Placentas

In the Newborn Nursery this past week I took care of a family with twins. They parents are from a country in Africa and through the week the mom (who is my age and in her last year of undergrad) and I really bonded and learned a ton about each other.

The first morning (those first 24 hours the babies sleep a lot) I went in and she was awake and perky and doing great. She'd delivered one vaginally and the other they had to do via c-section. So not only did she have twins to take care of (her first) but she was also recovering from surgery and had lost a lot of blood post op so was anemic.

Plus these twins were the first grandchildren on both her and her husband's side. And the first children of any of their friends or relatives in this country. Fortunately, the father's mother was in town to help and meet them, but still, mom had to be overwhelmed.

By the second day the babies have usually passed their meconium and their bowels are moving and they are hungry! And mom usually only has colostrum which does a lot for their immune status but little to fill up their bellies and curb their hunger.

That morning I went in to find her with a baby on each side of her in bed trying to nurse one while holding the other. The cousin who was supposed to be helping her was sleeping soundly in the less than comfortable bed at her side. I examined the babies and helped change the diapers as we talked about some of the newborn care tips. We started co-bedding the twins (putting them in the same crib) and they really liked being close to each other. They'd reach out their little hands or suck on each other's faces.

They had a name for the boy from the beginning, but still were struggling with the girl's name. The whole extended family was involved in the controversy and nothing was getting settled. Finally the family just told them to pick one that they liked. I talked with the mom about it and she wanted a name that had meaning. We didn't have any name books in the nursery so I looked up some on line and wrote out a couple pages of names with meanings for her.

The following day, the maternal hormones finally got the better of her and she broke down crying at one point. Post-partum "baby blues" last about three weeks before the woman's hormones calm back down. This is different than post-partum depression which usually presents later and can last up to six months. She had been super strong, and still was, but she was feeling like she wasn't a good mom and couldn't nurse well or do anything right.

On the first day that I had met them my attending said that sometimes families from Africa have a tradition of burying the placenta at the place where they were born or the place of their roots so that they will always remember where home is. I asked the mom about this when I saw her the next day. She wasn't sure about it, but said that her mom had her and her six siblings dried up umbilical cords though she wasn't sure why.

When grandma got off the phone next to her, we asked her about the traditions. She said it was true about the placenta. That many familiy's buried it so they would always have a home to come back to. And that the umbilical cord was used whenever the child had a cut or a fever to help him or her recover. She said that after drawing a circle around the cut with the cord that it would be gone in two days. Or with a fever, just rubbing the dried cord on the temples would make the fever go away the next day. Interesting.

Later in they day on the third day, I visited them and mom was sleeping, so I looked at the babies and she woke up a little. She said she'd named the girl at last. "What is it?!?" I was excited that she would have a name at last. "It's on a paper there." It was like she wanted me to find it to open the present. I didn't find the paper so just ended up just telling me. It was one of the names that I'd found for them! Or a permutation of one anyway. And it meant "pure."

By the fourth day, her milk was coming in well and she was doing better with breastfeeding, but the babies were young and still loosing a little more weight than we liked. We decided to keep them one more day and hope that they started to grow a bit more.

That gave me a chance to see if they wanted to have their placenta. Sounds gross, I know, but they are actually intersting. In Neonatal Pathology a couple days before we'd looked at pictures of her plactenta. Her twins here diamnionic-dichorionic but the boy had muce more than his share of the placenta, so their had discordant growth of 15%, that is, he was 15% bigger than her when they were born. You can see on the picture which half is smaller and has the cord insertion more off to the side. In fact the reason they'd decided to deliver them early was that the girl had stopped growing a couple weeks before delivery when they looked by ultrasounds (Intrauterine growth restriction = IUGR).

So, I got the bright idea to ask them if they wanted their placenta to bury or take back to Africa, even though I'm not sure you can take such things on a plane. It would have to be refrigerated for sure. Mom was a little grossed out, but wanted to see it at least.

Therein began my adventure of tracking down the placenta.

Fortunately I'd worked in the NICU already so I had connections there. One attending in particular was really into placentas so I got in touch with him and figured out where it might be kept if we still had it. In talking to him he also informed me that it wasn't the first time and that lots of families (well not lots, but some families) will take them and bury them where they plant a tree. Some "hippies from Northern California" even cook them and eat them. "I have recipies," he tells me. "Uh, that's okay," I decline and make a face, glad that I'm talking to him on the phone instead of in person.

Anyway, apparently there is a "placenta frigde" across from the OB area. I get one of the nurses to let me into the locked room. I'd been smart enough to get gloves for both of us before we went in, which turned out to be a very good thing. The fridge was one of those glass-doored slide open ones which labeled shelves full of styrofoam drinking containers containing each placenta. The lids were clear and you could sort of see the blood inside. They were all labeled with the baby's name. The ones that had been looked at already were messy on the outside, too. Gross...and smelly...like raw meat.

The nurse is nice enough to help me as we sort through all close to 100 placentas. We're taking them out and stacking them and reaching toward the back looking for the right one. "I'm elbow deep in placentas," I think to myself at one point, "Never thought I'd be doing this, that's for sure." It is of course one of the last ones we check, but at least we find it.

The only bag we can find is a clear one so as I'm trapsing around the NICU seeing if we have lecture that afternoon everyone is looking at me funny. But not as funny as the nurses when I get back upstairs. "What is that?!" "A placenta." I sort of enjoy the grossed-out shock on their faces. He he.

I take it to the mom and she gets the same grossed out look on her face. "I'm not sure I even want it now," she says. Then she takes a big sigh like she's bracing herself and says, "Okay, I let's see it." But she's about to eat lunch and I think it might not be great timing, so I offer to bring it back later. She looks relieved and agrees.

Then I have to find a refridgerator in which to keep it in the meantime. Fortunately, after more shocked nurse faces, I find that there is another placenta fridge at the other end of the nursery. The things you find out!

As I'm telling my attending about it over her lunch of a bologna sandwitch, she asks where I'd stored it. "In there," and I point quickly and casually to our office lunch fridge. She stops chewing and gets a little pale as her eyes dart to the fridge from which she'd just retrieved her lunch. I can't keep her in suspense long though and I tell her I'm only kidding.

Turns out that even after the mom's lunch she didn't want the placenta. They were too far from home (Africa) to really have anywhere meaningful to bury it anyway. They were only renting an apartment in town so it wouldn't work here either.

Oh, well, I tried. (And yes, that really is her placenta...in the flesh.)