The views of pregnant women in New Zealand on vaginal seeding: a mixed-methods study

Abstract

Background 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. 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. Methods We 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. Results Six 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%). Conclusions Given 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.

Oral administration of maternal vaginal microbes at birth to restore gut microbiome development in infants born by caesarean section: A pilot randomised placebo-controlled trial

“…Neonatal exposure to maternal vaginal fluids immediately after CS birth (more commonly known as ‘vaginal seeding’) is a potential mechanism to foster the development of the gut microbiome. Vaginal seeding has gained traction in recent years [ 37 , 38 ], despite warnings from some healthcare professionals that this procedure poses considerable infection risks to neonates [ 39 , 40 ]. Notably, evidence for the efficacy of this procedure has not yet been established.…”

The importance of the intestinal microbiota in humans and dogs in the neonatal period

“…While there has been increasing interest in vaginal seeding, only a few published studies have examined its use in humans (Butler et al, 2021). One small pilot study by Dominguez found that the microbiomes of babies born via cesarean section who received vaginal seeding were more similar to those born vaginally in terms of their skin, oral cavity, and anal cavity microbiota.…”

“…One small pilot study by Dominguez found that the microbiomes of babies born via cesarean section who received vaginal seeding were more similar to those born vaginally in terms of their skin, oral cavity, and anal cavity microbiota. However, since no stool samples were collected, the effect of seeding on the intestinal microbiota remains unclear (Butler et al, 2021).…”

Should we modulate the neonatal microbiome and what should be the goal?

“…While this area of research will undoubtedly contribute significant insight into postnatal microbiota transplantation procedures and effects on health, this topic has also garnered a growing fascination in public discourse over the last several years. Reflecting a trickle-down effect on social attitudes, a recent study examining attitudes towards vaginal seeding reported that pregnant individuals viewed these procedures as replicating a natural process and may help reduce maternal shame and guilt about undergoing c-section [ 64 ]. This self-reported shame and guilt about undergoing a lifesaving procedure reflects a long cultural history of blaming mothers for negative outcomes in their children, particularly mothers from historically oppressed groups [ 65 ].…”