Sunday, 9 May 2010

Where's the Placenta in Birth Films?

The placenta is an ignored organ in birth films. 

The following film is beautiful, but the cord is cut early and there is no placenta! I can't help but wonder why.

The way the woman gives birth so calmly and consciously in this video is a delight.  I love the way the tank enables the family, the midwife and the doctor to see what is happening without interfering or interrupting the woman's 'flow'. I also love the way the woman uses her hands to birth her baby's head and how she engages with the baby when the baby's head is born.  This woman was obviously well prepared for the birth of her baby.

BUT - where is the placenta???

The birth of the placenta is missing from most videos.  The fact that the placenta is missing from birth videos sends the wrong and incomplete message about birth.  Giving birth to the placenta is the third stage of labour. The third and fourth stage of labour, during which time the woman adjusts psychologically, physiologically and spiritually to the birth of the baby, are vitally important parts of the birth process. This period is a 'peak experience' time; one where women get surges of the 'love' hormone oxytocin if the environmental conditions are optimal. These surges in oxytocin are essential for optimal psychophysiological functioning for bonding with the baby, contraction of the woman's uterus, haemostasis and the initiation of lactation. 

The placenta is an awesome organ and needs to be given due respect and acknowledgment for the mighty role it plays in the beginning of life.

Many cultures have the Tree of Life symbol which is said to be a metaphor for the placenta; artworks across millenia demonstrate this potent recognition of the placenta's role in the life of a fetus and baby.  Not only is the symbolism missing in modern life, even the placenta itself is written out of the mainstream artform - that of videos.

Ignoring or dismissing the placenta comes at a cost.  Women don't know they have a placenta to birth; if they do know, they don't know the magnificence of it. What that means is they think birth is over when the baby is born. Unfortunately, thinking birth is over sends the wrong message to the neural networks and hormonal system.  Safe birth requires conscious engagement in the process.

A key lesson of modern neuroscience is that a change in the focus of our attention changes our brain firing patterns and changes the neurochemicals associated with the firing pattern. The practical application of this lesson is that our physiology responds to our thinking. The thought that birth is over when a woman doesn't realise that the birth of the placenta requires attention, especially when the feeling of relief is profound and/or the woman is disturbed/distracted from her baby and birth process can result in a blocking of the release of oxytocin.  A drop in the level of oxytocin can  predispose the woman to excessive blood loss because her uterus doesn't get the chemical messages it needs to contract well and seal off the placental site. The attentional network that I suggest is optimal in birthing the placenta and keeping safe in third and fourth stage of labour is the attentional neural network associated with fascination. When a woman is fascinated with her baby, she is safe and her physiology works as it ought. Disrupting, distracting or in any other way interrupting the fascinating network bodes trouble. Midwives have a duty of care to ensure the birth environment is conducive to women's fascination with their babies being enhanced and potentiated; a key aspect of midwifery guardianship. .

I've written a theoretical paper, with my colleague, Professor of Midwifery, Dr Kathleen Fahy,  on midwifery guardianship in the third stage of labour. You can access the abstract here

We also conducted a cohort study which showed that women who had active management of third stage were 7-8 times more likely to experience excessive blood loss in third and fourth stages of labour than women who were well prepared and, together with their families and midwives, had a mindful approach to the birth of the placenta.

The answer is: let's talk up the placenta, make sure women know that third and fourth stages are an integral and important part of labour and include the birth of the placenta as an integral part of any film about birth.
On this Mother's Day,  the recognition that knowledge is power and education about the placenta is lifesaving and helping women to stay safe in childbirth is a good thing to think about!


Amanda said...

Interesting topic and especially relevant to me as I have a two-week old placenta in my freezer. One of the most memorable moments of my homebirth experience is my midwife sitting on the floor in my bedroom, examining my placenta with my dad looking on. He was intrigued to say the least!

Thinkbirth said...

Congratulations Amanda on the birth of your baby and placenta! Men of your father's generation have missed on a lot to do with the magic of birth and all that goes with that experience. Great he was able to share that with you. Thanks for sharing your experience with us too! Happy mother's day!

Rebekah Costello said...

Utterly fantastic video!

I wanted to point out, though, that the cord was never cut in the video. It's there, it's just hard to see.

I agree about the placenta. I think our culture either sees it as unimportant or gross. It's not the part people want to show the world, ya know?

Unknown said...

I had a homebirth with my 2nd. He was born at 1:41 am and the placenta was born at right around 5am. This would have made for a long video! I was in no way up for being followed around for over 3 hours while I worked on getting it out either.

Lia joy said...

I purposefully included the placenta in my first birth video (second birth) and meant to take more pictures/video of the placenta at my third birth, but was too wrapped up in the baby.
I still have all 3 placentas in the freezer, and have re-examined them several times. They are amazing things! great topic :)

Thinkbirth said...

You are right Rebekah, people often have strange reactions to the placenta. My guess is that is where education comes in - helping people understand the all the amazing aspects of the placenta. A truly wondrous organ :-)

Michelle, I understand why you wouldn't have wanted to be followed around for three hours - although if you were being filmed for a video production for general use, the use of time lapse videoing with the ultimate birth of the placenta included would be a wonderful resource for teaching and informing people about normal third stage. Thanks for that comment, I love the variety of people's experiences, that's what helps 'normalise' the huge variation in what happens at birth.

Lisa Joy, what do you intend to do with your placentas?

Thanks for all your contributions to this topic. I agree Lisa Joy, a great topic and I appreciate each of you taking the time to comment.

Tracy Pemberton said...

I watched an older video called "Birth" it was an older one that has more hands on than I like to see but lots of birthing placentas. My daughter told me that with her first that is what she would have wanted to know more about. That there wasn't enough information in any of the videos that she had seen.

Thinkbirth said...

That's interesting that an older film had placental birth recorded. One older film that I love is Birth in the Squatting position made in Mexico. The film includes one woman giving birth to her placenta and in the squatting position. Just fabulous. The woman makes it all look so easy and normal. Just as it's meant to be. Well worth seeing if you can get hold of a copy Tracy.