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“Vaginal seeding” of infants born by caesarean section

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i227 (Published 23 February 2016) Cite this as: BMJ 2016;352:i227

Re: “Vaginal seeding” of infants born by caesarean section

It is bizarre that vaginal seeding should be discussed in this manner at all. Suddenly, seeding from the mothers vagina - which the baby would have got anyway had it been delivered the natural way, becomes a problem? Perhaps it comes about because of the unscientific assumption that every carried potential pathogens could kill us in one moment.

Are the authors unaware of the huge piles medical literature describing the crucial role of the vaginally seeded gut microbiome in the correct epigenetic step-wise programming of a new-born's immune development?

The biggest elephant in the room is the theatre itself and the people performing the caesarean. No matter the "sterile" procedures in place, the hospital environment has potential pathogens just as dangerous if not more so...., yet that is not part of the equation? Why is no thought given to the fact that the ignored flora of the theatre itself and the people "doing" the caesarean, might have potentially worse consequences to the baby? What would the result be if the same authors swabbed the theatres, gowns, gloves, the outside of mask and tested the air itself? Might that contain a very broad array of microbes that ideally we wouldn't want near any baby?

Doesn't it make sense that no matter what commensals a mother's vagina contains and even IF some expert considers them to be potentially dangerous, that the baby should FIRST be inoculated during a vaginal or after caesarean with what the mother has which she may well have immunity to , and provide further protection against, via colostrum? Might there be a good reason why vaginal seeding is the ideally designated method of primary microbiome seeding? And the lesser of two "evils"?

Surely, one of the reasons for the concern, is that the immune system of unseeded babies born by caesarean, are different, and many would say, are compromised and not ideal. Further, the literature we do have on the development of the neonatal immune system in both animals and humans shows very clearly that there are both short and long term problems which cannot be fixed when proper seeding does not take place.

The other point is that most caesareans, however they come about, are further complicated by giving the mother and babies routine IV antibiotics, which have the potential to totally undo seeding anyway, which is probably why seeding is only partially effective in changing the flora back towards vaginal "normal".

Solid foundations for immune development are crucial, and for humans a vaginal delivery is irreplaceable. In my opinion, the least the medical profession could do is get on board with what has served humanity wellin the past, instead of argue about purported lack of safety of trying to replicate that.

Competing interests: No competing interests

01 April 2016
Hilary A Butler
writer / journalist
none
Tuakau 2121