Caution is key when it comes to ‘vaginal seeding’

Our clinicians are seeing a rise in the number of parents requesting so-called ‘vaginal seeding,’ also known as microbirthing. The practice involves taking a swab from a woman’s vagina shortly after she has given birth to a baby via caesarean section. The swab is then wiped over the baby’s mouth, eyes, face and skin in the hopes that microbiota – beneficial bacteria – from the birth canal will boost the baby’s gut bacteria and reduce their risk of conditions such as allergies or obesity. Despite the popularity of this practice, there is not enough evidence to suggest that it actually helps the baby’s health, according to Dr Aubrey Cunnington, honorary consultant in paediatric infectious diseases at Imperial College Healthcare NHS Trust and clinical senior lecturer at Imperial College London. In a recent editorial published in the BMJ, Dr Cunnington argued that vaginal seeding could put babies at risk by transferring harmful bacteria. Here, Dr Cunnington outlines why medical professionals are not in the position to recommend or encourage vaginal seeding and why healthcare staff will not perform this procedure at the Trust’s hospitals.

I first looked into the procedure of vaginal seeding when I had a weekly meeting with neonatologists at St Mary’s Hospital and Queen Charlotte’s & Chelsea Hospital to discuss infectious diseases cases. One of the neonatologists mentioned to me that she had a patient who had requested vaginal seeding and the midwife was planning on doing the procedure. However, the consultant found out that the mother had a history of genital herpes and persuaded her not to go ahead with the procedure. This prompted me to look into vaginal seeding in more detail and I discussed it with my colleagues at the Trust and the College, who informed me that they have been asked more than once or twice to perform this procedure. We looked at current medical literature and we found that there is no evidence to suggest that the procedure provides any benefits for the baby or that it’s safe, at this stage vaginal seeding is just a theory.

In fact, mothers could be putting their newborns at risk of serious infections by following this practice. We believe there is a potential risk of transferring harmful bacteria, such as group B streptococcus, to the baby via the swab. This is bacteria found normally in the intestine, vagina, and rectal area in about 25 per cent of all healthy women. Group B strep can cause fatal infections in a baby such as meningitis and septicaemia. The herpes virus can cause severe brain infections, multi-organ failure and eye damage if left untreated. Although, a baby would be exposed to the same germs during a vaginal birth, after a caesarean section staff would not realise a baby has been exposed to this bacteria, should a newborn fall ill as a result of seeding.

We have advised our healthcare professionals at the Trust not to perform this procedure as we believe that the small risk of harm outweighs the possible benefits, as we don’t yet have evidence that it boosts the baby’s health.

From anecdotal evidence from patients one of the reasons why this practice is so popular in the UK is that it has been encouraged through National Childbirth Trust (NCT) classes. NCT practitioners should present both sides of the argument when discussing vaginal seeding to parents. The practitioners should tell mothers what evidence there is to show that this practice is beneficial and what are the potential risks of it. I don’t think this message is being conveyed strongly enough.

Since the publication of our article in the BMJ, one part of our research that we have discussed further is whether screening for infections such as group B strep during pregnancy would mitigate the risk of vaginal seeding. I think a screening programme could dramatically reduce the risk associated with the practice and if that was available then patients could think about getting it done. However, we would need to consider the costs associated with screening tests and who would pay for it. 

My advice to mothers who are thinking about having this procedure is to discuss this with their doctors first so that they are fully informed and are aware of the risks involved. If they are worried about the fact that there are some types of immune based diseases such as asthma and obesity which are associated with caesarean sections these risks are very small. Even if vaginal seeding worked and it partly reduced those risks it wouldn’t make a huge difference to the child’s long term health. Parents can perform the procedure themselves but I would also advise them to let their healthcare professionals know that their baby has received vaginal seeding if the baby becomes unwell.

Finally, parents who want to give their babies a healthy microbiota should focus on breastfeeding, if possible, and avoid unnecessary antibiotic exposure as these can alter the microbiota.

Read more of Dr Cunnington’s BMJ editorial on vaginal seeding.