Over the last 11 months there has been a lot of talk about the safety of placenta encapsulation if a mom tests positive for Group B strep due to one case report of a baby from Oregon who got sick from this bacteria. Just days ago, on May 3, 2018, a new study was released that sheds new light on this topic. This article from ScienceDaily.com says:

"The largest study of its kind found mothers who consumed their placenta passed on no harm to their newborn babies when compared to infants of mothers who did not consume their placenta. The joint study by UNLV and Oregon State University was published May 2 in the journal Birth.
Reviewing roughly 23,000 birth records, researchers found no increased risk in three areas: Neonatal Intensive Care Unit admissions in the first six weeks of life; neonatal hospitalization in the first six weeks; and neonatal/infant death in the first six weeks."

Let's review what happened. A baby boy in Oregon got sick when he picked up Group B strep bacteria from his mother during birth. 1 in 4 women are positive for GBS when they give birth. Unfortunately, when this mother was tested (typically around 36/37 weeks of pregnancy) she tested negative and therefore was not treated with antibiotics during labor. It can also go the other way, where mom tests positive at 36 weeks but then is negative at the time of birth. However, until a rapid test that can be done during labor is widely available we continue to unnecessarily treat some moms with antibiotics and miss others who are actually positive for this bacteria. 

So, this baby fell ill soon after birth and was hospitalized and treated with antibiotics. He recovered but then soon after got sick again and was re-hospitalized. At this time the placenta capsules the mother had been taking were tested and Group B strep bacteria was found in them. They did not find Group B strep in her breast milk. The CDC concluded that they couldn't be sure why or how baby got sick a second time but that all placenta encapsulation should be avoided. 

There are two main issues here. First of all, this mother should have never been consuming her placenta. If mom or baby has an active infection after birth, encapsulation is contraindicated. Second of all, clearly this encapsulator did not follow safe procedures and protocols. When done properly the encapsulation process will kill bacteria. I've discussed this more in-depth here in my prior article on the subject. There are some encapsulators who are not following safe procedures who will encapsulate at around 115 degrees to try to keep a food technically "raw" but this is not safe from a food preparation perspective. If you choose to encapsulate make sure you hire someone with extensive training, knowledge and a separative work space in their home where this process can be done professionally and safely. 

Just like we continue to eat chicken and eggs, knowing that proper preparation can keep us safe from harmful bacteria like e coli and salmonella, we can continue to benefit from placenta encapsulation by hiring trained providers and following basic safety precautions. 

I've been encapsulating placentas in the Twin Cities since 2011 and have personally encapsulated over 750 placentas and my company has handled many more in that time. When I started we definitely received comments from nurses and doctors along the lines of "you're going to do WHAT with this placenta?" but hospitals in the metro area have always been supportive of this practice and in seven years it's grown so much that now I'll hear nurses ask clients "so, are you saving your placenta?"

Unfortunately there are some metro area hospitals that have gotten less supportive in the last few years and lately it has become an increasingly frustrating issue for clients. I noticed recently that more and more clients birthing at The Mother Baby Center at Abbott were being told the placenta had to leave the hospital within two hours. It's even worse at Mercy in Coon Rapids. Clients are told the placenta has to leave one hour after birth. St. Francis in Shakopee is also in the Allina system and some encapsulators report problems there. United is also an Allina hospital though I personally haven't had problems at United and go there often to pick up placentas. Methodist, which is not an Allina hospital, also sometimes tells clients their placenta must leave in two hours but I have not been able to verify if there is an actual policy at Methodist.

​In a perfect world your professional encapsulator would come within two hours but many times that is not possible. Our pickup hours are 8 am to 8 pm. Even during these hours we are sometimes busy with another client, a meeting, or a family commitment and cannot come immediately, though we try to pickup placentas within 4-6 hours of being called during these daytime hours. 

For families who have hired a doula or who have extra family members attend their birth, the solution is relatively easy. Use the cooler you've brought along per the instructions we've given you and have your doula or family member take it home with them when they leave. However many of our clients don't have this extra help. It seems very unfair and problematic to ask dads/partners to leave at this time, even if it's just to run the cooler out to the car (which only works IF the weather is cool). The early hours after baby arrives are busy and intense. First there's the birth of the placenta, any stitches the birthing person might need, getting cleaned up and initiating feeding. Then at the two hour mark there is all the weighing, measuring, newborn exam, getting mom to the bathroom, skin to skin time with dad/partner and packing up everything to move to the postpartum room. 

So, what does the Allina policy actually say? I've posted links to the policy and related documents for Allina hospitals below. There is indeed language that says "the placenta must be removed from the hospital as soon as possible and within 4 hours post-delivery or prior to changing patient location (e.g. Labor room to postpartum room)." Obviously this is vague. Usually the move to the postpartum room is around 2 hours. But it doesn't say whichever comes first, moving to postpartum or 4 hours. Also one could argue with the language "as soon as possible" since for some folks it just isn't possible to remove it yet. They don't want clients to put the placenta into the fridges in the rooms since it is not food but considered waste and I understand this policy which is why we ask all clients to bring coolers. 

So what can you do? I suppose you can hope that you will be assigned a nurse who is supportive of this practice and doesn't force you to follow this guideline. That does happen often. Part of what is frustrating about this policy is how unevenly it is enforced. You can plan to have someone there to take it home with you. In the cooler months of the year you can plan to bring a very good cooler and use tons of ice to keep it in a car until we can come pickup. You can push back a little and tell the nurse you understand the policy and are working hard to get the placenta removed ASAP. Remember the nurses are just following procedures and trying to do their jobs as they've been taught so they have to tell you the policies but there is always wiggle room and at the end of the day the hospital wants you to have an amazing experience and tell all your friends they should go there for the births of their own babies!

In case you're wondering why this policy is so inconsistently enforced, I believe the explanation lies in nurses views on encapsulation. Some understand the benefits and have even done it themselves and these nurses will be more supportive. However, many nurses do not understand this holistic, alternative approach to postpartum wellness and are very judgmental of anything that is not mainstream. One nurse recently told a family and their doula that there have been "a lot of infections" from people doing encapsulation which is false. There was one case in Oregon in 2017 where a baby picked up the Group B Strep bacteria from his mother during birth (which was untreated since she had tested negative, as often happens since the bacteria is transient) and got ill, then was treated and recovered, then got ill again. The second time he was ill they discovered that there was Group B strep bacteria in the placenta capsules but the CDC concluded they couldn't be sure why the baby got sick a second time. (He recovered again.) It appears that the encapsulator did not dehydrate at a high enough temperature to kill bacteria and what's worse, this mother should have never encapsulated at all since her baby had an active infection just after birth. Active infections for mom or baby is a contraindication for encapsulation. Nurses can and should be encouraging clients to hire professionals who are well-trained and who have safety measures in place to keep everyone safe. When done properly placenta encapsulation is safe, even if the mom tests positive for GBS which 1 in 4 women do have at the end of pregnancy. Just last week a new study was released that supports the safety of this practice. You can read that here. 

If you have faced this policy and it was a hardship for you please send that feedback to the hospital! There is a simple solution that every hospital could implement that is already in place at Woodwinds and St. John's. At those locations, they have a dedicated placenta fridge (the one at Woodwinds isn't much bigger than a dorm fridge) and they will store the placenta until we can come pick it up. So easy!