What is the “ideal birth”?
This paper deals with the concept of an “ideal birth”. The ideal birth is a normative construct about what kind of birth experience women should plan for and strive to achieve. The ideal birth is part of birthing discourse characterized by two competing knowledges: the medical or technocratic view that emphasises the benefits of medicalisation and technology, and the natural or holistic view, which argues that medicalisation takes control and power away from women [34]. Pregnant people experience tensions due to the cultural pressures to conform to these competing narratives. This happens alongside pressures regarding fulfilling the social role of motherhood. These pressures feed into decisions and planning regarding parenting and pregnancy. Placentophagy is generally something decided upon before birth with the intention of improving the post-birth experience, as evidenced by the discussions captured in this paper, and is therefore understood best when examined in this context.
Parenting forums as communities valuing experience and autonomy
Both Mumsnet and Netmums adopt a sharing and participatory ethos that is a central feature of contemporary digital communication [35, 36]. Both forums upheld atmospheres of conversation that enabled mutual support and community to be built. Topics discussed on the forums include intimate subjects such as users’ sex lives [37] and their experiences of pregnancy loss and stillbirth [38], meaning the cultural space of the forums is one that facilitates conversations that are difficult to hold elsewhere. The space is almost exclusively occupied by women (Mumsnet’s statistics report men make up 2–5% of core users [39]), and this is reinforced explicitly and implicitly by users. Brubaker and Dillaway [40] argue that parenting discussion forums are a form of “MotherSpace”, a place defined by Marotta [41] as the “discursive spaces that contemporary mothers inhabit” that “helps shape their subjectivities and their possibilities.” These forums influenced people’s decisions to participate in placentophagy by constructing it as acceptable or unacceptable behaviour.
Parenting forums also exist as a culture that prioritises the experiences of individuals over that of scientific evidence. In over half of the threads the first post explicitly asked for other users to share their experiences. It was common to acknowledge the lack of scientific evidence available in favour of placentophagy and then dismiss this as unimportant, as one user does when posting “as far as I know there is no official conclusive ‘proof’ of the benefits...not that that really matters”. Another user comments that “however there are hundreds if not 1000s of first hand experiences of women. ..” after noting a documentary found placental encapsulation was no more effective than a placebo. Previous research agrees that users on Mumsnet “constructed a collective in which personal experience was evaluated on a par with, and often favoured over, formal scientific knowledge” [29].
Users valued the individual’s right to choose to participate in placentophagy, regardless of others’ opinions. Variations of the phrase “each to their own” were common sentiments. Users would criticise other users who expressed negative sentiments without such specifications, such as “What gives anyone the right to criticise someone’s decision to keep their placenta?” In the global North mothers are performing parenthood in a sociocultural context in which there is an expectation to adhere to idealised norms [40]. In a forum populated by people who experience this burden, the commitment to not replicating these expectations allows users to share diverse experiences without fear of repercussions. This means users can discuss placentophagy (relatively) freely where they may otherwise have been, or felt, judged. Users occasionally specified that the decision was their choice because it concerned their body and their pregnancy. One wrote about their unsupportive partner “.. . it’s my body and me that is the one who gets horrific PND then I think I should get the final say in the matter..” asserting their bodily autonomy. Women can feel alienated in medical birthing settings because their knowledge of their own bodies is not considered to be authoritative [42].
Discourse of medical and natural births
Conflicts about placentophagy were relatively uncommon and occurred mostly on threads asking for opinions on the topic. When arguments did happen, they were most commonly articulated by making references to the concepts of “natural” and “medical” births and the value of each. The distinction between the two here is that natural births are perceived to have been historically the norm and involve birthing at home or in the community with limited or no medical intervention, whilst medical births are the currently commonplace hospital-based births. Users both for and against the practice made arguments appealing to the value of both medical and natural births. The discourse produced therefore was not so much a “medical versus natural” dichotomy but rather for and against the inclusion of placentophagy in an ideal birth as articulated through medical and natural discourses. This reflects literature suggesting that very few women fully accept one of these two models and instead construct their own by negotiating ideal birth concepts with the realities of their individual experiences [43]. The following sections describe placentophagy in terms of these negotiations.
Placentophagy as “natural”: appealing to culture, traditions and nature
Users both for and against placentophagy made appeals to culture and tradition as justification for its inclusion or exclusion from birth plans. Users for placentophagy described it as a “centuries old tradition” used in European or Chinese medicine. It should be noted that this is true, but these records relate to non-maternal placentophagy only, where someone other than the mother consumed the placenta [3]. Some users specifically identified “western” people as experiencing “peer pressure and conditioning that somehow we are above that kind of thing”, indicating their perception that placentophagy was practiced either historically or contemporaneously in non-western cultures. Users arguing against placentophagy stated in contrast that placentophagy was rare and not part of any historical or cultural tradition. Users on both sides are acknowledging that a cultural argument would be a valid argument for placentophagy, but those arguing against are denying that it fulfils the criterion.
Users from both positions also described the placenta being a convenient source of nutrition historically where other food sources were more difficult to acquire. For those against the practice, they used this position to argue that “modern” humans have access to alternative forms of nutrition in the form of food and multivitamins so there is no reason to practice placentophagy. Users arguing for the practice used it as proof that the placenta is a beneficial source of nutrients. Additionally, almost all users acknowledged that most animals consume their placentas after birth. Advocates of placentophagy argued that this meant humans should consume it as well, whilst those against the practice argued that either humans do not need the same nutritional benefit that animals gain from it or that this was done as a method of predator avoidance and therefore unnecessary. In this way users both for and against placentophagy used the concept of what is “natural” by making comparisons to history or nature and then assessed the value of “natural” births in their contemporary context.
Medicalisation of placentophagy
Medicalisation is when a problem is defined or described in medical terms, understood through a medical framework, or “treated” with medical intervention [44]. It can be understood as a process where medical practice is used to eliminate or control experiences that are defined as deviant, in order to adhere to social norms [45]. It can be argued that placentophagy, especially placental encapsulation, has been (or perhaps always was) medicalised. It is practised to control negative birth experiences, often explicitly medical ones such as PND. It is also practised with the intention of fitting social norms such as the ability to breastfeed. Many users appealed to loosely biomedical understandings to explain the potential mechanisms for medical benefits. One user, defending concerns about bacterial contamination, wrote that they used an encapsulation provider who has “been signed off by public health England and environmental health”, ascribing the service medical legitimacy. Similarly, the Independent Placental Encapsulation Network (IPEN), often shared with other users as a resource, claims that their specialists have been approved by Brighton, Winchester, and West Hampshire Borough Councils, and that they follow a “comprehensive Food Safety Management System” [46]. An image of a pot of encapsulated placenta “pills” was posted onto one of the threads analysed. It includes “dosage” instructions and warns to “discontinue in case of infection”, mimicking medical or vitamin tablets.
Whether there is any truth to the claims made regarding benefits is uncertain but appears unlikely. Placenta is known to be a moderate source of iron but does not have any significant impact on post-partum iron status [47]. It has no effect on plasma prolactin levels or neonatal weight gain, indicating there is unlikely any improvement to breastfeeding [12]. B vitamins, beta-endorphins, prolactin, placental opioid-enhancing factor (POEF) and oestrogen have been proposed as being obtainable via placentophagy [3, 48] but a RCT found no significant differences in salivary hormone concentrations after consuming placenta compared to placebo [10] and no robust differences in postpartum mood, bonding, or fatigue [11]. It did however find a significant dose-response relationship between hormones found in the placenta and salivary hormone concentrations. An analysis of samples of placenta prepared “raw”, “steamed and dehydrated and “raw and dehydrated” found all hormones were sensitive to processing and only progesterone remained stable after dehydration, though its bioavailability is unknown [49]. Risks appear minimal; analysis of placental tissue has found trace amounts of toxic elements such arsenic, selenium and lead but these are below the toxicity thresholds for foodstuffs set by the European Union [50]. Bacterial contamination could occur, and potentially pathogenic organisms can be found in raw placental tissue, but processing appears to reduce this risk [49]. Additionally, a large medical records study including 7162 women who ate their placenta found no association with adverse neonatal outcomes, including infection [4].
The universal practice of placentophagy for perceived medical benefits distinguishes it from other practices associated with the natural birth movement (such as home births and placental burial) that are participated in from an explicit anti-medicalisation perspective [51]. Whilst Janszen concluded in [52] that placentophagy was part of the “back to nature” movement and founded on the belief that placenta consumption is common in other cultures and part of human heritage, this no longer appears to be the main motivation for the practice.
Resisting medicalisation: placentophagy as control
It has been suggested that midwives define “natural” births differently from conventional discourse, considering a birth natural even when it involves medical interventions as long as this is something the pregnant person had been actively involved in deciding to do [53]. Brubaker and Dillaway [40] argue that this is evidence that pregnant people operationalise discourse about natural birth through notions of control and autonomy [40]. This is reflected by some users; one writes that they valued placentophagy because they “had a really traumatic, out-of-control birth with lots of intervention and this is one of the only bits I was in control of.” Another described previous medical intervention during birth in the form of a blood transfusion and writes that they “would like to try and take control this time.” There is an association made between medical intervention and lack of control, and in contrast placentophagy is repeatedly asserted as a method of control, usually when perceived as a potential solution to problems arising due a previous negative birth experience. It is known that people who become pregnant following a traumatic birth find “the emotional distress of their first experience. .. vividly reignited” [54]. To counteract this feeling some actively sought to improve their well-being through yoga, homeopathy and diets. The active attempt to improve their next birth led them to, paradoxically, accept that the outcome of it is uncertain [54]. A similar narrative is seen in the users of parenting forums who are actively trying to improve their next birth experience through placentophagy.
This is also important when we consider how parenting forums value personal choice. If medicalisation is medical authority’s usurpation of control over women’s reproduction, leading women to be required to consult medical experts for what has “traditionally and naturally” been women’s domain [40] then the return to the valuation other users’ (women’s) experiences over the medical evidence is resistance to medicalisation. Placentophagy can therefore be conceptualised as both a medicalised phenomenon and a form of resistance to medicalisation. This dual understanding exists without contradiction precisely because most pregnant people do not subscribe to a purely medical or purely natural concept of an ideal birth, instead valuing aspects of both.
Future Research
With regards to future research indicated by this paper, it is the authors’ belief that there is not yet sufficient evidence regarding the medical risks of placentophagy to determine whether this practice should be discouraged and therefore whether there is a need to create official policy on the topic. Whilst it does not appear there is any association with adverse neonatal outcomes, this has not been studied outside of the United States. It may that be that methods and therefore frequency of contamination varies regionally. Depending on risk, it may be pertinent for hospitals to undertake a review of policy on release of placental tissue and what advice is given to pregnant people with regards to placentophagy.
Limitations
The nature of online discussion forums means that there are inherent limitations in this research. There was no ability to determine demographic information of the users. Some of the threads contained posts that had subsequently been deleted or edited by the user or deleted by forum moderators. Users occasionally mentioned moving to direct messaging to communicate about the topic privately, and it is likely this also happened and was not mentioned. The use of parenting forums creates a self-selecting pool of participants who may have characteristics that mark them as distinct from the population of parents as whole, not least because they predominantly exclude men, so some opinions may not be heard. This study only pertains to the discussions of UK parenting forum users, and the practice in other countries may or may not be substantially different.
