When a Patient Wants to Keep Their Placenta
The first thing to consider, when your patient wants to keep their placenta, is your hospital policy. For example, your hospital may require the patient to sign a waiver, allow or not allow it to be in the patient's room refrigerator, or require it to be stored in a specific refrigerator that only staff has access to. The first step is to be informed about your hospital's policy on placenta release.
The next steps are very important to follow if your patient is planning on encapsulating their placenta. They are not as important if a patient is simply burying their placenta, but in the event you're unsure of their intentions, then it is better to assume they are encapsulating.
1) Place the placenta in a leakproof storage container. Typically this is the laboratory container that the placenta would have been sent to pathology in. Label the container with a patient's charting sticker.
2) Make sure nothing is added to the placenta. This means no iodine, betadine, or preservatives. These can make the placenta unsafe to consume. The placenta should be placed in the bucket, with nothing else. Some contact with iodine or betadine for blood collection is understandable since it is standard to clean the area prior to collection and would not make the placenta unsafe to consume. In this case, iodine is preferred over betadine and contact with only the collection area is acceptable. It is always appreciated if you remove the umbilical cord clamps, but is fine if you don't have a moment to do that.
This placenta was immersed in Betadine and deemed unsafe for encapsulation.
3) Cool the placenta within 3 hours. Typically the bucket is then placed into a bag, whether it is a personal items bag or a red biohazard bag, and then placed in the patient's refrigerator. If this is against your hospital policy, then you can use the pink square wash basin as a cooling container. Fill the basin halfway with ice, then place the placenta bucket & bag into the ice. Remind the patient and her support person to replace the ice as it melts. Sometimes the patient will have their own transport kit or cooler as well.
4) The placenta cannot go to pathology. Once the placenta is sent to pathology it is considered unsafe to consume. If the patient is burying their placenta then this is not a concern for their placenta. If the care provider is requesting a portion of the placenta for pathology to examine, they may cut off a piece of the placenta themselves, or request that the encapsulator come and remove a portion of the placenta prior to leaving with the placenta. I have been asked by a doctor to cut out the cord insertion with 1 inch margins so, with nurse supervision, I cut out the cord insertion and placed it into a separate laboratory container to be sent to pathology. This was after steps 1-3 had been completed and was a few hours post birth. I have received placentas where the providers had taken a portion of a lobe before as well. This is a good way of getting a portion to pathology, and also meet the patient's request on releasing their placenta.
Contraindications for Encapsulation: Smoking throughout pregnancy, Fetal Demise, and concern for Chorioamnionitis. If a patient experiences a fever in labor, and you believe it to be from an epidural and not choirioamnionitis, this should be relayed to the patient and encapsulator (and should be deemed safe for encapsulation).
Cesarean sections, GBS, and Meconium are not contraindications to encapsulation. Meconium indicates that a patient should utilize the Traditional Chinese Method of encapsulation where the placenta is rinsed & steamed prior to encapsulation. STIs, such as the genital herpes virus and hepatitis, should be discussed with the encapsulator. Some encapsulators choose not to encapsulate in these scenarios or use one-time-use equipment, but considering the patient is already exposed to this virus, it is not a contraindication for their personal encapsulation. An encapsulator should always be certified in Bloodborne pathogens and Food Handler's Safety to prevent cross-contamination and use proper sanitation methods.
If you are a health care professional and have questions about how to safely care for your patient's placenta, you can ask your patient for their encapsulator's contact information or have your patient contact their encapsulator directly. Typically, professional encapsulators are willing to build trustful relationships with health care professionals. If the encapsulator is unable to answer specific questions, or does not act professionally, you may consider finding a local encapsulator you do trust to refer your patients to. Whether or not you believe in the benefits of encapsulation, or agree with the process, you still want to make sure your patient is utilizing a service that upholds high sanitation standards for protection of their health and safety.