Perspectives from Patients and Healthcare Providers on the Practice of Maternal Placentophagy

Introduction

Placentophagy refers to the act of consuming the placenta after childbirth. The practice of maternal human placentophagy has recently received substantial attention in the media, ^{1 –4} highlighting an increase in the use of complementary medicine and supplements for postnatal problems. ^{5 –7} The placenta can be consumed raw, cooked, or in an encapsulated form. Advocates of placentophagy suggest that it offers a wide array of postpartum benefits, including hormonal balancing, pain moderation, nutritional advantages (such as iron supplementation), increased lactation, improved energy, and prevention of postpartum depression. ^{8 –10}

The placenta is a vascular organ that begins to form in the uterus shortly after conception. During pregnancy, it acts as a conduit between the mother and fetus to provide oxygen to the baby, deliver nutrients, and filter out potentially harmful substances. The placenta is also a major source of steroid and peptide hormones that are critical to the maintenance of pregnancy, timing of birth, and fetal development. ¹¹ Many mammals consume the raw placenta immediately after delivery. ^12,13 Although an opioid effect from placental consumption has been shown to enhance endogenous pain relief in rats at parturition, ^14,15 limited evidence is available to support the benefits and/or risks of the practice in humans. ^{16 –18}

Ritualistic ceremonies surrounding the placenta are prevalent across multiple cultures. ^{19 –22} Chinese and Egyptian historical accounts describe the placenta as having medicinal properties, used for healing and fatigue. ^23,24 However, records of maternal consumption of the placenta specifically for postpartum benefits are limited. ^22,23 Today, anecdotal reports from women who have engaged in placentophagy span from favorable ²⁵ to strongly adverse. ²⁶

Prevalence of and attitudes toward placentophagy have been reported in two previous studies. Cremers et al. (2014) ¹⁷ conducted an online survey with 216 college students and found that most of the sample was familiar with placentophagy and a small proportion had tried it. Selander et al. (2013) ⁹ surveyed 189 women who had consumed the placenta in raw or encapsulated form after the birth of one or more of their children. Most women in the study reported benefits and believed consuming the placenta was a positive experience. Approximately half of the women in the sample had experienced symptoms of depression or anxiety after a previous pregnancy (63% reported self-diagnosed mood disorders, while 37% were diagnosed by a professional), ⁹ which may have motivated them to try placentophagy as a preventive method for postpartum mood management. The postpartum period can be a challenging time for women because of hormonal fluctuations, role changes, and increased stress. ²⁷ Recent statistics show that up to one in five women experience postpartum depression. ²⁸ Providers are often hesitant to prescribe medication to breast-feeding women because of concerns regarding untoward effects on the infant, ²⁹ and pregnant and postpartum women are more likely to prefer nonpharmacologic treatment methods for depression relapse/prevention. ³⁰ To some, consuming the placenta may appeal as a seemingly more natural remedy to address potential depressive symptoms postpartum.

The purpose of this study was to survey patients and providers regarding their familiarity with and interest in placentophagy and to identify perceived benefits and/or risks associated with the practice. Providers were included in the survey to ascertain professionals’ knowledge of existing research to support or discourage placentophagy. Ultimately, if patients are interested in pursuing placentophagy as a supplement or alternative to postpartum (mental) health treatment, it is important that providers be aware of this and are able to provide empirically informed advice about the practice.

Materials and Methods

Results

Discussion

The aim of this study was to characterize healthcare providers’ and women's attitudes toward human maternal placentophagy. Unlike other studies to date, this study included both patients and providers, allowing us to capture professionals’ knowledge of placentophagy and what they are recommending to patients. Patients’ perception of their clinicians’ openness and familiarity with alternative treatment modalities influences their willingness to disclose their use of such treatments, which is essential for comprehensive care. ^32,33 Results from the provider survey suggest that the popularity of placentophagy varies by region and occupation type. One provider noted that hospital policies for handling the placenta were common in the San Francisco area but were relatively unheard of at her practice in the Midwest. In the literature, the largest survey study of women who had practiced placentophagy came from an encapsulation service company in Nevada, and a large percentage (37.6%) of participants came from the West. ⁹ The data from the current study indicate that providers from the Denver area were more familiar with placentophagy and more frequently discussed it with their patients. However, because location was significantly associated with occupation type (e.g., more midwives responded from the Denver area), it is not possible to discern whether location or provider type was a driving factor. It is difficult to discern from these analyses the nature of the relationship(s) and/or any causal pathways between occupation and provider type. Future studies may want to incorporate modeling or stratification to control for confounders.

The findings also suggest that sociodemographic factors play a role in patients’ familiarity with and attitudes toward placentophagy. Participants with higher household income (>$100,000) and a bachelor's degree or higher showed a greater willingness to try placentophagy. This is consistent with previous studies ³⁴ indicating that individuals with higher socioeconomic status and education are more likely to have access to and to try integrative medical treatment compared to individuals with lower socioeconomic status/education. Alternative treatments, such as placentophagy, are often accompanied by increased out-of-pocket expenses that are not covered by health insurance. ³⁵ The cost of placenta encapsulation may be prohibitive to some women who would otherwise be interested in the practice and likely affects women's willingness or ability to engage in placentophagy.

Perhaps our most significant finding was that mothers with a history of a postpartum mood disorder were more willing to try placentophagy in place of prescription medication than women with no prior mental health issues. This supports the possibility that women who engage in placentophagy may be motivated to do so to avoid past pregnancy complications, such as postpartum depression. A previous survey showed that 52% of participants did not consume their placenta after the first birth but did so after a subsequent birth, ⁹ and approximately half (47%) of the participants who reported specific motivations for engaging in placentophagy also reported history of a postnatal mood disorder, mainly depression. ⁹ Previous studies have also established that pregnant women are more inclined to prefer nonpharmacologic treatment for depression prevention. ³⁰ Thus, placentophagy may be particularly appealing for women who are reluctant to accept prescription medication for mood management.

Although improved energy, mood, and lactation are common self-reported benefits, ⁹ few studies have investigated the hormone content or presence of toxic minerals in the encapsulated human placenta. ^{36 –38} Available data suggest that several hormones (e.g., estradiol, estriol, progesterone, testosterone) ^36,37 and trace minerals (e.g., arsenic, iron, manganese) ³⁸ remain integral in the encapsulated placenta. The mean concentrations of most hormones are low, and the potential to produce a physiologic response that supports claimed benefits are inconclusive. A recent pilot study identified 14 trace minerals in samples from 28 placentas from healthy female donors that were encapsulated (i.e., dehydrated and pulverized) through a standardized process. ³⁸ Concentrations of iron were high, and potentially toxic elements, such as arsenic and lead, were below established toxicity levels. These data confirm the presence of potential nutrients and toxins, but whether the concentrations are enough to achieve a therapeutic benefit or an adverse effects remains unclear.

As patients continue to independently seek resources for their healthcare, providers may be faced with more questions about placentophagy. The findings from our study suggest that the recommendation to practice placentophagy is mainly advocated by select groups of healthcare providers, primarily midwives. Furthermore, discussion regarding placentophagy is more often initiated by patients themselves than providers. Factors that may influence patients to choose placentophagy over pharmacotherapies include stigma surrounding mental health treatment, concerns of adverse effects of medications when taken while breastfeeding during pregnancy, and the limited safety data available for the majority of medications prescribed during pregnancy. ²⁹ These factors should be explored in future research.

Overall, the number of women in the sample who had considered or engaged in placentophagy was extremely low. Anecdotally, two patients reported having previously considered but not engaged in placentophagy. The prevailing theme among the survey respondents, both providers and patients, was that there is not enough information to make an informed decision about placentophagy. While many providers noted extreme disinclination toward the practice, several expressed high interest in future research that could shed light on the potential benefits and/or risks of placentophagy in humans.

The scope of this study is limited by the patient population surveyed. The majority of the sample was college educated, white, and of high socioeconomic status and lived in Chicago. For these reasons, the sample may not be generalizable to the broader population. Future studies would benefit from collecting survey data from across the nation in order to determine which demographic factors—race, socioeconomic status, and place of residence—significantly affect women's interest in and likelihood of engaging in placentophagy. Additionally, because of collaborations among Northwestern Medicine of Chicago, University of Colorado Denver, and Denver Health Medical Center, a disproportionate number of our providers came from one of these two cities. All patients were surveyed at Northwestern Hospital (Chicago). Finally, data about mental health history were obtained via self-report; ascertaining such information from a medical record would be a more reliable measure.

Conclusions

Women are considering placentophagy as a possible alternative or supplement to medication or other forms of treatment for postpartum depression. ¹⁸ Consequently, healthcare providers have a responsibility to be able to give informed recommendations to patients who express an interest in placentophagy. Many providers believe that empirical research is necessary to evaluate the potential risks and benefits of the practice before advising patients about it. In their recent publication, Marraccini and Gorman ³⁹ called attention to many challenges that face researchers looking to design and implement a randomized controlled trial examining the efficacy of placentophagy in humans, including identification of the nutritional properties of the placenta and standardization of placenta preparation, timing of administration, and dosing between participants. Despite these challenges, Marraccini and Gorman underscore the importance of continued research on human placentophagy, as well as the importance of clinician awareness and openness in discussing placentophagy with their patients. ³⁹ Given the growing interest, further studies investigating the physiologic response and related benefits or adverse effects to hormones and minerals present in placenta capsules is warranted.