Let Them Eat Dirt. B. Brett Finlay

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СКАЧАТЬ If there are any signs of a vaginal infection (itchiness, burning sensation during urination, or abnormal discharge), it’s recommended that the mother consult a doctor and follow treatment with oral and vaginal probiotics as appropriate. In fact, given the proven safety of probiotics during pregnancy, all expectant mothers should consider including probiotics in their diet, especially in the weeks preceding birth (see additional recommendations in chapter 3).

      If one could view birth through a microscope, a C-section is drastically different than a vaginal delivery: their microbiota is remarkably dissimilar. Studies comparing the gut microbiota of newborns in the days and weeks following birth consistently show that babies born by C-section have lower numbers of Lactobacillus and Bifidobacterium, as well as divergences in several other bacteria. These babies are colonized by microbes often found on skin, soil, and other external surfaces, instead of vaginal and fecal microbes. Even more worrisome, some of these differences persist and can still be detected when children are seven years old, according to a 2014 Dutch study.

      To better understand how different a C-section is in the context of microbes, lets trace a baby’s possible route of microbial exposure following a C-section. The brand-new bundle of joy goes from the doctor’s sterile gloved hands to a table or a scale where he’s touched with medical utensils and cloths. He may also brush someone’s lab coat or hand in the process. If all is well, minutes later the baby is brought to his parents, and they can finally touch and kiss him, providing skin and mouth contact. Very often the baby is not allowed to breastfeed until his mother has started to recover from the anesthesia, which takes hours in most cases (although a few hospitals are now allowing this right after delivery). During this period, the baby will likely be wiped clean, warmly bundled in a clean hospital blanket, and placed in a cot, heated by a lamp, where he is offered warm (sterile) formula. During all this, the baby is exposed to the air, which has many microbes, but they are very different from mom’s microbes, the ones humans are adapted to get exposed to at birth. It can take up to two hours before the baby is returned to his mother, when he can finally try breastfeeding for the first time.

Seeding Hope for the Future

      Clearly, a baby born via C-section surely misses out on something crucial: that first splash of mom’s microbes. But rather than judging mothers who have decided to give birth this way, whether by choice or due to medical necessity, we need to look at what can be done to make C-sections a more microbiota-friendly choice.

      How can one restore a baby’s microbiota following a C-section? If you think about it, the way vaginally born babies are exposed to microbes is very simple: they come in contact with vaginal secretions. Why not inoculate a baby born by C-section with mom’s vaginal secretions shortly after birth? Such procedures, called “seeding,” are currently being used and tested in several hospitals around the world, and have been gaining an increasing amount of attention.

      Veronica, a thirty-three-year-old mom from Edmonton, Canada, had to schedule a C-section some weeks prior to her due date because her baby was in breech position. However, she was aware of the importance of imparting her microbiota to her baby during vaginal birth and decided to talk to her midwife about this. Her midwife came up with a plan. She inserted a piece of sterile gauze into Veronica’s vagina while she was waiting to be taken to the operating room. Minutes before her C-section, her midwife removed the gauze and placed it in a sterile glass container. Right after their baby girl was born, Veronica’s husband took the gauze with gloved hands and swabbed it inside the baby’s mouth and on her skin. Veronica also swabbed her own nipples, with the hope that the infant would take in even more vaginal microbes while breastfeeding.

      As far-fetched as this method may sound, Veronica is part of a growing trend of moms and health practitioners who are trying it. Not only does it make scientific sense, but there’s also scientific evidence backing up its effectiveness. Dr. Maria Dominguez-Bello, a scientist at NYU and a leading expert in the field of microbiota studies, has focused her attention on the development of early microbiota. She recently conducted a study involving eighteen births, in which babies born by C-section were “seeded” with mom’s vaginal secretions and placed on mom’s chest. Her team found that this process resulted in the microbiota of “seeded” babies becoming much more similar to that of a baby born vaginally. “While not equivalent to a baby born vaginally, there is some important restoration happening,” she says. It’s still unknown whether this simple procedure will reduce a baby’s risk of suffering a chronic illness later in life. Her research group will follow up with these children in the years to come. Additionally, her group is working on conducting a much larger study that can provide sufficient evidence in terms of the safety of this practice. In the meantime, there’s a compelling argument that women planning to have a C-section should discuss this option with their doctor or midwife.

Antibiotics During Birth

      Antibiotics are routinely administered in conjunction with a C-section, given intravenously as a precaution against infection. As one can imagine, with the surge in C-sections, there has been a similar increase in the use of antibiotics during birth. In this instance, the antibiotics are truly necessary, as 10–15 percent of women that undergo C-sections will develop an infection. But it’s up for debate whether the antibiotics have to be administered before surgery, or if it can wait until after the baby has been delivered. If given before the C-section, the baby will likely be exposed to the antibiotics, further compromising her microbiota at birth. If given after, the mother will still get the treatment she needs to prevent an infection and the baby will not be directly exposed to the antibiotic.

      This was the case for Carley, now the mom of a healthy three-month-old daughter. During a doctor visit early in her third trimester, Carley learned she would have to deliver her baby via C-section (an umbilical cord abnormality made a vaginal birth too risky). As a naturopathic doctor herself, Carley had hoped for a vaginal birth, but she was aware of the need for a C-section for the safety of both her and her baby in this case. At the same time, Carley was aware that C-section babies have an increased risk of developing allergies, asthma, and obesity, with current research showing that a difference in microbial exposure influenced this risk. She had been taking daily probiotics throughout her pregnancy, but knowing that she would receive antibiotics before her birth, she was concerned that her baby would not received the optimal amount and type of microbes during birth. Carley explained her concerns to her obstetrician, who agreed to administer the antibiotics after her baby was born. They also agreed to “seed” her baby with her vaginal secretions after birth. Carley’s C-section went smoothly and she recovered very well from it. She continued to take probiotics and to eat a healthy and varied diet to help restore her microbiota afterwards.

      As in Carley’s case, doctors are getting an increasing number of requests to administer antibiotics to the mother only after the baby is delivered, and even to forego antibiotic treatment altogether. While delaying the administration of antibiotics is a reasonable proposition, eliminating antibiotics during a major surgical procedure puts the mother at a very significant risk of infection. Like all medical decisions, the risks must not outweigh a patient’s benefits. In this case, the desire to protect the mother’s microbiota is outweighed by the increased risk of a severe infection acquired during surgery.

      Another common use of antibiotics at birth is the application of antibiotic ointment (erythromycin) in the eyes of newborns. This is routine in the US and Canada, aimed at preventing the development of eye infections from the bacteria that cause gonorrhea and blindness caused by chlamydia. Because the possible outcome of these infections in a newborn is so severe, it is a medical indication in all births, although countries such as Australia, the UK, Norway, and Sweden forego the practice. In the US, thirty-two states are required by law to administer this treatment, regardless of whether the mother has chlamydia or gonorrhea, or whether the baby was born vaginally or via C-section (the infection can occur only during a vaginal birth). Recently, the Canadian Paediatric Society stopped recommending routine eye prophylaxis; however, this has not yet filtered down to common practice and many children still СКАЧАТЬ