Artificial vaginal seeding for elective caesarean section

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What is artificial vaginal seeding?  

In recent years, there has been increasing interest into the role of a newborn baby’s ecosystem of good gut bacteria which is known as the Microbiome. Research has shown that the bacteria the newborn’s microbiome is exposed to during and following delivery will have a significant impact in their developing immune system which will support them for the rest of their lives.  

Babies born by caesarean section will have different bacteria in their gut than babies born vaginally as their microbiome is not exposed to their mother’s vaginal bacteria but will be colonised by the mother’s skin bacteria.  There have been some studies that would suggest babies born via caesarean section could be slightly more likely to develop allergies, asthma and obesity. This research has indicated the benefits of a newborn being colonised by their mother’s vaginal bacteria at birth through vaginal seeding. However more research is required as there is not enough solid evidence for NHS Borders to promote this procedure, but staff will support parents who wish to undertake vaginal seeding themselves. 

To undertake vaginal seeding research suggests a mother should insert a sterile muslin / gauze swab into her vagina 1 hour prior to a caesarean section; this is to allow the gauze to collect the ‘good’ bacteria from the mother. The gauze is then wiped onto the baby’s face, hands and mouth to transfer the bacteria and allow the baby’s gut to be colonised following delivery.  

Process for vaginal seeding  

As there is limited evidence around the safety and benefits of vaginal seeding, NHS Borders Maternity Staff cannot facilitate this process. If you decide that you would like to try artificial vaginal seeding, speak to you community midwife who will be able to help you to prepare for the process. You will need a small pack of sterile gauze swabs or muslin and a labelled sterile container / unopened zip lock freezer bag to put the gauze in.  

When you attend the hospital for the elective caesarean section, inform the midwife looking after you that artificial vaginal seeding is in your birthing plan.  You will be advised what time your elective caesarean section will be, and you should insert the swab / muslin into your vagina one hour before.  You may require some sterile water for this which can be supplied by your midwife.  Fold the material into a fan/ concertina to allow for maximum surface area for vaginal flora. 

The swab/ muslin should be removed after an hour has passed before to being taken to theatre and placed in labelled sterile container, your midwife can supply you with a hospital patient label if required. You can take the swab / muslin out before the hour if necessary. Your birthing partner will be responsible for bringing the container with gauze swab/ muslin along to theatre. 

Once your baby is born, if they do not require immediate care, you can wipe the gauze swab / muslin on your baby’s hands, face and mouth to allow them to be colonised by the bacteria from the vaginal flora.  

If circumstances change and your baby has to be born sooner, then the gauze swab / muslin can be inserted or wiped around the vagina for a shorter period of time before delivery. 

When is vaginal seeding appropriate? 

Due to the limited evidence available on vaginal seeding, we do not promote this procedure to our women and families. However, patient centred-care is at the centre of our service at NHS Borders and we will support our women to be able to make informed choices about their care.  

We do not recommend vaginal seeding for; 

• Pre-term delivery 

• If your waters have broken prior to your caesarean section 

• If you feel unwell or have any signs of infection such as increased heart rate or high temperature  

• You are known to carry Group B Strep, Hepatitis B or C, or genital herpes   

What about Group B strep? 

Group B Streptococcus (GBS) is a normal bacteria found in the gut and lower genital tract of healthy adults.  Around 20-40% of women are found to have GBS in their vaginal flora. It can be reoccurring and there is usually no symptoms. It is not harmful to women carrying it however, but babies who are exposed to it can become extremely unwell.  

Around half of babies born vaginally to women who are GBS positive will be colonised by the bacteria. If they are not treated with antibiotics around 1 in 400 will go on to become unwell with the disease. 1 in 19 babies who have developed GBS disease may die and as many as 1 in 14 will have life-long disabilities.  

If you have a planned caesarean section, there is only a small chance your baby will be colonised with GBS disease. This is significant as vaginal seeding may introduce babies to harmful bacteria from the vagina they would have otherwise avoided exposure. When deciding if vaginal seeding is something you wish for your baby it is important to recognise the significant risk of GBS prior to proceeding. 

Although tests are available for GBS whilst you are pregnant, the disease can come and go from the vaginal flora and may not be present on the day of testing but may be there on the day of your delivery. A negative GBS test does not guarantee your baby will not be exposed to the disease at time of delivery. If you test positive for GBS during your pregnancy NHS Borders cannot support your decision to undertake artificial vaginal seeding.  

What if your baby becomes unwell?  

Prior to discharge from hospital, your midwife will provide you with information given to all parents about signs and symptoms that your baby may be unwell. If you are concerned your baby is unwell you should tell your healthcare professional that your baby had vaginal seeding at birth as this may help with diagnosis and treatment.  

You should always seek urgent medical advice if you are concerned that your baby:  

• shows abnormal behaviour, for example, inconsolable crying 
• is unusually floppy 
• is not feeding well / develops new problems with feeding
• has an abnormal temperature (lower than 36C or higher than 38C) 
• Changes in breathing for example breathing faster than normal
• has a change in skin colour. 

You must tell your doctor, or the health professionals involved in your baby’s care that they had artificial seeding at birth. This may help them to diagnose and treat your baby. 

Other methods to support your baby’s Gut Microbiome and Immune System after birth. 

Other methods of developing your baby’s gut microbiome after birth include skin-to-skin and exclusive breastfeeding.  Your baby’s first breastfeed should ideally take place within the first hour after delivery. 

Current World health Organisation recommendations are that exclusively breastfeeding for the first 6 months of your baby’s life will help develop a healthy gut microbiome and immune system. However, we encourage you to feed your baby for as long as you can.  It is also recommended that you do not introduce solid foods before 6 months old. 

Further help and advice contact: 

Your Community Midwife  

Ward 16 at Borders General Hospital   01896 826016 

Infant Feeding Team            07825120186 / 07775227114 

About our patient information  

We aim to make the information as up to date and accurate as possible, but please note that it’s subject to change. You must always check specific advice on any concerns you may have with your doctor.