Last week, the CDC posted notes regarding infant Group B Streptococcus infection associated with placenta capsule consumption by the birthing person.
It’s been in the news. It’s been all over social media.
Let’s break down what we know about this birthing person and this baby:
A baby was born after an uncomplicated pregnancy, to a person who had tested negative for the presence of GBS bacteria at the 37 week prenatal appointment.
The baby developed early onset GBS infection, was treated for 11 days with antibiotics, and then discharged from the hospital and sent home.
Five days later the baby was readmitted to a different hospital after exhibiting symptoms of irritability. A blood culture indicated GBS bacteria was present in the baby.
There was no evidence of GBS bacteria found to be present in the expressed breast milk of the birthing person and serial exams could not determine a source for the bacteria.
Three days into the second treatment at the second hospital, physicians were notified that the birthing person had arranged for the release of the placenta after the birth for the purpose of placenta encapsulation.
Three days after the birth, the birthing person received the dehydrated and encapsulated placenta from Company A and began taking several capsules several times per day.
The birthing person was advised to stop consuming the placenta capsules by the physician during the second hospital stay.
The placenta capsules were cultured, and the bacteria present was indistinguishable from the bacteria present in the initial and second blood culture of the baby.
The baby was treated with antibiotics, this time for 14 days and discharged home.
Transmission of GBS bacteria to the baby from other household members could not be ruled out
Final diagnosis of the baby was late onset GBS infection due to high maternal colonization after the consumption of GBS-infected placental tissue
Here’s what we know about Company A:
Clients register for Company A’s service prior to birth.
Company A was hired by this birthing person to “pick up” and prepare the placenta for consumption through encapsulation.
Company A’s clients are asked to disclose preexisting infection such as HIV/AIDS, hepatitis, herpes, chlamydia, syphilis, and Lyme disease.
Company A does not ask about intra- or postpartum infections.
Company A’s website outlines that the placenta is cleaned, sliced, and dehydrated at 115°F–160°F (46°C–71°C). The ground placenta is then placed into gelatin capsules which are stored at room temperature (1).
So what does all of this mean for someone who is interested in placenta encapsulation?
I want to start by reminding everyone that while there are potential benefits to placenta consumption, there are also risks.
GBS “colonization” is relatively common, with infection in baby being less common (you can find more about all of that here). Placenta services are also quite common. Although this was an unfortunate illness for this baby and unfortunate circumstances for this family, it is a single documented case. Remember, if things like this were happening all of the time we’d be hearing about it all the time.
I’ll be honest. As a certified Postpartum Placenta Specialist I saw red flags immediately when I read the notes when they were released. There are safety standards that would have minimized the risks to this family which ultimately may have prevented this in the first place.
Let’s talk about the red flags.
The birthing person tested negative for GBS at 37 weeks, however the baby developed early onset GBS infection and spent 11 days in the hospital.
We know that a person can test negative for GBS bacteria prior to birth, but still have a higher level of the bacteria present in their system at birth. Since the birthing person tested negative for GBS at 37 weeks, the birthing person was most likely not given the option to have IV antibiotics administered during labor. If IV antibiotics had been administered it would have been mentioned in the CDC notes. This baby likely became colonized with the GBS bacteria during birth and developed the initial early onset GBS infection due to that bacteria.
The birthing person arranged for her placenta to be released from the hospital immediately after birth and it was “picked up” by Company A, who did not inquire about intra - or postpartum infection. Three days after birth, the placenta capsules were delivered to the birthing person who began consuming the capsules.
Many hospitals hold placentas for several hours and/or up until a patient is discharged from the hospital. They do this so that should an illness or infection arise, the placenta can be tested to rule out additional complications. It’s important to recognize that policies like this are helpful in reducing the risk of consuming and being in contact with a placenta that may contain harmful bacteria. In this case the placenta was immediately released. Had it been held, it most likely would not have been released once the baby started exhibiting those initial symptoms.
I’m going to draw a line in the sand for you readers. This placenta should not have been “picked up” from the hospital, plain and simple. This is a HUGE red flag on its own, on so many levels.
Firstly, the person “picking up” the placenta should have inquired about intra- and postpartum infection. Even if there were no symptoms at the time of “pick up” immediately after birth, the baby was likely experiencing symptoms when the capsules were delivered back to the client three days later. At that point the person providing placenta services should have had the information that the baby was ill, and should have advised the client NOT to consume the capsules.
Second, we simply do not know what training, if any, the person providing the service received. Not asking a client about infections or illness suggests that this person’s training was lacking. Aside from that, processing a placenta outside of the client’s home opens up a myriad of concern.
We do not know anything about this person’s “work space”.
I want to be clear of what I’m talking about when I use the term “work space” because I know a great deal of people who use this term, and it is misleading to clients and people who are curious about placenta services.
There are people who provide this service and prepare placentas in their personal home kitchen or a dedicated space within their home. That means there is likely a placenta in their home refrigerator next to their dinner, waiting to be processed until after their family has gone to bed or at the very least until they are ‘out of the way’. There may even be more than one placenta in their home or dedicated space at the same time. Now, I don’t know about you, but I don’t want someone else’s organ next to my kids’ juice boxes, and I don’t want my personal placenta next to someone else’s leftovers.
Let that just sit for a minute…
So back to this client (or any client choosing to have their placenta processed in a person’s “work space”) - The client does not know what kind of safety precautions the person took in regards to sanitation and adherence to universal precautions. Potential for cross contamination much?
The description of the process followed by this person processing the placenta suggests a lack of knowledge about protocols and of safety standards.
Company A’s website outlines that the placenta is cleaned, sliced, and dehydrated at 115°F–160°F (46°C–71°C), then ground and placed gelatin capsules, and stored at room temperature
It appears that the placenta was NOT steamed prior to being prepared for dehydration. We do not know what temperature was used for dehydrating this placenta. According to the CDC notes, “ heating for sufficient time at a temperature adequate to decrease GBS bacterial counts might not have been reached” (1). The birthing person (who was likely already “colonized” with GBS bacteria prior to giving birth), then became highly “colonized” from contact with GBS infected placenta tissue causing a secondary late onset GBS infection in her baby.
While there are no national standards for placenta encapsulation training and certification, the Postpartum Placenta Specialists at Doulas of Cincinnati follow elite safety standards as outlined by ProDoula to minimize risks.
As a person pursuing placenta services, you also can minimize risks:
Build a relationship with your Care Provider and your Postpartum Placenta Specialist.
Talking about your plans for placenta consumption with your care provider will help you know if this is the best decision for you and your baby. Your care provider is an expert in your and your baby’s health. There are times when placenta consumption may not be recommended. Keeping lines of communication open is extremely important.
Share information with your Postpartum Placenta Specialist (PPS) regarding the health and well being of both you and your baby. Aside from disclosing information about blood borne pathogens (STDs, Hepatitis, HIV/AIDS, Lyme Disease etc) prior to birth, you need to be open about any signs of illness or infection in you and / or your baby after birth (including something seemingly simple like a fever).
Similarly, your PPS will inquire about how you and baby are doing before beginning the encapsulation process. Your PPS will follow up again during the first several weeks of placenta consumption. Ask your PPS if there are any reasons why a placenta should not be consumed (by the way, the answer is: yes there are - you need to find out what they are).
Have your placenta encapsulated in your own home.
Following this precaution will insure that your placenta does not come into contact with outside bacteria. You are guaranteed that your placenta is indeed YOURS, and is the only one being worked with. Since you have complete oversight of the process, you are 100% confident that all safety protocols are followed. If you aren’t sure, just ask. Your PPS is there to help you understand the process. We get into this work because we enjoy what we do, so please don’t think you’re bothering us before we start the process or while we work.
Be sure your placenta is being steamed, dehydrated and stored appropriately.
How you ask? (Because let’s face it, you’re not personally processing placentas regularly).
Steaming the placenta helps to minimize potentially harmful bacteria. Dehydrating your placenta for the appropriate time at the appropriate temperature means that moisture isn’t present to encourage the growth of potentially harmful bacteria. Storage guidelines are given to add another level of safety. Asking your PPS about the steaming, dehydrating, and storage guidelines and the “why” behind them will help you feel confident that the professional standards are being followed.
Doulas of Cincinnati wants you to be confident that your placenta is being handled with the highest level of safety and care available in the Greater Cincinnati area.
Find out more about our Placenta Services and Contact us Today to speak with a Postpartum Placenta Specialist.
Katie Brenner, MFA, ProDoula Certified Childbirth Educator, ProDoula Certified Labor and Postpartum Doula, and ProDoula Certified Postpartum Placenta Specialist
1. Buser GL, Mató S, Zhang AY, Metcalf BJ, Beall B, Thomas AR. Notes from the Field: Late-Onset Infant Group B Streptococcus Infection Associated with Maternal Consumption of Capsules Containing Dehydrated Placenta — Oregon, 2016. MMWR Morb Mortal Wkly Rep 2017;66:677–678. DOI: http://dx.doi.org/10.15585/mmwr.mm6625a4.