Appendix

Author:
Myra J. Hird
Publication Date:
22 Jun 2022
Pages:
99–108
DOI:
https://doi.org/10.51952/9781529206586.bm001
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Our planet is filling up with waste: plastics permeate our oceans, incinerators create hazardous waste and dumps are surpassing capacity. A Public Sociology of Waste critically examines how public sociology might usefully engage in debates concerning our global waste crisis. The book centrally argues that public sociology is well placed to shape future deliberations concerned with our waste maker global society because it is uniquely positioned to move deliberations from downstream responses to much more challenging upstream issues. This re-framing of waste is only achievable by engaging with various publics in ways that illuminate the relations between waste and wider societal issues concerned with over-production and over-consumption, poverty, racism, sexism, and social justice. As such, the book's main contribution is to provide detailed empirical studies that detail how publics currently engage, and are engaged by, waste but also how publics might transform the framing of waste problems and their solutions.

This Appendix provides a detailed account of how placentas are redefined, several times, in order to make them available for scientific research. I include this detailed analysis in order to demonstrate how critically important both ontology and epistemology are to framing waste. As this research shows, scientists define placentas as waste (ontology) in order to secure the availability of placentas for their research. And this classification (epistemology) of human tissue as waste (and then not-waste, and then waste again) goes largely (but not entirely) unchallenged.

Phase 1: placentas are waste

Anthropological, nursing and bioethics literatures have recorded diverse interpretations of placentas across cultures and times (see Yoshizawa’s 2013 review). Beliefs that placentas are spirit doubles, omens or medicine, potentiate rituals around disposal, such as burial with significant objects, or consumption, such as placental dehydration and encapsulation. Despite working closely and directly with placentas, some participants were not aware of these practices:

To tell you the truth, I have not come across any incidence where people treated placenta[s] differently. In my experience, every placenta is considered a throwaway tissue. … I have never met someone who did some ritual thing with the placenta. ... When the use of something is gone, then you basically don’t worry about that thing. So the pregnancy is done, delivery has taken place, you have your own baby, why do you want to worry about [the] placenta? [P15]

I haven’t thought that people had access to the placenta, because you know, in the labour room, it was just discarded properly. You wouldn’t really give it to the mother, so I never thought people could do anything with this. ... I have no clue about it. I haven’t heard of it. [P25]

Some participants were aware of cultural valuations of placentas, but when specifically questioned about them, mostly minimized the popularity and importance of certain public understandings of placentas as non-waste. As in the extract above, some participants suggested that women consider the placenta during their pregnancy as it pertains to the health of their foetus, or that women who have pregnancy complications are more mindful of its role. However, most participants asserted that pregnant women, mothers and the public at large strictly “do not care” about placentas:

They [pregnant women] never think about the placenta – ever, ever, even during pregnancy. They’re thinking of their baby. [The placenta] is so important during pregnancy. But after that, once it’s delivered, the baby has no use for it. The mom has no use for it. So it has fulfilled its role, you know? [P8]

Some participants associated the conceptualization of placentas as not-waste with ‘cultural minorities’:

I am a very matter-of-fact person, and I see the placenta as being the biological necessity for mammalian reproduction. ... But if [a mother] were of the cultural minority who wanted to take the placenta away, she should have the opportunity to say “no”. So I respect people who have those views. I don’t know why they have those views, but that’s their business, not mine. I don’t have any reverence for the placenta, in that sense. I think it’s a very interesting tissue. Very versatile, and I think quite extraordinary. But that’s a biological science fascination. [P14]

Here, as with other participants’ responses, ‘cultural minority’ interpretations were contrasted with an apparently unified and uniform scientific definition of placentas as waste. A researcher made a distinction between cultural valuations and how they can be respected “scientifically”, suggesting such valuations do not have a place within science proper:

Following women during their pregnancy and then actually discussing separately as to whether we can have their placenta, and taking into consideration that they might be happy to participate in one part of the study, but they may not want us to have their organ, I find that most women are happy to donate their placentas. But you do occasionally have women who say, “no, I want to take my placenta home and bury it”. Or plant a tree on top of it or something like that. And I think that’s about as respectful as we can be scientifically in relation to other people’s placentas. [P20]

Placenta science research commonly accepts a definition of the placenta based on two assumptions: (1) that placentas are intra-uterine tissues that perform a function during pregnancy alone; and (2) that maternal and foetal needs for the placenta are temporary. As such, these assumptions differentiate non-‘natural’ meanings of placentas as beyond the interest of science (see Yoshizawa, 2016). This determination effectively precludes a recognition that different and/or postpartum purposes necessitated by women, infants or communities might be important for understanding the placenta in science and medicine. It concomitantly determines the meaning of waste in placenta science: biological waste is a culturally meaningless matter whose life-course has run out.

Numerous scientific articles confirm the assumption that placentas may be used for scientific research because they will otherwise be wasted (see Barachini et al, 2009; Chang et al, 2007; Ilancheran et al, 2009; Muralidhar and Panda, 2000; Scalinci et al, 2011; Barbati et al, 2012; Wang et al, 2008; Wolff et al, 1996; Yen et al, 2005; Yu et al, 2009; Zhang et al, 2006). For instance, Sergio Scalinci et al write that they used the placenta as a source of stem cells in part because of ‘the absence of ethical issues, considering that the placenta is a waste product’ (2011: 691). The scientific definition of placentas leans upon the classification of placentas as strictly ‘natural’, biological material, without layers of cultural meaning, as evinced by the following response:

But when I see a placenta in the lab, it’s just a specimen. ... I mean, you watch a cat or a mouse or a dog give birth, and the mother just turns around and eats it. I mean it has no value. ... I know a much broader animal vision of it, just being part of a natural process without needing to take on anything extra. [P18]

Considered together, these excerpts suggest that the placenta scientists who participated in our study believed that the placenta is, in essence, biological matter whose functions and roles end with delivery. With no purpose, disposal is the expected next step at the end of the placenta’s natural life-course:

And you know, this piece of tissue, that’s all it is: it’s a piece of tissue that otherwise would be thrown in the garbage. [P11]

I think placenta tissues are fine to take because they’re really just going to go and get thrown out. They don’t have any other use. [P22]

In science – I mean, we are scientists – it’s considered a throwaway tissue. In our clinic, in IRB’s, you have this category: throwaway, residual tissue, or useful tissue. It’s considered a residual, throwaway tissue. So you don’t sometimes even need IRB approval for getting placenta, because it’s considered a throwaway tissue. [P15]

A fascinating repeated discursive thread in our respondents’ remarks concerned the claim that nature defines placentas as waste. Participants frequently cited the ‘disposal’ of placentas by animals as evidence for this claim, and compared disposal of placentas in hospital incinerators as the equivalent practice among humans. For example:

It’s a fact of how, well, mammalian reproduction that takes place, isn’t it? You have pups and all the placenta[s], you have the foetal membranes and everything else, and that also applies to the bird’s eggs. When the chick comes out of the egg, the eggs are thrown away, and of course they try to throw it away at a distance so that the predators are not going to find the nest. ... That may be the reason why we like to discard these things. Not to leave traces when you have a placenta. It’s just lying there at the entrance of ... a rabbit hole, say. And if the placentas are thrown on the outside, all the foxes will find it. ... Discarding the placenta is a sort of natural process. [P1]

In this sense, discarding the placenta is figured as a survival strategy inherent to reproduction itself. The participant continued:

And that’s why a lot of animals eat the placentas of the birth. Even non-carnivores, like for example ruminants. They don’t have the enzymic system to get to digest that meat material. But that’s an ecological protection. That’s why I think they get rid of all that. For example, when so many ... hide their waste products, when they defecate and so on, they hide it and they bury it just to avoid all traces of having been there. Otherwise it attracts others. ... It just came into my mind, but that’s a fact: so you never find placentas in nature. They’re all hidden, or buried, or eaten. Because they have to, as a protection for the young that are somewhere. [P1]

Within this logic, it follows that because there are “no placentas in nature”, all animals with placentas actively discard them after birthing. Humans, as a biological species, do the same via the incineration of placentas. Significantly, what these excerpts suggest is that anything that is disposed of is waste. This is affirmed in the conviction expressed by P1 above that animals do not eat their placenta for its nutritive properties (which would suggest that placentas are not waste but food), because some animals lack the ability to digest their placentas.

Indeed, participants in our study framed the discarding of placentas as a necessary, natural and logical practice. As such, for participants, defining placentas as waste is not actually a process of defining, since placentas are waste.

Phase 2: placentas are not waste

Now that placenta scientists have (as in phase 1) established that women, their families, society at large and indeed nature itself define birthed placentas as waste, a second discursive phase involves scientists redefining placentas as not-waste, evincing the mobilities of the waste hierarchy. This is evident in placenta science publications. For example, in an article published in the journal Placenta, Ornella Parolini writes:

The placenta should never be seen as a waste material, but in addition to claiming its important role during pregnancy, it should be regarded as a great gift from nature as a source of cells and bioactive molecules for therapeutic applications. ... The placenta may continue to sustain our life even outside of the womb. (2011: S284)

The book Regenerative Medicine Using Pregnancy-Specific Biological Substances (Bhattacharya and Stubblefield, 2011) contains only one chapter (among 400 pages; Samuel et al, 2011) addressing ethical issues pertaining strictly to cord blood, but laments the ‘massive wastage’ of expelled reproductive tissues that could be used for research or therapeutic purposes (Burd and Huang, 2011: 3).

Waste claims are not merely rhetorical; rather, they are frames that provide a conduit for placentas to physically move to laboratory spaces as acceptable objects of scientific study. Placentas, that is, are discursively and materially diverted from waste to resource. And it is not so much that mothers, their families and members of the public at large are ‘wrong’ in defining placentas as waste, as it is that placenta scientists are able to understand placentas as transformable objects (from waste to not-waste). Thus, this re-classification affords a significant amount of leverage to scientists’ unique expertise.

In fact, while some respondents advanced the necessity to secure informed consent, some contended that it is a rather superfluous and unnecessary requirement. Since, these respondents assert, women effectively abandon their placenta after birth (and through this action define the placenta as waste), scientists may recuperate this waste material:

When it’s finished, it’s finished. And what I regret is that there are so many barriers stopping people using it for research purposes. The ethics, the formal ethical requirements for researching on the placenta are very stringent, and quite ridiculously so, since it’s a throwaway tissue. If it’s not used for research, the thing is just destroyed. [P14]

I don’t see any ethical issues, because as I said, so far, throwing it away has not hurt anybody. So by keeping it also, I don’t think it’s going to hurt anybody. You use it as much as you want, and then if you don’t use it, save as much as you want to save, and then the rest of that can go to the dump. ... I don’t know, because that’s a complicated issue. Women don’t even know where the placenta goes. So how can they not consent? They don’t even know, where did it go [sic]? So what’s the point of not consenting? [P15]

So, I like the idea that we can just use the tissues since they are just about to be discarded without having to get consent. ... After it has fulfilled its purpose, 99.99% of placentas are discarded, you know? ... If it’s going to be used for research, should there be consent? If it’s going to be thrown out, no, no consent is necessary for that. [P8]

These views are further justified by claiming that there is no harm caused to anyone by using placentas for scientific research, including compromises to patient privacy, as one of the participants excerpted above explained:

Many institutions do not require approval for placenta[s] because as I said it’s a throwaway tissue, so we don’t require it. But if you are really going to follow and look at the data, clinical data of the person, anyone to compare, then you need prior IRB approval, consent from the woman. ... The consent is for going into her clinical data. [P15]

Participants sometimes even suggested that asking for consent is an excessive ‘generosity’ given to patients: “I always didn’t have [sic] to have informed consent, but I always just ask the individual [orally] if they were happy with us using their placenta in research. ... It was almost a courtesy to these women. And I would always respect their wishes [P5].”

One participant considered that the necessity of informed consent did a great disservice to women:

I had arguments with our ethics committee for ages. They say “you’ve got to give the woman at least 24 hours to consider the proposal that you’re going to use her placenta”. I said “well how can you do that? She’s out at home, and then she comes in and labour [sic], and then she delivers her placenta. There is no way to do it.” Now if it were doing research on her baby, yes. ... I say, “look, when women have been pregnant and delivered, they’re not looking to deliver the placenta and then take a picture of it and put it above their mantelpieces”. They’re after their baby. The placenta is irrelevant. That’s true in our culture, anyway. And therefore, what are you fussing about? ... For a woman, she wants to have a baby. She doesn’t want to enter into a binding legal agreement which clearly the hospital thinks they are going to argue about for years and years. She wants to be done with the placenta, have it taken away and destroyed, and get on with her life. [P14]

None of our respondents reflected on the possible conflict of interest in asking for placenta donation after birthing, a time of major distraction for mothers and families during which the possibility of obtaining informed consent may be compromised. This was dismissed because, as one participant (P12) claimed, when asked if they would donate their placenta to science, women “always agree”. In this collective discourse, we can see that one ethical praxis – seeking informed consent – is viewed as undermining a greater moral good.

Phase 3: expertise and placenta rehabilitation

The placenta scientists in our study strongly agreed that the placenta is not given due scientific attention. For example, one participant talked about how other scientists and clinicians do not understand the value of the placenta:

I think among scientific people, those who do the very specific reproductive stuff, know the value of [the] placenta. Most of the physicians don’t know this. When I give classes for my students in medicine, I have to tell them this: the placenta is not a throw-out. We have to understand the placenta, to study the placenta, to give value to this placenta. Most of the physicians think that placenta is [sic] garbage. ... And I can say, in my hospital, if I don’t put my student inside the centre [that is, delivery room or caesarean section operating theatre], they will throw it out. So we still have a lot of work to do to change the mind[s] of the people. And even with the [medical] students. [P13]

This is an advocacy issue for placenta scientists. The placentological literature explicitly highlights other scientists’ ignorance of the value of placentas for producing scientific knowledge or therapies. For example, Nadia Badawi et al ask ‘Why is the placenta being ignored?’ (2000), while in an article entitled ‘Remarkable placenta’, respected placenta scientist Kurt Benirschke claims that the placenta, ‘once richly studied’, has become a ‘forgotten organ’ (1998: 194). The journal Placenta repeats this imperative to revisit the history of placenta science in order to revive interest and show how the foundational insights of reproductive science came from studies of the placenta (see, for example Carter, 2011; Carter and Mess, 2010; Lapaire et al, 2007; Pijnenborg and Vercruysse, 2008; Pizzi et al, 2012). Numerous articles decry a lack of placental examination after birth (Baergen, 2007; Benirschke et al, 2006; Salafia and Vintzileos, 1990; Tellefsen and Vogt, 2011). The placenta can even be seen to have been ‘discarded’ from the medical and scientific curricula, a ‘transience’ directly linked to how animals discard the placenta:

And the first thing to go is the placenta, because it’s so transient, you know? You have it when you’re born. We said the animals were eating them. They’re discarded. And so pathology for a physician is the organs that form the individual. And that’s what you’re going to study for 70 or a hundred years depending on how old you become. You’re never going to go back and look at this placenta. So it’s the first thing to get dropped out of curricula. [P18]

In sum, there is a sense in which, if the views of others that the placenta is of no value after delivery could be corrected, even more important scientific work could be done with delivered placentas. And further, the very specialization of placenta scientists makes them uniquely qualified to identify placentas as not-waste.

Phase 4: placental research as moral imperative

Scientists argue that they are morally obligated to use this potentially bio-valuable material in experimental contexts. The participants in our study regretted that placentas are moribund after delivery unless they ‘rescue’ them:

I think it helps so much, for people to study it. It’s no risk for her [the mother] or the baby, so it’s stupid if you block this. ... I know in Germany – I don’t know in Canada – they cannot use the cord blood in some places, because they have to ask the foetus. You know, because it’s from the foetus. ... If you think like this, it’s stupid. I think we have to take care. Of course, we have to be ethical, of course we need informed consent. But we cannot be stupid. Like if we will throw out the placenta or the cord blood, we’ll do nothing with that, even though we can help a lot of women by studying that. [P13]

Indeed, participants showed excitement in discussing the potentials of such placentas, as exemplified by this participant:

Like I said, it’s big, and nobody wants it. And its discarded, from the human subject’s standpoint. Often, it’s a discarded tissue so you need minimal IRB involvement. Sometimes it can be exempt. ... You know, we do a dissociation procedure where we isolate the trophoblast cells [cells that form the placenta], and you can get a hundred million cells easily. You can get two hundred million cells sometimes, which is a lot of cells to do your studies with. You can do multiple studies. ... And it’s a primary tissue, meaning its not derived from a tumour or a cell line. It’s primary tissue culture. This is very rare. The only [other] thing you can do this with is a blood sample. The blood sample is the next easiest thing to do because many people don’t mind giving up a little bit of blood. ... We get the placenta without any intervention at all. ... So, identifying those processes and surgical interventions where there’s some discarded tissue is a very good thing, I think. The placenta is a real obvious one from that standpoint. [P4]

This registers the final phase of the process of determining placentas as bio-valuable research products. While placental waste material is defined as ethically neutral, our respondents argued that recuperating placentas as not-waste is a positive ethical behaviour; in fact, scientists have a moral imperative to use placentas in scientific research. The majority of participants reflected upon their motives and goals of studying placentas by invoking an altruistic discourse of science and medicine. Three participants’ words are exemplary:

The placentas I get are all from healthy women, and someone’s had a baby, and they’re happy. And you know, this piece of tissue ... that’s all it is. It’s a piece of tissue that otherwise would be thrown in the garbage. And I guess plus the added thing is that, you know, again, I can do some good with this. But it’s garbage. It’s not a living, feeling, thinking tissue. And, you know, I’m next door, and I hear the baby cry, and there’s a happy event. [P11]

Actually, it’s the beginning of all of our journeys. We all were in the same phase, like we all were a foetus. So, it’s always good. And if we come to know from the beginning what is happening, then if there is some problem which can affect our adult life, we can remove it at the beginning. So that’s why I think it’s very important to learn the placenta biology. And anything related to reproductive health, so we can give and produce a good world with healthy people. That’s what motivates me. [P21]

It’s so important, and I really, really love the area that I’m in because it can make such a difference. I work with two recurrent miscarriage clinics, and a high-risk pregnancy clinic, and it’s wonderful when someone gets pregnant naturally and has a healthy, happy baby. ... I mean, I’ve even been invited to some [of] the deliveries. You get quite close to some of the women, and holding this beautiful baby at the end and knowing you may have had a part of it – it’s a very rewarding field. I’m really at the interface of the clinical and lab-based science. [23]

Interestingly, this moral imperative can sometimes be advanced at the expense of others. At a 2013 workshop on building tissue-sharing networks, an attendee shared her displeasure at having to “fight off the mother who wants to eat it [the placenta] or bury it” (field notes). One clinician shared her “trick” for obtaining consent to take the placentas for scientific purposes from women who had already expressed a desire to take them home: reminding them of the countless women and children who could be helped if only they would donate them, and offering to take and email photographs of the organ. Others in the workshop laughed and nodded their heads in seeming agreement with her frustration with these patients.

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