Have you heard that your placenta will stop working properly after your ‘due date’ or the words placental insufficiency?
Sounds scary, doesn’t it?
But what is the evidence for this claim?
I recently did an online course with Sara Wickham: “Post-Term Pregnancy: Exploring Evidence, Inspiring Confidence”. (Which was awesome and highly recommend to any birth folk).
Sara has also written a fantastic book on Inducing Labour which I highly recommend you buy.
So where did this notion of Placental insufficiency or deterioration come from?
Why do we think placentas start to die at a given point in pregnancy?
It is a fetal organ and no other fetal organs start to die.
Also, you will hear of many women being induced or even booking a c/section because their babies are “big” and will get bigger if they continue with their pregnancies.
How does this happen if the placenta is going to start deteriorating???
I really don’t think OBs can have it both ways!
There is no evidence that the placenta starts to deteriorate at a set point in a pregnancy.
It is what is Sara terms “Pathophysiological Speculation”.
Pathophysiological Speculation actually occurs all the time in medicine.
It is when doctors, nurses, midwives, and obstetricians are presented with a situation and try to work backward to ‘speculate’ how it happened.
In 1954 Dr. Stewart Clifford did this with babies who looked a certain way and were post their “due date” and he speculated that the cause was placental insufficiency.
This became known as “Clifford’s Syndrome” or post-maturity syndrome.
And I can actually understand how this notion of placental insufficiency occurred when I think about my first baby.
He was 10 days “overdue” and he was scrawny, with no vernix, long fingernails and dry peeling skin, 4 of the symptoms of “Clifford’s Syndrome”.
So I can see why someone might think my placenta had stopped working properly.
However, he was fine, with no health issues and no one commented on the condition of my placenta at the time.
Also, my 3rd baby was 8 days ‘overdue’. She was a whopping 4.9kg, beautifully chubby and I had an enormous, healthy placenta. No sign of “deterioration” there, and a very similar gestation to my first baby.
“Pathophysiological speculation is fine as a theoretical discussion point, or to direct research. But it is not fine to use it to make policies that affect millions of women.” ~ Sara Wickham
For this we need evidence, and there is absolutely no evidence that directly correlates the length of pregnancy with the quality of the placenta.
Sara Wickham also pointed out: Placental insufficiency is a real thing and does occur. But the notion that it is all about timing is actually dangerous.
It might mean we miss babies for whom the placenta starts to deteriorate, for real pathological reasons, earlier in pregnancy.
So what was going on with my pregnancies?
I am going to do some pathophysiological speculating now.
My 2nd baby was born at 40+ 1 days and was 4.2kg, and my 4th baby was 38+5 days and was 4kg.
So my last 3 babies were lovely, chubby, healthy babies and I had gorgeous big placentas with them.
I really think it was my attitude during my pregnancies that affected my babies’, and possibly my placentas’, growth.
For my first pregnancy, my boyfriend (now husband and father of all my babies) and I were young, a bit foolish and a bit in denial. We were traveling the world, not really watching my nutritional or physiological state. We actually turned up in New Zealand when I was 35 weeks pregnant, which in hindsight was a really lucky break for us. New Zealand has an amazing, woman-centered maternity system and no one was the least bit worried about me being ‘overdue’.
For my next 3 babies, I was very settled and had become trained as a registered midwife. I understood the importance of nutrition and my own physical and emotional health during pregnancy, and it showed in my babies.
So what can you do if someone tells you your placenta is going to stop working?
1. Firstly, remember that there is no evidence directly correlating placental deterioration and the length of pregnancy.
So you could always see what happens if you ask your care provider to supply it?
There is some research on stillbirth ‘risk’ as your pregnancy progresses, but once again this is not clear cut and I have written about that in my blog “We Need to talk about Stillbirth Risk”.
2. Secondly, demand individualized care.
Get your care provider to explain why he or she thinks YOUR placenta is not up to the job and what their evidence is for making this claim.
When care providers make these sweeping statements their underlying assumption is that all woman’s bodies function in exactly the same way and all babies develop in exactly the same way.
Do you think these are valid assumptions to base your birth choices on?
If you have read my previous blog you will realise we really don’t know when YOUR baby is “Due”, only YOUR baby and YOUR body knows that.
Finally, remember these very wise words, which are too often forgotten in the modern obstetric model of pregnancy and childbirth:
“We should encourage women to take really good care of themselves, so their bodies can take really great care of their babies” ~ Sara Wickham
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