Is ‘Seeding’ After C-Section Safe?

In my 10 years as an OB/GYN, I have read many interesting birth plans, but over the last month I’ve had several patients request something I’d never heard of before: “seeding.“ This is a process where the patient places gauze in her vagina for an hour then after her cesarean section rubs the gauze in her baby’s mouth and over his body in order to help colonize the baby with healthy bacteria. Once I got past the initial “yuck factor” and did some research, I found that there was some merit to idea but not enough safety data to recommend the procedure just yet.

By Heather Rupe, DO

Babies born vaginally have been shown to have healthier gut bacteria (microbiome) than babies born by cesarean section. Babies born vaginally also have lower rates of allergies, asthma and obesity than babies born by cesarean section, but a cause and effect relationship has yet to be proven. It is theorized that it’s the healthy bacteria from a vaginal delivery that actually reduces the risk of these disease, but the studies that prove this hypothesis are missing. Before we start rubbing vaginal secretions in our infant’s mouths, let’s look a little closer at the data.

The practice of vaginal seeding is based on a poster presentation by Dr. Dominguez-Bello that was presented at the American Society of Mirobiology. The research involved 21 babies, only 7 of which were seeded with vaginal flora. The babies were followed for 1 month and found to have an increased diversity of bacterial flora.

This is a research poster, not a full peer reviewed published study. Basing clinical decisions on a poster is like giving a movie an Oscar based only on the preview. (Editor’s note: A small study published Feb 1 in the journal Nature had similar findings as the poster.) However, this practice is now being promoted in many natural childbirth circles as way for babies born by C-section to have a more natural experience. The actual benefit, though, is only theoretical.

“This study has yet to prove that this practice increases the microbiome in a sustainable or even beneficial way. There is no proven clinical benefit of this practice yet and unfortunately has a potential for harm for the mother and the baby,” says S. Shaefer Spires, MD Epidemiologist and Assistant Professor, Division of Infectious Diseases, Vanderbilt University School of Medicine.

The main risk is that babies could be exposed to harmful, disease-causing bacteria. “Infection is one of the top ten causes of infant deaths in the first month of life,” says Neonatal-perinatal specialist Eric Scott Palmer, MD. He warns that seeding “does not guarantee that enough ‘good’ bacteria will reach a baby’s intestines. Even worse is the chance that large amounts of deadly bacteria will.”

Vaginal pathogens such as herpes simplex, HIV and group beta streptococcus (GBS) have the potential to cause fatal infections in newborns. And while there are screening tests for active infections like GBS or herpes, these tests are not 100% effective in detecting disease. There is also risk of contamination of the gauze in its route from vagina to baby. As the gauze is inserted and removed from the vagina, there could easily be fecal contamination. The significant swelling that often occurs in the vagina and rectum in pregnancy can place the two orifices very close together. It is difficult to know which pregnant women truly have healthy vaginal bacteria, and which are struggling with yeast infections and bacterial vaginosis which are extremely common in pregnancy. While yeast infection would rarely be fatal to the baby, it could lead to thrush and breastfeeding difficulties.

Interestingly, we’ve had patients request vaginal seeding even when they know that they have vaginal infections. It seems their passion for desiring a more natural experience for their baby can sometimes outweigh their comprehension of the risks.

Here are a few safer options to improve baby’s microbiome:

  • Reducing your risk of C-section – Vaginal delivery is safest for mom and baby, so increase your chance of vaginal delivery by maintaining a healthy lifestyle to during pregnancy. Limiting weight gain to the recommended amount, staying active with exercise throughout your pregnancy, and avoiding elective induction with your first pregnancy have all been shown to reduce your risk of cesarean section.
  • Early breastfeeding – Breast milk is ideal for safely inoculating your baby with healthy bacteria.
  • Skin to skin during C-section – Placing the baby directly on the mom’s chest after a C-section helps with bonding and breast feeding, and can make the surgical birth feel more natural. It’s also theorized that this immediate skin to skin contact may improve the microbiome – and, while I don’t have science to support that, it certainly doesn’t do any harm.

While the theory behind seeding has merit, I need more research before I can recommend it to my patients. Hopefully there will be quality studies in the future that can give us useful guidelines on the efficacy and safety of the procedure.

 

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