Health Viewpoints
Cesarean section (C-section) deliveries in the United States made up more than 30 percent of all births in 2021. An important distinction between babies born by C-section and those born naturally is a lack of bacterial exposure to their mother’s vaginal and fecal microbiome. This lack of exposure stifles the development of their gut microbiome, which leads to an increased probability they will suffer from a wide variety of ailments, including increased infections, diabetes, arthritis, obesity, allergies, asthma, and autoimmune disease.
A possible solution to this problem is a new procedure called vaginal microbiota transfer, or simply “vaginal seeding.” This technique allows for the mother’s beneficial vaginal microbes to be administered to the newborn after C-section, and it might improve the child’s neurological development and reduce disease burden later in life.
C-Section: Medical Versus Elective
A C-section is a surgical procedure in which the baby is delivered through an incision in the mother’s abdomen. C-section is performed for various reasons, including nonprogression of labor, breech positioning, multiple gestations, and hydrocephalus (excess fluid within the baby’s head). Depending on the circumstances, the procedure can be lifesaving for both the mother and the baby.
Planned C-sections can be scheduled by the mother or the doctor, and a medical reason isn’t always required. As awareness grows of the repercussions of C-sections on the baby, such as altered gut microbiome, a weaker immune system, and other health issues, there could be a decrease in the number of C-sections performed when they aren’t necessary.
C-Section Babies at Increased Risk of Health Problems
C-section babies are more likely to suffer from a wide variety of health problems because of their reduced diversity of gut microbes that affect metabolism and immune function (pdf). Stool studies in C-section babies showed that their microbiomes were dominated by bacterial species regularly found in hospitals and on the skin, such as Staphylococcus, Streptococcus, Klebsiella, and Enterococcus.
During the natural birthing process, the baby travels through the vagina, and a large number of microbes cover its body and are ingested. Stool studies in vaginally birthed babies revealed Lactobacillus, Bifidobacterium, Bacteroides, and Prevotella bacteria.
These bacteria become the seeds from which the baby’s gut microbiome will develop and one day expand into a mature and diverse state. The connection between the gut microbiome and immune function, metabolism, and a host of other physiological processes has been well-established over the past several decades.
Vaginal Seeding May Replicate Nature
Vaginal seeding was first discussed in a 2016 pilot study, which found that a healthy and diverse gut microbiome could be restored through a simple technique. Doctors inserted sterile gauze into the mother’s vagina an hour before performing the C-section. Within two minutes of delivery, the newborn babies were swabbed with the fluid-saturated gauze, beginning with their mouth, then their face, then the rest of their entire body. All mothers were screened for any harmful pathogens they could transfer to the infant, and seeding was only performed if all tests were negative for Group B Streptococcus and bacterial vaginosis and if vaginal pH was normal in the hour preceding the C-section.
The babies were tested one month after birth, and it was shown that the microbiomes of the vaginally seeded babies more closely resembled those of babies born vaginally when compared with the control group of babies born by C-section.
A more extensive observational study performed in 2021 (pdf) confirmed the results. Further, it expanded our understanding of the role of vaginal microbes in the developmental trajectory of a child’s gut microbiome. The study suggested that vaginal fluid and its microbes can seed pioneer species that will later facilitate the colonization of other beneficial microbes.
In addition to improving the child’s health, there is evidence that vaginal seeding can enhance the baby’s neurological development. In a recent triple-blinded study in China, 76 infants born by C-section were randomly separated between a vaginal-seeded group and a control group “seeded” with a saline solution.
Results revealed that in the vaginal-seeded group, there was a significant increase in neurodevelopment at 6 months of age compared with the control group. Neurodevelopment was measured by gross motor, communication, problem-solving, personal-social, and fine motor skills. Improvements in neurological development were correlated with improvements in the infants’ gut microbiomes and metabolomes.
Although not currently entirely accepted by large health care institutions and medical colleges such as the American College of Obstetricians and Gynecologists, the initial data are promising, and successful randomized, blinded studies have been performed. This simple procedure could reduce many health problems without exposing the baby to any more risk than that found in the traditional vaginal birthing process.
Once larger and more long-term trials are completed, vaginal seeding could one day become standard protocol in hospitals worldwide for babies delivered via C-section. There are tremendous implications of reducing the risk for infections, obesity, allergies, asthma, and autoimmune disease and improving the neurodevelopmental arc of close to one-third of babies.
