After a Cesarean: Seeding a Baby's Microbiome

Vaginal Seeding!

Say it loud enough and I bet you'll get a few raised eyebrows and maybe even a disapproving look sent your direction (unless you happen to be at one of our DFW-area birth network meetings, that is).

The first time I heard of vaginal seeding was in 2014, and to be honest, I think I probably had a raised eyebrow myself.  I believe I'd read an article online somewhere about it and then heard some talk about microbiomes and their relation to gut-health in some of the natural-living groups I'm a part of.  I was intrigued but really didn't pay it much thought.  Then I listened to Penny Simkin's lecture on "Maternity Care and the Microbiome" at the Gold Midwifery Online Conference and this time I was hooked.

Vaginal seeding, the process of exposing a cesarean born baby to the mother's vaginal microbiome, is gaining popularity - particularly in Europe- as research about the differences between vaginal born and cesarean born babes' gut health continues to emerge.  Studies have shown that cesarean born babies had lower levels and a less diverse range of good bacterial flora than vaginal born babies (1) and that babies born via cesarean were more likely to develop obesity, asthma, and diabetes later in life (2).

But first, let me back up just a bit.  The human microbiome is the collection of bacteria, viruses, fungi, etc. (also known as our microbiota) that live in and on the body, and it's a powerful thing.  It helps us to defend against disease, helps us to break down food, and even helps our bodies make certain vitamins.  In fact, bacterial cells outnumber human cells in the body with 100 trillion microbes living in the gastrointestinal tract alone (3). The Human Microbiome Project was launched in 2008 with "the mission of generating research to characterize the human microbiota and to analyze their role in human health and disease".  From their research we re beginning to understand the microbiome's effect on gut health skin health, respiratory illnesses, chronic inflammation and a host of other conditions.  It's a fascinating and incredibly promising field of research!

So what does this have to do with a cesarean, and what the heck is vaginal seeding?

The fetus and placenta are first colonized in the womb with the mother's microbes.  In fact, the placenta has its own biome, closely resembling the mother's mouth biome (4).  While passing through the birth canal during a vaginal delivery, the baby is then "seeded" by the vaginal and gut microbes, providing an opportunity for them to collect on the baby's skin. Then, when the baby is placed skin to skin with the birthing parent, even more seeding takes place from her skin microbiome.  Finally, to complete the cycle, breast milk contains microbes that nourish and feed the gut bacteria that infants need while also protecting the baby from pathogens (5).  It is through this cycle, a vaginal born baby is exposed to, or naturally seeded with, the bacteria which aid in digestion and stimulate the development of the immune system, thereby helping to protect the baby against infection.

Typically, if a baby is born via cesarean they miss out on the transfer of the mother's microbiome that takes place as the baby passes through the birth canal, and can instead become seeded with the bacteria and microbes that exist in the hospital environment, such as Staphylocci and Clostridium difficile (c. diff).  Performing vaginal seeding after a cesarean helps expose baby to helpful bacteria she may have otherwise missed out on, such as Lactobacillus and Prevotella, both of which help us break down sugars and carbohydrates in the gut.

Vaginal Seeding and You: Planting the Seed Locally

Naturally, because we have such an amazing birth community here in Tarrant County, we have at least one group of care providers in our area already offering vaginal seeding to their planned cesarean patients.  I called up Carla Morrow, DNP, CNM, owner of Fort Worth Birthing and Wellness Center and Grace OBGYN who was more than happy to discuss what vaginal seeding after a cesarean looks like for her patients. "It's so easy!  We shouldn't be asking 'Why should we do this?' we should be asking 'Why can't we do this?!' It just makes sense." says Morrow.

First, the mother is tested to ensure the ecology in the vagina is healthy- sexually transmitted infections or HIV would both be contraindications for the seeding process.  According to Carla, if a mother is positive for GBS (Group Beta Strep), she would need to be treated per CDC guidelines before proceeding.

A stack of sterile 4x4 gauze squares is given to the mother upon admission with instructions to roll them up, sort of like a tampon, and insert them in her vagina as far up and close to her cervix as possible.  It is important that the gauze is sterile and that the mother is the one that inserts the gauze, so only her flora is present on the gauze.

"The rest of the cesarean process is routine.  The gauze is removed by the nurse, wearing sterile gloves, a couple of hours later when the catheter is being placed in preparation for the surgery- before the uterine incision is made.  The gauze is then placed directly into a sterile container and mom seeds the baby herself when she is back in her room, usually in the first hour before breastfeeding.  To seed the baby, mom would begin by swabbing the baby's face and eyes with the gauze before moving on to the rest of baby's body.  It is recommended that the first bath be delayed at least 6 hours, preferably 24 hours, to protect the baby's newly transplanted microbiome," explains Carla.

How Do I Approach My Care Provider About This?

Women who desire vaginal seeding need to have an open dialogue with their care provider. "The first thing they need to do to make this happen is to ask the question," said Carla.  "Gather some data and articles for them to read and give them some instructions, because they've probably never done it before."

So, What About Special Situations, Like Premature Babies?  Can They Still Be Safely Seeded?

Vaginal seeding is becoming more prevalent and with good reason.  Carla explained that healthy, term infants and even healthy, late pre-term babies (34-37 weeks gestation) should be ok, pending any other health or respiratory issues.  "I really believe that in ten to fifteen years, seeding will be common practice and supported by professional organizations," she said.  

As we continue to learn from the ongoing research, the more we see how important vaginal seeding is.  Use your voice as a consumer, open the lines of communication with your care providers and hopefully, this once unheard of practice will be a routine procedure.

References:

1. Azad, M. B., Konya, T., Maughan, H., Guttman, D. S., Field, C. J. Chari, R. S., ... Kozyrskyj, A. L. (2013). Gut microbiota of healthy Canadian infants: profiles by mode of delivery and infant diet at 4 months. Canadian Medical Association Journal, 185(5), 385-394.

2. Blustein, J., & Liu, J. (2015). Time to consider the risks of cesarean delivery for long term child health.  The BMJ. doi:350:h2410.

3. Johnson, C. L., & Versalovic, J. (2012, May). The Human Microbiome and Its Potential Importance to Pediatrics. Pediatrics, 159(5), 950-960.

4. Aagaard, K., Ma, J., Antony, K. M., Ganu, R., Petrosino, J., & Versalovic, J. (2014, May 21). The placenta harbors a unique microbiome. Science Translational Medicine, 6(237). doi: 10.1126scitranslmed.3008599

5. Simkin, P. (2015). Maternity Care and the Microbiome: How Birth Practices Dictate Future Health. Gold Midwifery Online Conference.