When Mina Bregman was having her third child, she had already decided she was going to eat the placenta after childbirth. It would not be the first time she had eaten her own afterbirth. Following her second pregnancy, the midwife dehydrated Bregman's placenta, processed it at a low temperature and ground it into powder form for consumption. But this time, it would be a little different.
The placenta is an organ that develops in the womb during pregnancy to deliver nutrients to the fetus. Believed by some to provide health benefits, the practice of placentophagy, or ingesting afterbirth, is well outside of the mainstream but has become a trend worldwide in recent years.
In March, actress January Jones told People magazine that she ate her own placenta in the form of capsules after becoming a first-time mum, adding that the practice is 'not witchcrafty'.
Those with a more conventional outlook may find the idea difficult to stomach.
'Every time I give birth, my family always wonders what crazy things I'm going to do to shock them,' says Bregman. At the time, she was living in the Netherlands where home births assisted by midwives are fairly common.
After a smooth delivery, Bregman's doula, Rachel Hopkins, placed the placenta into a pan and brought it to the kitchen where a scalpel, a cutting board sterilised in an autoclave and plastic bags had been set aside for the postnatal preparation.
Hopkins assessed the health of the placenta by checking the colour, texture and size. She examined the flow of the tree-like veins and checked for evidence of clots or infections. Satisfied, she carefully cleaned the organ and divided it into ten pieces, reserving one portion for the day's use and storing the rest in the kitchen freezer.
With the help of Bregman's five-year-old daughter, Hopkins mixed the reserved placenta with coconut water and frozen strawberries in the blender to make a special smoothie.
'I swear that it didn't taste like placenta. It's like a frozen daiquiri,' says Bregman.
She felt that it was a positive experience and credits the smoothies for her smooth recovery from a pelvic condition that developed post pregnancy. She adds: 'I did find that my emotions were more on an even keel. I didn't have the depression dip that you usually do after day five. Also, I noticed that my milk came in sooner.'
A recent study conducted by Mark Kristal, professor at State University of New York, Buffalo, revealed that placentophagy has medical benefits in non-human mammals. One notable finding is the way in which eating the placenta can amplify the painkilling effect of naturally occurring endorphins released during labour and delivery.
'The placenta contains a molecule that enhances opiate processes that go on at the time,' says Kristal.
The afterbirth functions as a natural mechanism to keep the female from pumping out too much endorphins. '[Placentophagy] gives more of an opiate effect without more opiates,' says Kristal.
'It works with the female's own endorphins without any opiates from outside.' The analgesic effect is true for non-pregnant females and even males.
Kristal thinks this will have applications for pain management and addiction recovery.
It also sheds some light on why almost all non-human mammals eat their own afterbirth. But Kristal stresses that his research is specific to non-human mammals. He cautions against using these results to make a case for human placentophagy.
Yet, it is precisely because it occurs in nature that women like Bregman believe that ingesting afterbirth is a healthy practice. She says: 'It made sense to me because animals do it and there is a lot of nutritional value.'
'When you consume placenta it's bio-identical material. It's your child's unique material, your own and your husband's,' says Hopkins, who studied the uses of the placenta with German midwife Cornelia Enning. 'This is a form of hormone replacement, in effect, and helps those with a history of postpartum depression, weakness and anaemia following pregnancy.'
With her knowledge of nutrition, Hopkins developed her recipe for raw placenta smoothies. In the past eight years, she's helped 56 people and trained a dozen midwives and maternity nurses. She received all of her referrals by word of mouth.
'I'm happy and fortunate to have someone like Rachel,' says Bregman. 'Even though I'm not prone to postpartum depression, with each subsequent pregnancy my body gets so depleted. It's hard for your body to build a baby.'
Part of the challenge is not only persuading clients to keep an open mind but also getting full co-operation from family members. 'A woman needs to have full support of the family,' says Hopkins.
'It is taboo for some people. But I've never had anyone regret it or act up because when the family members have seen someone they love go through postnatal depression before, they are relieved to see her flourishing.'
Her husband, a vegan, prepared Hopkins's placenta after she gave birth to their second child. 'I felt the effects immediately,' she says of her experience.
'I drank it within a minute and immediately asked for more. I got up and wanted to take a shower until the midwife showed up and told me to get back into bed. I felt great.'
'There is something about [placenta] that when it hits your tongue, your body wants it,' Hopkins says. 'It's heavily laden with hormones. It's a massive vitamin and mineral bomb.'
Kristal regards such accounts with scepticism: 'Most accounts are anecdotal. The [new mothers] have a positive response no matter how much they take or when they take it. This raises issue that it might be a placebo.'
He says it's difficult to substantiate these health claims because it's hard to find control subjects or even identify conditions such as postnatal depression.
'In non-humans, there really is no equivalent to postnatal depression,' he says. 'In humans, it's such a nebulous concept that it's difficult to deal with.'
Other medical experts claim that such an approach to medicine has its own limitations. '[Western medicine] considers efficacy in terms of hormones, blood cells, immunity,' says Jiang Xiajiang, professional consultant of Chinese medicine at Chinese University.
'Traditional Chinese medicine doesn't think in those terms. Although ancient doctors did not know this kind of science, they were knowledgeable about the efficacy of using the placenta in medicine.'
Eating the human placenta is an ancient practice in Chinese medicine, according to Jiang. Called zi he che, the uses are varied but the placenta is taken primarily to tonify the kidney system, revitalise the blood or to treat issues triggered by a deficiency in the kidney system. It can treat a range of gynaecological ailments, says Jiang, such as female infertility, amenorrhea, or premature menopause, as well as improve milk production.
It is also used to treat asthma, allergies, underdevelopment in young children, and impotence and sterility in men. After the placenta is processed to make medicine, it can come in many forms: pills, powder and injections. Commonly prescribed in powder form, it is generally boiled in combination with other ingredients to make a soup.
'There are people who eat placenta raw, mostly on the mainland and not in Hong Kong,' says Jiang. 'Hospitals would have to provide it right after the birth, which is unlikely to happen in Hong Kong.'
Although Jiang has never prescribed raw placenta for her patients, she says cooking fresh afterbirth into foods is still done in parts of China. 'They would first flush out the blood vessels to clean them thoroughly and braise [the placenta] in huangjiu [a grain wine] to cook out the gaminess,' she says.
'Once it shrinks to about palm size, they just wrap it in dumplings to eat the way you would pork or another kind of meat. The taste is virtually undetectable because it has the flavour of meat. And a lot of times the sick person may not even know they're eating it.'
Traditional use of placenta has changed with greater safety controls, concerns about hygiene, a gradual shift in perception and lack of supply. Placentophagy poses certain risks especially if the pregnant mother has an infectious disease such as hepatitis.
Jiang explains, because the Chinese government now restricts the sale of human placenta, the parts used for Chinese medicine in Hong Kong tend to come from animal sources such as pigs, cows, sheep or horses.
'Eating your own placenta is easy, economical and clean,' says Kathryn of her own experience. 'It's better than [taking] horse hormones.' Kathryn requested to keep her surname private owing to the sensitivity of her family towards the subject. She first encountered the consumption of the placenta while studying at the Chengdu College of Chinese Medicine in the early 1990s.
She says: '[If] animal body parts should be appropriate for humans as a tonic, it makes sense that eating your own body part isn't strange.'
When she gave birth to her first child, Kathryn was living in a small town in Mexico. 'My husband tried to separate the umbilical from placenta. It was very bloody and he was making a mess,' she says.
'We kept it in the refrigerator after we cleaned it and then cooked it in an interesting dish. It was basically five-spice stew over rice. We also cooked it with curry.'
'Giving birth takes so much from your health, according to Chinese medicine,' says Kathryn. 'It's a great drain on a female's jing.' (Jing is a medical concept referring to a person's essence and is a fundamental determinant of the body's constitution.)
But she says she felt no change after eating the placenta.
'My take is what contributes to your general health is a combination of several factors,' Kathryn says. 'You can't isolate one thing and say that's the determining factor.'
Kristal says he's always been sceptical about reports from women praising the benefits of eating their own placenta.
'It is much more efficient and medically sound to treat women with hormones than for them to eat a placenta,' says Kristal.
He says behind it all is a 'back to nature idea that we're animals and, if they do it, we should do it. Some animals eat their own young, but that doesn't justify humans doing it.'
Hopkins, on the other hand, points out that the benefits of using human and animal placentas are now being explored in cosmetics and the health supplement industry.
Rather than distancing ourselves from the source of our medicine, we should accept it, she says.