Giving babies a swab of vaginal fluid after they鈥檝e been born by caesarean section gives them a different, and possibly beneficial, set of gut bacteria.
The dramatic transition from womb to world is the time when a baby ingests some of the first bacteria that will colonise its guts. But babies born by C-section miss out on this process, and end up with a different set of bugs 鈥� including some from the hospital environment.
A number of studies have found evidence that this C-section microbiome could make the child more vulnerable to problems later in life, such as , food allergies, and . 鈥淢aybe we can reduce this risk by restoring the microbiome of C-section babies,鈥� says at Mount Sinai School of Medicine in New York City.
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We are still getting to grips with just how important the collection of bacteria in our guts 鈥� and other body sites 鈥� are for our health. The gut microbiome starts developing in the womb but the process really takes off during birth itself, when babies pick up bacteria from their mother鈥檚 vaginal canal and skin.
Bacterial bath
For the last few years, Clemente, along with of New York University and their colleagues, have been trying to replicate this process. Before a planned caesarean, they give women a sterile gauze, which is concertina-folded and inserted like a tampon about an hour before the surgery. Just before the women enter the operating theatre, the gauze is removed and bagged. Within 2 or 3 minutes of the baby being born, its mouth, body and anus are swabbed with the gauze.
The team presented some of their early work at a conference a couple of years ago. Word of the procedure spread, and some women started asking midwives and doctors to help them 鈥渟eed鈥� their own babies, many after seeing a 2014 (see 鈥淚 swabbed my newborn baby with my vaginal fluid鈥�, below). Now, the group has published their first findings 鈥� that seeding really does seem to give a C-section baby a more 鈥渧aginal birth-like鈥� microbiome.
The study was small: 18 mothers were included, of whom seven had vaginal births and 11 C-sections. Four of the C-section babies were swabbed with their mother鈥檚 vaginal fluid. The team then sampled bacteria from the babies鈥� mouths, anuses and a range of body sites one, two and three days after birth, and then weekly for a month.
鈥淭he C-section babies that were swabbed had a more vaginal-like microbiota than those that weren鈥檛,鈥� says Clemente. For example, there were blooms of a type of bacteria called Lactobacillus in the vaginal-born and the swabbed babies but not in the other C-section babies. It is too soon to tell whether these changes will have any effect on the baby鈥檚 long-term health, however.
Health effects?
鈥淚t is hard to know whether the changes will last, and if they are sufficient to prime the immune system,鈥� says of Imperial College London. 鈥淏ut it鈥檚 a cheap and easy way of exposing C-section babies to vaginal bacteria at birth.鈥�
Before the procedure, the team screened the mothers for harmful bacteria, such as group B Streptococcus, as well as some viral and fungal infections. Still, as with faecal transplants no one can be certain of not transferring something that might cause disease, or put a baby at increased risk of disease in the future.
Clemente thinks the procedure is safe. 鈥淚f you were born vaginally, you鈥檇 be exposed to the bacteria anyway,鈥� he says. 鈥淚 would do it.鈥� However, he also advises people not to try the procedure without talking to their doctor. 鈥淚t鈥檚 not particularly complex, but we want to minimise the risk of transferring pathogenic bacteria,鈥� he says.
MacIntyre is more cautious. 鈥淲e still don鈥檛 know what a healthy gut microbiome is, and how it relates to the vaginal microbiome,鈥� he says. 鈥淲hat bacteria would you want to transmit? If a mother is obese or diabetic, for example, it might not be a good idea to transfer her microbiome.鈥� MacIntyre says he would want to wait for more evidence that the procedure is indeed beneficial before trying it himself.
Clemente and his colleagues are continuing their research, and hope to identify specific types of bacteria that are beneficial to newborns. 鈥淢aybe 10 years in the future we can find a more effective way to deliver the important microbes,鈥� he says. 鈥淭he field is still very much in its infancy.鈥�
Journal reference: Nature Medicine, DOI:
"I'd done a lot of reading around the microbiome, and it seemed worth a go," says Viv Kuh, who lives in Bristol in the UK. Kuh decided to seed her daughter with vaginal microbiota when she was born by C-section last February. It was Kuh's midwife who first brought up the idea, after seeing a film describing the procedure. Kuh had previously given birth to a baby via an unplanned C-section, and was preparing for a second. She was aware of recent research demonstrating the importance of a healthy gut microbiome for immune health, and how this might be compromised in children born by caeasarean section. "I was quite ill as a child, and had chronic bronchitis," says Kuh. "My son [who was not swabbed after his C-section birth] was going down the same route. So seeding seemed worth trying for my daughter, although I'm not sure my microbiome is any good." When Kuh asked doctors to help her perform the procedure, "they didn't know what we were talking about," she says. "They looked at us as if we were quite strange." The surgical team went ahead with Kuh's request anyway. A sterile gauze was inserted before entering the operating room, and was removed after surgery to allow her husband to swab her daughter's face and neck.
I swabbed my newborn baby with my vaginal fluid
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