The theory is that babies born by cesarean section bypass the trip through the birth (vaginal) canal and thereby miss the opportunity to pick up (seed) with the mother’s normal flora (microbiome). To remedy the situation, gauze moistened with sterile saline is rolled like a tampon and inserted into the mother’s vagina an hour before the scheduled cesarean birth. After birth the gauze is used to swab (orally?) the infant leading to “seeding” of mom’s bacteria. Much like breastfeeding transfers the immunity of many illnesses to baby, seeding baby’s microbiome is thought to align the infant’s microbiome with the mother’s flora.
There is the “ew, gross” factor to get past in order to find merit in the idea. After thirty years of nursing there is not much that gives me the knee-jerk reaction of “ew, gross”. I think my cure for the this was the time I had to poke holes in a man’s hand with a large bore needle (one through each fingernail and one on back of the hand) and apply medicinal leeches. Hurt in a work accident with a crush injury, the application of leeches saved his hand after microsurgical repair left his hand intact but arterial supply cut off by venous congestion. The leeches fixed that. Nothing came close to gross after that incident. So I should be okay with seeding a baby if I can get the facts.
As a hospital-based labor and delivery nurse, I have many questions about this practice. Does it really help? Is there evidence-based medicine to support the theory? How long is long enough to leave the gauze in the vagina? From the time it is removed (prior to sterile drapes for surgery), until the time of seeding (after birth), how would this bacteria laden item be stored? Are there temperature requirements? How do you know if there is “bad” flora included, such as group beta strep or bugs introduced during recent intercourse (see “Parsing the Penis Microbiome” for an overview). How can we know if we are killing a baby rather than protecting it? Of course, vaginally delivery may expose infants to bad bugs, but somehow it doesn’t feel the same as actually collecting and swabbing a baby with vaginal fluid and secretions.
A good introduction and articles about human microbiomes and the work being done in the field can be found at the National Institutes for Health Human Microbiome Project site and the CDC page on genomics and microbiome. It left me with more questions regarding microbes , pregnancy, delivery and infant health. A search of peer-reviewed journals did not turn up anything on seeding baby’s microbiome. A Google search turned up articles on possible research but no facts. A few blogs addressed seeding, but they offered no links to proof of necessity or safety.
I don’t have the answers I need to incorporate seeding into my practice, but the discussion led me to research and learning about the role of microbiomes and practical application in medicine and nursing, just not in seeding a baby.
What do you think? Parents, would you seed your baby? Nurses, midwives, and physicians, what do you say when a patient brings this up?