by Donna Walls, RN, BSN. ICCE, IBCLC, ANLC

What is vaginal seeding?  Simply stated it is placing vaginal microbes on the face, mouth, eyes, ears, and skin of those newborns who are born via cesarean section birth, especially if there was no labor or rupture of membranes prior to the surgery. A gauze is placed in the mother’s vagina prior to the surgery to “soak up” the microbes and then applied to the newborn immediately post birth. Some early investigators began exploring the possible concerns about infants deprived of contact with the maternal vaginal bacteria when born via cesarean. The next question to be explored was if there is a resulting deficiency when establishing the newborn gut microbiome. It seemed to make sense that when the infant was not exposed to these microbes it would be healthy to find a way to provide the newborn with “replacement bacteria” such as Lactobacillus and Bifidobacterium species from the vagina. We do have extensive research supporting the benefits of a heathy newborn gut microbiome including:

1. Production of nutrients including vitamins K, B6 and B12
2. Thickening of the gut lining
3. Establishment of a healthy gut-brain axis
4. Enhance and strengthen the immune system
5. Metabolic regulation and reduced risk of obesity
6. Reduced risk of inflammation
7. Reduced allergic responses including asthma
8. Decreased risk of Irritable bowel disorders
9. Fewer cases of Necrotizing enterocolitis in preterm and vulnerable infants
10. Reduced risk of diabetes mellitus
11. Fewer incidence of neurologic disorders including autism spectrum disorder and Parkinson’s
12. General improvement in digestive capacity
13. Reduced rates of infectious conditions

So, does “seeding” the newborn make a clinical difference in the establishment of a healthy gut microbiome? One pilot study demonstrated that 4  in 11 infants born via cesarean and inoculated with their mother’s vaginal fluids (with no rupture of membranes prior to birth) demonstrated the microbiota of these infants resemble that of infants born vaginally. In another small study in 2016 by the Journal of Nature Medicine the authors found no conclusive benefits to the practice and In 2017 another study in the Nature Journal found no difference between the microbes of infants born by cesarean with seeding or no seeding and found that at 6 weeks of age the microbiota was organized more by body site rather than mode of birth. Researchers from the University of Western Australia have concluded that the differences between the vaginally and cesarean born infants, as well as infants receiving vaginal seeding or not, show inconclusive results and many studies do not consider many confounding factors such as maternal antibiotic therapies, history, or maternal diet. Another question to consider is if there are risks associated with this practice. There are some concerns that infections such as group B streptococcus, herpes, chlamydia, HIV, gonorrhea, or bacterial vaginosis could be transmitted to the baby. Prenatal screenings are not 100% accurate and most screenings are completed at 36-37 weeks leaving time for infections to occur. Some asymptomatic women may be capable of infecting the newborn or, in the case of GBS there may be insufficient time from the time of administration of antibiotics to the birth. Due to the lack of definitive research and continued questions regarding the possible risks The American College of Obstetricians and Gynecologists (ACOG) has made the following recommendations:

1. The American College of Obstetricians and Gynecologists does not recommend or encourage vaginal seeding outside of the context of an institutional review board-approved research protocol, and it is recommended that vaginal seeding otherwise not be performed until adequate data regarding the safety and benefit of the process become available.
2. The American College of Obstetricians and Gynecologists only supports the performance of vaginal seeding in the context of an institutional review board-approved research protocol.
3. Should a patient insist on performing the procedure herself, a thorough discussion with the patient should be held acknowledging the potential risk of transferring pathogenic organisms from the woman to the neonate. Risk stratification is reasonable for such women in the form of testing for infectious diseases and potentially pathogenic bacteria. Serum testing for herpes simplex virus and cultures for group B streptococci, Chlamydia trachomatis, and Neisseria gonorrheashould be encouraged. It is further recommended that the obstetrician–gynecologist or other obstetric care provider document the discussion. Because of the theoretical risk of neonatal infection, the pediatrician or family physician caring for the infant should be made aware that the procedure was performed.
4. Although findings are mixed regarding associations between breastfeeding and the development of asthma and atopic disease in childhood, exclusive breastfeeding for the first 6 months of life has multiple known benefits and remains the recommendation of ACOG for all women who do not have physical or medical conditions that prohibit breastfeeding.
5. The paucity of data on this subject supports the need for additional research on the safety and benefit of vaginal seeding.

Dr. Aucott,  a member of the AAP Committee on Fetus and Newborn published a 2018 statement from the American Academy of Pediatrics: “The development of an appropriate microbiome can be done through ongoing efforts to promote and encourage breastfeeding and minimize antibiotic exposure. At this time, more research is necessary to understand the full impact of vaginal seeding on infants.” Until there is more supportive research we can educate expectant parents on well established, evidence-based methods of establishing the healthiest microbiome:

1. Encouraging childbirth education and/or labor support technique or doula care that decrease the risk of cesarean birth
2. Support birth centers and birth caregivers that assure uninterrupted, continuous skin to skin care initially after birth and continuing through the early postpartum time.
3. Promote breastfeeding through education and connections with parenting groups. Work with local hospitals and birth centers to implement the Ten Steps to Successful Breastfeeding of the Baby Friendly Hospital Initiative.

References

1. Dominguez-Bello MG, Costello EK, Contreras M, Magris M, Hidalgo G, Fierer N, et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci U S A 2010;107:11971–5.
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