All about Your Placenta

What is the placenta?

Did you know, in pregnancy, your body grows a completely new organ?
If the title of the article didn’t give it away, it's the placenta!

Your body creates it completely from scratch using the uterine lining to form the maternal side that connects to your uterine wall, and cells from the baby (blastocyst) to form the fetal side.

The placenta cells dig into the uterus wall, creating a strong hold for the duration of the pregnancy, catching the mother's blood stream and directing oxygenated blood flow and nutrients through the placenta to the baby via the umbilical cord.

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After the baby is out, the “afterbirth”, the placenta, is no longer needed, and your body will expel it.

You may so wrapped up in enjoying your newborn that sometimes you may even have forgotten about it until you wonder where the cord is going, or you feel the cramps start up again.

When the placenta comes out, it comes with the membranes from the amniotic sac attached, and sometimes you can hold up the sac and see the hole where the baby came out.

The placenta is on average, 22cm long, about as round as a standard dinner plate. The average weight at full term is 500g, but it often weighs up to 700g or more.

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The role of the placenta is to transmit nutrients from the mother to the baby and carry waste from the baby back to the mother to be discarded. 

This is why the side of the placenta attached to the mother is lumpy and spongy to absorb all possible nutrients from the mother’s blood efficiently. 

The side of the placenta towards baby is smooth with arteries and veins joining together to form the umbilical cord. 

The cord has one vein to carry blood from mother to baby and two arteries to carry waste products from the baby back to the mother. The vein and arteries are surrounded by special fluid, Wharton's Jelly, to help insulate them, prevent compression of the cord and protect the blood flow.

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Birthing the placenta

The placenta and membranes (amniotic sac) together cover your entire uterine wall. The membranes are all one piece, stuck to the walls and your placenta like wall paper in a balloon shape. At birth, a hole is made in the membranes at your cervix when your water breaks and your baby comes out. 

After birth, the placenta detaches with the aid of hormones and contractions, and comes to the cervix because of gravity.

The umbilical cord has one end attached to the placenta, and the other is outside your body, attached to your baby, that also helps pull it downward.

The uterus contracts down on the mothers blood vessels that were attached to the placenta, and constricts them to minimise bleeding.

You might feel the placenta right there at your vaginal opening, along with seeing a gush of blood from the separation. Often a blood clot or few will come out with the placenta from the blood that built up behind the placenta as it slowly sheared off from the uterine wall.

When you push out the placenta, the membranes peel off the walls of your uterus. Placentas almost always come out cord first, with membranes trailing behind, essentially turning the whole thing inside out. 

• The placenta might feel like you're birthing a jellyfish, as it has no bones and is kind of like a large blood clot.

• In a survey done in an unassisted birth group, the majority of mothers said it was painless. It can feel warm and soothing on your vagina as it exits.
  However a small percentage of mothers said that it did hurt to pass. Some of the pain felt like sharp scratching as it came out.

• Contractions will start up again as the placenta is detaching. For most mothers, these are mild or slightly uncomfortable. A few have found them very painful, but almost all agree that they are not as bad as labour.

• The placenta may take 45-120 mins to be birthed, and something like 96% of placentas are out by the 60min mark. However, immediately, 5 mins, or longer such as a few hours are all variations of normal. 

• The issue is not the time taken, but the efficient detachment when it happens. You must keep an eye on your bleeding in case it becomes excessive or if you have concealed bleeding trapped behind the placenta.

• There is a small risk that your cervix will begin to close up again after the baby has come out, and trap the placenta, but the contractions that detach the placenta will also help keep the cervix open in most cases.

• When the contractions start up again, or you are uncomfortable and want to try birthing the placenta in your natural timing, it will help if you support yourself in an upright or semi seated position i.e squatting.

• You may notice that it has detached inside you if you see the cord has lengthened, or there is a trickle of blood from the detachment, or you may feel a change of pressure inside. 

• Do not yank on the cord as premature detachment can lead to hemorrhage. There is also the rare risk of prolapse (pulling your uterus inside out), or more commonly, snapping the cord.

• You may need to push slightly or bear down gently as if pooping. This will help move the placenta down and out.

• You can also gently lift up your belly, and push down on your abdomen and uterus, if you feel comfortable or instinctively to, as this will also help move the placenta down and out if it is already dislodged from the uterine wall and is just waiting above your cervix.
  
  

Retained Placenta 

Retained is generally and medically defined as not being expelled within 30 mins, which is very limiting, and doesn't take into account the normal and variable range of women.

More important factors than time alone are how the mother is feeling, if there is bleeding, and if the placenta will detach on its own (no percreta)

If it has been some time, and the placenta is not detaching or coming out, you will need to ascertain if the block is Hormonal or physical.

Hormonal

• If you are not having any/enough contractions to detach the placenta, it might be hormonal = you need to create oxytocin for contractions

• Relax, stay in a calm, warm, and partially dark environment. Continue or start breastfeeding, and sniff baby. If they won’t feed, nurse a toddler if you have one, or get yourself or your partner to apply nipple stimulation
  Physical

• One of the #1 reasons I hear about transfers for freebirthing mothers is that they think their placenta is retained, but they simply didn't know they could push it out. Please try a simple squat and push, or squat and cough (the coughing tenses and pushes for you) and see if you feel it move that way.

• There may be another reason contractions haven't started: tired uterus. Consuming a sweet drink or food will help regain energy.

• You can also take some doses of Angelica Tincture to help create contractions, open the cervix, and release the placenta.

• If the block is physical, it may be that your bladder is in the way, you are in a less than optimal position, or your cervix is closing.

• You could try peeing to make space for the placenta to get past. Sniffing peppermint oil or standing in the shower may help you pee, along with these other tips.

• You can also try putting peppermint oil on your thighs or a few drips in the toilet to help you relax and pee.

• Sitting on the toilet also has the benefit of changing position and giving a natural urge to relax. Stretch a towel or place a bowl in the toilet to catch the placenta. Cough into a closed fist to help dislodge the placenta.

• You can also try squatting; over a bowl or pad, or on the floor of the shower are good places.

• Catching the placenta on a pad or in a bowl helps prevent mess, and allows you to easily transport it to another room.

• If you examine the placenta and find a piece missing, continue to take Angelica tincture and encourage the piece to come out with upright posture. This can take some time, so monitor yourself over the next few hours/days for infection, pain, or increased blood loss.

• If the placenta is not coming out, and you have excessive bleeding, you can read about PPH here.

• Otherwise, unless you are uncomfortable or concerned, you have time to rest, nurse, build some strength up with food and fluids, take the tincture, and try again in 30 mins.

• Some women even have a short nap before birthing the placenta. If you do this, I would encourage you to have someone keep an eye on you and your blood loss as you sleep.

Once the placenta is out, you may feel another sense of relief or achievement. The birth is fully over! Congrats. Snuggle your baby and rest, and continue to eat and hydrate with nourishing foods. Postpartum is a blissful and tiring time, and the next few days can set the tone for your recovery.

You should continue to monitor yourself for signs of excessive blood loss. Keep an eye on how many pads you're filling, and take some Shepherds purse tincture if you are losing a concerning amount.

Remember that some postpartum bleeding and lochia is normal.

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You may have heard somewhere that you have a dinner plate sized wound. This is a myth because the uterus shrinks down after birth (involution), and within 24hrs is quite small. By 6 weeks its back to around pre-conception size. But all the bleeding and shrinking means you are definitely healing, so support your body to rest and recuperate with baby close by. If your lochia increases after a few weeks, it might be a sign you are doing too much.

Inspecting the placenta

• The maternal side of the placenta is lobed and lumpy. The fact that it’s lumpy on the mother’s side means it has to properly detach from the uterus during birth to prevent any hemorrhaging. If any part of the placenta is retained and doesn’t detach, it will prevent the uterine wall from shrinking properly and possibly cause immense loss of blood.
  Therefore it is important to inspect the placenta to ensure that it is complete.

• Place the placenta in a bowl or on a pad  under a clear light.

• Check both sides for any obvious tearing or missing chunks
  - Fetal side, looks like a tree with roots, is smooth
  - Maternal side, lobed, will look messy, but still together

• Also inspect the membranes
  - the bag, sac, is rubbery looking. Sometimes complete with just a hole, sometimes shattered into pieces like a popped balloon

• There are 3 tubes in the cord (2 arteries, 1 vein) check for 3. Only 2 may be a sign of congenital defects in baby and worth getting checked out

• Colour of the placenta should be a natural fresh reddish purple - if green, do not consume due to meconium staining in the last week.

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Photographing The Placenta 

It is my suggestion that you photograph your placenta on both sides, and take close ups of any parts of interest or concern.

This allows you to preserve it for posterity and a second opinion i.e. in case you think it is incomplete and some is retained, you can send the photograph to someone you trust.

• Lay the placenta out on a clean flat surface such as a tray or chux pad.

• Make sure the area is well lit so you can see details well.

• Photograph both maternal and fetal sides.

• Shape, size, weight, calcification (or lack of), and cord location are all signs of health and situations in your pregnancy. You can search certain details after birth, and the photo will help jog your memory or be useful for comparison.

• Also, it's a beautiful organ that sustained your baby and you might like to look at it closer later on for no reason other than to admire it

• (and another good reason is you can submit it to our placenta gallery - here. Yes, I’m biased haha)

• Tip: Rinse the placenta first for clearer pictures of details

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What to do with the cord while the placenta is being birthed

The placenta contains large amounts of rich blood in it which is still being pumped even after the baby is born. All that blood is vital for the baby and where possible, must be allowed to enter the baby’s body until the umbilical cord stops pulsing. 

Cutting the cord while placenta is inside

• Reasons you might cut it: short cord, need to move the mother or baby, uncomfortable, has been a long time.

• If you can, wait for the cord to go white and stop pulsing. Then clamp or tie BOTH baby and mother’s side to prevent blood loss in the mother.

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Cutting the cord once the placenta is birthed

• Quite simply - Wait for white, tie/clamp tightly on baby’s side, then cut with clean scissors.

• You may prefer to burn it, or not cut it at all (lotus birth)

• Read more on our dedicated cord cutting info page

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Disposing and uses of the placenta

After the baby has finished with the placenta, you need to dispose of it. Many women like to do this in a respectful or considered way. Lots of cultures hold reverence for the placenta and have certain rituals. Other people are happy to simply put it in the bin. There is no right or wrong way. You must do what feels right for you.

You’re also not limited to one choice, as some of these options can be done concurrently, eg you can make placenta prints, dry the cord, then bury the placenta.

• Freeze: Many women freeze their placenta for months or even years until they can do what they had planned, or make a decision. 

• Prints: You can clean the placenta, then brush the baby’s side in blood or paint, and create art that looks like a tree from it.

• Lotus: cover the placenta in salt and herbs, and leave the placenta attached to baby until it naturally falls off, aprox. 3-10 days

• Cord drying: It’s possible to shape the cord and dry it to preserve it, or send it to a company to make into jewellery 

• Burying/planting: many women like to bury the placenta on land somewhere, or plant it next to a tree, or in a pot under a special plant to nourish it.

• Binning: You can double bag the placenta and put it in the rubbish bin for collection with the usual waste.

• Donating: you can donate to cadaver dogs, or scientific human research. Look up places in your area ahead of time as they may want it stored or preserved a certain way immediately after birth.

• Consuming: women eat their own placenta for the alleged benefits. This is not a new idea, as many animals do it post birth. For some women it may decrease PPH, PPD symptoms, and provide a boost in energy and milk supply. For other women it has the opposite and detrimental effect due to the hormones the placenta contains.
  If you choose to consume it, keep an eye on how it makes you feel. You can keep raw placenta up to 3 days in the fridge. You should refrigerate it within a couple hours of birth.
  Some ways you could consume it are: Raw, cut into bite size chunks. Blended in a berry smoothie. Cooked, like a liver/steak, or mixed in with a mince recipe. Encapsulated, dry it yourself or pay for a service (doulas often offer this)

• Note: Some people are concerned that its a Biohazard or illegal to trash or bury. But its no more of an issue than menstrual pads, or a piece of steak. Just wrap it properly and dispose of discreetly as you would any other human products. You can check the law in your area if you are particularly concerned but you may find the rules apply to what hospitals need to do, not what you need to do at home.

Placenta complications or interests

• Retained membranes: If you twist the membranes as they come out, they're more likely to come out all together, like a rope, which lessens the chance of leaving a piece behind that can cause infection. However small pieces of membranes are much less likely to cause issues like a piece of placenta does, and some pieces may pass a few days after birth.

• Retained whole/Broken placenta: as above 

(If you cannot get the placenta or pieces out, you may need to transfer for assistance such as synthetic pitocin, manual removal, or a D&C.)

• Bleeding before the placenta/after the placenta is out - read more on PPH

• Twin placentas: this takes extra consideration during birth as you want both babies out before the placentas detach, especially if the placentas or sacks are stuck together, as it can cut off blood supply to one of the babies. It depends on the type of twins. If you are having twins, I encourage  you to do more research on the birth of twins and their placentas.

• Extra lobe (Accessory/Succenturiate lobe): a small extra placenta lobe that can sometimes tear away from the main piece and be retained. 

• Bleeding before baby is born: a small amount is normal, and could just be cervical changes or “bloody show”, but a large amount could be a sign of placental abruption, or uterine rupture, in which case immediate birth or transfer of baby is required.  

• Placenta Previa: the placenta covers the cervix in part or whole, preventing a vaginal birth. If it doesn't move out of the way by term, unfortunately, it is one of the few true reasons you will need a cesarean. 

• Placenta Accreta, Increta, or Percreta: When the placenta grows into your uterus or through your uterus into other organs, and cannot detach without medical help. Often needs a hysterectomy. 

• Small placenta: some placentas are quite small, and nothing can be done after birth, but can be a sign of insufficient blood flow and growth if the baby is also small (IGUR) or other issues like preeclampsia.

• Cord knots - most knots are not an issue, and aren’t even diagnosed until after birth. Watch this sliding knot video

• Marginal, Velamentous cord insertion: Where the cord doesn’t insert into the centre of the placenta, but through the edges or the membranes, some variations of which can be problematic if say, someone breaks the waters unnaturally, using something sharp, which can cause blood loss (example pictures of unique insertion) https://www.sarawickham.com/original-articles/the-most-interesting-placenta-ive-seen-all-year/ 

• Nuchal cord: cord wrapped around the baby’s neck 

• Postdates, “Old,” or calcified placenta:  
  “So what if what is seen in the placenta and interpreted as a sign of aging, are in fact normal, healthy changes, which are a sign of healthy growth and development and which may also play a role in the start of labour?” - Sophie Messager (https://sophiemessager.com/the-myth-of-the-ageing-placenta/)

Placenta Gallery

We have a gallery of homebirthed  placentas to showcase the beauty, variation, and normality of placentas

• View the gallery (and submit your own photos) here!