Alternative Birth Plans and Unintended Maternal and Neonatal Consequences: A Review of the Literature

Abstract

Importance Birth plans are an important part of childbirth preparation for many women. Objective The aim of this review was to discuss some common requests, specifically home birth, water birth, placentophagy, lotus birth, vaccination refusal, and vaginal seeding, including evidence-based recommendations, perceived benefits, and potential maternal and neonatal consequences. Evidence Acquisition A literature search for each topic was undertaken using PubMed and Web of Science. For the home birth section, the MeSH terms home AND birth OR childbirth AND outcomes OR complications OR recommendations OR guidelines were used. For the vaccination section, birth OR childbirth OR maternal AND vaccination refusal were searched. For the remainder of the sections, umbilical cord AND nonseverance OR placentophagy OR vaginal seeding OR lotus birth were searched. A total of 523 articles were identified. The abstracts were reviewed by 2 authors (J.R.W. and J.A.R.); 60 of these articles were selected and used for this review. Results Home birth is currently not recommended in the United States. Immersion in water for labor is acceptable, but delivery should not occur in water. Placentophagy and lotus birth should be discouraged because of risk of neonatal infection. Vaccines should be administered in accordance with national guidelines. Vaginal seeding should be discouraged until more is known about the practice. Conclusion and Relevance These evidence-based recommendations provide clear guidance for physicians so that the birthing experience can be enhanced for both mother and neonate without compromising safety. Relevance Statement This is an evidence-based literature review of alternative birth plans and recommendations for directive counseling. Target Audience Obstetricians, midwives, family practitioners, pediatricians, and nurse practitioners who provide obstetric and/or pediatric care. Learning Objectives After completing this activity, the learner should be better able to counsel patients on the risks and benefits of alternative birth plans; distinguish which maternal requests are associated with increased risk of neonatal infections; and risk stratify patients for home birth and identify absolute contraindications to home birth.

Vaginal seeding after cesarean birth: Can we build a better infant microbiome?

“…3 Individual variations in the microbiome are hypothesized to affect host health, and differences in the microbiota between cesarean-born and vaginal-born infants have been previously investigated. 2,4,5 The newborn infant has previously been considered sterile, and studies have demonstrated that vaginal-born infants acquire a microbiome similar to the maternal vaginal microbiome, whereas cesarean-born infants acquire a microbiome that resembles the microbial composition of maternal skin or operating room flora. 2 Therefore, vaginal seeding is a practice developed to trans-fer the maternal vaginal microbiome to cesarean-born infants to address the potential impact of an altered microbiome on the future risk of the development of immune and metabolic disorders in the infant.…”

“…Vaginal seeding is performed by incubating a gauze within the maternal vagina and subsequently inoculating the infant by swabbing the skin, mouth, nose, and/or eyelids after delivery. 2,4 Prior work in a small pilot series of seven vaginal-born, seven cesarean-born, and four cesarean-born, vaginally seeded infants demonstrated that vaginal seeding was associated with infant microbiomes that more resembled vaginal-born infants, especially in skin and anal samples for 30 days after delivery. 5 These findings have garnered interest by the public and media; however, vaginal seeding is not currently recommended outside of formal research protocols because of current data being limited by low sample size, limited follow-up time, and unknown risks or benefits in published data.…”

“…5 These findings have garnered interest by the public and media; however, vaginal seeding is not currently recommended outside of formal research protocols because of current data being limited by low sample size, limited follow-up time, and unknown risks or benefits in published data. 2,4 The relationship between the mode of delivery and the infant microbiome, and the potential implications of vaginal seeding on the infant microbiome, are provocative but require more investigation. Song et al add extensive longitudinal data for 177 infants through the first year of life, including 30 vaginally seeded infants, with over 8,000 samples from stool, mouth, and skin of maternal-infant dyads, in addition to maternal vaginal and nasal samples (Figure 1).…”