Placenta Encapsulation to Treat PPD: Yay or Nay?

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I've had enough of you ask me about placenta encapsulation lately that I figured I needed to get an answer. To the uninitiated, this means …

if you're the queasy type, stop reading right here

… having someone dry, powder and encapsulateyour own placenta after the birth of your baby and then taking the placenta capsulesfor a few weeksbecause it is purported to give you more energy and prevent PPD.

I reached out to Dr. Marlene Freeman of the MGH Center for Women's Mental Health. She practices integrative medicine, has published many important papers on the topic, including this one and this one. She knows of what she speaks. Here's her response:

"From an evidence-based perspective, even with a viewpoint open to complementary and alternative therapies, this doesn't pass the test for women with postpartum illness or at risk for postpartum illness. My concern with this and other unsubstantiated claims about complementary and alternative medicine (CAM) treatments is that 'natural' is often assumed safe and seen as advantageous over more rigorously tested treatments. At worst, a woman with postpartum illness or at risk for it might forego a comprehensive assessment (that she deserves to have), a full menu of options for treatment (that could include more proven CAM treatment options) and careful monitoring of her symptoms."

Update: Be sure to check out the comments below. Very interesting differing viewpoints Just click on the underlined word "comments" directly beneath this post.

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About Katherine Stone

is the founder & editor of Postpartum Progress. She was named one of the ten most influential mom bloggers of 2011, a WebMD Health Hero and one of the top 25 parent bloggers using social media for social good. She also writes the Fierce Blog, and a parenting column for Disney's Babble.com.

Comments

  1. Though I completely agree with the Dr. in regard to concern that women will opt of of or hesitate to seek evidence based treatments for their PMD once they have it, I do believe that there may be merit in placenta encapsulation in order to comprehensively prevent or lessen your PMD symptoms, especially in Survivor Mamas like myself. If and when I become pregnant again I plan to encapsulate my placenta, possibly begin bio-identical and/or progesterone therapy and do whatever else I can, knowing that I am at extremely high risk to suffer again. I am grateful that there are all sorts of options out there. Katherine as you stated so beautifully in a blog post a few weeks ago, the reality is that no one method or treatment for PMD is "one size fits all." That means we each individually will need to work with a healthcare prof. to develop a plan that is unique to us and will likely require more than just one method.

  2. Katherine Stone/Post says:

    I don't believe this post contradicts the idea of allowing women to choose their own treatment options. As you say, you have to make the plan that works for you.
    I do think it's important, though, to let people know what science says. Currently there has been no human testing on the effectiveness of placenta encapsulation in the prevention of PPD. Perhaps some data will be forthcoming to either prove it works or disprove it works, and to uncover any potential side effects.

  3. Katherine, the anecdotal evidence of my clients and those of my peers suggest that those who take the capsules feel that their moods are better regulated, feel less stressed and therefore less at risk for developing PPMDs. Since placenta is a whole food, it's actions are rolled up in lots of other actions: improving breast milk supply, reducing lochia flow, increased energy –> all contribute to an easier postpartum/new parenting experience that may be responsible, in larger or smaller part, for improved and regulated postpartum mood and therefore less mood disorders or minimised mood disorders.
    Those of us who are placenta service providers would welcome more testing and research. There is a project in the works at the University level involving PBI that is exploring these issues.
    Of course, any woman who feeling ill at ease, unhappy or disturbed in any way in the postpartum period should seek expert advice. Experts will know what is normal, what is transient and what deserves more active management.

  4. Katherine Stone/Post says:

    It would be great if we could get that
    data soon. I know lots of people are interested in it, and it would be wonderful
    if we could back up the anecdotal data with
    scientific data. I would imagine that,
    given all the interest, there must be at
    least a few studies in the works.

  5. Unfortunately, there is no money in placenta encapsulation for pharmaceuticals and virtually all research these days is driven by big pharma funding.
    You may want to cast your net a little farther to find opinions from the larger health community regarding placenta encapsulation. Traditional Chinese Medicine has been using placenta for centuries. Modern encapsulaters most often follow the TCM protocols when preparing the placenta for encapsulation. Exploring encapsulation from this aspect will probably afford you a more informed opinion.

  6. Hi Katherine,
    I have to back Leanne up on this. I am a placenta service provider as well, and not only do my clients provide the anecdotal evidence, but I have experienced it for myself. I'm not going to reiterate what she said because she covered the subject (from our point-of-view) pretty throughly, but I would like to add that, while I am certainly interested in the science, I personally don't require it to substantiate placenta medicine. If thousands of new mothers say that they feel great after taking their pills (and many have prior experiences to compare to) then that is enough for me to say, "This works!" I understand that Dr. Freeman comes from a medical background and, as a doctor, can not approve of something with little scientific research, but I think it's important to remember that the wisdom of nature that was passed down for centuries had not laboratories to "prove" peoples' experiences. For me, it is an inner wisdom that guides my passion for providing placenta services to women in my community.

  7. This conversation rides the fine line between 'evidence-based' protocols and more common sense, traditional ones. When considering best practices for mothers who are suffering, treatment must always include professional care and respect for the mother's choices.
    When this question came up on my blog, Wellpostpartum E-News, Dr. Dean Raffelock offered the following insight:
    When I was researching my book A Natural Guide to Pregnancy and Postpartum Health (Avery-2003) I found an article that stated what nutrients and hormones placentas contain. As one might suspect, all the blood building nutrients (iron, B-12, folic acid, B-6) proteins, fatty acids, but also LOTS of hormones…progesterone, cortisol, etc. All the nutrients and hormones that we typically find deficient in postpartum women having physical and psychological health issues are contained in placenta. In the past it was much more common for women to be given their placentas in soup or even pate form soon after giving birth to replenish the nutrients and hormones that their body donated to form their baby’s body and placenta. While ingesting one’s placenta is largely out of vogue these days and there are some potential toxicity issues for some, if we look at this practice from a purely nutritional point of view it makes sense. No wonder our canine and feline friends instinctively eat their placentas immediately postpartum.
    Dr. Dean Raffelock, D.C., Dipl.Ac./L.Ac, CCN, DIBAK
    Dr. Raffelock tests women's nutrient levels postpartum (pre- and post-treatment) and is very aware of the link between nutritional deficiencies and mood and anxiety issues. Data shows this link exists in the general population, it is forthcoming in our population. My good pleasure is providing information on this groundbreaking work via WellPostpartum E-News.
    We do have a long way to go for research to catch up with clinical data.
    Thank you Postpartum Progress for opening this discussion.

  8. Amber @Beyond Postpa says:

    I don't think so, either, and I am sorry if my comment implied otherwise. Thanks for ALWAYS keeping us up to date with research based information, Katherine.

  9. Katherine Stone/Post says:

    Pec Indman has asked me to share her comments with you. She is an internationally recognized expert on perinatal mood and anxiety disorders and wrote the book "Beyond the Blues". I know her and respect her. (She couldn't get the comments to work for her.)
    Pec's comments:
    The claim (which seems odd for women supporting "natural benefits") is that you can "avoid the blues". As we know, the blues is a NORMAL phenomenon. Why should it be avoided? These women do not suggest you avoid labor pain … what's wrong with having the blues for a week or so if it's natural? No, what they are implying here is that it will prevent mood/anxiety disorders. There is aonly one page of research cited. I have reviewed every article. One is from 1954 about breastmilk production and has never been repeated. The second is about cultural aspects (and mentions the first article, ironically, criticizing its methodology). Several others are about rats, then about hormones in the placenta, etc. Not one article is about ingesting placenta in any form and its relation to mood. In contrast, there is lots of research about the human ingestion of chocolate and mood.
    For all we know it's the act of paying someone who is caring to come to your home and prepare something for you. Having a doula come and make some yummy chicken soup would probably be as effective. There is absolutely no evidence that it's the placenta that is causing the anecdotal positive response. We know 30% will have a placebo effect. That is powerful. I think this claim exploits women. Why would you sell something that has not shown to be effective? There has been research about omega 3 and some about herbal remedies. To say this will "not be researched" is to hide from scientific evaluation. This takes advantage of vulnerable women. There are "natural" methods that have been researched that are less expensive. Marlene Freeman and Kathleen Kendall-Tackett's work show that.

  10. Katherine Stone/Post says:

    I'd point you to examples of natural treatments believed
    to have worked but which science has shown do not:
    Gingko biloba for cognitive decline: <a href="http://jama.ama-assn.org/cgi/content/abstract/302/24/2663?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=gingko+biloba&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT&quot; rel="nofollow"&gt <a href="http://;http://jama.ama-assn.org/cgi/content/abstract/302/24/2663?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=gingko+biloba&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT” target=”_blank”>;http://jama.ama-assn.org/cgi/content/abstract/302/24/2663?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=gingko+biloba&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
    Or this story from the Associated Press:
    <a href="http://www.msnbc.msn.com/id/31190909/&quot; rel="nofollow"&gt <a href="http://;http://www.msnbc.msn.com/id/31190909/” target=”_blank”>;http://www.msnbc.msn.com/id/31190909/ about the ineffectiveness
    of echinacea for
    colds, shark cartilage for cancer,
    glucosamine and chondroitin for arthritis, etc.
    There is a difference between cause
    and correlation. Is this treatment
    a direct cause of the recovery, or is
    it simply correlated? I don't know.
    I'm providing the data, and I personally
    choose not to outright endorse anything
    for which almost zero data exists.
    That's my policy. That doesn't mean
    I'm saying don't do this. I'm not.
    My motto: Always do what YOU think
    is right, but be open to other ideas
    if it doesn't work.

  11. It's incredibly disingenuous to throw up pain med free labours and make them comparable to "baby blues". The use of pain meds in labour comes with a long list of risks, variable effectiveness and disruptions to the physiologically normal birth mechanism. There are consequences to using pain meds that can effect mothers and babies.
    When I work with women who desire to avoid pain meds, I am using many multi-disciplinary tools and methods to give women a sense of mastery, to empower them, to help them achieve positive mental and physical health outcomes.
    When I encapsulate a woman's placenta, I am again giving her a tool to use. I am empowering her to be proactive about her postpartum health.
    Maybe I'm completely wrong, but it's my understanding that while baby blues is normal, there are other factors that can increase the chance of normal baby blues morph into an ongoing mood disorder. Placentaphagy appears, from the few studies and from the overwhelming anecdotal evidence, to moderate these extra factors and also possibly provides a low level of the woman's own hormones, the removal of which has caused the baby blues adjustment period.
    This wholistic approach to postpartum health is positive for the woman and her family. The info and tools are available to anyone who wishes to encapsulate their own placenta. A woman could even ingest the placenta in food without any special preparation. There is a big ick factor for many women, however, and they are very happy to outsource the preparation for a fee.
    I really don't see what is wrong with this. We outsource all kinds of things in this modern world: coffee making, food prep, housecleaning, etc, etc, etc, but I don't think we look to Starbucks as taking advantage of people who could easily and more cheaply prepare coffee in their own homes.
    The same accusation could be made to the allopathic system that overwhelming relies of chemicals to treat problems far more organic than simple chemical imbalances.
    I get it, though. I totally understand the skepticism in light of the lack of studies and in a culture that relies so heavily on chemical manipulation.
    I operate my business in good faith; I seek to improve the lives of the families I work with. Placenta encapsulation is merely one aspect of that.

  12. Amber @Beyond Postpa says:

    As a peer support provider and advocate for women (specifically those suffering from/or having survived a PMD), I feel I must clarify and expand upon my above comment in light of the comments below it…
    I will probably choose to encapsulate my placenta and perhaps try additional alternative methods such as acupuncture and or estrogen/progesterone therapy, supplements, etc. in CONJUNCTION with being under the care of my physician, whom I am already seeing as a result of simply considering a 2nd pregnancy after a PMD. I will try anything reasonable to help prevent or lessen the effects of a possible and likely mood disorder this time around and here's why: I am blessed that I can currently afford to do so (within reason). If something does not compromise my health or that of a baby, I feel that it is worth a try. However, for women whose socio-economic status allows them only very limited resources or for whom a very specific budget is allocated to postpartum treatment, I would only recommend proven, scientifically researched methods.
    For example, if a woman with say $500 (random figure) to devote to her PPD treatment would come to me for peer support, my recommendation, based upon opinion and experience, would be likely to see a specialist in perinatal mood disorders (preferably a psychiatrist who also does psychotherapy, in the case that meds are prescribed so that she wouldn't have to pay a 2nd person). We KNOW that meds and therapy, as well as social support ARE effective for PMDs, esp. moderate-severe reactions.
    I am grateful for the wide variety of treatment options that exist today…some of which weren't readily available, even just 3 years ago, but I also believe that given limited resources we have to be responsible and focused.
    This discussion and so many others are the result of tireless volunteer efforts on the part of women all over this planet to help take care of one another and our families. I am so grateful that we can come from our differing belief systems and experiences and have helpful, respectful conversation.

  13. To be fair and to follow the argument from Katherine:
    "I'd point you to examples of natural treatments believed
    to have worked but which science has shown do not…"
    There are also plenty of non-natural techniques, medications, therapies; etc. that were once thought to be immensely helpful and safe and are now known to be in question or outright dangerous. Think hormone replacement therapy, re-birthing therapy, medical birthing interventions of the past, bloodletting; etc.
    The truth about the treatment in question is that it has not been studied well enough to say definitively that it is a scientifically sound, evidence-based protocol that can be prescribed for the general population without any trace of doubt. If one ascribes to the idea that it is okay to try something that does not appear harmful and they have reviewed case studies and great amounts of anecdotal evidence or clinical evidence, then one can feel good about offering such a treatment as an option. This leaves the decision up to the woman who will (ideally) have several options open to her.
    I am starting to wonder what the clinical evidence is… Are there blood tests available to show an impact from ingesting the placenta versus ingesting food only?
    We must remember that 'birthing women' are not all Americans. The African woman who gave birth in a tree during a flood several years ago ate the only food available to her for three days- her placenta. She was not going to wait for other's opinions; she had to survive and care for her baby.
    Options exist throughout the world and across cultures that are radically different from one another. I was once introduced to an Indian OB/GYN who trained in the US, then decided to use her training to help the women of her homeland. She was confounded to find that women were not using the medications she offered. When she questioned them they told her, "Why would we use that medication for this issue when we can boil the leaves of the neem tree for free and get the same response?"
    So, it really doesn't matter what each of us may think- it matters what the woman seeking care thinks. It matters that we provide balance and offer everything that is reasonably safe and effective and that we have an open mind regarding what other people desire.
    I don't believe there is data on the effectiveness of prayer in our population either, but I will talk about it if a woman is willing and curious. Same with deep breathing, meditation, ignoring dust bunnies; and pure, naturally provided sunlight.
    Women are smart enough to know the difference between what has been thoroughly studied and what is considered an emerging treatment.

  14. Katherine Stone/Post says:

    Pec Indman asked me to share one more follow-up comment with you:
    Perhaps my comparison to labor was incorrect. I stand corrected. All I'm saying is I have not see any research evaluating mood and the ingestion of placenta. I have looked. I would love to see those "few" studies. There is no evidence to support or deny that there is benefit or harm from placental ingestion. We don't know what freeze drying or cooking does to hormones, vitamins, etc. In food, we know the process can destroy them. As far as I can tell, no one has looked at what active ingredients are in the placenta, once ingested. When people go to starbucks they know they are getting what they order; coffee. My problem is with people claiming benefits when claims are unfounded. There is no reason or evidence to suggest that someone taking placenta capsules will not "morph" into a mood disorder. To tell women it will protect them is incorrect and and therefore, unethical, in my mind. I am not suggesting "chemical manipulation". I'm suggesting that the blues is normal, natural, mild, transient, and only lasts a few weeks. It does not require treatment. The suggestion that people should take pills to "avoid" the blues is problematic to me, because it frightens women about the blues, and confuses the blues with mood disorders. To imply placenta ingestion will prevent a mood disorder is irresponsible when there is absolutely no data to show this is true. There is no information available about how it impacts postpartum health. Let's empower moms to do things that we know are effective (it's an ever changing list): sleep, good nutrition, breaks, activity, fun, omega 3's. We are all working toward the same goal.

  15. Dr. Dean Raffelock says:

    Dear Katherine Stone,
    I so appreciate PSI and that you are passionate about helping postpartun mood disorders. I am too. My wife and I are both advocates for women with PPD getting the care they need. We are for whatever works to help relieve the terribly destructive symptoms of PPD/PPA.
    When we talk about science, Meta-studies tend to be the best way to evaluate many studies on the same topic. They ferret out poorly designed studies and can detect biases etc.
    The two most recently published meta-studies on SSRI drugs clearly demonstrate the ineffectiveness of these drugs for the vast majority of people they are prescribed for. 79% are women. Only the most severe cases of depression have been helped by SSRIs. The rest were left with no help, side-effects and the daunting task of having to wean off drugs that made them feel worse.
    Here are the references:
    The January 2010 edition of JAMA cites a metastudy called Antidepressant Drug Effects and Depression Severity which clearly documents that antidepressant drugs only work for very severe cases and only a fraction of the people they are prescribed for.
    Ethical Human Psychology and Psychiatry, Volume 11, Number 3, 2009 Published another metastudy called
    Meta-Analysis of Antidepressant Augmentation: Piling on in the Absence of Evidence by
    Craig A. Yury, PhD
    Jane E. Fisher, PhD
    David O. Antonuccio, PhD
    Marcia Valenstein, MD
    Jeremy Matuszak, MD
    which also documents that these drugs are over-prescribed do not work for the vast majority of people.
    Ideally an integrative approach would be taken that would provide women suffering from PPD the best of both worlds. When they truly need drugs and they work great. But we can not leave out the beneficial effects of dietary supplements (fish oils etc.),a good nutrient dense diet, meditation/deep breathing, exercise, psychotherapy,birth trauma/PTSD therapy, community support, etc.
    Kind regards,
    Dr. Dean Raffelock

  16. The Muser says:

    What a fascinating discussion! I do think it's unethical to claim that placental encapsulation _will_ help prevent ppd, especially if you are charging for it and there is not good evidence that it will help. BUT I don't think there's anything wrong with offering it as a possible preventive method when you are honest about the lack of scientific evidence for it and if you are urging women who might need more support to get it. The problem I saw with the blurb you published, Katherine, is that it's a little confusing and unclear. I think Dr. Freeman is saying simply that there's not evidence to show that this works, but she is not saying that there is evidence that this _doesn't_ work. It doesn't look like there's evidence (aside from anecdotal) either way. For me, that means that if you're a practicioner who's treating postpartum women, you should be up-front about all the options open to women and be up-front about why you think each one might or might not work (whether that's studies or anecdotal evidence). Women wishing to prevent ppd have a right to know what is most likely to work and why. I think this goes for those selling encapsulated placentas as well as doctors prescribing meds. If a woman has a mild to moderate form of depression that is less likely to respond to antidepressants (as Dr. Raffelock claims in the above comment), they have a right to know that there is not good evidence for the effectiveness of ssris in her case. She also has a right to know that her practicioner's reason for believing in the effectiveness of placental encapsulation is anecdotal and experiential, and I hope both the medical doctor and the natrual practicioner would be responsible enough to point her to treatments that have a lot of info and evidence in their favor (a combination of meds/therapy, exercise, nutrition, sleep, omega-3s, cognitive-behavoiral therapy, etc.) along with any less evidence-based treatments they believe in (meds alone for mild to moderate depression, placental encapsulation, etc.). If, however, a woman has a severe case of ppd or has suffered from major depression in the past (as I did), I seriously hope any person working with her (whether doula or medical doctor) will let her know that the best info we have suggests that her most likely road to recovery does include meds. It scares me when practitioners urge against meds or suggest less proven natural treatments in severe cases like mine when it really can be a matter of life-and-death to get fast and effective treatment. Natural remedies–even those that are evidence-based–did zilch for me, and I am so glad I was urged to get myself on meds. They saved my life.

  17. Katherine Stone/Post says:

    You wrote: "Only the most severe cases of depression have been helped by SSRIs." I
    think it is completely disingenuous to make
    that statement.
    Readers, you might want to check out the
    following:
    http://www.nytimes.com/2010/01/09/opinion/09warne
    http://carlatpsychiatry.blogspot.com/2010/01/anti
    http://www.nytimes.com/2010/01/12/health/12mind.h
    And that's all I have to say about this subject. The end. Comments closed.

  18. Katherine Stone/Post says:

    Thanks for your comment. Some people feel
    that natural remedies have saved them. Others
    feel meds have saved them. Whatever works
    for you, if it makes you better and able
    to care for yourself and your babies, I say
    Amen (as I have ALWAYS said). I'm here to
    share the information that is made available
    that women do not usually have access to. Then they have to make their own decisions.