1. Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN

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There has been a lot of interest recently in the human microbiome. The last issue of MCN featured a four-article special topics series on mother and baby microbiomes and implications for nursing care during pregnancy, labor and birth, postpartum, and in the neonatal intensive care unit. Microbiome profiles of newborns birthed via cesarean vary significantly from babies born vaginally (Dunn, Jordan, Baker, & Carlson, 2017; Stokholm et al., 2016). As recent emerging evidence seems to suggest that cesarean birth is a risk factor for later development of childhood problems such as metabolic and inflammatory diseases including asthma, allergies, and other chronic immune disorders, some researchers have theorized that microbiome differences based on mode of birth may be a factor in occurrence of these pediatric health issues (American College of Obstetricians and Gynecologists [ACOG], 2016; Haahr et al., 2017).


As a method to alter the microbiome of a cesarean-born baby to be more similar to a vaginally born baby, researchers tested wiping cesarean-born babies with swabs that were in their mother's vagina for approximately an hour before cesarean birth (Dominguez-Bello et al., 2016). They found they were able to partially restore the microbiota of cesarean-born babies with this technique (Dominguez-Bello et al.). Others studied differences in the baby microbiome at birth and at 6 weeks of age and found no significant differences based on mode of birth by 6 weeks (Chu et al., 2017), thus they concluded clinical implications of microbiome differences at birth may be negligible if any.


In November 2016, ACOG issued a practice advisory on vaginal seeding in response to obstetricians reporting requests from women for this procedure. According to ACOG (2016), theoretically, benefits of vaginal seeding may seem biologically plausible; however, there is no supportive evidence on risks and potential harm to the baby. Transfer of some pathogens, which may be asymptomatic in the mother, could cause severe adverse consequences for babies, including "group B streptococcus, herpes simplex virus, Chlamydia trachomatis, and Neisseria gonorrhea" (ACOG, p. 1). An editorial in BMJ in February 2016 by pediatricians in the United Kingdom offered similar warnings (Cunnington et al., 2016). In August 2017, a group of Danish obstetricians and pediatricians authored a commentary with detailed recommendations against vaginal seeding and included a patient information handout (Haahr et al., 2017).


Until there is rigorous evidence to support benefits of vaginal seeding and evidence confirms those benefits outweigh risk of unintended harm to newborn babies, vaginal seeding should not be performed (ACOG, 2016; Cunnington et al., 2016; Haahr et al., 2017). Nurses should be aware of the growing interest in vaginal seeding, be knowledgeable about the evolving research, and be able to effectively discuss it with parents. As per ACOG, vaginal seeding is not appropriate at this time based on the current state of the science and could result in serious harm.




American College of Obstetricians and Gynecologists. (2016). Vaginal seeding (Practice Advisory). Washington, DC: Author. Retrieved from https:// [Context Link]


Chu D. M., Ma J., Prince A. L., Antony K. M., Seferovic M. D., Aagaard K. M. (2017). Maturation of the infant microbiome community structure and function across multiple body sites and in relation to mode of delivery. Nature Medicine, 23(3), 314-326. doi:10.1038/nm.4272 [Context Link]


Cunnington A. J., Sim K., Deierl A., Kroll J. S., Brannigan E., Darby J. (2016). "Vaginal seeding" of infants born by caesarean section. BMJ, 352, i227. doi:10.1136/bmj.i227 [Context Link]


Dominguez-Bello M. G., De Jesus-Laboy K. M., Shen N., Cox L. M., Amir A., Gonzalez A., ..., Clemente J. C. (2016). Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer. Nature Medicine, 22(3), 250-253. doi:10.1038/nm.4039 [Context Link]


Dunn A. B., Jordan S., Baker B. J., Carlson N. S. (2017). The maternal infant microbiome: Considerations for labor and birth. MCN. The American Journal of Maternal Child Nursing, Aug 18. doi:10.1097/nmc.0000000000000373. [Epub ahead of print] [Context Link]


Haahr T., Glavind J., Axelsson P., Bistrup Fischer M., Bjurstrom J., Andresdottir G., ..., Clausen T. D. (2017). Vaginal seeding or vaginal microbial transfer from the mother to the caesarean-born neonate: A commentary regarding clinical management. BJOG, Aug 23. doi:10.1111/1471-0528.14792. [Epub ahead of print] [Context Link]


Stokholm J., Thorsen J., Chawes B. L., Schjorring S., Krogfelt K. A., Bonnelykke K., Bisgaard H. (2016). Cesarean section changes neonatal gut colonization. The Journal of Allergy and Clinical Immunology, 138(3), 881.e2-889.e2. doi:10.1016/j.jaci.2016.01.028 [Context Link]