resources at it and then cobble together a solution using as many of them as we can. But in time, that jungle of interacting parts usually resolves itself into a skeletal framework that does the same work, but more economically. In a way, it’s like a sentence in which, instead of a subject a verb and an object that succinctly communicate a message, there are a whole host of unnecessary words thrown in -for colour, not clarity.

In short, simplicity -at least in a device- almost always trumps complexity: less to go wrong, simpler to understand and fix, and usually cheaper to produce. Of course those are some of the more important characteristics of equipment that would be useful in less well developed countries. Places with large needs but small budgets and even smaller infrastructures.

If, for example, a machine is clever, but complex, helpful but profligate of energy, it would be of limited use where electricity is sporadic, or non-existent. Or where, after prolonged use, there are no people trained to maintain it, or no accessible spare parts for that matter. And if the parts themselves are so complex and intricate that they don’t lend themselves to innovative adaptations with available local items, the machine is effectively useless: flashy new cars without wheels. Or engines…

Our society thrives on complexity simply because it can. It reveres new technology both because of its utility in solving old problems –often not appreciated as problematic before its inception- and because it can support its necessary underpinnings. And if the infrastructure is not yet in place, there is usually some facility locally extant that is wealthy enough to create it. For a price, of course.

But there are some regions of the world where babies die needlessly. Low birth weight babies, for example. Some are born prematurely, some are disadvantaged in the womb and never grow properly. And among other requirements, what their small size and lean body cannot provide, is warmth. The inside of the uterus where the baby has been developing is warm –it’s the mother’s body temperature. Normally, when mammals are cold, they shiver to produce heat. But, shivering, which is an attempt to warm the body by contracting skeletal muscles, is energy expensive -energy depleting. And these babies in particular have minimal energy stores when they are born. They are thin and have no extra fat to use as fuel. If they become hypothermic, they can die.

One answer, and one known by every new mother, is to cuddle the baby next to her skin –let her own body’s heat warm the baby. But suppose the mother is unable to do this –say she’s hemorrhaging, or convulsing from pregnancy induced hypertension (eclampsia)? And unfortunately, among other problems, these complications are far more common in poor countries with inadequate antenatal care programs –or at least health clinics that are relatively inaccessable to many in isolated rural communities, even if they could afford the care.

So low birth weight infants need warmth; if the mother can’t provide it, they need to be in incubators until they can fend for themselves. But incubators are expensive and energy-intensive. They require a fairly complex infrastructure for both their performance, and their maintenance. The idea may be intuitive, but the ultimate product is complex; it is usually merely a transplantation of a device that is taken for granted in a labyrinthine, infrastructure-laden country, into one whose poorer inhabitants may not have adequate sewage disposal, let alone electricity, even in the larger towns. And conditions are seldom better in the distant rural villages where roads or communication facilities may not allow reception of news of an emergency or access to provide timely help.

What to do? Well, fortunately dire need spawns ingenuity and there are several ingeniously simple devices created that may well help to fill some of these gaps. An article in the BBC News outlines some of the innovations:

http://www.bbc.com/news/business-23817127

I think my favorite is ‘Embrace’, a product envisioned during a class assignment at the Stanford Institute of Design in 2007. It is basically ‘a sleeping bag with a removable heating element’. It only requires 30 minutes to heat it up, and a phase-change material maintains the bag at 37 degrees C. for up to six hours. And ‘More importantly for mothers, it allows for increased contact with their child, unlike traditional incubators. So it also encourages Kangaroo care, a technique practiced on newborn, especially pre-term infants, which promotes skin-to-skin contact to keep the baby warm and facilitate breastfeeding and bonding.’ It costs about $200 the article asserts, and is reusable. Furthermore, ‘Embrace is a non-profit venture. The product is not sold, but is donated to impoverished communities in need.’ And apparently the organization has even set up educational programs to teach the mothers about hypothermia. Wow!

And there was another article in the BBC News talking about yet another innovation by a student names James Roberts; this one won the ₤30,000 2014 James Dyson Award (which, as Wikipedia explains ‘is an international student design award, organised and run by the James Dyson Foundation charitable trust. The contest is open to university level students (or recent graduates) in the fields of product design, industrial design and engineering, who “design something that solves a problem“’.[ ). The design is for an inflatable baby incubator called Mom.

http://www.bbc.com/news/technology-29900968

‘The device is designed to be delivered as flat-packed parts that are assembled at their destination. At its heart is a sheet of plastic containing inflatable transparent panels that are blown up manually and then heated by a ceramic element. This wraps around the interior of the unit to keep a newborn warm. “When it’s opened it won’t collapse in on the child and will maintain its shape,” Mr Roberts stressed. An Arduino computer is used to keep the temperature stable, control humidification, and manage a phototherapy lamp that can be used to treat jaundice, as well as sound an alarm. The electronic components are designed to use as little power as possible and can be run off a car battery for more than 24 hours when mains electricity is not available. The modular design of the kit allows damaged parts to be replaced without compromising the whole unit. And after the child is taken out of the incubator, it can be collapsed and the plastic sheet sterilised so that Mom can be easily transported for re-use elsewhere.’

Impressive!

So, take an ‘old’ design, and simplify it so it can satisfy a need elsewhere. “How far that little candle throws its beams. So shines a good deed in a naughty world.” How prescient, William…