Examining the Placenta

http://static.open.salon.com/files/placenta-side21255005664.jpg

Steps to examining the placenta:

1. Note the cord insertion. Usually in the center of the fetal side (side that faces the baby in the womb). Sometimes on the side and, rarely, out in the amniotic membrane and joining the placenta only by blood vessels (velamentous insertion).

2. Note the size of the placenta and ask yourself, “does this seem small, large or just right for this size of baby?”. A full term placenta will be about 7 inches in diameter and about 1 1/2 inches thick.

3. Look for anything unusual on the fetal side. (e.g. true knot in the cord).

4. the membranes will cover the fetal side and go off the side edges to form the water bag that enclosed the baby. Take the membranes in your fingers and lift them to see if there is enough membrane to make a sac for the baby. Note where the sac “popped” when the membranes released. The sac may not have a neat hole, but rather, may be in tatters if it broke explosively.

5. Note the colour of the membranes (usually whitish or bloody but may be yellow or green stained if the baby passed meconium in utero). Take the membranes between your fingers and see if you can unpeel the amnion (inner bag) from the chorion (outer bag). They are together like two sheets of saran wrap. If there is a sizable chunk of membranes missing, the mother may complain of “something weird” hanging out of her vulva in the days post birth. The membranes may be showing at the vulva and will eventually just fall out or can be “roped” by twisting a hemostat gripper round and round and then gently tugging out of the vagina.

6 Wipe off the cut end of the umbilical cord. Look for the two arteries and one (larger) vein. A single artery cord can mean kidney problems, if you have a smallish baby. If the baby is big and well grown, there is less to worry about (the two arteries may have grown together into one).

7. Note the length of the cord, including any that was left on the baby’s tummy.

8. Turn the placenta over and look at the maternal side. Cup the placenta in your hands so that all the lobes fit together like a nice jigsaw puzzle. Note any missing pieces. (I have never seen a piece missing in 30 years but this seems to be a big fear in obstetrics).

9. The maternal side will be a rich, red colour. There can be fatty deposits (white) and calcifications (places that feel like sand when you run your fingers over them). These things are not a problem. In a woman that smokes, the maternal side may be somewhat yellowish from the nicotine.

At a home birth, the midwife should put the placenta in double ziplock bags and label it. Put it in the fridge and show it to the mother on Day 3 or 4 postpartum. Don’t get into a big conversation about the placenta on the day of the birth. The birth attendants might find it very interesting but, remember, the parents are only interested in the baby at that point.

What do you see in the photo above? Can you see the amniotic sac? Can you see the umbilical cord? Is it the maternal or fetal side that you are seeing? Does the amniotic sac have a neat hole (indicating late release of the membranes) or did it explode?

About gloria

I live and work in Vancouver BC Canada. I've been in the childbirth business for 30 years. I teach midwifery and doula courses both online and in person.
This entry was posted in Holistic midwifery & doula education. Bookmark the permalink.

20 Responses to Examining the Placenta

  1. Chrissy says:

    Wow, very interesting. i love placenta talk. I wish my midwife had offered to look over my placenta with me on day 3 or 4. I would have been intrigued. Lucky I still have it in the freezer , 2 years later, so can have a good google myself.

  2. Amy says:

    thanks gloria. I bet it would be hard to find a qualified person explain how to do an examination of a placenta in laywoman’s terms anywhere else online.

    I am such a wimp I have a hard time with blood, so I cant answer your questions! :P

  3. Joni Nichols says:

    Interestingly enough the only doctor here in Mexico who could provide me with documentation as to why the Mexican obstetricians (with the exception of my partner Jose Luis) ROUTINELY do manual cleaning of the uterus gave me a paper in which they stated that they didn’t have enough professionals who were able to revise the placenta correctly!!! How sorry an excuse is that?

  4. Neekie Ramsay says:

    Thank you for such an informative article on the placenta, I am starting my bachelor of midwifery next year and am very interested in this article.
    I have all 3 of my placenta’s from my babies still in the freezer will defrost and have a good look when I am studying, then put them in the ground and plant a nice native tree (New Zealand). I also have info on my 3 miscarriages and went into the What ifs and anatomy of the placenta , what went wrong etc. So understand some of the terms.
    Thanking you again

  5. Janet says:

    Joni I’m shuddering at the thought of a hand in a woman’s body like that. It was done fairly routinely in Australia once too. Shocking.

    Moving on…

    I love placentas. :) I helped a woman do some prints from a thawed one before she buried it at her motherway recently. It was very special!

    “8. Turn the placenta over and look at the maternal side. Cup the placenta in your hands so that all the lobes fit together like a nice jigsaw puzzle. Note any missing pieces. (I have never seen a piece missing in 30 years but this seems to be a big fear in obstetrics).”

    Ah memories. :-) When my dd1 was born and I ended up having to transfer, the hospital checked over our placenta and declared it entire. I smiled and nodded and signed the paperwork promising I wouldn’t plant it anywhere Dangerous and then guffawed with laughter because it wasn’t entire at all, I’d been chowing down on it for a PPH after birth. So even when it’s not entire, it seems some people can’t even tell. Still makes me laugh nearly four years later.

  6. Gayle says:

    What a great description. I have never had the opportunity to really examine a placenta~ Even my own 2, I really wish I had as my second was a homebirth it would have been easy! One of my favorite memories of that night is the midwife asking if “any of us wanted a bite?” The look on my 6 year old sons face was priceless!
    On a side note the deciding factor in the midwife we chose was her story about doing placenta prints~ Sounds beautiful.

  7. Anna says:

    I have been reading your blog, specifically on how it relates to VBAC and have some questions.

    My son was born after 4 hours of natural labor. My daughter was born almost 2 years later. I was 6-7 centimeters. My doc broke my water and once contractions started she was born an hour later. My third, a boy, had reduced fetal movement, so I went in for monitoring at 36.5 weeks. They were reluctant to do anything, but were worried by his invariable heart rate. They decided to put me into labor as I was already 4 centimeters dilated. Within a few contractions they rushed me to the emergency room. On the way there, he died. Blood tests showed that he had a massive fetal maternal hemmorhage.

    Having now had a section, I am wondering at what to do. I live in the Vancouver Fraser Valley, and the obsetrician, doctor, and midwife I have talked to all recommend waiting 24 months before delivering another baby. Having lost a child already, I feel so much less willing to risk another life as well as my own. However, my home, heart, and kids were all ready to welcome a baby into our home this month. The thought of waiting 24 months feels unbearable.

    If you have time, which I am sure you don’t. But if you do, could you give me some advice?

  8. gloria says:

    Anna, I’m so sorry about the death of your baby boy. I think you mean he had a “variable” heart rate. When they “put you into labour”, was that done by breaking your waters?

    I would advise you to get a copy of your son’s pathology report and also ask the coroner for a copy of the coroner’s report. These documents should be reviewed with a trusted medical professional who can give you more accurate information on what really happened.

    For the midwifery students, a story like Anna’s should make you very reluctant to introduce an amni hook into a woman’s vagina in case you have one of those blood vessels from a velamentous insertion in the portion of the bag that you might pierce with the hook. If you catch a blood vessel, the baby can die very quickly from hemmorhage. The baby only has the amount of blood in his/her body that can fit in a soda can so “massive” means one cup.

  9. Janet says:

    I’m so sorry for your loss, Anna. Love and light to you.

  10. Amy Gow says:

    Very sorry to hear your story Anna :(

    Gloria, I can’t seem to find this info elsewhere: I’ve observed that after a birth where the cord remained unclamped/uncut until after the placenta has been born and the cord has turned white, the placenta seems less thick than one where the cord is clamped and cut immediately. I am guessing this has to do with baby receiving all of his/her blood supply and that the smaller placenta is easier to push out and allows for better tone in the uterus. Am I on the right track here?

  11. gloria says:

    Good food for thought, Amy.

  12. I’m taking on your questions as a study moment. :)

    Can you see the amniotic sac? Yes, it is covering the fetal side
    Can you see the umbilical cord? Yes, although not a good clear view
    Is it the maternal or fetal side that you are seeing? Fetal
    Does the amniotic sac have a neat hole (indicating late release of the membranes) or did it explode? Neat hole in the amniotic sac.

    Thanks for sharing this with us.

  13. gloria says:

    Very good, Amber. The fetal side is shiny and feels like a satin pillow (maybe that’s why we all love satin pillow cases?). When the placenta emerges from the woman’s body it’s very hot (core temperature) so the baby has a lovely heating pad (as well as hot amniotic fluid) to rest upon.

    Sometimes that amniotic sac is turned inside out so that the fetal side can be seen more clearly in a photo and the maternal side appears to be covered but that is just because it has slipped around to the maternal side. The baby, cord and amniotic fluid are all contained within that sac. It’s so amazing that it is strong enough to contain the little Kicker.

  14. Tracy says:

    Gloria, When you ask “or did it explode” if it did, what would that indicate?

  15. gloria says:

    When the baby’s head is well down in the birth canal, and the membranes release during the pushing stage, the hole can be very precise and neat.

    If the baby sticks his toenail through the bag before the birth process begins, the bag will just tear all over the place. It doesn’t really matter if it happens that way “explodes”, it’s just a way to tell, if it is neat, that the waters were intact right up to the end. Thanks for asking, Tracy.

    • Mary franchini says:

      I have a question for Gloria. My last two placentas had quite a large amount of fatty deposits on them. So much so that my mydwife ,who is very experienced said that it was similar to that of women had thier gallbladders removed. Do you know of a way that I can prevent this condition with my currant prenancy?I am due in April. Thank you

  16. gloria says:

    Were the fatty deposits on the maternal side or the fetal side, Mary? Could you ask your midwife for references that fatty deposits could indicate gallbladder removal?. . . I’ve never heard of that and find it interesting. Here’s a pdf on how to examine a placenta and there is no mention of fatty deposits having significance http://www.thebiomedicapk.com/articles/243.pdf

    • Mary franchini says:

      If I can remember correctly, the fatty deposits were on the smooth side , fetal side. It was like a ring around the edge about 1 inch wide. I saw a picture of a placenta that was simular to mine and the midwife describing it used the words”very unhealthy”. I will ask Pam about her references when I go for my appointment. And about the corilation. I just assumed that since I do have issues digesting fats that it made sense to me.

  17. Gloria, for about 3 years I have been offering placental encapsulation for supplementation during the postpartum period to ensure an amazing postpartum as well. There are so many advantages and I have a few paragraphs about it on my website. A couple days ago I processed a placenta that had quite a bit of fatty deposits and when I put the dehydrated placenta in the blender in order to encapsulate it, it blended up as if I were making a graham cracker crust. I had never seen anything like it and called the midwife to share my findings. It was my opinion…and the midwife reacted the same way without my mentioning it…that a metabolic screening out to be done to make certain the baby could tolerate, digest, assimilate fats well. Can you tell me more about your experience in finding fat deposits on the placenta? Does it mean anything? or is it simply a normal variation? Thanks for your reply! Debbie Gordon

  18. nagami achan suzan says:

    Thanks Gloria. You do great job and even make my work of teaching midwives in Uganda easy and interesting. Those steps can be followed by even lay women. Some people here still have their placenta kept for that long whereas the hospital disposes of it, some times before the mother looks at it.

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