Seeding after C-Section: The Fast Track to a Better Microbiome?

April 5, 2016

Modern day surgical procedures are performed under the most stringent aseptic practices. And for good reason. Postoperative infections, before the practice of sterile technique, were often the cause of greater morbidity than the condition being treated. But there’s one increasingly common surgery that has the potential to get a lot dirtier. Delivering a baby by Cesarean section.

Over the past ten years the  C-section rate has continued to increase such that it accounts for 26.2% of live births in the U.K. and 32.2% in the U.S. What’s becoming clear, as we discover more about the critical function of our body’s microbiome, is that babies born without passing through the vaginal canal are starting life with, what some researchers claim, is a significant risk factor for future disease. “Inadequate or inappropriate seeding of the microbiome is in many ways the equivalent of being born with a serious birth defect, resulting in inappropriately matured physiological systems.” so says the authors of this article in The Scientist.

Compared to vaginally born babies, those born via C-section are more likely to experience asthma, allergies, eczema, type 1 diabetes, obesity and celiac disease. They are also more likely to be hospitalized for gastroenteritis.

Enter the technique called ‘seeding.’ For the past several years  Maria Dominguez-Bello of New York University and her colleagues, have been trying to replicate the benefits of a vaginal birth by inoculating babies with vaginal fluid immediately after birth. Before a planned caesarean, they gave women sterile gauze, which was folded and inserted like a tampon about an hour before the C-section. Before the women entered the operating theatre, the gauze was removed and bagged. Within 2 or 3 minutes of the baby being born, its mouth, body and anus were swabbed with the gauze.

The technique has been studied so far only in small groups of babies. But the results look promising, with microbiome flora similar at three months in C-section babies as the ones born vaginally. However, seeding is hardly standard of care and some medical providers are starting to push back, citing the possibility of infection with harmful bacteria such as Group B strep and chlamydia, or viruses such as herpes. Recently, the British Medical Journal cited there was not enough evidence to justify the risks of seeding. “The known benefits of breastfeeding and avoiding unnecessary antibiotics may be much more important than worrying about transferring vaginal fluid on a swab”.

But what the BMJ authors seem not to be taking into account is that most babies come through the bacteria-laden, microbiome-rich, vaginal canal already and the seeding technique isn’t any more dangerous than a routine vaginal delivery. In the U.S. and U.K., screening  for STI’s and  Strep B is generally routine. The point of the article seems to be that the risk is unnecessary if the mother hasn’t been screened for disease carried in the vaginal tract. But might the long-term benefits of receiving that crucial dose of microflora far exceed the low possibility of infection, when it’s looking likely the rates of asthma, diabetes, and obesity might well be reduced with a healthy microflora present from birth?

As the microbiome continues to be studied, it’s becoming clear that our preoccupation with cleanliness and bacterial eradication might just be putting our long-term health at risk, especially when it comes to our littlest humans. The act of seeding after a C-section has potential to address this, and needs to be part of the birth plan conversation with all prospective parents as our C-section rates continue to rise.


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