The latest trend in the world of natural childbirth is vaginal “seeding,” swabbing babies’ mouths with mothers’ vaginal secretions.
The theory is that C-section birth “deprives” babies of prolonged contact with the bacteria in women’s vaginas and that putting that bacteria in babies’ mouths “restores” the normal bacteria.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The recommendations of the natural childbirth industry are based on what they believe will increase market share, not on scientific evidence.[/pullquote]
There’s two major problems with that claim:
1. There’s no evidence that babies benefit from exposure to mother’s vaginal bacteria.
2. There’s considerable evidence that babies can face serious illness and death from bacteria and viruses that live in the mother’s vagina.
That’s the warning encompassed in an new editorial in the British Medical Journal (BMJ), “Vaginal seeding” of infants born by caesarean section. The authors Aubrey J Cunnington, clinical senior lecturer, Kathleen Sim, clinical research fellow, Aniko Deier, consultant Neonatologist, J Simon Kroll, professor of paediatrics and molecular infectious diseases1, Eimear Brannigan, consultant in infectious diseases and infection prevention and control, Jonathan Darby, infectious diseases physician, know whereof they speak.
Evidence is accumulating that the human microbiota can also be manipulated to benefit health, but not (yet) that vaginal seeding is beneficial to the infant. Indeed, such evidence will be difficult to gather, requiring large clinical trials with many years of follow-up. It might seem reasonable to perform this simple and cheap procedure, even without clear evidence of benefit, but only if we can be sure that it is safe.
We lack that certainty at present. Newborns may develop severe infections from exposure to vaginal commensals and pathogens, which the mother may carry asymptomatically. 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 would probably also be transferred on a vaginal swab, potentially abrogating the protection from infection afforded by elective caesarean section.
In other words, there’s no evidence that vaginal seeding is beneficial and considerable evidence that it can be harmful and even deadly. Indeed, vaginal bacteria are the leading cause of infectious death of newborns.
So where did the recommendation come? From the natural childbirth community through … the movie Microbirth.
The issue of vaginal seeding can serve as a paradigm of much of what passes for “evidence” in the world of natural childbirth. Natural childbirth, a philosophy that unmedicated vaginal birth is superior to any other form of birth, is largely the “unresearched antithesis of obstetrics.” That’s how gender scholars Annandale and Clark describe contemporary midwifery, which is essentially the whole hearted embrace of natural childbirth philosophy.
An alternative is called into existence in powerful and convincing terms, while at the same time its central precepts (such as ‘women controlled’, ‘natural birth’) are vaguely drawn and in practical terms carry little meaning.
Simply put, much of contemporary midwifery is merely unreflective defiance of obstetricians. Whatever obstetricians recommend, midwives recommend the opposite. In contemporary natural childbirth advocacy, every day is Opposite Day.
Obstetricians medicalized childbirth to make it safer; natural childbirth advocates pretend that childbirth was safe before obstetricians got involved.
Obstetricians offer pain relief; natural childbirth advocates insist that feeling the pain improves the experience, tests one’s mettle and make childbirth safer.
Obstetricians whisk babies off to pediatricians to make sure that they were healthy; natural childbirth advocates claim that skin to skin contact between mother and infant in the first moments after birth is crucial to creating a lifelong bond.
Obstetricians can perform C-sections; natural childbirth advocates demonize C-sections in every way they can think of insisting that C-section rates are too high, C-sections cause [insert your favorite illness: allergy, asthma, diabetes, hypertension, etc.], and C-sections damage both the infant gut and infant DNA.
Not a single one of the claims of natural childbirth advocates is true. So why do they make them? To retain market share. Obstetricians are the chief economic competition of midwives and natural childbirth advocates and midwives and natural childbirth advocates are determined to increase market share.
Vaginal seeding was popularized by natural childbirth advocates in the movie Microbirth. Its thesis?
…We believe “seeding of the baby’s microbiome” should be on every birth plan – for even if vaginal birth isn’t possible, immediate skin-to-skin contact and breastfeeding can still help to provide bacteria crucial to the development of the baby’s immune system. In the scientists’ view, if we can get the seeding of the baby’s microbiome right at birth, this could make a massive difference to the baby’s health for the rest of its life. Consequently, we believe that “Microbirth” is of extreme importance for global health and potentially, for the future of mankind!
Who do is the “we” when the producers of Microbirth announce “we believe”? It wasn’t microbiologists since there is no scientific consensus on the composition of the neonatal microbiome, let alone what it ought to be. It wasn’t neonatalogists and pediatricians since they aren’t going to “believe” anything about the microbiome that isn’t established by microbiologists. That goes for obstetricians, too.
So the “we” in “we believe” is natural childbirth advocates who promote the largely unresearched antithesis of obstetrics. Natural childbirth advocates recommend vaginal seeding for no better reason than defiance. The fact that there was never any evidence to promote vaginal seeding, and considerable evidence that it could be dangerous or deadly was never even considered. That’s what you would expect from a marketing tactic completely divorced from the scientific literature.
As the authors of the BMJ editorial note:
In the absence of evidence of benefit, or of guidelines to ensure the procedure is safe, how should health professionals engage with the increasing demand for vaginal seeding? We have advised staff at our hospitals not to perform vaginal seeding because we believe the small risk of harm cannot be justified without evidence of benefit. However, the simplicity of vaginal seeding means that mothers can easily do it themselves. Under these circumstances we should respect their autonomy but ensure that they are fully informed about the theoretical risks.
Parents should be advised to mention that they performed vaginal seeding if their baby becomes unwell because this may influence a clinician’s assessment of the risk of serious infection. Health professionals should be aware that vaginal seeding is increasingly common and ask about it when assessing neonates who may have an infection…
I would add an additional caveat:
Parents need to remember that natural childbirth is an industry, and an unregulated industry at that. Just like any unregulated industry, the recommendations of the natural childbirth industry are based on what they believe will increase their market share, not on scientific evidence.
Parents should treat the natural childbirth industry with the same level of skepticism that they would treat any industry. You wouldn’t get your advice on solar power from the oil industry, and you shouldn’t get your advice on microbiology from the natural childbirth industry.
