[Title picture credit to the BMJ article]
By Carolyn Holmes
When it comes to maternity, ever-changing practice and evidence from new research can mean what was perfectly acceptable yesterday could be unintentionally harmful today. Gone are the days when we crossed our fingers and hoped we could raise a thriving infant with the formidable knowledge of a few Old Wives and a safety pin; parents in the twenty-first century want cold, hard facts about new procedures (and a happy nod from their care provider).
As a doula, my job is to signpost my clients to make informed choices from reliable sources. That means I have to be sure that these sources are credible and not heavily weighted by my own bias. However, when someone suggests a practice I am not familiar with, I will tell them, honestly, that I don’t know but I will find out more about it. And then off I trot to bury my head in a book, a journal or Google Scholar for the pro’s and the con’s.
So, when Vaginal Seeding and the Microbiome came to my attention, that was precisely what I did. Both might sound like something out of the Eden Project but I assure you, they are concepts within the childbirth world that are coming under close scrutiny. I put it “out there” on Instagram and it was met with nods of approval and a few dozen Likes. One doula told me she would be interested to see what came up from it. I haven’t seen it mentioned on anyone else’s Feed or Story at the time of writing this article, so I hope I can promote a little knowledge.
The Microbiome is the generic term for all the fungi, bacteria and viruses that live inside and on the human body. Astonishingly, the number of genes in the Microbiome is over 200 times in the human genome and it weighs five pounds! Because each person’s Microbiome is different and these differences are associated with the treatment and research of disease, it’s no wonder that interest has surged in recent years to promote health. When a baby is born, their Microbiome comprises of the flora obtained from their mother as they pass through the birth canal. That is assuming that the child is born vaginally. But what happens when a baby is born by Caesarean-Section (or through abdominal birth, as it is coming to be known)? Well, that is where Vaginal Seeding comes into play.
Before delivery, pieces of gauze, soaked in saline, are placed into the mother’s vagina. When the baby is born, these pieces of gauze are removed and wiped over the baby, including around the eyes and in the mouth, to restore the microbiota of the child to a more natural state. Through increased media attention, this practice is being demanded in maternity settings around the world although it is being asked that parents do this themselves rather than relying on the staff. In fact, some hospitals are asking their staff not to perform the Seeding themselves due to the small risk to the infant that cannot be backed up by evidence of good practice. The Guardian and The Daily Mail ran articles within a couple of months of each other about this in 2015. Both were of the opinion that there needed to be more evidence and parents should only indulge fully aware of the risks.
Although it may be true that baby animals born in a bacteria-friendly environment obtain natural immunity from their mother, there is little evidence to support that Vaginal Seeding would replace the lost good-bacteria in human babies. There is also a small window of opportunity after birth to promote the benefits. It would need more clinical trials and then years of follow-up research to argue the case for employing this routinely.
Healthcare practitioners have also stated that Vaginal Seeding may unwittingly pass on unhealthy bacteria to a newborn rather than good. For mothers who are asymptomatic with Group B Strep and deliver by Caesarean Section, there is a possibility of putting their child at unnecessary risk. Group B Strep may cause eye infections and at its most severe, neonatal sepsis and blood infections. Given that UK does not routinely screen for pathogens in pregnancy and as 20-30% of women have it without even knowing, there may be needless exposure to babies from it. Also, it is vital that parents tell their healthcare provider that they have performed Vaginal Seeding if their baby becomes unwell.
Evidence shows that babies born by C-section show a modest increase in the risk of obesity, asthma and auto-immune diseases associated with alterations in their Microbiome. However, it should be noted that recent research has suggested the microbial differences between a baby born vaginally and that of one delivered by C-Section, disappears around six weeks of age. This suggests that shows that babies’ bodies adjust naturally, regardless of how they were born.
Considering that asthma tends to run in families, I wanted to discover more about the susceptibility of C-Section babies to asthma and what the evidence suggested from studies carried out in the last five years. Arrieta et all (2016) performed a study into how the early infancy Microbial and metabolic alterations affect the risk of childhood asthma. They found that babies at risk of asthma had an impaired Microbiota (Microbial Dysbiosis) during the first 100 days of life. Four types of bacteria were decreased in these children essential for the reduction in airway inflammation. Children with higher levels of exposure to bacteria had protection from asthma and allergies although the specific types of microbes were unknown. They noticed that wheezing in children at one year of age connected to the absence of these four essential types of gut bacteria at three months old. Therefore, not the lining of the gut with “friendly bacteria” in the early post-neonatal period could be correlated to asthma in the first few years of life.
The Quadram Institute (2020), a faculty dedicated to delivering healthier lives through innovations in gut health, microbiology and food, have been researching feeding pre-term babies probiotics as well as breastmilk to help boost their gut health. The probiotics help newborns to digest breastmilk better and could enable these babies to survive and thrive in early life. As most pre-term infants are delivered by Caesarean, they may have missed out on the vaginal microbes from their mother but as breastmilk accounts for 30% of beneficial bacteria to line the gut, this can only be advantageous. Although some ICUs now routinely promote this practice, the majority still do not as “there has not been a large, long-term study into the benefits, including how the microbiota may change.”
So how can we promote the Microbiome safely?
Skin-to-skin immediately after birth not only promotes oxytocin for breastfeeding and regulates newborn body temperature, it will also transfer 10% of the body’s good bacteria to the baby from the skin around the breasts. As it is, breastfeeding itself promotes the microbiota and colostrum is rich in antibodies – liquid gold. Conversely, babies delivered abdominally fed exclusively on formula milk, tend to have a lower level of friendly gut bacteria which may go a long way to affect the infant feeding choices made by new parents. A study by Ingram et al (2020) showed that there were significant differences in the gut bacteria Pediococcus of exclusively breastfed babies compared to those who were exclusively formula fed. The limitations here are that there must have been some babies who were mix fed and not all recipes for formula milk are the same.
There is also the widely accepted rule of not bathing a baby for the first twelve to twenty-four hours of birth. The vernix (the creamy-white sticky stuff that protected the baby in the womb) should be massaged into the skin rather than wiped off. Premature babies have a lot of vernix and post-term babies tend to still have it in the folds of their skin and under their nails. Historically, practitioners would wipe it off and bathe the babies straight away as they were seen to be “filthy” at birth. The “Wait To Bathe” movement advocates promoting the vernix as a protection from infection. It is now routinely advised to top-and-tail a newborn for the first few days to promote hygiene and allow the flora between families to be transferred and thrive on the skin naturally.
While I am all for keeping things as natural as possible and embracing new ways of thinking, I am still on the fence about Vaginal Seeding. The Microbiome can be promoted and protected in more ways than simply transferring vaginal secretions to the skin and mucosa of a newborn baby. While the practice is simple and can be performed by the parents themselves, given the threat of Strep B and other STIs that may be laying undetected, it would not be something I would advocate myself. That said, if that was what my clients wanted to do, then as long as they knew the risks, I would not stand in their way. I would suppose that parents wanting to indulge could ask/pay to be screened beforehand to eliminate any threats. It is very easy to go to a GUM clinic and have a high vaginal swab taken. It might even be a good thing to go in forewarned. I hope there is more research done on this and I will be actively looking out for future publications.