Vaginal seeding and the microbiome – bloom or bust?

My kids’ pediatrician (who are amazing – click here if you’re in LA!) meets with prospective new patient families during their pregnancy. A few weeks ago a woman asked: “what do you think about me wiping my vagina with a cloth and spreading it all over my baby’s mouth”. He knew she was talking about vaginal seeding but was surprised by the bluntness of her description (I mean, come on, he’s a pediatrician) and didn’t exactly know how to answer. He remembers saying something like “ummmmm, that’s not usually a good idea”

My son’s appointment was the next day so he knew he had the perfect audience for this story and the perfect opportunity to discuss it. He wanted to know how often this is actually happening in the delivery room (as a general pediatrician he isn’t at deliveries) and what exactly did happen during the vaginal seeding process. And finally, what is the best way to answer that question?

People have taken ahold of this concept and essentially “advertised” it to people as a good option to help expose baby to the benefits of the vaginal microbiome bacteria if she has a cesarean delivery. According to one of my patients, “everyone” has told her this is “now common practice”.

Is this the whole truth? Is vaginal seeding a good alternative? Is it safe? Is everyone doing it? Or are we better off without ever knowing this was a thing?

VAGINAL SEEDING – HELP OR HARM?

WAIT. YOU’VE NEVER HEARD OF VAGINAL SEEDING? YOU’RE NOT ALONE. WHAT EXACTLY IS IT, YOU ASK?

Technically, it’s inoculating a cotton gauze / pad / swab with vaginal fluids to transfer the vaginal flora to the mouth, nose, or skin of a newborn baby. Or, “wiping my vagina with a cloth and spreading it all over my baby’s mouth”.

WHY ARE WE EVEN TALKING ABOUT THIS? WHAT’S THE HYPE ABOUT?

We know breastfeeding and skin to skin contact immediately after delivery help establish a newborn’s microbiome through colonization of different types of bacteria. The vaginal microbiome probably plays a huge role for those babies exposed to the vagina during labor.

WHY IS THE MICROBIOTA IMPORTANT?

• We’re noticing increasing incidence of child health problems – asthma, eczema, atopic dermatitis, as examples – being correlated with increasing rate of cesareans.
• The microbiota of babies born via c-section is different than babies born via vaginal delivery.
• Expert theorize that exposure to the vaginal microbiome during labor and vaginal delivery helps the baby recognize good bacteria from bad, which in turn helps the immune system function better, which in turn may optimize health.
• When the baby is not exposed to the vaginal microbiome, the immune system may falter due to the difference in the microbiota.
• It might not the c-section itself that affects the child’s health but the lack of exposure to the vaginal microbiome during the birthing process
• This is of course oversimplified … but you get the general idea

RESEARCH

A study was conducted to look at this more. Researchers (in Puerto Rico) wanted to see if they could make the microbiome of babies born via c-section be similar to those delivered vaginally. How did they do this? Vaginal seeding.

And it worked! The babies exposed to vaginal fluid after c-section had immediate similar microbiota as those babies born vaginally. And that microbiota differed from those babies born via cesarean and not exposed to maternal vaginal fluid.

These results provided a lot of optimism for women who deliver via cesarean and are worried about the microbiome exposure.

WHAT’S THE PROTOCOL? HOW EXACTLY DO YOU DO?  

This was the study protocol:

• a wet gauze pad was placed in the vagina an hour before the c-section
• Right before the c-section started, the gauze was removed
• When the baby was born (within the first minute), the baby was swabbed with the gauze pad. First lips, then face, chest, arms, legs, genitals and anal region, then back.
• All the swabbing happened in about 15 seconds.

SINCE THIS ALL SOUNDS GREAT, WHY AREN’T WE DOING IT?

Yes, I agree, it sounds great.  But the benefits – these are all potential at this point. The study followed babies for the first 30 days of life. A different study showed that babies born via vaginal delivery versus c-section WITHOUT vaginal seeding had the same microbiota at 6 months of life anyway, so we’re not sure if there would be a difference looking at these babies long term. The whole labor and delivery process is extraordinarily complex and isn’t completely understood. To say the only difference between a vaginal delivery and a c-section is the exposure to the vaginal microbiome is oversimplification. To say the way to restore a microbiome is by swabbing a baby with an inoculated gauze pad is oversimplification.  Also, there were only 4 babies studied. We never (or should never) take 4 individual outcomes and apply it to the general population.

THE PRIMARY CONCERN HERE IS THE RISK OF UNKNOWINGLY EXPOSING THE BABY TO HARMFUL AND POTENTIALLY LETHAL INFECTIONS.

The women in the study had negative STD panel, negative GBS, no signs of vaginosis or viral infections, and a vaginal pH <4.5 immediately before the process started. This isn’t a standard check for all pregnant women and would be cumbersome and almost impossible to do. A woman with an undiagnosed infection (say, genital herpes, which can be asymptomatic in up to 25% of women who carry the virus) may inoculate their newborn baby with herpes. This kind of exposure can be lethal (so much so that we don’t want women laboring if they have a herpes outbreak, and we give medication to prevent outbreaks and limit viral shedding weeks before anticipated delivery).

So bottom line for me: I see a lot of potential here. So did the authors, apparently, because a little side note at the bottom of the study reports a submitted US patent application.

But, as of now, those benefits may only be temporary, and the associated risks could be damaging and / or permanent and / or catastrophic. Instead, I’m advocating for reducing overall rate of c-sections when possible and safe. And when c-sections are recommended and necessary, I’m loving the “gentle cesarean” – direct skin contact between mom and baby immediately after delivery.