Gemma Gracewood grew a baby and a placenta and then she gave the placenta away. Here she interviews the scientist she gave it to. Content warning: There are photos of a placenta in this post. These photos are either totally “ewww” or completely effing amazing depending on your opinion of the placenta.
I was preparing my birth plan, and the question came up: what do you want to do with the placenta? It’s one of the really beautiful parts of our treaty partnership: that, because the whenua (placenta) is sacred to Māori, we all get to be asked the question and we are all given the choice.
Returning Wiremu’s whenua ki te whenua appealed, but being Pākehā, his dad and I don’t have a home marae, or any family land, really. The family bach had to be sold a few years back, and our own non-existent backyard wasn’t an option.
(A side note: how unsurprising that this story about my son’s placenta is also an Auckland real estate story. Insert eye-roll emoji. On the other hand, if you do own a house, Birth to Earth is a nice idea. Otherwise, who wants to help start a campaign for a whenua garden in every town?)
Briefly we entertained the idea of storing it in my mum’s freezer and deciding later, but horror stories from friends of power cuts and thawed-out freezers put us off. Then it came to me: I’m from a science-positive family; my father spent his final months volunteering in a chemotherapy study that had no chance of saving his life. So in honour of the Poppa my son would never know, I wondered if his placenta could be donated to science: his first gift to the world.
How do you donate a placenta to science? Take a chilly-bin along to the birth and then drop it off at the nearest medical lab? Not exactly. The Australian and New Zealand Placental Research Association (ANZPRA) put me in touch with Dr Jo James from the University of Auckland’s Department of Obstetrics and Gynaecology.
Re-reading that original email, I’m touched that the response included these lovely words: “CONGRATULATIONS!!! What an exciting time for you… Best wishes for a safe and joyful delivery”. It’s the small details when you’re pregnant…
Dr James confirmed that she would very much appreciate the donation of a healthy, full-term placenta for comparative purposes, and made the necessary arrangements for one of her staff to pop over the road to the hospital on Wiremu’s birth day.
It’s not like they wait around every day for placentas. You have a chat to see if you fit into their research needs, sign some consent forms, provide a mobile number for an on-call staff member which goes into your birth plan, and then someone on your team calls them when things are gearing up.
So, after a good start followed by a hairy afternoon, with the music of Billy Bragg filling the theatre, our Billy was lifted out to us just after 6pm (all hail modern medicine).
As I was wheeled into Recovery I had a sudden and urgent need to thank this incredible, temporary organ for its role in growing my baby. “I want to see the placenta!” I blurted to somebody. A nurse apologised that it had already been “cleaned up” (you get that when things turn medical) but, ten minutes later, a lovely orderly came in clutching a large plastic bag with what looked like a giant bluish-reddish (okay, purple-ish) blob inside and kind of awkwardly held it up to me.
“You wanted to see this?” he said, shyly.
And that was that. Except, I couldn’t stop thinking about what had happened to it. We’d spent nine months growing it and about nine seconds saying goodbye, and it’s a slightly weird sensation knowing there’s an organ on the other side of the city that was once inside you.
So I contacted Dr James for an interview. In a lovely twist of fate she was on maternity leave herself, so we left our baby boys with their grandmothers and met up on Karangahape Road. Jo came bearing gifts of photographs from the lab, which was extremely cool considering I never thought I’d see the placenta again.
Gemma Gracewood: So, Jo, how did you get into placental science?
Dr Jo James: In the last year of my Bachelor of Technology in Biomedical Science we had to choose a project on any organ in the body that we felt like studying. We had all of the academic supervisors come and parade in front of us and try and sell us on their organ, and I basically picked the placenta because the placenta guy was super passionate and enthusiastic about his organ, in a slightly crazy way.
So since it was only for six months of my life, I thought let’s give that a shot, and then I never left because he was right, it was a really interesting organ! It kind of hooked me. I’m so invested in this area and I find it so exciting and interesting that really that’s me. I wouldn’t swap to another organ now. Placenta for life.
There’s a lot I didn’t know about the placenta until I started thinking about talking to you. How big is a placenta, actually?
It’s usually about half a kilogram in weight, so it’s a pretty solid guy. Placentas from babies with growth-restriction tend to be smaller, so they’re often 250 grams. Normal placentas are around 400 to 500 grams. It’s probably the size of a small dinner plate and 2.5cm thick.
And if you were to lay it out, how big would it be?
The placenta has a branching tree structure, covered on the outside by one massive single cell called the syncytiotrophoblast, which is in contact with mum’s blood. If you were to take that and stretch it out, it would be 11 square metres at term. That’s the area of exchange that’s available for getting nutrients from mum’s blood to baby’s blood, so that’s an enormous area. That’s how folded and convoluted all the placental branches are.
That’s amazing. What are the coolest or weirdest things about the placenta?
Well the coolest thing about it, as an organ, is the interface between mum and baby. It’s regulating mum’s whole physiology, adapting her to the pregnancy through the hormones that it’s secreting and the way cells from the placenta are physically invading into her uterus and changing all the blood vessels.
But there’s also the fact that it’s like the multi-super-organ, so it’s acting like a lung and a kidney and a stomach all in one. It’s bringing nutrients in, it’s also pumping wastes out. It’s really facilitating the whole pregnancy and kind of controlling it.
I was so focused on the baby, like most people I guess, that I kind of ignored the placenta. The thing that blows me away is that it wasn’t there before I got pregnant and it’s not there now. Like, it doesn’t even make it to a year old itself. It dies when we are born.
Yeah, it’s just a transient thing. It’s around for a while and then it goes away.
And we wouldn’t exist without it.
Yeah, but it’s so often massively underappreciated. It gets chucked out. No-one even thinks about what it did.
So what are you researching, and why do you need placentae?
At the moment I mainly focus on using placental stem cells to understand how pregnancy pathologies might arise, and how the placenta develops in early pregnancy and why that might lead to pregnancy pathologies*.
We have two pregnancy pathologies in particular – preeclampsia, where mum’s blood pressure is really high, and fetal growth-restriction, where the baby doesn’t grow as well as it should – and we see these in the clinic in the third trimester near term [birth], but actually they are established quite early in the pregnancy.
There’s a huge amount that we want to know to understand why these pregnancy disorders are actually occurring, and stem cells are kind of neat because they form all the other cells in the placenta, so they almost give us the ability to look back in time at how cells might have grown and differentiated during pregnancy, to understand more of a causative link between placental development and pregnancy pathologies.
So you’re kind of time-travelling, looking for clues at the end of a pregnancy into what might be happening at the beginning of a pregnancy?
Yes. The catch is that we have no way of knowing in the first trimester which pregnancies are going to go on to become pathological. That’s one of the major problems we have: we can’t predict them, and we also can’t treat these disorders. So there’s a huge amount that we want to know to understand why they’re actually occurring.
One of the stem cell populations we look at are called mesenchymal stem cells. Mesenchymal stem cells contribute to the formation of the vasculature in the placenta and help it branch properly. The placenta’s branching structure is important to create a large surface area for exchange. So you want it to be really branched. You want it to be able to maximise transport of nutrients into the placenta.
So we’re interested in specifically looking for how those cells might not be doing their job properly in supporting blood vessel growth in the placenta in cases of fetal growth restriction.
So, don’t keep me in suspense. What happened to Wiremu’s placenta after I gave birth at Auckland City Hospital?
My PhD student Teena Gamage would have come across the road and collected that placenta as soon as we knew that it was available. Then she took it back to the lab, and she would have cut chunks about the size of the end of your thumb out of different parts of the placenta, and then washed it out so that all of your blood that’s stuck to the outside of the placenta was washed away, and then she’d digest the tissue up using enzymes so that she could extract from that the different types of cells that she’s interested in. This is so that she can study how different cell populations in the placenta form in normal pregnancies, and compare these to other tissue samples from growth restricted pregnancies to find out what might be going wrong.
Then after that she passed it onto one of my other PhD students, Win Tun, who is the one who injected all that dye into the vessels on the back of the placenta that you can see in that picture [below]. Win works on a project run by me and Dr Alys Clark of the Auckland Bioengineering Institute, which uses a combination of real anatomical inputs and computational models to look at how the structure of blood vessels in the placenta affect its function.
So here she injected the dye into the umbilical vein in order to map all of the major blood vessels on the back of the placenta, and from this she can use the computer to ‘grow’ the whole placental vascular tree and model how blood flows through this. She’s doing that in both normal and growth-restricted placentas so that we can understand how the placental vasculature and placental function differs between the two.
So Wiremu’s was a multi-purpose placenta. It was a good one.
What could you see? Is there anything obvious? Could you see whether I smoked during pregnancy or not? (I didn’t.) Could you see whether I had the odd glass of wine? (I did.)
In terms of the gross anatomy, you can’t see anything. Part of it is that we understand so little about what goes wrong with miscarriage and what goes wrong with preeclampsia or fetal growth restriction that a lot of the studies are still just figuring out the basics behind it. They’re not set up to measure things like drugs and alcohol so certainly in our work we don’t collect that information from patients. We just assume that every patient is normal and placentas vary enough without going into that.
Yeah, I thought my question was very telling. “Can you see from the placenta if I drank a bit, can you tell if…”. Like there isn’t enough guilt associated with motherhood. At week 18 of my pregnancy I had a bleed from a subchorionic hematoma, which was terrifying. Those things are somewhat common, apparently, but even knowing that, I found myself thinking “What could I have done differently?”
I think because I am in the field and I think so much about it, I always felt like I had less guilt than a lot of my friends. They were saying “you know about all the things that go wrong, aren’t you freaking out?!” And I was like, “but I also know that all those things that go wrong just happen”. It’s just biology to me, it’s not “I did this, it caused this”.
So I guess the thing would be to try and educate the general populace in some way as to how complex the whole system is and how many tiny things can go wrong, and how it’s not because you had that one doughnut and therefore you didn’t eat properly –
– and now you have gestational diabetes
It’s just a really complicated and amazing system and stuff can go wrong.
And it’s a miracle that we humans can get pregnant in the first place. I mean, we’ve got the most inefficient fertility system.
Okay, that’s nice to hear. There’s something really beautiful in that where, if you know the science, then most of us can be absolved of our guilt! We shouldn’t be feeling guilty in those nine months anyway. We should be feeling relaxed and looked after.
Yeah, I mean I think there’s so many studies out there and so many individual things to run with, I mean, not to bash the media –
– No no no, bash away! We’re the worst!
But it’s all sort of guilt-inducing and I think the key thing is just be good to yourself. Eat a healthy diet. Try not to stress too much. Keep, you know, exercising if that makes you happy.
Yeah. be pregnant! That’s my fundamental advice to friends who are pregnant. Just, be pregnant! (Not that anyone should ever offer any advice to anyone who is pregnant. Lolz.)
Yeah. I wasn’t throwing up in the first trimester but the hungover feeling was bad enough.
Yeah! You just feel like you’ve got a constant hangover, but without the martinis! But, actually in terms of eating, are there “placenta superfoods”?
Not really. The same thing that’s good for you is the same thing that’s good for the baby. So, lean protein, lots of fruits and vegetables, whole grains and cereals. It’s the same stuff the media says all the time, but I guess there’s a gap between “you know what you should do and what you actually do do”
I guess I’m thinking in terms of the amount of blood that’s flowing, are there good antioxidant foods for the placenta?
There are some research groups around the world that work on antioxidants, for example, selenium, which has been shown to be good for placental health, for the function of the mitochondria in the placenta. Mitochondria are organelles within cells that produce the energy, but that also respond to oxidative stress which can occur if blood flow to the placenta isn’t as good as it should be.
There’s a few things like folate and iodine and iron that are common supplements prescribed during pregnancy and have clear beneficial effects. There are also many places where a wider range of dietary supplements could improve pregnancy outcomes, like in developing countries where they’re not getting enough of the micronutrients that the baby and placenta would need. But with our diet in a western, theoretically well-nourished nation, we should be able to get what we need. Like, selenium for example: one Brazil nut would give you your whole day’s worth of selenium.
So there are better ways that you can eat, but at the same time, I shouldn’t feel guilty for the KFC quarter packs I inexplicably found myself scoffing in the second trimester, having not touched the stuff since the ’90s?
Well for my first son for some reason it was pies! I hadn’t eaten pies for six or seven years but suddenly, I needed a pie.
Nothing wrong with a pie! Full disclosure: My husband makes pies for a living. Okay, so, Jo, I think I can predict your answer to this, but what did you do with your children’s placentas?
I gave my children’s placentas to my lab! [Laughs] My husband hand delivered them to my PhD students, who isolated cells from them for their research. So I just donated them to my own project.
My first son’s was quite good because he was actually born at 36.6 weeks, so he made quite a good early-gestation control.
Did you have, like, “feelings” about those donations, or was it just a given that you were gonna give your sons’ placentae to your own lab?
I guess it was straightforward that I was going to do that. I’ve been working in this field for so long, it’s a really normal thing to do with the placenta, for me. We do that every day. And I didn’t want to take it home or bury it. We don’t really have a big backyard to bury it in, nor do we expect to live in this house for the next 20 years.
You didn’t want to have the placenta made into pills that you could take daily?
No, I didn’t. Um, no, not even vaguely!
I mean no judgement on those who do. I briefly looked into it when I read that the actor January Jones did it, but decided against it. What’s your thinking around that?
My thinking around that is that I think there’s no really good randomised, controlled studies that show anything either way about it, so there’s not really any good evidence that it’s beneficial. It’s difficult to control for it, because you have a population of people that are inclined to do that and there’s probably a lot of placebo effect around that, because they believe it’s going to help, so that’s why they do that in the first place.
Animals often eat their placentas, right? But animals have just given birth out in the wild and they’re probably not in the best state and it’s a good form of nourishment for them that they can easily eat and not have to run out and catch anything… but we have supermarkets.
Yeah. We have sushi and pâté and oysters (if our birth support team are doing their job right!)…Is there anything else you want people to know about the placenta that we haven’t talked about?
I think people just need to appreciate it more, really. It’s one of the least understood human organs, but it’s also everyone’s life support machine for the first 10 months they’re alive. It’s what sustained you and without it working properly none of us would be here, so give it some credit!
Dr Jo James is a HRC Sir Charles Hercus Senior Research Fellow at University of Auckland. If you are interested in making a placenta donation and you’re in Auckland, send Jo an email.
Gemma Gracewood is a producer, writer, performer and mum.
*Pathology: something abnormal; especially: the disorders in structure and function that occur in a particular disease (from Merriam Webster for kids)
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