This is the first placenta I ever saw. The first placenta I was able to examine and learn from. I've now seen a countless number of placentas and yet the magic and miracle of these crazy organs never ceases to amaze me!
A really basic explanation of a placenta is that this is the organ a woman's body grows during pregnancy in order to provide the baby with oxygen and nutrients as well as discarding any waste products (such as CO2).
The placenta inserts and grows from the wall of the uterus and is attached to a bag of 'membranes'. These two membranes are kind of like a clear film that encloses the baby and the 'waters' (aka amniotic fluid). So when you hear of someone's waters 'breaking' or 'leaking' this is what they're referring to.
The white cord you can see in the picture is the connection between baby, placenta and mother. It usually (but not always) inserts near the center of the placenta and then into the baby's umbilicus (aka belly button). This cord is usually fat and purple. It is made up of one vein (transporting waste and de-oxygenated blood away from the baby) and two arteries (transporting nutrients and oxygenated blood to the baby). Essentially this is the baby's lifeline. If the cord snaps or is severely compressed it can cause significant fetal distress. Another complication involving the cord is a 'cord prolapse'. This occurs when the cord presents through the cervix before the baby's head. This can cause the cord to become severely compressed or break before the baby is born. As you may be able to tell, this is a medical emergency and requires immediate delivery of the baby, usually via Caesarean section.
In a normal, uncomplicated, vaginal birth, the placenta is delivered after the baby's already born and on the mothers chest. The placenta can either be delivered through 'active management' (the current norm in Australia) or what's known as a 'physiological third stage'.
'Active management' - what most women will experience in Australia, sees the placenta born between 5-20 minutes post-birth of the baby. A kind of synthetic Oxytocin (the hormone that stimulates contractions) is injected intramuscularly in order to contract the uterus and encourage placental separation. It is best practice to then wait for the cord to stop pulsating and for 'signs of separation' between the uterus and the placenta. There are two reasons for this... 1. Is that by delaying cord clamping until the cord stops pulsating the baby is able to gain those last bits of blood, oxygen and nutrients before fully transitioning to life on the outside. 2. Is that by waiting for the placenta to separate we decrease the risk of pulling the uterus inside-out with the placenta.
Signs of separation include cord lengthening or a short but fresh bleed. After this the midwife will use one hand to push back on the uterus and the other to gently pull the placenta out using the cord. The reason active management is often considered to be 'best practice' in Australia is because it is thought to contract the uterus sooner and therefore prevent post-partum haemorrhages. The evidence surrounding this, however, is debatable so I would encourage you to do your own research.
A physiological third stage, however, is simply allowing the placenta to birth naturally and on it's own without any medication, cord clamping, cutting or traction. Women who desire this must ask their health provider if it is safe for them.
Once the placenta is born, it is the midwife's job to check that it is completely intact (so no bits have been left behind) and to note any abnormalities.
Overall placentas are pretty incredible organs. Another amazing thing about them is when flipped over so the uterus-inserting-side is flat on the table, the up-facing side looks like the tree of life. Sounds whack but I'll attempt to find a photo that shows this and repost it later.
Well if you made it this far into my placenta rant good job! Any questions/queries/suggestions/comments don't hesitate to send them through.
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