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
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]
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]
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]
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
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]
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]
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]
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
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.
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]
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].”
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
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]
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
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]
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]
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.