I think we can all agree it’s been a whirlwind of a few weeks. Between the hyped up media headlines, the variety of certification company responses, conversations between fellow encapsulators and concerned emails from clients, there has been a lot of discussion about the CDC report on Group B Strep and placenta encapsulation. There have also been some overblown responses and general misinformation which is to be expected when people race to be the first or loudest voice.
I’ve privately spoken to dozens of placenta specialists who are upset, scared, frustrated and are looking for reassurance. I want to share how I myself have responded to the situation and what I think a healthy response is for birth professionals. At the end of this article I’ve included a statement of facts from the CDC report and a set of my own lingering questions.
1. Be Slow to Speak
Whenever there is a crisis or a complex situation, my number one suggestion is to shut up and listen. Be exceedingly slow to respond publicly. Those who respond first in a crisis are highly likely to respond in error, either from having incomplete information, having incorrect information or not taking the time to measure their response. If people ask you questions, it is perfectly acceptable and even shrewd to say “I don’t know yet, I need time to review the information before I can reply.”
2. Question Your Biases
One of the hardest emotional responses is to force yourself to question your own beliefs. I’m a placenta specialist. My company has been in existence since 2010 and encapsulates well over 100 placentas per year in Seattle. I need to immediately acknowledge that it is impossible for me to have an unbiased opinion on this report. I need to be willing to be wrong about everything.
3. Approach from a Place of Humility and Respect
I am not a microbiologist. I am not a extremely frightened mother of an infant with GBS infection. I am not the placenta specialist in question. I need to show respect to everyone involved in this case study and the only assumption I should make is that these are all decent human beings who want the best for everyone involved. I want to respect the family by not using their horrible experience as a marketing angle for profit (or a prop for any agenda). I want to respect the CDC as an organization that specializes in diagnosing infections and who has scientists who are far smarter than I can ever hope to be. I need to respect the specialist in this case and not automatically assume that she or he did the encapsulation wrong or didn’t have a safe process. I also need to have enough humility to recognize that this case could have happened to anyone, including me.
4. Healthy Skepticism is Good
While showing humility and respect, I can still have a healthy skepticism of this report. That means looking at exactly what evidence is given, how it was gathered and when it was gathered, as well as what evidence was not reported. I also need to look at what parts of the report are hard facts and what parts are implications. For example, the CDC report quotes the specialist’s website in terms of the variety of preparation methods she or he offers for clients but it does not explicitly report exactly how this particular family’s placenta was prepared. I also need to consider that I am only hearing one side of this situation which is the CDC & reporting hospital’s case study. I have not heard directly from the family. I have not heard directly from the specialist. I have some facts as reported by the CDC but not ALL of the facts.
5. Pursue More Knowledge
My first reaction to the CDC report was “I need to learn more about GBS”. Even having been in the birth profession for over 14 years, I feel that GBS is an incredibly complex bacterium that I don’t know nearly enough about. Even the best researchers in the world do not know how most secondary GBS infections are acquired. GBS is hard to eliminate and easily spread. Most people have it living in their body (happily symptom-free) as part of their normal microbiome at one time or another in their lives. Even with this tiny amount of information, I recognize the potential for many, many factors at play when it comes to GBS infection. I think it is worth my time to study GBS more in depth and to seek the knowledge of people with more experience in this field. If your response is one of ego... “well that could never happen to me”, instead of humility... “what are the gaps in my knowledge?” then you need to check your priorities.
6. Do Not Make Any Claims Whatsoever
It is incredibly short sighted and dangerous for any placenta specialist to guarantee or even imply that their process is safe enough to protect their client’s pills from GBS contamination. We do not have enough verifiable lab testing to confirm that ANY method of processing the placenta unequivocally eliminates GBS 100% of the time. We have some lab testing about what level of disinfection GBS is responsive to but that does not mean we know for sure that this applies to placenta preparation. The scientific method requires something called reproducibility. So until we can show multiple lab tests that prove the same result across multiple clients (specifically that a GBS positive placenta was prepared and then subsequently tested negative for GBS) we have absolutely no confirmation whatsoever that our processes are guaranteed safe. It doesn’t matter what you believe to be true or how confident you are. Have the humility to not make these claims, or if not that, have the wisdom to not put yourself in the position of getting the pants sued off you if a client gets sick and finds that their capsules test positive for bacteria after you made those types of promises.
7. Refuse to Engage in the “Us vs Them” Game
To be quite honest, I have been disappointed in the reaction of the birth community to the CDC report. I feel like most people immediately drew lines in the sand and started defending their turf. Why can’t we all just say “this sucks, I feel horrible for this family, I don’t have all the answers and I need to see what I can do to be better”? Why do we need to immediately bunker down with people who think like us and start playing the blame game… “this could never happen to us, because our process is the safest” or “the specialist must have done something wrong, she’s dangerous” or “this report is horrible, the CDC is evil” or “see, I told you placenta encapsulation was risky”? It is these types of responses that divide us and make us weaker. Put your ego in check and admit that you don’t have all the answers. Also, recognize that a single case study cannot prove anyone correct or incorrect. This is not a game to see who can best leverage a crisis for profit.
8. Reassure Your Clients Carefully
If we can’t make claims, then how do we reassure clients? A measured and neutral response is best. Something along the lines of “Like yourself, I have many concerns and questions regarding the CDC report. What we know for sure is that this is a single case study with limited evidence and no concrete conclusion. Until we have reproducible research, I cannot be certain whether any encapsulation process eliminates GBS. However, I do feel encouraged that of the many thousands of women who have consumed their placentas, that we have only had this one case study reported up until now. I believe that there are some reasonable precautions we can take to reduce risk and I’m happy to try to answer any questions you have.” We always need to be speaking in terms of REDUCING risk, not eliminating it. Some clients are going to push me to give assurances. How I word my response is critical to protecting my liability. As much as I may want to say “I can promise you that my process is completely safe and there is no chance of this happening to you” that statement is loaded with risk for me and it is also untrue. I need to do what's best for my clients (and what's best for me as well) by not making promises like that.
9. Ask “How can I improve?” and “How can I better serve my clients?”
Self reflection is one of the most powerful tools you have at your disposal. Instead of trying to prove how everyone else is wrong, we need to be looking at ourselves the harshest. Try to find balance; you don’t need sky-is-falling overreactions either. Here are some questions I’ve been asking myself…. Since I don’t have the evidence and testing I need to be certain about my processes, what reasonable precautions can I take? The CDC report seems to imply (although we don’t have confirmation) that the mode of transmission was through the mom transferring GBS via touching her baby. If that’s the case, then I can recommend my clients wash their hands before and after taking a dose of capsules or touching their pill bottle. I can improve my screening and informed consent processes. If a client is GBS positive, I need to tell her that I don’t have rigorous scientific research proving that my process eliminates GBS. I need to give space for my clients to choose not to encapsulate if they are not comfortable with the situation. If I find myself in convincing mode, that’s where the danger lies for me as a specialist. I do not persuade. I only answer questions simply and clearly and wait for the family to tell me what they want. I require them to take ownership of their choice. The CDC report also makes preparation temperature recommendations of 130F for 121 minutes (however this is based on salmonella, not GBS). I need to consider if it is worth the risk to prepare at a lower temperature when a client explicitly asks me to and has received informed consent.
So that is the summary of my thoughts on the CDC case study and our response to it. At any rate, I feel the field of encapsulation is undergoing massive shifts. I am skeptical that they are constructive. It is my hope that we unite in pursuing further lab testing to better understand if GBS can be eliminated via the encapsulation methods that are common in our field. If you have further thoughts or concerns or would like a private listening ear… feel free to message me!
A statement of facts as reported by the CDC:
- The infant had one case of early onset GBS and one case of late onset GBS. Both cases were treated and the infant recovered.
- The early onset case of GBS is reported as starting shortly after birth and the infant was treated for 11 days in the hospital.
- A final diagnosis stating the source of the early onset GBS is not given.
- The late onset case of GBS was diagnosed 5 days after the first discharge and was treated in a different hospital for 14 days.
- The final diagnosis stating the source of the late-onset GBS disease was high maternal colonization secondary to consumption of GBS-infected placental tissue.
- The mother tested negative for GBS at 37 weeks of pregnancy.
- The mother had her placenta encapsulated, received the capsules at 3 days postpartum and consumed some of her capsules.
- The capsules were tested for GBS several weeks after they were prepared and they tested positive for the same strain of GBS as the infant.
- The mother’s breastmilk tested negative for GBS after the second infection was diagnosed.
- Transmission from other colonized household members could not be ruled out.
- Serial exams did not reveal a source of the GBS infection.
Questions that I have:
- Since it was not explicitly stated, was the mother tested for GBS after the birth via blood testing, urine testing or vaginal/rectal swab?
- Since it was not explicitly stated, were other household members tested for GBS?
- The report quotes the specialist’s website regarding their available processing methods, since it’s not explicitly stated, what specific method of preparation was used on this placenta?
- As the report implies that elevated intestinal and skin colonization of the mother was the mode of transfer to the infant, can it be ruled out that poor hand washing hygiene or in home contamination of surfaces with GBS is not also implicated as a source of GBS colonization?
- Since the capsules were tested for GBS only several weeks after the birth, can it be ruled out that the capsules themselves became contaminated from handling by the mother or being in infected environments?
- Did the mother stay in the hospital with the infant? Did she bring her capsules with her to the hospital at any time? Did she take doses while at the hospital?
- What were the standard operating procedures that the specialist had in place? Has he or she reviewed this case study with their training organization? What is their joint response?
- Are any placenta encapsulation training companies taking the initiative to pursue serial testing regarding GBS and placenta encapsulation?