Abstract
BackgroundVaginal seeding is the administration of maternal vaginal bacteria to babies following birth by caesarean section (CS), intended to mimic the microbial exposure that occurs during vaginal birth. Appropriate development of the infant gut microbiome assists early immune development and might help reduce the risk of certain health conditions later in life, such as obesity and asthma. We aimed to explore the views of pregnant women on this practice.MethodsWe conducted a sequential mixed-methods study on the views of pregnant women in New Zealand (NZ) on vaginal seeding. Phase one: brief semi-structured interviews with pregnant women participating in a clinical trial of vaginal seeding (n = 15); and phase two: online questionnaire of pregnant women throughout NZ (not in the trial) (n = 264). Reflexive thematic analysis was applied to interview and open-ended questionnaire data. Closed-ended questionnaire responses were analysed using descriptive statistics.ResultsSix themes were produced through analysis of the open-ended data: “seeding replicates a natural process”, “microbiome is in the media”, “seeding may have potential benefits”, “seeking validation by a maternity caregiver”, “seeding could help reduce CS guilt”, and “the unknowns of seeding”. The idea that vaginal seeding replicates a natural process was suggested by some as an explanation to help overcome any initial negative perceptions of it. Many considered vaginal seeding to have potential benefit for the gut microbiome, while comparatively fewer considered it to be potentially beneficial for specific conditions such as obesity. Just under 30% of questionnaire respondents (n = 78; 29.5%) had prior knowledge of vaginal seeding, while most (n = 133; 82.6%) had an initially positive or neutral reaction to it. Few respondents changed their initial views on the practice after reading provided evidence-based information (n = 60; 22.7%), but of those who did, most became more positive (n = 51; 86.4%).ConclusionsGiven its apparent acceptability, and if shown to be safe and effective for the prevention of early childhood obesity, vaginal seeding could be a non-stigmatising approach to prevention of this condition among children born by CS. Our findings also highlight the importance of lead maternity carers in NZ remaining current in their knowledge of vaginal seeding research.
Highlights
Vaginal seeding is the administration of maternal vaginal bacteria to babies following birth by caesarean section (CS), intended to mimic the microbial exposure that occurs during vaginal birth
The majority of participants were of European ethnicity and highly educated, there was a lesser proportion of university-educated questionnaire respondents compared to interviewees (Table 1)
Based on currently available evidence, many of our participants were technically correct in their responses; it is currently unknown if vaginal seeding reduces the risk of any specific health conditions, while only one very small study suggests it may shift the microbiome of infants born by caesarean section to more closely reflect that of infants born vaginally [11]
Summary
Vaginal seeding is the administration of maternal vaginal bacteria to babies following birth by caesarean section (CS), intended to mimic the microbial exposure that occurs during vaginal birth. The microbiome of infants born by caesarean section differs from those of infants born vaginally [7, 8] This may be due to a lack of exposure to vaginal bacteria during birth, a critical period of transition and microbial colonisation, and potentially explains the increased risk of adverse health outcomes associated with birth by CS [9]. Vaginal seeding is a relatively new practice, whereby maternal vaginal bacteria are artificially administered to babies following birth by CS [10] This is intended to mimic the natural process of maternal microbial exposure that occurs during a vaginal birth [11]. Our group is currently conducting the Early COlonisation with Bacteria After Birth (ECOBABe) study, assessing the effectiveness of vaginal seeding in establishing the gut microbiome in CS-born babies [12], whilst other trials are ongoing elsewhere [13,14,15]
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