Depression

Key Points

Many women plan on taking placenta pills to prevent the “baby blues” and postpartum depression (PPD)
The “baby blues” is a normal hormonal transition and is not considered a state of mental illness
Research shows that the postpartum hormonal state is unique and should not be defined as abnormal

Recent randomized controlled trials done on placenta pill ingestion to prevent PPD has shown that placenta pills have no beneficial effect in preventing PPD
There are many traditional, community and psychological support methods that exist to support the postpartum mother

Most women say they consume placenta pills to prevent PPD

One of the primary reasons reported on why women are encouraged to ingest their placenta is the belief that it will prevent postpartum depression (PPD) (Benyshek et al. 2018, Selander et al. 2013). This is not based on evidence of any past cultural practices, nor on current research (Kristal 1980, Young et al. 2010, Gryder et al. 2017, Norhayati 2015). A rationale women are commonly given for ingesting placenta is that they are told that the “baby blues” and postpartum depression are an unwanted result of the pregnancy hormones leaving the body at birth with the delivery of the placenta. The reasoning goes that if a woman reintroduces the placenta hormones into her system in the days and weeks following the birth, she will not have to experience the hormonal transition of the pregnancy ending. Women are being told that the placenta being expelled at the birth makes the body “lose” beneficial hormones needed for health and well-being, and that ingesting placenta will “balance their hormones.” This message is in effect telling a woman to not trust her body, and to alter the natural hormonal process of childbirth. What is referred to as the “baby blues” has commonly been understood as a normal and temporary state of heightened emotion and vulnerability. This is during the hormonal transitioning from the pregnancy to the postpartum time, and goes away on its own around the first week after the birth. The “baby blues” is not the same as PPD.

The World Health Organization published a 2008 comprehensive report, Maternal Mental Health and Child Health and Development. This report included a literature review, Postpartum Depression: Literature Review of Risk Factors and Interventions, which describes postpartum blues in the following way, “Postpartum blues is the most common observed puerperal mood disturbance, with estimates of prevalence ranging from 30-75% (O’Hara et al., 1984). The symptoms begin within a few days of delivery, usually on day 3 or 4, and persist for hours up to several days. The symptoms include mood lability, irritability, tearfulness, generalized anxiety, and sleep and appetite disturbance. Postnatal blues are by definition time-limited and mild and do not require treatment other than reassurance, the symptoms remit within days (Kennerly & Gath, 1989; Pitt, 1973). The propensity to develop blues is unrelated to psychiatric history, environmental stressors, cultural context, breastfeeding, or parity (Hapgood et al.,1988), however, those factors may influence whether the blues lead to major depression (Miller, 2002).” (Italics added). Additionally, this same study found a number of risk factors for postpartum depression (PPD), and among these were various social factors that contributed, not biological or hormonal factors (Robertson et al. 2003).

A 2015 literature review, Magnitude and Risk Factors for Postpartum Symptoms reviewed 203 studies to find the prevalence of and factors associated with PPD in both developed and undeveloped countries. Their results showed that, “Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude toward pregnancy and lack of social support are significant contributors to postpartum depression.” They go on to say, “Physical and biological factors as well as cultural factors show inconclusive result” (Norhayati et al. 2015). In another literature review, Biological Aspects of Postpartum Depression, the authors describe the uniqueness of the hormonal milieu of the postpartum woman, “A normal pregnancy and postpartum period bring about large endocrine alterations, which represent adaptive changes in preparation for childbirth and nursing, but would be considered pathological in a non pregnant woman” (Skalkidou et al. 2012). Lactation consultant and author Jan Riordan, in her book Breastfeeding and Human Lactation, emphasizes that “Postpartum hormonal shifts, although dramatic, appear to play no clear role in postpartum depression. Maternal hormonal levels during lactation represent the normal postpartum state: thus breastfeeding women should be at no greater risk for postpartum depression because their hormonal levels are different from those in nonlactating women, particularly if this pattern of mothering is supported” (Riordan p 476). Psychologist and lactation consultant Kathleen Kendall-Tackett has published extensive work on the topic of postpartum depression and has a list of references that research the risk factors for PPD.

Randomized Controlled Trials show no benefit to placenta pills for PPD prevention or improved iron levels

A recent randomized, double-blind, placebo-controlled trial was done in 2017 by the University of Las Vegas (UNLV).The results of their study Placentophagy’s Effects on Mood, Bonding, and Fatigue show that there is no benefit from placenta pills compared to a placebo (Young et al. 2017). Another randomized controlled trial was done in 2016 at UNLV, to see if ingesting encapsulated placenta improves iron status for postpartum women, to possibly provide evidence of PPD treatment through reducing anemia. The results of this study concluded that there is no statistically significant difference of iron benefit from ingesting encapsulated placenta over a placebo (Gryder et al. 2016).

Given that placentophagy is not a traditional human practice, and is not a proven method for preventing PPD either in recent randomized controlled trials or from what we know about the natural postpartum/lactation hormonal state, then it is possible that the basis for utilizing placenta pills for PPD prevention has been generated and marketed primarily in the popular media.

What about reports of energy from the placenta pills?

Another rationale many women are given for the placenta preventing PPD are the signs they get of having increased energy from taking the pills. The pressure women feel to go back to their busy before-baby life as soon as possible is a common experience for the modern mother. Despite the placenta being a natural organ created by the body for pregnancy, caution should be taken with consuming it as a comprehensive solution under the guise of ingesting something natural. It has become a trend to give a woman a bottle of placenta pills so she can have the “energy boost” immediately postpartum to go back to full steam ahead, as if she hadn’t just had a baby. Often mothers report that the pills give them so much energy at just a few days after the birth, they quickly bounce back to their old routines. This quick energy fix is a far cry from traditional cultural postpartum practices of lying-in with family and community support around the woman during this vulnerable and tender time. What is in the pills that could give them this energy? Recent studies have shown with hormonal analysis that most placental hormones are destroyed with the high temperatures of processing. In a 2016 UNLV study, Presence and Concentration of 17 Hormones in Human Placenta Processed for Encapsulation and Consumption, only estrogen and progesterone were retained in levels that may reach bioactive threshold levels after processing (Young et al. 2016). A German study published in 2018, Human Placentophagy: Effects of Dehydration and Steaming on Hormones, Metals and Bacteria in Placental Tissue, found a 89.2% – 99.6% reduction of hormones with the most thorough processing (steaming followed by dehydration). However, they found that for the placenta that was raw-dehydrated, the concentration of progesterone increased in the samples (Johnson et al. 2018). From this available research, it appears that there may be levels of estrogens and progesterone, varying in amounts and concentrations based on preparation methods.

No research has been done to conclude whether these steroid hormones in placenta pills are responsible for the energy buzz that women report. While the energy from the pills may at first sound appealing, clearly, the high energy state these steroid hormones could potentially create in the early postpartum time would be anything but a “natural” state. Is the support a new mother needs in an energy pill? A risk in this is that ingesting placenta may be directly reversing the hormonal process the body is trying to maintain during breastfeeding. See the section on the body’s natural hormonal cycling after birth, and how it is important for breastfeeding. In addition, there is research that shows that breastfeeding and the naturally occurring lactation hormones are built-in protective factors for mood in the postpartum woman. (Ahn et al. 2013, Hahn-Holbrook et al. 2015, Kendall-Tackett 2007). Is there something inherently wrong with a woman’s body and the hormones she naturally has in the postpartum period, or is there something more to PPD that has to do with how modern societies treat new mothers?

What are traditional cultural practices to prevent PPD?

Extensive research into human history shows that it has never been a traditional human practice to eat the placenta in the postpartum period. Looking into traditional cultural practices, and contrasting these with how modern cultural practices predispose women for PPD, lactation consultant and psychologist Kathleen Kendall-Tackett, wrote an informative article How other Cultures Prevent Postpartum Depression: Social Structures that Protect New Mother’s Mental Health. For example, she explains that traditional cultures are known to have in place a distinct postpartum period, protective measures reflecting the new mother’s vulnerability, social seclusion and mandated rest, functional assistance, and social recognition of her new role and status. Another example is in Traditional Chinese Medicine (TCM) and traditional Chinese customs, where great care is taken to support a postpartum woman’s health and recovery and specifically only giving gentle medicinal remedies. In fact, according to TCM, the properties of placenta are actually directly contraindicated according to what a postpartum woman should be given. These are practices that have inspired a current movement based on old concepts to recognize the tender postpartum time as a transitional “Fourth Trimester” to be honored and supported. Midwifery texts published before the 2006 trend of placenta encapsulation held extensive guidance on supporting this normally vulnerable time for postpartum women, and none of them included trying to alter her natural hormonal state (Davis 2004, Sinclair 2004, Gaskin 2003, England 1998).

Normal hormonal transitioning into postpartum

The “baby blues” is not a mental illness. It occurs during the temporary and normal hormonal transitioning, and there is no evidence that this normal process should be prevented. Postpartum depression, however, is a real condition that is complex and serious. “Untreated postpartum depression can have adverse long-term effects. For the mother, the episode can be the precursor of chronic recurrent depression. For her children, a mother’s ongoing depression can contribute to emotional, behavioral, cognitive and interpersonal problems in later life” (Robertson et al. 2003). If you are concerned you might have postpartum depression, seek support from a qualified mental health professional.

Every woman should be able to make an informed decision regarding whether or not to ingest her placenta. There are no proven benefits to the claims that have been made regarding placenta ingestion. In addition, there are several risks to consider with this practice. See the “Risks” dropdown above.

References

Ahn, S., & Corwin, E.J. (2015). The Association Between Breastfeeding, the Stress Response, Inflammation, and Postpartum Depression During Postpartum Period: Prospective Cohort Study. International Journal of Nursing Studies, 52, 1582-159.

Benyshek DC, Cheyney M, Brown J, Bovbjerg ML. (2018). Placentophagy Among Women Planning Community Births in the United States: Frequency, Rationale, and Associated Neonatal Outcomes. Birth 00:1‐10.

Davis, E. (2012) Heart and Hands: A Midwife’s Guide to Pregnancy and Birth (5th edition) Berkeley, CA: Ten Speed Press.

England, P. (1998). Birthing from Within. Albuquerque, NM: Partera Press.

Gaskin, I. M. (2003). Ina May’s Guide to Childbirth. New York, NY: Bantam Dell Publishers.

Gryder, L., Young, S., Zava, D., Norris, W., Cross, C., Benyshek, D. (2017). Effects of Human Maternal Placentophagy on Maternal Postpartum Iron Status: A Randomized, Double-Blind, Placebo-Controlled Pilot Study. Journal of Midwifery and Women’s Health 62; 1

Hahn-Holbrook, J., Haselton, M.G., Schetter, C.D., & Glynn, L.M. (2013). Does Breastfeeding Offer Protection Against Maternal Depressive Symptomatology? A Prospective Study From Pregnancy to 2 years After Birth. Archives of Women’s Mental Health, 16, 411-422.

Johnson, S, Groten T., Pastuschek J., Rödel. J., Sammer, U., Markert, U (2018). Human Placentophagy: Effects of Dehydration and Steaming on Hormones, Metals and Bacteria in Placental Tissue. Placenta 67; 8 – 14.

Kendall-Tackett, K. A. (2007). A New Paradigm For Depression in New Mothers: The Central Role of Inflammation and How Breastfeeding and Anti-Inflammatory Treatments Protect Maternal Mental Health. International Breastfeeding Journal, 2:6

Kendall-Tackett. How Other Cultures Prevent Postpartum Depression Social Structures That Protect New Mothers’ Mental Health. http://www.uppitysciencechick.com/how_other_cultures.pdf Accessed September 2018.

Kristal, M. (1980). Placentophagia: A Bio Behavioral Enigma, Neuroscience & Biobehavioral Reviews, 4(2) 141-150.

Norhayati, M.N., Nik Hazlina, N.H., Asrenee, A.R., Wan Emilin, W.M.A. (2015). Magnitude and Risk Factors for Postpartum Symptoms: A Literature Review. Journal of Affective Disorders. 175, 34 – 52

Riordin, J.(2005). Breastfeeding and Human Lactation. (3rd edition) Sudbury,MA: Jones and Bartlett Publishers.

Robertson, E., Celasun, N., and Stewart, D.E. (2003). Risk Factors for Postpartum Depression. In Stewart, D.E., Robertson, E., Dennis, C.-L., Grace, S.L., & Wallington, T. (2003). Postpartum Depression: Literature Review of Risk Factors and Interventions.

Selander, Jodi, et al. (2013). Human Maternal Placentophagy: A Survey of Self-Reported Motivations and Experiences Associated with Placenta Consumption. Ecology of Food and Nutrition. 52.2: 93-115.

Sinclair, C. (2004). A Midwife’s Handbook. St. Louis, MO: Saunders Publishing.

Skalkidou, Hellgren, Comasco, Sylvén & Sundström Poromaa. (2012). Biological Aspects of Postpartum Depression. Women’s Health 8(6), 659–672

Young, S. M., & Benyshek, D.C. (2010). In Search of Human Placentophagy: A Cross-Cultural Survey of Human Placenta Consumption, Disposal Practices, and Cultural Beliefs. Ecology of Food and Nutrition, 49(6), 467-484

Young, S., Gryder, L., Zava, D., Kimball, D., Benyshek, D. (2016) Presence and Concentration of 17 Hormones in Human Placenta Processed for Encapsulation and Consumption. Placenta 43:86‐89.

Young SM, Gryder LK, Cross C, Zava D, Kimball DW, Benyshek DC. (2017). Placentophagy’s Effects on Mood, Bonding, and Fatigue: A Pilot Trial, part 2. Women Birth.

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“To educate and empower women to breastfeed; to encourage breastfeeding-friendly attitudes, policies, and images in the community; to promote unity among breastfeeding professionals and advocates; and to increase public awareness of the value of breastfeeding.”

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The Sonoma County Breastfeeding Coalition is a community organization formed in 1996. The coalition is supported by volunteer community members comprised of Physicians, Lactation Consultants (IBCLCs), Midwives, Nurses, Dietitians, La Leche League Leaders and breastfeeding supporters representing local WIC agencies, hospitals, health clinics and various community members.