Your Baby's Microbiome: the Critical Role of Vaginal Birth and Breastfeeding for Lifelong Health

The Human Microbiome: considerations for pregnancy, nativity and early on mothering

This post was co-authored by Jessie Johnson-Cash and based on her presentation at the USC Midwifery Education Day.

The human being microbiome is rather fashionable in the world of science at the moment. The NIH Human Microbiome Project has been ready to explore correlations between the microbiome and human health and affliction. To date the human being microbiome as been associated with, amongst other things obesity, cancer, mental health disorders, asthma, and autism. In this postal service I am not going to provide a comprehensive literature review – this has already been done, and the fundamental reviews underpinning this give-and-take are: Matamoros et al. (2012) 'evolution of intestinal microbiota in infants and its bear upon on health' and Collado et al. (2012) 'microbial ecology and host-microbiota interactions during early life stages'. Instead I am going to focus on what this ways for pregnancy, birth, mothering and midwifery.

What is the man microbiome?

Based on a chart by Matamoro et al. 2013. Adapted and extended by Jessie Johnson-Greenbacks.

Considerations for mothers and midwives

The following are not inquiry based recommendations – the enquiry is withal to be done. They are more considerations/questions arising from the developing knowledge effectually the man microbiome.

Pre-conception and Pregnancy

The unremarkably accustomed belief that the the babe inside the uterus is sterile (whilst membranes are intact) is beingness challenged. It seems that maternal gut microbiota may be able to translocate to the baby/placenta via the blood stream (Jiménez et al. 2008; Metamoros et al. 2013; Prince et al. 2014; Rautava et al. 2013; Zimmer 2013). And the unique ecosystem of bacteria in the placenta may originate from bacteria in the female parent'south mouth. Women's gut microbiota change during pregnancy and this impacts on metabolism (Koren et al. 2012; Prince et al. 2014). And so ideally, women need to head into pregnancy with a salubrious microbiome and then maintain information technology. Unfortunately our modern lifestyle is not very microbiome friendly, and many of us have dysbiosis (an imbalance in gut bacteria). Dysbiosis and too much of the 'wrong' leaner has been linked to premature rupture of membranes and premature birth (Fortner et al. 2014; Mysorekar & Cao 2014; Prince et al. 2014). Glue affliction (leaner) has also been linked to pre-term nascency. Suggestions:

• You are what you eat… and you are the microbiota that you feed. Eat foods that nurture your microbiome: don't swallow toxins; eat fermentable fibres – starchy vegetables such as sweet potatos – they are microbiota food; eat fermented foods – kefir, sauerkraut etc. – they provide probiotics. Dietary probiotic foods may too aid with balancing vaginal microbiota (Hantoushzadeh et al. 2012; Rautava et al. 2013).
• If your gut is damaged heal it and restore the balance of microbiota. This may involve taking probiotics.
• Minimise stress. Stress messes with your gut microbiota – Chris Kresser explains how – and mother'south may laissez passer on the furnishings of stress to their baby via bacteria (Bailey et al. 2011; Zijimans 2015). Perhaps antenatal intendance should involve reassuring words and a relaxing massage rather than constant clinical testing and discussions about risk?
• Avoid antimicrobial skin products (eg. handwashes), and business firm cleaning products – yous can picket a youtube explaining the FDAs concerns about such products.
• Avert unnecessary pharmaceutical drugs (Bengmark 2012) particularly antibiotics (Cotter et al. 2012). See Chris Kresser for more details re. antibiotics and what to do if y'all demand to take them.
• Stop smoking (Biedermann et al. 2013).

Birth

There is a difference between the microbiome of a babe born vaginally compared to a baby born by c-section (Azad, et al. 2013; Penders et al. 2006; Prince et al. 2014). During a vaginal nascence the babe is colonised by maternal vaginal and faecal bacteria. Initial human bacterial colonies resemble the maternal vaginal microbiota – predominately Lactobacillus, Prevotella and Sneathia. A baby built-in by c-section is colonised by the bacteria in the hospital surround and maternal skin – predominately Staphylocci and C difficile. They as well have significantly lower levels of Bifidobacterium and lower bacterial diversity than vaginally born babies. These differences in the microbiome 'seeding' may exist the reason for the long-term increased risk of item diseases for babies born by c-section.

The environment in which the baby is born also influences their initial colonisation. A study by Penders et al. (2006) found that term infants born vaginally at home and then breastfed exclusively had the most 'beneficial' gut microbiota. Information technology is probable that these babies only came into contact with the microbiota of their family during the key period for 'seeding' the microbiome. No one has researched waterbirth and the microbiome withal. Might information technology dilute the bacteria? The chance of colonisation and infection with grouping B streptococcus (GBS) is reduced with waterbirth (Cohain 2010; Neugeborene et al. 2007). This may be due to dilution of the GBS or boosted colonisation of the baby with beneficial leaner. Another future research topic is caul nascency and the microbiome. Does a baby born in the caul miss out on colonisation via the vagina?

What we do know is that antibiotic exposure alters the microbiome in adults (see higher up). When a woman is given antibiotics in labour her baby likewise gets a dose. In 2006 a medical expert review (Ledger 2006) raised concerns about condom antibiotics in labour. A report in 2011 found that antibiotics given in labour increased the incidence of antibiotic resistance when treating late-onset serious bacterial infections in infants (Ashkenazi-Hoffnung et al. 2011). A more recent study found that antibiotics given during labour or a c-section are associated with baby gut microbiota dysbiosis (Azad et al. 2016). This is apropos considering the number of women/babies given antibiotics in labour (eg. for 'prolonged' rupture of membranes or for 'epidural fever'). Add together to that the use of prophylactic antibiotics for c-sections = a significant proportion of women and babies being exposed to antibiotics effectually the time of birth. Suggestions:

• A vaginal nativity in the mother's own environment is optimal for 'seeding' a healthy microbiome for the infant (Penders et al. 2006).
• Minimise concrete contact by care providers on the mother's vagina, perineum and the babe during birth.
• Avoid unnecessary antibiotics during labour. If antibiotics are required consider probiotics for mother and baby following birth.
• If the infant is born by c-section… Research is currently being undertaken into the use of vaginal swabs* to 'seed' c-section babies. The preliminary results are that the microbiome of swabbed babies are more similar to vaginally born babies. The protocol the researchers are using is:
  1. have a piece of gauze soaked in sterile normal saline
  2. fold information technology upwardly like a tampon with lots of surface area and insert into the female parent's vagina
  3. go out for 1 hr, remove just prior to surgery and go on in a sterile container
  4. immediately after nascency apply the swab to the baby's oral fissure, face up, then the rest of the trunk (you can run across photos of this process here)
• If a infant is built-in past c-section it is fifty-fifty more important to encourage and back up their mother to breastfeed. It may besides be worth considering boosted probiotic intake.

*In that location has been a fleck of hysteria about the safety of vaginal swab seeding in the media. I will leave information technology to Sara Wickham to address (rant near) this one.

Postnatal

After birth, colonisation of the baby by microbiota continues through contact with the environment and breastfeeding. In that location are significant differences in the microbiota of breastfed babies compared to formula fed babies (Azad, et al. 2013; Guaraldi & Salvatori 2012). Beneficial bacteria are straight transported to the baby'due south gut by breastmilk and the oligosaccarides in breastmilk support the growth of these leaner. The deviation in the gut microbiome of a formula fed baby may underpin the health risks associated with formula feeding. In the short term, baby colic may be associated with loftier levels of proteobacteria in the babe's gut (wish I'd know this 20 years ago!). Suggestions:

• Immediately following nativity, and in the first days, baby should spend a lot of time naked on his/her mother's chest.
• Avoid bathing baby for at least 24 hours after birth, and then only use plain water for at to the lowest degree 4 weeks (Tollin et al. 2005).
• If in hospital, utilise your own linen from home for baby.
• Minimise the treatment of infant by non-family unit members during the start weeks – particularly peel to peel contact.
• Exclusively breastfeed. If this is not possible consider probiotic support.
• Avoid giving baby unnecessary antibiotics (Ajslev et al. 2011; Penders et al. 2006). Again, if antibiotics are required probiotics need to be considered.
• Probiotics may likewise be beneficial for babies suffering from colic.

Summary

The more nosotros empathise nearly the human microbiome the more it seems cardinal to our health. Pregnancy, birth and breastfeeding seed our microbiome and therefore have a long-term outcome on health. More research is needed to explore how best to support healthy seeding and maintenance of the microbiome during this key menstruum. I have discussed a number of considerations and suggestions arising from what we already know. I welcome whatsoever comments, discussion and further suggestions from readers.

Farther reading and resource

• Microbirth – the movie
• Birthful Podcast: Your babe's microbiome with Dr Rodney Dietert
• Scientific discipline and Sensibility: The healthy birth: dyad or triad? Exploring birth and the microbiome
• 'Is guild existence shaped on a microbiological and epigenetic level by the way women requite birth? – the Crickey wellness blog
• Eureka Alert – The infant gut microbiome: new studies on its origin and how it's knocked out of balance
• Abdomen Belly – Seeding infant with good bacteria using vagina swabbing
• Gut feelings: the future of psychiatry may be within your stomach
• Gut bacteria might guide the workings of your minds

About MidwifeThinking

Midwife • Physician of Philosophy • Writer • Presenter • Researcher

This entry was posted in infant, birth, midwifery practice, pregnancy and tagged nascence, breastfeeding, Chris Kresser, gut leaner, gut microbiota, homo microbiome, microbiome, nutrition, pregnancy, probiotic, stress. Bookmark the permalink.

smithlinim1992.blogspot.com

Source: https://midwifethinking.com/2016/04/13/the-human-microbiome-considerations-for-pregnancy-birth-and-early-mothering/

Share this post