Vaginal seeding, according to the American College of Obstetricians and Gynecologists (ACOG) is the swabbing of a newborn's mouth, nose, or skin with a cotton gauze or swab soaked in its mother's vaginal fluids. The purpose of vaginal seeding is to transfer the mother's vaginal flora to her newborn infant.
Are you grossed out yet?
Well, the reality is that the crazy assortment of bacteria that live in a healthy woman’s vagina (a.k.a. the vaginal microbiome) may play a really important role in preventing allergies, asthma and immune disorders (such as diabetes or obesity) in their children. Babies who are born by cesarean section do not travel through the vagina on their way into the world, and therefore theoretically do not have a chance to be exposed to helpful bacteria. At least, that is the hypothesis. There are plenty of studies currently taking place, but we don’t have a definitive answer yet as to whether vaginal seeding should be a part of every cesarean delivery.
For this reason, ACOG cautions OBGYN’s NOT to routinely practice vaginal seeding, and to only allow their own patients to do so themselves, once they have had a thorough conversation with their patients about the possible risks.
How could vaginal seeding theoretically benefit your baby?
Bacteria are very important to our health and well-being in many ways. They are necessary for:
A strong immune system to keep us healthy
Preventing the growth of disease-causing bacteria
Production of vitamins for the host
In utero, your baby’s gut (gastrointestinal tract) does not have any bacteria (it is sterile). Through vaginal birth (or once your water breaks) bacteria are transferred from you to your baby. Transfer also happens through skin-to-skin contact after birth and breastfeeding.
Cesarean delivery, antibiotics given before and during labor, and formula feeding may interrupt the natural mother-baby bacterial transfer during your baby’s first days of life. Scientists and doctors are just begining to study and understand the importance of the mother-baby bacterial transfer. We don’t yet know how a baby’s gut microbiome (or lack thereof) may impact its health and well-being for the rest of its life.
So what are the possible risks of vaginal seeding?
Unfortunately, not all bacteria in the vaginal microbiome are healthy for babies. For this reason, there may be a risk of infection (eyes or lungs) in infants when they are exposed to “bad bacteria.” In some instances, we are able to screen for “bad bacteria” and for this reason, women who have tested positive for the following bacteria or infections should not perform vaginal seeding:
Herpes simplex virus
Group B streptococci (usually tested on all women at 36 weeks gestation with a vaginal swab, about 20-30% of pregnant women are group B strep positive at the time of delivery)
Chlamydia trachomatis (usually screened for at the beginning of all pregnancies)
Neisseria gonorrhea (usually screened for at the beginning of all pregnancies)
Other reasons you may not choose vaginal seeding:
Research shows that infant gut microbiomes in all infants regardless of mode of delivery (cesarean or vaginal) and mode of feeding (bottle or breast) was the same by 6 months of age. They were different at birth and still after the first three months. So, it is not yet clear if a different bacterial makeup in a baby's first 3 months of life makes a big difference in terms of health benefits.
We don’t have enough scientific data to definitively say that vaginal seeding is risk-free to your baby.
We also don’t have conclusive data to show that vaginal seeding actually lowers the risk of allergies, asthma, or immune disorders. Studies have only observed that rates of these conditions are higher in babies born by cesarean section. We need large studies (many women) whose children are followed for many years (longitudinally) to get any sense of what the health benefits might be. So far we only have a few, small studies (120 women in one study which is currently underway who have only been followed for one year).
Your doctor or midwife may refuse to allow you to perform vaginal seeding.
Some researchers argue that the antibiotics that are nearly always given to mothers prior to a cesarean section to reduce their risk of infection, also wipe out all of mom’s good bacteria. Thus, vaginal seeding after cesarean won’t make any difference because there wouldn't be any bacteria to transfer.
What should you do if you think vaginal seeding makes sense?
Have a thorough discussion with your OBGYN, midwife, doula, birth partner and any other people who will be present at your birth about the risks and benefits, why you are requesting this be done, and who can do the swabbing at the time of delivery if you are unable to.
Include your request for vaginal seeding in any birth plan and make sure to discuss with any labor and delivery nurses, OR nurses, or other hospital support staff.
Review your plans for vaginal seeding with your pediatrician so that they can be on alert for any early signs of possible infection in your infant.
Ultimately, whether or not your baby has a “bacteria baptism” as vaginal seeding has been nicknamed, will depend on a combination of factors: your requests, your childbirth provider’s opinion, whether or not you have a cesarean section, if you have any of the infections listed above, the circumstances of your delivery, and ultimately, whether anyone even remembers to do it in the excitement of your baby being born.
Like so many of the delivery details that expectant moms worry about while pregnant (delayed cord clamping, immediate skin-to-skin, whether or not to apply eye ointment after birth), the importance of vaginal seeding may fade once you hold your healthy newborn in your arms. Learning about practices like vaginal seeding can help you to be a more a informed patient and parent, but until we have more answers, try not to add it to your list of pregnancy worries.
Sources for this post:
Vaginal seeding. Committee Opinion No. 725. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017:130:e274–8. Available at: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Vaginal-Seeding?IsMobileSet=false