Often the baby’s slow weight gain goes unnoticed using the common “fish scale” that midwives use in their practice. The fish scale is easy to transport to the home and cradles the baby in a comfortable sling-like hold but measures in two- to four-ounce increments versus a digital scale that is calibrated to measure newborns in grams. Digital scales are much more accurate in assessing daily weight gain as well as breastmilk intake per feeding. Cases of low supply and slow weight gain can be too subtle and nearly impossible to detect with the fish scale, which may otherwise be adequate for its purposes in a normal breastfeeding situation. When I detect slow weight gain, sometimes the response from the midwives or doulas is that the mom has plenty of milk and that the baby is just following his or her own weight gain pattern. Babies have been brought into the clinic for the first time still significantly below birth weight by two or even four weeks of age, or are still gaining weight far below the expected range by the two-month visit. Such cases of failure to thrive are sometimes diagnosed in the clinic by looking at the growth curve in the baby’s growth chart, following the completion of the six-week midwifery care, so in many cases the midwife is not ever made aware of this finding. In so many of these low supply cases, the moms themselves report that they believed they had full milk supply. They commonly say that they believed breastfeeding had been going very well because baby nursed with a pain-free latch “every 45 minutes to an hour around the clock.” When nursing a baby, this is actually often a sign that there is not enough milk, not a sign that there is plenty. I am concerned that the assessment and reporting of milk supply remains a complex issue. As a lactation consultant, I have seen enough direct cases that I have serious concerns about the increasingly popular practice of having postpartum women consume their encapsulated placentas.

The claim made by placenta encapsulators that these pills will increase milk production is certainly not based on valid current research, nor does it make physiological sense. With that said, I have spoken with several moms who have told me that they had previously consumed their placenta and never had milk supply issues, and I have been able to verify that their babies had gained weight normally. I am sure this is a part of the picture as well, as we also know that some women’s milk supply can withstand hormonal suppression from birth control pills while others don’t. In any case, this remains a high-stakes gamble.

In my postpartum support group, I have seen women struggle with profound postpartum depression after taking their encapsulated placenta, especially as they are dealing with such heartbreaking milk supply issues. Tragically, most of these women had decided to take their placenta pills primarily to prevent postpartum depression. I wonder about the reasoning behind this idea. Is this accurate or even ethical to tell women? Isn’t your body meant to flush out the pregnancy hormones after the birth to allow the lactation hormones to come in? This is the big hormonal shift during the ‘baby blues’ that is happening with the natural hormonal cycling, and by clinical definition is not postpartum depression. I am concerned that the popularization of the “Happy Pill,” as many encapsulators refer to it, is not only potentially risky but is giving women the message that their body is naturally set up for depression and that they need a hormonal pill to “prevent” this process. What happened to the advice for women to trust their bodies? What is a “balanced hormonal state” for a lactating woman? I am concerned that there is a lack of understanding among some healthcare providers about the hormonal cycling from pregnancy to lactation. Continuing to give yourself pregnancy hormones for days and weeks and months once you’re done being pregnant doesn’t sound to me like a balanced hormonal state. I can appreciate the likelihood that ingesting estrogen and progesterone, which are steroid hormones, could certainly cause the dramatic energy surge moms so often report after consuming their placenta, but who can be certain that this is a natural and healthy state for postpartum women?

As the popularity of placenta encapsulation grows, we are seeing new situations and new potential risks that deserve a closer look. Ingesting the placental estrogens may increase a woman’s risk for thromboembolism (blood clots, stroke) as we know estrogen-containing birth control pills can (Hayes, 2016; Academy of Breastfeeding Medicine, Protocol #13, 2015). In yet another new development, many moms are now even advised by encapsulators to give their infants and toddlers the placenta in powder or tincture form as medicine for colic or temper tantrums. What are the health implications for babies ingesting these hormones? The GBS Case Report that the CDC released this year on an infant hospitalized from an infection coming from the same strain of GBS found in the mom’s placenta pills (Buser et al., 2017) illustrates that infection is yet another potential risk associated with this practice.

Given the recent valid research studies that clarify that no human culture ever had postpartum women routinely consume their placenta begs the question whether humans have evolved to not eat their placenta for a good reason? We can continue to experiment on our new moms and babies and find out, but I believe this raises an ethical dilemma.