Expert / 6 April, 2021 / Dr. Nauf AlBendar
You may have heard of the term ‘vaginal seeding’, but what actually is it? What are the risks, and what are the benefits? Medical scientist and founder of The Womb Effect, Dr Nauf AlBendar, is here to clarify all the terms and shed light on this lesser discussed topic. It certainly isn’t something to squirm about!
Vaginal seeding (or micro birthing) is the practice of using a cotton swab to transfer vaginal fluids to the mouth, eyes, nose, or skin of a newborn. The purpose is to transfer a mother’s vaginal microbiome to her baby as she would during normal birth.
Even though the risks are probably low, the main concerns with vaginal seeding are that vaginal infections, such as group B streptococcus (20% of pregnant women have it), herpes, chlamydia, and gonorrhoea, could be passed from mother to baby. As for premature babies (premies), it could increase the risk of sepsis.
In ongoing clinical studies, scientists are testing mothers for potentially dangerous bacteria before examining whether the practice of vaginal seeding can change a baby’s gut microbiome. These are tests that are happening outside of a routine hospital setting.
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Caesarean sections have shown to affect the development of a baby’s population of microbes leading to an increased risk of some conditions such as infection-related hospitalization, asthma, obesity, type 1 diabetes, and auto-immune disorders later in life.
Children born by cesarean section are also five times more likely to suffer with allergies than those born naturally.
The long-term effects are most probably due to the combination of the mode of delivery, antibiotics administered to mothers, altered stress levels of babies, breastfeeding duration, maternal obesity or age at birth.
It is now known that contrary to caesarean babies, vaginally delivered babies can come into contact with their mother’s gut microbiome first! Which then forms most of their initial biome.
Thus, the bacteria picked up during vaginal births may come from the anal area rather than the vagina. This question the long-term effectiveness of vaginal seeding.
In fact, a recent study has demonstrated that the intestinal microbiota of infants born by C-section postnatally could be restored and treated by maternal fecal microbiota transplantation. The caesarean delivered babies were given a dose of a few million cells of live fecal bacteria in their first milk feeding, after a week their gut microbiome was significantly similar to the vaginally delivered babies and both were distinctly different from the microbiome of untreated caesarean delivered babies.
Research is currently underway to try and identify specific microbe strains that could be given to C-section delivered babies to make their microbiotas resemble those of vaginally delivered babies. As mentioned above, some studies are also looking at maternal fecal microbiota transplantation. Until more is understood, health professionals are currently reluctant in putting undefined microbes in children that are immunologically underdeveloped.
The microbial development in utero (during pregnancy) is still not fully understood. The most accepted theory at the moment is that the baby’s microbiome is first seeded at birth. However, some recent studies have found microbial communities in the placenta, amniotic fluid and meconium.
It is believed that the placenta could harbour a wide range of microbes, many of which originate in the mouth. Thus, if babies are indeed exposed to a placental flora in utero, one can readily understand why maternal prenatal oral health is so important.
Newborns delivered by C-section tend to be particularly low in gut bacterial numbers and diversity and can lack certain strains such as Bifidobacterium and Bacteroides which influence the immune system and help to quell inflammation. Instead, their guts tend to harbour opportunistic microbes that are common in hospitals such as Enterococcus and Klebsiella. This might also be due to the fact that C-section delivered babies tend to spend a longer time in hospital.
In addition, mothers who have had a C-section are given antibiotics with the objective to avoid surgical infections. If these antibiotics are administered before the clamping of the umbilical cord, the newborn is then exposed to the drugs through the placenta. Breast milk can also be another way by which antibiotics from the C-section procedure can pass from mother to baby.
A new concept in science called the Microbiota-Gut-Brain-Axis concept implies the important role of the gut microbiome in brain processes. With studies seeing a link between cesarean sections and the incidence of behavioural problems or neuropsychiatric disorders, more investigations are needed to confirm this relationship in order to design nutritional strategies that can help with the establishment of a correct microbiota-gut-brain axis connection in early life.
Therefore, it is quite important to take into consideration and not underestimate the potential short and long-term consequences of decisions about mode of birth.
In many cases, a caesarean is a life-saving procedure, and can be the right choice for mum and baby but it should only be encouraged when it is medically necessary due its impact on the natural interactions between humans and microbes.
The World Health Organization recommends that caesarean sections do not exceed 10–15% of the total deliveries; nevertheless, this rate has been increasing rapidly worldwide in the last two decades. In some countries, 30% of all births are by medical or elective C-section. Other countries like Brazil, for instance, the number can top 80% in private hospitals and over 50% in the public health care system.
Colonisation of microbes is affected by various numerous things including diet (breast milk vs. formula) and weaning to solid foods. This “window of opportunity” only happens in early life, during which the gut microbiome can still be “re-programmed” through nutritional and environmental interventions. The beginning and end of this window is from conception until the age of about 2–3 years.
Therefore, new mothers should practice skin to skin whenever they can in the first few months and strongly consider breastfeeding to help establish natural colonisation. The established clinical probiotics such as Lactobacillus acidophilus and Bifidobacterium infantis can also be taken as supplements to lactating mothers or to newborn babies.
Research has found that a formula containing Lactobacillus reuteri positively modulated the early development of the microbiota of infants born by caesarean whereas the addition of the strain Bifidobacterium lactis positively affected the immune and gut functions of those babies.
Exposure to pets whilst in the womb or postnatally is another way to boost a baby’s microbiome. Research showed that not only did this exposure reduce the incidence of transmission of vaginal group B strep but it was also linked to a reduction in childhood allergies and obesity.
Playing in the dirt in nature for a minimum of 30 minutes a day is encouraged for young babies and growing children. This early exposure to microorganisms can help to train and strengthen young immune systems and it may lessen the chance of developing allergies and autoimmune conditions especially if exposed in the first year of life.
Last but not least, weaning is another important stage, where the gut microbiota becomes more complex and diverse.
The intestinal microbiota is first conditioned by the breastmilk’s dietary and immunological components. When solid food is introduced during weaning, the gut microbiome then develops and bacteria proliferate. The timing and selection of the first solid foods are factors that have an important effect in the correct development of the gut microbiota.
Scientists have also discovered that a key immune response is generated when solid food is first introduced and microbiota expands. This immune reaction is essential as it is involved in educating the immune system and leads to low susceptibility to inflammatory disorders and autoimmune diseases throughout adulthood.
Article by Dr Nauf AlBendar, medical scientist and expert in foetal origins of disease. Founder of The Womb Effect, an educational platform for aspiring and expecting parents.
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