Steps to examining the placenta:
1. Note the cord insertion. Usually in the center of the fetal side (side that faces the baby in the womb). Sometimes on the side and, rarely, out in the amniotic membrane and joining the placenta only by blood vessels (velamentous insertion).
2. Note the size of the placenta and ask yourself, “does this seem small, large or just right for this size of baby?”. A full term placenta will be about 7 inches in diameter and about 1 1/2 inches thick.
3. Look for anything unusual on the fetal side. (e.g. true knot in the cord).
4. the membranes will cover the fetal side and go off the side edges to form the water bag that enclosed the baby. Take the membranes in your fingers and lift them to see if there is enough membrane to make a sac for the baby. Note where the sac “popped” when the membranes released. The sac may not have a neat hole, but rather, may be in tatters if it broke explosively.
5. Note the colour of the membranes (usually whitish or bloody but may be yellow or green stained if the baby passed meconium in utero). Take the membranes between your fingers and see if you can unpeel the amnion (inner bag) from the chorion (outer bag). They are together like two sheets of saran wrap. If there is a sizable chunk of membranes missing, the mother may complain of “something weird” hanging out of her vulva in the days post birth. The membranes may be showing at the vulva and will eventually just fall out or can be “roped” by twisting a hemostat gripper round and round and then gently tugging out of the vagina.
6 Wipe off the cut end of the umbilical cord. Look for the two arteries and one (larger) vein. A single artery cord can mean kidney problems, if you have a smallish baby. If the baby is big and well grown, there is less to worry about (the two arteries may have grown together into one).
7. Note the length of the cord, including any that was left on the baby’s tummy.
8. Turn the placenta over and look at the maternal side. Cup the placenta in your hands so that all the lobes fit together like a nice jigsaw puzzle. Note any missing pieces. (I have never seen a piece missing in 30 years but this seems to be a big fear in obstetrics).
9. The maternal side will be a rich, red colour. There can be fatty deposits (white) and calcifications (places that feel like sand when you run your fingers over them). These things are not a problem. In a woman that smokes, the maternal side may be somewhat yellowish from the nicotine.
At a home birth, the midwife should put the placenta in double ziplock bags and label it. Put it in the fridge and show it to the mother on Day 3 or 4 postpartum. Don’t get into a big conversation about the placenta on the day of the birth. The birth attendants might find it very interesting but, remember, the parents are only interested in the baby at that point.
What do you see in the photo above? Can you see the amniotic sac? Can you see the umbilical cord? Is it the maternal or fetal side that you are seeing? Does the amniotic sac have a neat hole (indicating late release of the membranes) or did it explode?