Whenever I give a talk at a conference, or during a Q&A after a film screening of Microbirth, or at a book event, or posted as a comment in the discussion about the free webinar, the same questions tend to crop up. These questions are answered in much more detail within the 9 hour course, but I thought I would provide quick answers in a series of FAQ themed blog-posts.

Frequently Asked Question:

"Swab-seeding" for babies born by C-section

What's the problem with C-section?

As explained in the free webinar (a quick summary) and full 9 hour course (in much more detail) whilst in the womb, a baby develops in a near-sterile environment protected by an amniotic sac. The baby might receive some prenatal exposure to small colonies of bacteria from the mother's womb, amniotic sac and placenta - but the main founding of the infant microbiome begins when the amniotic sac is ruptured.

With vaginal birth, the rupturing of the amniotic sac, otherwise known as the waters breaking, usually happens sometime during labour. This opens the doors to the baby being covered in the mother's vaginal bacteria in the birth canal.

With C-section, as the baby doesn't pass all the through the birth canal, so the infant isn't exposed to the full "payload" of the mother's vaginal bacteria (unless the amniotic sac has ruptured prior to the C-section being performed). In addition, the infant won't usually come into contact with the mother's fecal matter during surgery so is unlikely to be exposed to the mother's gut bacteria.

Instead, if the waters are still intact when the C-section surgery begins, the infant's first main exposure to the world of bacteria occurs when the surgeon opens the amniotic sac whilst the baby is still inside the womb.

Assistant Professor Maria Gloria Dominguez Bello from New York University, one of the key scientists featured in our Microbirth School online courses, found that with C-section babies, they are exposed to airborne bacteria likely to originate from the skin of someone in the operating theatre. Then as with vaginal born babies, more bacteria is acquired from every breath, from being touched, handled, kissed and fed.

Whether it is because of the resulting 'altered' infant microbiome, or epigenetics, or a combination of both the microbiome and epigenetics or another reason altogether, research suggests that babies born by C-section are at increased risk of developing immune-related disease including asthma, type 1 diabetes, coeliac disease and increased risk of becoming overweight/obese later in life.

{IMAGE CREDIT: Fadhley, Salim (2014). "Caesarean section photography". Wikiversity Journal of Medicine 1 (2). DOI:10.15347/wjm/2014.006. ISSN 20018762. -Cesarian the moment of birth.jpg, FAL, https://commons.wikimedia.org/w/index.php?curid=42...}

What is "swab-seeding"?

To help partially restore the altered infant microbiome of babies born by C-section so that they are more similar to the microbiome of vaginally born babies, Dr Dominguez Bello and her colleagues are currently researching a technique called “swab-seeding”.

{IMAGE CREDIT: Alto Films Ltd 2017)

PHOTO: Dr Maria Gloria Dominguez Bello, Associate Professor, New York University, pioneer of ground-breaking "swab-seeding" research.

The "swab-seeding" technique involves wiping the mouth, face and body of a newly born C-section infant with a swab taken from the mother's vagina, with the idea of partially restoring some of the bacteria the infant would have received if born vaginally.

Right now, even though some institutions are supporting mothers who specifically request "swab-seeding", it is not a recognised medical procedure. There are risks involved with this "swab-seeding" technique especially if the mother tests positive for pathogens during pregnancy. Plus a baby that has been "swab-seeded" would still miss out on receiving exposure to the mother's gut bacteria, and would still not experience the potentially beneficial epigenetic changes associated with vaginal birth. (The full length 9 hour course goes into this technique, the risks and the preliminary results of Dr Dominguez Bello's research in much more detail)

{IMAGE CREDIT: By HBR - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=66...}

Given that C-sections are not going to go away as they are an important often life-saving procedure, could "swab-seeding" become a recognised medical procedure in the future?

Well, quite possibly. Dr Dominguez-Bello's research into "swab-seeding" is ongoing and the full results of her research will not be published for some time. When they are finally published, if the full results conclude that "swab-seeding" does indeed partially restore an "altered" infant microbiome (providing the strict study protocols are followed), and also if the results show that this technique can be beneficial to a child's long-term health without any negative side-effects, then perhaps "swab-seeding" could potentially become a recognised medical procedure in the future. Or perhaps in the meantime other evidence-based solutions will emerge. Only time will tell.

However a baby is born (whether vaginally born or by C-section), and wherever a baby is born ( at home, hospital or other alternative), research suggests that in terms of establishing the baby's microbiome for the optimal development of the infant immune system, ideally the baby would be delivered straight onto to the mother's chest to allow for immediate skin-to-skin contact (unless the mother or baby needed emergency treatment) and for the baby to be exclusively breastfed.

For more information about the critical importance of vaginal birth (when possible), immediate skin-to-skin contact and exclusive breastfeeding, do consider checking out our regular free webinars.

For much more in-depth knowledge about the implications of C-section and for more detail about the technique, risks and benefits of "swab-seeding", then do consider checking our full-length Microbirth Online Course.

Scientific References

The Human Microbiome before Birth

Blaser, Martin J; Dominguez-Bello, Maria G

Cell host & microbe. 2016:20(5):558-560.DOI: 10.1016/j.chom.2016.10.014

Antibiotics, birth mode, and diet shape microbiome maturation during early life

Bokulich, Nicholas A; Chung, Jennifer; Battaglia, Thomas; Henderson, Nora; Jay, Melanie; Li, Huilin; D Lieber, Arnon; Wu, Fen; Perez-Perez, Guillermo I; Chen, Yu; Schweizer, William; Zheng, Xuhui; Contreras, Monica; Dominguez-Bello, Maria Gloria; Blaser, Martin J

Science translational medicine. 2016:8(343):343ra82-343ra82.DOI: 10.1126/scitranslmed.aad7121

Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer

Dominguez-Bello, Maria G; De Jesus-Laboy, Kassandra M; Shen, Nan; Cox, Laura M; Amir, Amnon; Gonzalez, Antonio; Bokulich, Nicholas A; Song, Se Jin; Hoashi, Marina; Rivera-Vinas, Juana I; Mendez, Keimari; Knight, Rob; Clemente, Jose C

Nature medicine. 2016:22(3):250-253.DOI: 10.1038/nm.4039

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