An obstetrician, or a midwife for that matter, usually considers
retained placental fragments when the mother has unusual cramping and
bleeding after delivery, especially if this goes on for longer than
expected.  If there are no such symptoms, there is no problem.  Just
another example of how we use the bottle feeding baby as our normal
model.  Quite right, if mothers are formula feeding, retained
placental fragments which do not cause bleeding or cramping are no
problem.  In fact, we don't even consider the possibility.

I saw this the other day, when I asked one of our obstetricians where
I work which is the best way to diagnose retained placental fragments.
She said she didn't consider the possibility if there were no symptoms
as noted above.  When I suggested that a low milk supply could be a
symptom, she hadn't even considered why this should be and was
surprised, a light went on, when I said that estrogen secretion from
the placental fragment could interfere with milk production.

Jack Newman, MD, FRCPC