Every 4th baby in UK is born by Caesarean Section.
Parents of the Caesar babies are requesting a procedure called as
‘microbirthing’ or ‘vaginal seeding’.
Vaginal seeding involves taking a swab from mother’s vagina
and swabbing it over babies face, eyes, mouth and skin immediately after
caesarean birth.
This article is based on recent
editorial in BMJ (
BMJ 2016; 352:i227) by Cunnington A.J. et al “Vaginal
seeding” of infants born by caesarean section. How should health professionals
engage with this increasingly popular but unproved practice?
Our body is colonized with millions of microbes,
collectively called as microbiota. They outnumber our cells by 10:1. The
microbiota varies according to parts of our body and also person to person. As
described by microbiology professor Graham Rook at University College London,
we are designed to live in nature’s biodiverse ecosystem encountering our old
microbial friends as part of our early immune education.
During the process of vaginal birth, specific species of
good bacteria are transferred to the baby during and immediately after birth
via the birth canal, immediate skin-to-skin contact and breastfeeding. This is
the seeding of the baby's
microbiome. The process heralds the training of baby’s
immune system to recognize between ‘good’ and ‘bad’ bacteria and protect the
neonate from diseases now and also in future.
Large epidemiological studies and reviews have concluded that babies
delivered by C-section have moderately high risk of obesity, asthma, and
autoimmune diseases, these
diseases being
associated with alteration in microbiota.
For babies entering this
world via a C-section, this microbial transfer from the mother to baby is
interfered with or bypassed completely. According to the latest research if the
baby is not seeded with mother’s bacteria, it can have significant health
consequences. Dr Rodney R Dietert, Professor of Immunotoxicology at
Cornell University says “Over the past 20-30
years, we've seen dramatic increases in childhood asthma, type 1 diabetes,
coeliac disease, childhood obesity. We've also seen increases in Caesarean
delivery. Does Caesarean cause these conditions? No. What Caesarean does is not
allow the baby to be seeded with the microbes. The immune system doesn't
mature, and the metabolism changes. It's the immune dysfunction and the changes
in metabolism that we now know contribute to those diseases and conditions.”
So, many researchers advocate that even if vaginal birth is
not possible, immediate skin to skin contact and breast feeding should be
initiated.
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In spite of all the hypotheses, we lack scientific proof at
present. The newborn may be at risk of developing infection, being exposed to
vaginal commensals that the mother maybe harboring without any symptoms. These
include group B streptococcus (the most common cause of neonatal sepsis),
herpes simplex virus, Chlamydia trachomatis, and Neisseria
gonorrhoeae (the last two, causes of ophthalmia neonatorum). These
pathogens may also be transferred on a vaginal swab, potentially voiding the
protection offered by elective caesarean section.
Clinically we are aware of only one clinical trial going on,
called as
Potential Restoration of the Infant Microbiome (PRIME) trial. That
study is expected to be completed in February, 2019.It is looking at the
neonatal microbiota according to mode of birth, the women being screened beforehand
for potential pathogens.
Dr. Cunnington, who is the lead author of the article,
affirms the lack of sufficient evidence to put vaginal seeding into routine
practice. Studies need to be sufficiently large, randomized and need follow up
of many years before a recommendation can be made.
In a statement Dr Cunnington says: "Demand for this
process has increased among women attending hospitals in the UK - but this
has outstripped professional awareness and guidance. At the moment we're a long
way from having the evidence base to recommend this practice. There is simply
no evidence to suggest it has benefits - and it may carry potential risks."
He also believes in fully informing the risks and harm of this simple procedure
to the patients who are demanding it.
He also emphasizes that there are other ways of influencing
baby’s microbiota at birth and “Encouraging breast feeding and avoiding
unnecessary antibiotics may be much more important than worrying about transferring
vaginal fluid on a swab.”
References:
https://clinicaltrials.gov/show/NCT02407184?link_type=CLINTRIALGOV&access_num=NCT02407184
