A small ‘seeding’ rant

4197076733_2b2b540b4bMay I jump into the microbiome/seeding debate really briefly, while acknowledging that the issues are much larger and more complex than I have room to discuss in one blog post? Because I have been watching several recent conversations in medical and other forums about the research which considered whether transferring maternal vaginal flora to the baby is effective as a partial means of helping babies become colonised with beneficial bacteria.

The things that are concerning me are manifold, and not least of these is the continued notion that we can make caesarean section almost as good as vaginal birth. (I really do think that we need to make caesarean section as good as possible for the women and babies who truly need one, but we need to be very careful about thinking that we can improve on a process that we don’t even fully understand.)

But one element of this discussion that is really disturbing me is the fact that a number of debates have broken out about whether it is justifiable to expose the caesarean-born baby to the vaginal bacteria of his mother, with some proponents of this debate arguing that this has not been proven to be safe, which has led to responses by health information departments.

Wednesday, Thursday, Friday, people!

This is the same bacteria which the baby would have been born through if the caesarean section hadn’t taken place. Unless there is pre-existing concern that a women has an infection which may be potentially problematis for her baby, then for goodness sake, let us THINK!

While we’re at it, I’d like to throw my two penny’s worth into the debate which is also taking place about why artificial seeding after caesarean section isn’t as good as the natural seeding which occurs during vaginal birth. Even apart from the fact that one is intended to happen (and is probably more complex than we think) and the other is a crude and human-created approximation of the first, might the fact that women who are undergoing caesarean section are (with very good reason, given the high risk of infection after caesarean section) being routinely given antibiotics have anything to do with it?

Just a thought… Feel free, as ever, to pile into the discussion…

photo credit: Bifidobacterium via photopin (license)

13 comments for “A small ‘seeding’ rant

  1. April 21, 2016 at 5:58 am

    WHOAH!!! Go rant!
    Totally agree with you here Sara, in many ways.
    Such a complex thing that isn’t fully understood. I’m very much in favour of Seeding the Microbiome. Still, I’m realistic that the man made effort will not likely be equivalent to the vaginal occurrence, while at the same time baby will at least receive some beneficial bacteria from mum, we hope!
    I had exactly the same reaction as you when I read that some are questioning the safety of exposing baby to mums own bacteria. I pulled a proper face and “What the…?!”.
    Great point about administration of antibiotics too!

  2. April 21, 2016 at 6:28 am

    Really pleased you’re returning to this discussion, have high regard for both placenta’s and yourself, so will return to this when time allows 🙂

  3. Shari_12
    April 21, 2016 at 7:05 am

    When I initially heard of seeding, I thought “Of course, that makes total sense”. But then I heard Michael Odent’s comments that babies born in the caul when birth is let be, don’t get colonised at all. Now I’m not sure what to think.

  4. April 21, 2016 at 7:37 am

    Hi
    The fact that now we are protecting the C/S babys is wonderfull. Weather mothers hace Antibiotics is bot here or there.
    I loved reading your blog. I am a retired midwife.

  5. Kathryn K
    April 21, 2016 at 11:34 am

    So interesting to reflect back to a man that his concerns that his partner’s vaginal flora might not be ‘good’ for his baby are possibly misplaced…?!

  6. April 21, 2016 at 12:16 pm

    well put, as ever

  7. April 21, 2016 at 12:40 pm

    I feel cautious about this the wisdom of this. Not a midwife – but 41 years interest in childbirth and an AN teacher and birth partner to family members. My thinking is – in the spontaneous vaginal birth the baby is sliding down the birth canal in some amniotic fluid and there may well have been some released beforehand as well. This makes a different mix to the vaginal microclimate, I should have thought, than an elective CS vagina where there has been no membrane rupture. Then of course we have GBS – again usually not a problem in the 20-30% or women who have it where the baby is coming through at his/her own pace and – again – flushed with amniotic fluid. In the caul again – no direct contact. Rather than doing something that really isn’t very ‘natural’ at all (wiping a vaginal swab over a newborn baby) could we not instead just ensure that the CS baby a) gets some cord blood b) goes straight to mum to be ‘seeded’ by the skin to skin contact and c) gets colostrum for his/her gut to start making it’s own lovely flora.

  8. April 21, 2016 at 1:22 pm

    A mother’s vaginal bacteria = potentially harmful for baby
    But hey! No problem with exposing baby to any number of dangerous hospital bacteria…

    One of my fears is that hospitals and OBs will use the vaginal seeding as a way to up-sell Caesareans. All the benefits of a vaginal birth, but none of the blood, sweat and tears. Could be packaged up like a sweet deal and that really worries me.

  9. April 22, 2016 at 1:03 am

    Isn’t it wonderful and exciting that we live in an era when our understanding of the microbiome is expanding – I truly love learning more about this incredibly complex relationship between mother, baby and bacteria….. It would seem to be a fairly simple matter to measure colonization after cesarean born babies are seeded artificially. Most of the directions I’ve seen for doing this suggest that a vaginal swab is taken in advance of the surgery and preserved in saline. I would be curious to know how the routinely given antibiotics affect colonization over a period of time.
    As someone who loves water birth, I’d also love to see more research about the potential impact of this practice on the baby’s microbiome. Again, it doesn’t seem like a terribly difficult research project to pull off and we would benefit so much from knowing more.

  10. April 22, 2016 at 3:54 pm

    Great blog-post and I love the rant.

    In fact, I think there should be much more ranting about the “seeding and feeding” of the infant microbiome – it’s so critically important. (I say this as I’ve just spent the past three years interviewing world-leading professors about this very subject for our MICROBIRTH film and our new THE MICROBIOME EFFECT book!).

    The “swab-seeding” technique being researched by Dr Maria Gloria Dominguez Bello at New York University only partially restores the baby’s microbiome – and only deals with vaginal microbes. And yes, the aim is to partially restore the vaginal microbes the baby would have received if the mother had a vaginal birth. Saying that, the technique doesn’t restore the mother’s gut microbes (which could be acquired from contact with the mother’s faecal matter – which could be a really good thing). And it doesn’t replace or restore the beneficial natural stresses, pressures and hormones released during vaginal childbirth.

    Yes, “swab-seeding” does come with risks, and it’s not a recognised medical procedure yet, and it’s simply the subject of ongoing research (albeit research that is getting worldwide attention right now). As Dr Dominguez Bello says herself – it should never be used to justify or encourage more C-sections. And yes, any antibiotics taken would have a devastating effect on the mother’s microbiome.

    What’s exciting is that people like you Sara (and I do love your blog), and me, and other people in the birth-world are really starting to champion the infant microbiome – it’s exciting new science that underpins midwifery and it’s the science that supports vaginal birth where possible, immediate skin-to-skin contact and breastfeeding.

    That’s my own small seeding rant over.

    But yes, roll on more seeding rants please!

  11. April 22, 2016 at 10:10 pm

    I generally agree but do have some reservations which are mainly to do with what happens to the bacteria when outside the woman’s body on a swab – we do know that some bugs eg gbs can multiply at a really fast rate. Could it find it easier to multiply on a swab outside the vagina? As you say, we don’t even understand the natural process, let alone what happens when we intervene in such a complex event… Not saying I’m against ‘seeding’ and in practice I don’t think I’d even raise this reservation as it’s so theoretical – I think this probably is an area that really does justify extra research.

  12. louise
    May 20, 2016 at 2:46 pm

    I understand I late to enter this debate however I have an imminent enquiry. I have asked for a microbial swab at hospital for a c section I am booked in for on the 26th May (yes 6 days time!). They said they were not at the liberty to do this and will not partake in this activity. There reasons were it was not policy to do so on the grounds that this could increase the Group B strep infection as 20% mothers have this bacteria and they do not test for this plus they also agreed with a previous comment that the vaginal bacterial cultures are not exposed to the waters eg changing pH and bacterial cultures in a c section. I don’t know what to do, can anyone help?

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