Vaginal Seeding after a Caesarean Birth: Safe? Effective? What does the EVIDENCE say?

caesarean birth Vaginal Seeding after a caesarean birth – what’s it all about?

The news this week has been all about vaginas – specifically the idea of “seeding” a newborn’s gut with a swab from the vagina after a caesarean birth.

Vaginal Seeding after a caesarean birth was first widely covered in the film “Microbirth” which covered the work by Maria Dominguez-Bello and her colleagues, looking at whether the differences in gut bacteria between vaginally and caesarean born babies was due to the fact that caesarean born babies do not absorb gut flora from their mother’s vagina. Because these differences are linked to long term health problems, the research is attempting to find whether the swabs help to change the gut bacteria in a positive way.

The results of the pilot study were very positive, with the gut bacteria of 100% of the “seeded” caesarean-born babies being very similar to those of the vaginally born babies, in contrast to the caesarean-born babies who were not seeded where 100% of them had a different microbiome. The authors state that they don’t yet know whether this would impact the baby’s health over time, nor whether the results would replicate with a wider study group, and more work needs to be done.

Concerns have been raised about the risk of infection from vaginal seeding, and the original paper which triggered the media storm recommends not doing vaginal seeding following a birth which was planned as a caesarean specifically in order to reduce the risk of infection from, say, HIV or herpes.  Surely this is self evident? There is also a question of whether pathogens such as Group B Strep (GBS) may put babies at risk – but as many as 1/3 of women carry GBS at the time of a vaginal birth, and there is no reason to think that this would be more readily passed on through seeding than a vaginal birth although this would be important to look at in future studies.

It has also been suggested that amniotic fluid may “wash” the vagina and change the flora experienced by babies passing through during birth compared with seeding the baby after a caesarean birth. The authors of the pilot found that there was no difference in a woman’s vaginal flora before and after birth, so this does not seem to be the case, and most babies do not simply flow down on a wave of fluid!

Perhaps one consideration is that babies are often born with their eyes and mouths closed, and so when considering vaginal swabbing, it would be useful to know whether the swab should be put into the baby’s mouth or eyes, or simply wiped over them. Timing of when is best to use the swab needs to be better understood, and the pilot study says that parents should be aware that skin to skin and breastfeeding are well understood to be extremely important to a baby’s gut health and long term health.

The pilot was very small, with only 18 babies in the study, and the authors are clear that more research is needed. This is contrary to much of the misleading media coverage which has stated that there is no evidence for vaginal seeding after a caesarean birth. There is, it’s just a very small sample study and is not sufficient to change recommendations.

If only medicine was always this diligent.

Guest post by Emma Ashworth

Airedale NHS Trust – Leading the Way!

On almost the same day that Airedale NHS Trust, Yorkshire, announced that it is welcoming independent midwives onto their midwifery bank, a study into The Albany, one of the finest examples of midwifery caseloading in the UK, has yet again shown how the outcomes of caseloading and continuity are outstanding, for women, families, midwives and indeed the NHS. (Click for full Albany document)
Airedale NHS has joined a number of NHS Trusts who have recognised that independent midwives and NHS health professionals are a team who can work together to improve care for women, and to improve NHS services. They have welcomed independent midwives onto their bank contract system, ensuring that women who were left without their known and trusted midwife following the NMC’s decision can now obtain antenatal, labour and postnatal care from the midwife that they have chosen. This applies to existing and to new clients, and is not limited to the Airedale geographical area.
A Yorkshire independent midwife who is part of the new arrangement explained the workings of the IM’s holding bank contracts & what that means for them & the women.

 
‘Under these new arrangements we will use a bank contract from AGH [Airedale] when attending our clients in labour to ensure that we have indemnity insurance in place as required by the NMC for registration. This situation is fully discussed with our clients during the antenatal period. We use NICE as a starting point for our care discussion already and most guidance from AGH is the same. If there are any differences between NICE and AGH’s guidelines, we will discuss them. AGH understand that many women opting for IM care do so because they want care which is different to hospital/NICE guidelines, and they respect that. If women choose to have us care for them under AGH bank contract for birth (some may choose alternatives) we have to acknowledge their guidance, discuss this with the woman and document the choices then made. We will be being supported in this by Sarah at AGH who will complete the hospital ‘risk assessment’ process for us by offering women a phone or meeting consultation where their choices can be documented so correct procedures are being followed internally. Women remain completely able to make the choices they wish and we will support them fully in their decisions’.

 
In return, the local IMs will work with Airedale Trust on joint training projects, sharing knowledge and experience and improving the maternity care offered by all. The IMs will also act as back up to the Trust’s homebirth service, especially to support women with more complex needs for which specific IMs have extensive experience in the context of home birth.

NOT a solution to the IMUK/NMC Crisis
It is essential to understand that this does not resolve the fact that the NMC have refused to allow midwives using the IMUK’s indemnity solution, despite the NMC’s statement to IMUK that, “We (the NMC) are unable to advise you about the level of cover that you need. We consider that you are in the best position to determine, with your indemnity provider, what level of cover is appropriate for your practice”
While this offers independent midwives the ability to be able to work and support women and families, and while we are hugely grateful for the support and understanding of Airedale Trust, this is still not midwives being truly independent. The fight continues!
#savethemidwife
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