Friday, November 3, 2017

Ob/Gyns Warn Against ‘Vaginal Seeding’ Trend for Newborns

“Vaginal seeding” is growing in popularity because it’s thought that babies born through Cesarean-section miss out on certain “helpful” vaginal microbes that might shield the infant from asthma, allergies and immune disorders.

“Vaginal seeding has become a rising trend for patients,” noted Dr. Jennifer Wu, an ob/gyn at Lenox Hill Hospital in New York City. “Patients read about the benefits of a vaginal delivery and hope to replicate these benefits with vaginal seeding.”

As explained by the American College of Obstetricians and Gynecologists (ACOG), it’s thought that contact with healthy vaginal bacteria helps stimulate the infant immune system, prevents the growth of dangerous bacteria and regulates the gut. That contact doesn’t happen for babies born via C-section, however, so in vaginal seeding, a cotton swab with vaginal fluids from the mother is used to transfer vaginal bacteria to a newborn.

But in a statement issued Oct. 24, ACOG – the nation’s largest ob/gyn organization – said the procedure is not recommended because the known risks outweigh any potential benefits. “Due to the lack of sufficient data, the very real risks [of vaginal seeding] outweigh the potential benefits,” Dr. Christopher Zahn, ACOG’s vice president of practice activities, said in a college news release. “By swabbing an infant’s mouth, nose or skin with vaginal fluid after birth, the mother could potentially, and unknowingly, pass on disease-causing bacteria or viruses,” he explained.

Wu agreed. “There are very real risks attached to this practice,” she said. “Certain viruses, such as group B step and herpes, can cause serious illnesses such as meningitis in newborns.”

And Zahn stressed that there’s a much safer way for a new mom to transfer her helpful bacteria to her newborn: Breast-feeding. “Breast-feeding for the first six months is the best way to overcome the lack of exposure to maternal vaginal flora at birth,” Zahn said. “The bacteria present in breast mild and on the nipple is sufficient for natural colonization or seeding of the gut. There may be some initial difference in the gut [microbes] of infants based on mode of delivery, but research has shown that difference disappears after about six months,” he added.

My Take:
It seems to me that the ACOG is overlooking the obvious – if you avoid the C-section, vaginal delivery makes this argument mute.

The rate of C-section in the United States in 2013 was 32.7%, roughly a third of all deliveries. The World Health Organization (WHO) states the “medical necessary” C-sections account for no more than 10% of all deliveries.
Physicians like C-sections because they are scheduled rather than spontaneous and generate significantly more income. On average, the cost of a C-section is 50% higher than a natural birth.

I also question the concerns raised about possible infection. Studies on women with known herpes infections failed to find one case of transmission to the newborn, although herpes antibodies were frequently found in both cord and neonatal blood samples. It appears that the mother’s immune system protects the child from most vaginal infections.

It’s not just “thought that contact with healthy vaginal bacteria helps stimulate the infant immune system, prevents the growth of dangerous bacteria and regulates the gut.” There are many evidence based studies that prove that inoculation of healthy bacteria during vaginal delivery improves many aspects of health, including long term morbidity and mortality.

The Bottom Line:
The take away from this study is reduce the rate of C-section from a third of all births to 10% where it belongs. Then devise a study that looks at the risk of infection for vaginal swabs as has been done with vaginal deliveries. This will solve the “lack of data” claim and recommendations for or against vaginal seeding can be evidence based.

Source: October 25, 2017 National Institutes of Health

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