For Medical Providers

Women of many cultural backgrounds are choosing to keep their placentas following birth. If a patient in your practice or at your facility is requesting the release of their placenta, appropriate preparation can help to seamlessly facilitate this request and increase patient satisfaction. Placenta release directly to patients is established as written law in the states of Hawaii, Oregon and Texas. The release of healthy placentas to healthy mothers is not prohibited by law in any state in the U.S. The legal precedent of Swanson v. Sunrise Hospital in 2007 demonstrates that hospitals are liable for the handling of placentas and upholds a patient’s right to the release of their placenta, free from any willful or negligent contamination.

  • Updating or Developing a Placenta Release Policy
    • Policy wording- The Nurse-Manager for Labor & Delivery can revise policy wording in conjunction with the Risk Management Department & a member of the Pathology Department. Most hospitals that APPA has worked with find it works best to have patients sign a release waiver during triage which is filed in the patient’s chart.
      • Upon delivery, staff double-bags the placenta and releases to the partner or spouse who is responsible for the storage and handling of the placenta upon release. Most patients will bring a cooler with them for transport and may require use of facility ice machines.
      • Release immediately after the birth reduces the risk of negligent contamination of the placenta and frees the hospital from further liability caused by prolonged holding and release times.
    • Release Waivers- Waivers should include the patient’s name, signature and date of signing following a summary of your practice or facility’s release wording. Example release waivers from the state of Hawaii as well as other facilities are available for review here, and here.
    • Differentiation in processes and standard order sets for vaginal and cesarean births- Some facilities have standard order sets built into their EMR systems which may need revised to seamlessly facilitate such patient requests.
      • For example, if your facility’s standard post-cesarean order set includes an order for the placenta to be sent to Pathology, this needs revised so that mothers who are requesting their placenta and whose placentas are not clinically suspicious or in need of pathological examination can have the placenta released to them or their spouse directly in recovery.
      • For uncomplicated vaginal births where the placenta is not clinically suspicious or in need of pathological examination, no order for Pathology should be required prior to post-delivery release to the patient or spouse.
      • For malodorous or otherwise clinically suspicious vaginal deliveries, a culture can be taken from the placenta in the patient’s room or a portion of the placenta can be removed and sent to Pathology. See the section on suspected infection below for more details on how to handle release in such instances.
  • Contraindications for Placenta Release
    • While a percentage of the women requesting their placenta may be doing so for burial purposes, others may have more culinary-minded plans. It is in the best interest of the patient and their family that we are mindful of the instances in which placentas are not suitable for release or potential ingestion. For the most part, there are very few instances of when a placenta is not suitable for release for burial or ingestion.
      • Special circumstances that are not contraindications: STI’s including HSV, HPV, Chlamydia, Gonorrhea, meconium staining, GBS+ or use of prophylactic antibiotics in labor for GBS+, labor epidurals and spinal anesthesia, IV medications such as Nubain, Pitocin, Mag Sulfate.
      • Contraindications: Hepatitis, HIV, Confirmed chorio or other infection.
        • For suspected chorio, neonatal sepsis, or other infection: Placenta should be frozen/refrigerated after being cultured as per facility policies/order sets. If maternal and neonatal labs are confirmed clear and the placental culture is confirmed clear, the placenta may be released at the discretion of the clinician.