Madhva Prasad

The placenta is an exciting organ. No other organ is as temporary as the placenta. It serves as a pivotal part of the pregnancy. It leads to major problems to the fetus, even if there is slight alteration in the location or function. Despite the excessive dependence and overriding importance of this tissue, not many really bother about what happens to it once delivery takes place. The placenta is just discarded. Its life is akin to a soldier’s. Placentae, like soldiers are “disposable heroes”. Way back in 1986, the American based alternative music group-Metallica, wrote a song titled “Disposable heroes”, themed on the lives of soldiers. Writing the lyrics verbatim here, the song goes “…I was born for dying. Life planned out before my birth, nothing could I say. Had no chance to see myself, molded day by day. Looking back I realize, nothing have I done. Left to die..”  If the placenta could speak, these words appear absolutely appropriate too.

Wells et al (2014) have explored Indian traditional birth practices and had identified that one unique feature of the birthing process was the importance attached to the mode of disposal of the placenta. In some communities, it has been accorded a good deal of respect and is given befitting burial also.
Burns et al (2014) have explored the importance of the placenta in an Australian context. An in-depth interview of 51 patients revealed that they did acknowledge that after births have to be given more importance than what is usually given. They identified three methods which are commonly practiced.
First is placentophagy. It is the consumption of the placenta by the members of the family, and thereby imbibing it into each one’s body.

Second is burial. The placenta is cleaned and is buried in a safe spot deep under the soil, and saplings or seeds are planted above it. The growing tree is considered a life long symbolism of the placenta, which supported their progeny during the time of need.

Third is the lotus birth.  Clamping and cutting of the umbilical cord is done almost immediately after birth. The established medical methods are “delayed” cord clamping and “early” cord clamping. The delayed clamping is by far the most advantageous (Fogarty 2018).   However, an entity called “physiological cord clamping” method – synonymous with Lotus birth has been reported. 
Lotus birth is an approach wherein the umbilical cord is not cut. The placenta is expelled spontaneously and its complete expulsion is ensured. The placenta is wrapped in a clean sterile moist cloth and periodically, moistness is ensured by irrigating with sterile water and salt is poured. Sterility is maintained at all times. It has been observed consistently that by the 5th or 6th day of postnatal life, the umbilical cord separates on its own. No major health issues had been observed in the neonates undergoing lotus birth. (Zinsser, 2018) Whether it can be adopted in all settings is yet to be looked into.

Viewed from an Indian mythological context, the Lotus birth seems natural. The human body form attached to a placenta through a cord is quite popular, with one ancient text stating that the universe took physical form from the Umbilicus of the Lord (Nabhyaa aaseedantariksham) and the term “One with lotus like umbilicus” used as a common description of a commonly worshipped deity (Padmanaabha).

Coming back to more modern versions, the term “cut the umbilical cord” can refer to moving out of house thereby ending of a long relationship between a young adult and a supportive parent. In medical education terms, it can refer to the completion of either an undergraduate/ postgraduate medical course. The student is akin to the fetus. The medical college and its faculty are akin to the placenta, serving as the most critical part for growth. The medical education which the student resident received is akin to the nutrition received. However, every trainee doctor has to eventually become independent, move forth and enter the world to serve humanity.
It is envisioned and encouraged that just like there is so much reverence attached to the placenta, those providing medical education will also be respected and revered by all passing-out doctors for their entire careers. 
With this, we bring to you the journal’s last issue for this year. We hope that you enjoyed reading the articles of this year.