C-Section Babies

Damage Control: Can We Restore the Microbes of C-Section Babies?
November 19th, 2017

It’s been well established that babies delivered vaginally have better health outcomes than those born via C-section. This is in large part because the microbiome – the mix of some 100-trillion bacteria and other microbes on and in the body – is quite different in C-section babies. This can affect mental health, digestion, immune function, and other facets of our wellbeing. Studies even demonstrate that children born via C-section are twice as likely to be obese later in life.[1], [2]

But why is the microbiome so different in these children?

C-Section BabiesVaginally born babies enter the world through their mothers’ vaginas, swallowing and absorbing the mix of microbes found there as they pass through. They also typically emerge facing towards the mother’s rectum, further adding some more diversity to their microbial mix. Babies born via C-section, however, exit mom’s body through an incision made in the uterus, taking in whatever microbes happen to be transiently floating around in the air of the operating room.

Probiotic supplements have been shown to help decrease the risk of allergies[3], eczema[4], [5], and a host of other ailments in children. But can we do anything else for these children? Can we intervene even sooner?

New research suggests yes. A practice known as “microbial seeding” or “vaginal swabbing” may hold the key to microbial balance for C-section babies. To “seed” a C-section baby, an expectant mother inserts a piece of sterile gauze into her vagina for an hour. She then removes the gauze and places it into a sealed container until the birth of her child, at which time the gauze is wiped over the baby’s eyes, nose, and mouth to mimic the inoculation he would have received had he passed through the birth canal. The research on the therapy is limited, and the studies small. But the data do show that C-section babies who undergo “seeding” have a microbial composition closer to that of naturally-born babies and less like that of their “un-seeded” C-section counterparts.[6] But will these children actually be healthier in the long run? Time will tell.

Seeding is not without its risks, however. If mother has Group B Strep (GBS), HIV, or other infection that can be transmitted through vaginal fluids, seeding may expose the baby and potentially cause him harm. If a mother is getting routine prenatal care, however, she will likely be screened for such infections and will know her status prior to delivery, therefore empowering her to make an informed decision.

Some obstetricians roll their eyes at seeding, saying there’s not enough evidence to warrant its practice. Nevertheless, many an expectant mother is slipping gloves and sterile gauze into her birthing bag in the meantime. The therapeutic promise of seeding is by no means a reason for us to tolerate the disturbingly high C-section rate in this country, but it may afford us some damage control.

 

Guest post by: Dr. Erica Zelfand, Family Physician

 


[1] Huh S, Rifas=Shiman SL, Zera CA, Edwards JW, Oken E, Weiss ST, Gillman MW. Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study.
 Arch Dis Child. 2012 Jul;97(7):610-6. doi: 10.1136/archdischild-2011-301141. Epub 2012 May 23. PMID: 22623615

[2] Pluymen LPSmit HAWijga AHGehring UDe Jongste JCVan Rossem L. Cesarean Delivery, Overweight throughout Childhood, and Blood Pressure in Adolescence. J Pediatr. 2016 Dec;179:111-117.e3. doi: 10.1016/j.jpeds.2016.08.059. Epub 2016 Sep 26. PMID: 27686586

[3] 
Vliagoftis V, Kouranos V, Betsi G, Falagas M. Probiotics forthe treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. Annals of Allergy, Asthma & Immunology 101:6, 200

[4] Kalliomäki M, Salminen S, Poussa T, Arvilommi H, Isolauri E.Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet. 2003 May 31;361(9372):1869-71

[5] Kalliomaki M, Salminen S, Poussa T, et al. Probiotics during the first 7 years of life: a cumulative risk reduction of eczema in a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2007;119:9–21.

[6] Dominguez-Bello M, De Jesus-Laboy KM, Shen N, Cox, LM, Amir A, Gonzalez A, et al. Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer. Nat Med. 2016 Mar;22(3):250-3. doi: 10.1038/nm.4039. Epub 2016 Feb 1. PMID: 26828196

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Dr. Erica Zelfand
Dr. Erica Zelfand