I've been asked to republish a thought-provoking article I wrote back in 2017 ago for Placenta Services Australia.
The CDC dropped a case report allegedly linking placenta capsule consumption to late-onset Group B Streptococcus (GBS) infection in infants. The aftermath brought a whirlwind of discussions and speculation in the birth and encapsulation spheres. So, grab a cuppa and join me as we delve into the facts surrounding this case and the intriguing world of placenta encapsulation. Oh, and a quick heads-up: This piece is all about sharing info, not doling out medical advice. Let's get informed!
Placenta Services Australia response
On the 30th June 2017, the Centres for Disease Control and Infection (CDC) in America published a report associating the consumption of placenta capsules by a mother with the late onset of Group B Streptococcus (GBS) infection of her infant . Since then there has been numerous news reports, articles, discussions within the birth and parenting worlds on social media and speculation by many. But what do we actually know about this case and about the process of placenta encapsulation?
What is Group B Strep?
Group B Streptococcus, otherwise known as Streptococcus agalactiae is a gram-positive circular bacteria that tends to grow in pairs or short chains. GBS is a commensal bacterium reported to be present in 15% - 40% of the population. It lives in the gastrointestinal and genitourinary tract of humans usually without any harm to us. It can however cause significant problems in newborns if they become infected. Infection in neonates occurs from exposure to their mother’s genital tract colonisation during labour or birth or from the amniotic fluid is the membranes are ruptured prematurely and the bacteria travels up into the uterus and is known as early-onset infection. If the baby contracts GBS after the first week, it is known as late-onset infection and is believed to be transmitted from the mother through her breastmilk in a rare number of cases, or from environmental and community sources such as hospitals and their staff . Antibiotic treatment of the mother to eradicate genital tract group B streptococci has shown to only be useful temporarily and reinfection may occur.
What is Placenta Encapsulation?
Placenta encapsulation is the process of drying, crushing and putting the desiccated placenta powder into capsules for the mother to consume postnatally. This is usually done through a business, the mother’s doula or midwife or in a few cases through family and friends.
Anybody who encapsulates should follow industry standard protocols including the use of personal protective equipment, maintenance of the cold chain, heating at correct temperatures and sanitisation of all areas and equipment with the correct disinfectants.
What did the CDC report and what questions does it raise?
The mother’s screening test for GBS at 37 weeks was negative - Your GBS status can change between when the test was taken and when you go into labour. The culture test can also show false negatives and it is likely this was the case as early-onset infection comes from the mother.
The infant was treated with antibiotics for the first infection - there are known cases of recurrent infection of GBS after treatment and the bacteria were shown to be identical in each case as was reported here by the CDC. This raises the possibility that the first antibiotic treatment was ineffective and allowed persistent colonisation of the newborn.
The mother’s expressed breast milk was GBS negative and serial exams did not reveal a source of the recurrent infection being transmitted from the mother - so where did it come from? Was the mother retested? Was the placenta swabbed before being collected? This seems to be in conflict with the CDC statement “the final diagnosis was late-onset GBS disease attributable to high maternal colonization”
Were hospital staff in contact with the baby tested ?
The strain of GBS isolated by the CDC known as the ST-17 clone, is known to have a strong association in epidemiological studies due to its specific virulence factors . Surely this adds to the plausibility that it was a recurrent infection rather than reinfection from the mother?
The CDC report states that “ transmission from other colonized household members could not be ruled out”
The CDC report does not give the exact temperature at which the placenta was processed, instead it gives a range of temperatures from the processing company’s website based on the different processing methods. Even if processed by using what is commonly known as the raw method, the placenta should be heated to reach a core temperature of 75℃ before lowering to the ‘raw foods’ temp. Encapsulators should also ask about infections when collecting their client’s placenta. The client can then be counselled on appropriate processing methods if it is safe to proceed. If infections such as chorioamnionitis are present, then the placenta should not be encapsulated. If the client becomes aware of an infection in herself or her baby between the time her placenta is collected and the capsules are returned, she should notify the placenta services specialist so that proper information can be given, which may include disposal of the prepared capsules instead of consumption.
The CDC states that “The placenta encapsulation process does not per se eradicate infectious pathogens” yet provides no reference for this statement. If we look at the (limited) research on placenta encapsulation, the preliminary results from Jena University Hospital has found that “The preparation of placental tissue has a clear effect on the microbial contamination: dehydration causes a drastic germ reduction, steaming followed by dehydration causes an even greater reduction of microbial species. Regarding to foodstuff regulations of the European Union, no “unsafe” organisms were detected in our samples.”
So the CDC has reported one case of placenta consumption that coincided with the newborn sadly acquiring a disease, yet how many women have consumed their placenta with no ill effects? Data collected by Placenta Services Australia shows that over 90% of the nearly 400 women surveyed, reported that they experienced no ill effects from consuming their placenta and those that did were minor effects such as headaches, nausea or even unpleasant aftertaste .
Let’s remember that correlation (if there even is correlation here) does not equal causation, however we should all be mindful to take the possible implications seriously. This report from the CDC seems to raise more questions than it does answers, using placenta encapsulation as the scapegoat.
What can you do to ensure a safer encapsulation experience?
1. Become informed about the risks of Group B strep to you and your baby and how it can be detected and treated. Here are some links for further reading:
Group B Strep in Pregnancy: Evidence for Antibiotics and Alternatives. April 9, 2013 by Rebecca Dekker https://evidencebasedbirth.com/groupbstrep/
More about GBS and How to Help Protect Your Baby https://www.groupbstrepinternational.org/more-about-gbs-and-how-to-help-protect-your-baby.html
Group B Strep Resources by Sara Wickham http://www.sarawickham.com/topic-resources/group-b-strep-resources/
2. Question your placenta services provider about their processes for transporting and storing your placenta, making your capsules and sanitising their prep area and equipment.
3. Enforce hand washing for everyone before touching your baby or your placenta capsules. See the World Health Organisation for How to Wash Your Hands Properly
4. Steaming your placenta to a core temperature of 55℃ for 30 minutes will inactive Streptococcus agalactiae. The temperatures reached by a dehydrator alone (usually a top of 70℃) is insufficient to inactivate it. Dry heat of 160-170 ºC for at least 1 hour is required. The bacteria is also susceptible to 1% sodium hypochlorite (bleach) which should be used by all placenta services providers to sanitise their equipment and prep area.
Buser GL, Mató S, Zhang AY, Metcalf BJ, Beall B, Thomas AR. Notes from the Field: Late-Onset Infant Group B Streptococcus Infection Associated with Maternal Consumption of Capsules Containing Dehydrated Placenta — Oregon, 2016. MMWR Morb Mortal Wkly Rep 2017;66:677–678. DOI: http://dx.doi.org/10.15585/mmwr.mm6625a4
Barcaite E, Bartusevicius A, Tameliene R, Kliucinskas M, Maleckiene L, Nadisauskiene R (2008). "Prevalence of maternal group B streptococcal colonisation in European countries". Acta Obstet Gynecol Scand. 87: 260–271.
Burianová I, Paulová M, Cermák P, Janota J. Group B streptococcus colonization of breast milk of group B streptococcus positive mothers. J Hum Lact. 2013 Nov;29(4):586-90. doi: 10.1177/0890334413479448. Epub 2013 Mar 22.
Edwards MS, Nizet V (2011). Group B streptococcal infections. Infectious Diseases of the Fetus and Newborn Infant (7th. ed.). Elsevier. pp. 419–469. ISBN 978-0-443-06839-3.
Streptococcus agalactiae, Pathogen Safety Data Sheet, Public Health Agency of Canada. 2011. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/streptococcus-agalactiae-eng.php
Edina H. Moylett, Marisol Fernandez, Marcia A. Rench, Melissa E. Hickman, Carol J. Baker; A 5-Year Review of Recurrent Group B Streptococcal Disease: Lessons from Twin Infants. Clin Infect Dis 2000; 30 (2): 282-287. doi: 10.1086/313655
Six A, Joubrel C, Tazi A, Poyart C. Maternal and perinatal infections to Streptococcus agalactiae. Presse Med. 2014 Jun;43(6 Pt 1):706-14. doi: 10.1016/j.lpm.2014.04.008. Epub 2014 May 20.
Based on the recommended temperature to eliminate Salmonella, Campylobacter and a 6D heat process for Listeria monocytogenes. Food Standards Australia New Zealand Safe Food Australia, A Guide To The Food Safety Standards, Third Edition. November 2016. https://www.foodstandards.gov.au/publications/Documents/Safe%20Food%20Australia/Appendix%203%20-%20Limits%20for%20food%20processes.pdf
Sophia Johnson, Jana Pastuschek, and Prof. Dr. Med. Udo Markert. A scientific approach to placenta remedies: What hormones are found in placenta tissue? April 2017. https://experiment.com/u/DKKnUQ
Results from PSA Data Collection. http://www.placentaservices.com.au/psa-data-collection-results.html
Streptococcus agalactiae, Pathogen Safety Data Sheet, Public Health Agency of Canada. 2011. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/streptococcus-agalactiae-eng.php
Are you craving those elusive nights of restorative sleep with a new addition to your family?
I am excited to introduce my new infant and family sleep consultant services, born out of a deep understanding of the challenges that come with little ones in your home.
Holistic Support Through Every Step: Having walked alongside families through the precious moments of pregnancy, the miracle of birth, and the tender postpartum period, I bring a unique blend of professional expertise and personal understanding to my sleep consultant services. Our journey together goes beyond sleep training; it's about fostering a peaceful and nurturing environment that supports your family's well-being.
Personalised Approach for Sustainable Solutions: In our world, there are no right or wrong answers—only what feels sustainable for your unique family. As a passionate advocate for individualised care, Elemental Beginnings sleep consultant services are crafted to fit seamlessly into your lifestyle. I believe in empowering you with the knowledge and tools to make choices that align with your family's values, creating a sleep strategy that feels just right for you.
Sleep Success is a Journey, Not a Sprint: Embarking on the path to better sleep is a journey, not a race. There are no guarantees, but rest assured, progress is within reach. With my guidance, I am confident that your family will make strides towards positive sleep habits that set the foundation for a lifetime of restful nights. Together, we'll navigate this marathon, celebrating every small victory along the way.
As you embark on this transformative journey, consider Elemental Beginnings' baby sleep consultant services as your compass to navigating naps and the night. Let's work together to create a sleep strategy that aligns with your family's unique needs, ensuring a well-rested and harmonious household.
Reach out today, and let the journey to sweet dreams begin!
Reasons Why Families Might Seek Support From A Sleep Specialist
When you don't know a lot about birth except for what you've seen in the media or heard from well-meaning friends and relatives, it can seem big and scary at first.
I love working with clients who are keen to explore what a positive birth means for them, what the hurdles along the way might look like and how we can work through them together.
Even when Covid stopped me from being present in person to support clients in labour, Meg's story shows how the work we do together during pregnancy is invaluable. It is not just the pain coping strategies but also the more profound work of knowing what is important to you and advocating for it.
I value Meg's strength and determination and the support from her partner to get the information they needed to make decisions as individuals in the face of typical systemic behaviour.
Meg's Birth Story
When I first found out I was pregnant, I knew I wanted to soak in as much information as possible. I'm a control freak by nature and from what little I already knew, pregnancy and birth were so unpredictable.
Thank you so much to Meg and her family for sharing their story.
If heading into your birth confidently knowing how to advocate for yourself sounds like your jam, send me a message and we can get started with a package of prenatal sessions.
Free resources to get you on your way to a better birth:
10 Questions to Ask Your Care Provider
What is Informed Consent?
5 Birth Planning Tips
"I'm looking for a doula who is familiar with hypnobirthing" is a very common comment I see in many groups on social networks and get asked by potential clients. So am I familiar with hypnobirthing?
Heck yes I am! Here's a little info around my personal and professional experience:
Way back in 2006 when I was pregnant with my daughter, I took part in a self-hypnosis trial with Dr Allan Cyna (Consultant Anaesthetist) at the Women's & Children's Hospital in North Adelaide. We had 3 in-person hypnotherapy group sessions with Dr Cyna as well as CDs to take home and listen to. I remember very clearly how calm and relaxed I felt during my labour, to the point I was falling asleep in between contractions. I had been induced with gels and the OB breaking my waters so was a little apprehensive about it all but it was very straight forward. I then went on to use those skills during my next two births at home - one of which was 19 hours long!
Many of my doula clients have undertaken group hypnotherapy or calmbirth classes with one of the many providers here in Adelaide. As with all my clients, we talk about what they want for their birth. This includes any particular techniques they may have learnt or terminology they want used, for example using the word 'surges' instead of contractions'.
I have sat in on client's private hypnobirthing classes and gone through the learning with them and practiced the breathing and soft-touch techniques. I know for one particular client, these skills became essential during her 50 hour VBAC!
For further professional training, I have undertaken studies with the HypnoDoula course.
So yes, I am familiar with hypnobirthing and would love to support you through your pregnancy, labour and birth as your doula!
Read below for one of my client's hypnobirthing stories from January 2021.
Kate's hypnobirth with Elemental Beginnings
We first met Kelly in 2018 when we hired her as a Doula for the birth of our first son. From our very first meeting with her we felt incredibly comfortable and relaxed in her presence and we knew straight away she was exactly the type of support person we wanted and needed at the birth.
Kelly helped us clarify our birth preferences by making sure we understood the birthing process so we could make informed choices throughout. For our first baby we opted for a home birth, and Kelly supported us through 20 hours of labour at home before I was ultimately transferred to hospital due to some complications. She was a huge support to both myself and my husband throughout the long labour. I think he was particularly grateful to have an extra support person to tag team with. I was also grateful to have Kelly's support postpartum and she helped me navigate my disappointment that the birth had not gone exactly the way I had hoped.
When we found out I was pregnant with my second son in May last year, the first thing my husband said to me was "we will definitely get Kelly again won't we?". It really wasn't a question for either of us as we couldn't imagine doing it without her. We greeted Kelly back into our lives as a friend and once again, she helped us feel calm and supported in the lead up to the birth.
This time around we decided for a hospital birth from the outset. My labour progressed slowly and was manageable throughout the day. My husband was in regular contact with Kelly to keep her updated and we both felt reassured knowing she was ready and waiting for us when we needed her. Later that evening when things had progressed we asked her to come over. She arrived at our home, her usual unphased and calm self, using a soft voice and gentle touch. I used a TENS machine and utilised my learned hypnobirthing skills to remain 'in the zone', while Kelly and my husband supported me through each contraction.
Around an hour later I decided it was time to go to the hospital and Kelly rode with us (squeezed in the back of our car between two baby seats), offering words of support where needed, but just as much comfort in her silence. On arrival at the hospital ER, my husband dropped us at the door and left to park the car. I remember thinking how I would have been left alone at that time had we not had Kelly with us. I was so grateful to have her there, guiding me through admission and responding to some of the questions on my behalf so that I could remain focused on my labour and breathing.
It was a long walk from the emergency room to birthing and assessment, and Kelly was with me every step of the way, helping me block everything else out as I breathed through each contraction. I chose to walk as it felt the right thing to do at the time, so Kelly was left to fend off multiple offers of wheelchairs from concerned nurses and hospital staff as we walked the long corridors together. It felt so reassuring to know she was in my corner, helping me to trust my instincts and encouraging me to 'walk my baby out'.
My husband was already in the birthing suite waiting for us when we arrived. Kelly straight away raised the bed to the highest height so I could continue to stand and lean against it while she placed her hands on my hips and back for gentle support. Her experience means she know exactly the right things to do to help in the moment, with very little communication needed, meaning I could remain 'in the zone' for labour.
Soon after I decided to get into the bath and spent the next little while in the water in silence, breathing through each contraction and feeling my baby move down. Kelly continued to provide subtle support - whether it was occasionally wafting peppermint oil under my nose to help with nausea or placing an extra towel under my head, or gently reminding my husband to hit replay on the hypnobirthing affirmations track playing in the background.
Only two hours after arriving at the hospital, I breathed into my final contraction and pushed out my baby. The birth was exactly what I had hoped... A calm and beautifully supported experience.
Kelly's support did not end once our baby was born. She helped me breathe through the birth of my placenta and helped me with my first post-birth shower. I also required some minor stitches so she came with me to the room next door while my husband remained with our baby. I was more scared of the stitches than I had been at any time during my labour and for the first time needed pain relief. As I breathed in the gas deeply and squeezed her hand tightly, she offered continuous words of encouragement and support throughout the procedure. I was so incredibly grateful for her kind and caring presence during that time.
After such a beautiful birth, our baby experienced some unexpected breathing complications and ended up in neonatal special care for 12 days. This was an incredibly stressful and upsetting time for us but once again, Kelly was a continuous support for me throughout with texts and phone calls, offering a level of empathy and understanding I would not otherwise have had.
We are forever grateful for the friendship and support Kelly has provided to our family. If you are thinking about hiring a Doula, I cannot recommend Kelly enough. She is calm, kind, patient, genuine, knowledgeable and understanding - the perfect person to support you throughout your pregnancy and birth.
Thank you Kelly!
You might also like to read more about Kate's other birth from her husband Simon's perspective.
Another Adelaide Dad has been so kind to share his thoughts on working with me as their Doula for their son's birth at Calvary North Adelaide. I've asked Kyle some interview type questions and these were his responses. Don't forget to keep reading for Mumma's thoughts too.
My favourite memories from this birth are Carrie sitting in the bath tub with sunglasses on because there were no blinds in the hospital bathroom and the room was so bright. And I will never forget seeing the OB kick off her shoes and sit on the floor to facilitate Carrie's chosen birth position of standing and leaning on the raised bed. It's certainly something you don't see very often! I also loved these moments because they both show the value of prenatal education and emphasis on factors that can help you achieve a physiological birth - dark lighting and gravity!
Thanks again Carrie & Kyle!
Dads working with Doula Kelly
What were your honest thoughts when Carrie first mentioned hiring a doula?
How much is this going to cost us?
If you had any initial questions or concerns about working with a doula, what were they?
I don’t think I fully understood what a doula did. My partner (Carrie) had mentioned that working with a doula reduced delivery times and reduced the overall likelihood of interventions but I didn’t know why or how.
Could you talk a little about our work together, both during the birth and before and after, from a partner's perspective?
Kelly met with us several times leading up to our due date. She set us at ease, both with the birth and in being parents, answered all of our questions, and assured us that she would be prepared if we forgot or needed anything.
During the birth, she was there with soothing music and a calm presence. She had a bag full of anything we could possibly need, including pressure point cue cards that came in handy for pain management. Kelly supported my partner both emotionally and physically. At one point, when my partner said “I can’t do this”, Kelly responded, “you are doing this”. Sometimes, it's reassurance like that which can make all the difference. She was a body to lean on, when I grew tired or couldn’t be there. She even took pictures of the birth for us which was a life saver.
How would you explain a doula to your best mate?
If this is your first time, you’re going to be clueless. If it’s not, then you already know. Do yourself a favor and get a doula. A good doula will keep you sharp and focused because a doula is just as much about supporting you as much as they are about supporting your partner, allowing you to be your best self, so again, you can be there for your partner. She’s like an angel on your shoulder, reminding you of all things you should be doing, and providing a third and fourth set of hands when you need it.
What is your advice to other dads and partners who may be considering a doula now that you've experienced birth with a doula?
You absolutely will not regret it.
A word from Mum
"Being an expat and first time mum, I wanted to be sure my husband and I had a support system in place for our baby's arrival. Kelly is nurturing, kind, and incredibly knowledgeable. In our sessions leading up to the birth, she helped educate us on the system here in Australia, guiding us to create a birth plan we felt comfortable and empowered by.
Her calm and gentle demeanor was exactly what I needed during labour. I burst into tears when she came into the room; like her arrival made it real, but that I was safe.
If we didn't think of something, it didn't matter because we had Kelly there and she probably had it in her bag of tricks. (I'm still thankful she was able to quickly get the diffuser going when the hospital served my husband the world's smelliest lunch.) It was a long day, but she kept us going, offering so much physical and emotional support on such an intimate level. Kelly even captured some photos of my son being born, and they are images I will treasure for the rest of my life. I couldn't imagine giving birth without Kelly and I hope I never have to."
Prepare for an easier fourth trimester with these 25 Secrets From A Postnatal Doula!
Kelly Harper is the owner of Elemental Beginnings Doula & Placenta Services in Adelaide. She provides sleep consultancy, placenta encapsulation and doula services to families during pregnancy, birth and in their fourth trimester.