ACOG Guidelines: Vaginal Seeding Not Recommended

Diana Phillips

November 01, 2017

Vaginal seeding of infants born by cesarean delivery should not be performed unless it is part of an approved research protocol, according to the American College of Obstetricians and Gynecologists (ACOG).

In a new policy statement published in the November issue of Obstetrics & Gynecology, ACOG cites a lack of sufficient data on the safety and potential benefits of vaginal seeding, The policy statement is consistent with one issued earlier this year by the Danish Society of Obstetrics and Gynecology, as previously reported by Medscape Medical News.

Vaginal seeding, also called microbirthing, entails inoculating a cotton gauze or a cotton swab with vaginal fluids to transfer the vaginal flora to the mouth, nose, or skin of a newborn infant. Proponents say it allows a baby born via caesarean section to come into contact with bacteria from the birth canal, and thus may boost the infant's gut microbiome and reduce risk for conditions such as asthma, allergies, or obesity.

Because the effect of the fluid transfer remains unknown, ACOG "does not recommend or encourage vaginal seeding outside of the context of an institutional review board-approved research protocol," the authors write. They also note additional safety concerns, including the potential transfer of pathogens from mother to neonate from undiagnosed maternal infections such as gonorrhea, human papillomavirus, and group A streptococci.

Any patient who insists on performing vaginal seeding herself should be educated about the risks and tested for infectious diseases and potentially pathogenic bacteria, the committee states. "Serum testing for herpes simplex virus and cultures for group B streptococci, Chlamydia trachomatis, and Neisseria gonorrhea should be encouraged."

In addition, the authors urge obstetricians and other care providers to document discussions with patients about vaginal seeing in the medical record and to inform the infant's physician about the procedure, given the potential for neonatal infection.

At this time, the available research on vaginal seeding is limited to a pilot study of the practice in four infants published in February 2016 by researchers from New York University. The results of that study, previously reported by Medscape Medical News, indicate vaginal seeding led to the development of bacterial communities similar to those found on babies delivered vaginally. To date, there have been no additional studies of other clinical outcomes.

"The paucity of data on this subject supports the need for additional research on the safety and benefit of vaginal seeding," the authors write. In the meantime, although there are mixed data on the link between breast-feeding and the development of asthma and atopic disease in childhood, the authors recommend exclusive breast-feeding in the first 6 months, a practice that has "multiple known benefits and remains the recommendation of ACOG" for all women who do not have physical or medical conditions that prohibit it.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2017;130:e274-e278.

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