Photo by Holly Clark via Stocksy
Stop reading this and retreat to a sterile cell for the next few years if you are a germaphobe. It turns out that while we've been applying anti-bacterial gel with abandon, scientists have discovered the invisible world of the human microbiome. And they think bacteria might just be our best friends.Like it or not, you are already in a committed relationship with a microscopic community living on and in you: your microbiome. As filmmaker and author Toni Harman explains in The Microbiome Effect: "Bacteria are on your skin. They are in your mouth, throat, airways, and lungs. You inhale quite a few every time you breathe." It's estimated that someone could inhale 600 bacteria a minute, 36,000 an hour, totalling more than 860,000 bacteria every day.
We begin our job as the ultimate Airbnb for a range of fungi, viruses, bacteria, and other organisms during the birth process. Emerging from the near-sterile environment of the uterus, babies make their way through the microorganisms that live their mothers' vaginas and anuses as they are squeezed through the birth canal. Each newborn emerges with hitchhikers of their own—a colony of microbes gifted from their mother.Researchers like Dr Maria G. Dominguez-Bello at New York School of Medicine think that the microbial community we are exposed to at birth could impact—for better or worse—our future health. These microorganisms have largely been ignored by researchers until recent initiatives like the US-government funded Human Microbiome Project (HMP). The revolutionary work has led to a bizarre-sounding birth practice that some are calling swab seeding, or vaginal seeding.When Alice Monkman, 41, was pregnant with her third baby, she was desperate to have a vaginal birth after two "traumatizing and disappointing" cesareans. When she was advised to have another surgical birth, she was determined to embrace it and find a way to make it her own.
On the night before Herbie (now five months old) was born, Alice packed a kit containing a sterile urine pot, scissors, a gauze, gloves, and saline solution. Part of Alice's plan to make Herbie's birth positive involved her inserting and 'incubating' a fan-like gauze in her vagina for an hour before her baby was born. In that time the organisms that live in Alice's vagina—the ones Herbie would have been exposed to during a vaginal birth—would have colonized the gauze. As he emerged into the bright light of the operating theatre, he was treated to a microbial bath from Monkman's husband Dan, who ensured Herbie was wiped from head to toe with the gauze from her vagina.
"I felt like a pioneer," explains Monkman. Her sister had first alerted her to the growing scientific interest in the human microbiome and the theory that this could be seeded at birth. The simple swabbing technique Alice describes is taken from Dr Dominguez-Bello's recently published pilot study, which determined that it was possible to transfer vaginal microbes from a mother to her cesarean-born newborn. These babies' microbiomes usually differ dramatically from those born vaginally. Without swabbing, caesarean babies pick up bacterial inhabitants from the environment around them. Their microbiota resembles those normally found on the skin, rather than the diverse community found in vaginally-born babies.Could this explain the why being born by cesarean has been linked with an increased risk of non-communicable diseases (NCDs) like asthma, eczema, and cardiovascular disease? Nobody knows right now, and there is no evidence of a direct causal link between the way you are born and your future health. But the Human Microbiome Project suggests there could be several hundred times more genetic material within our microbes than there is within our human genes—and the implications of that could be profound and disturbing.Though the research is new and untested, scientists are beginning to link this complex community of microbes and their genes with an 'epidemic' of NCDs that the World Health Organization fears could bankrupt our health care systems. Dominguez-Bello and others theorize that by exposing cesarean-born babies to vaginal microbes, we might mimic a process that leads to a more normal colony of organisms in the baby. If the theory that an abnormal microbiome increases our risk of NCDs proves correct, this could be one way to tackle what the 2011 UN High-level Meeting on Non-communicable Diseases termed a "slow-motion disaster."
Frederique Rattue was already aware of these theories when she became pregnant with her fourth child last year. After three home births, Rattue was "devastated" to need a caesarean with her fourth baby, but feels that doing a vaginal seeding procedure was key to feeling like she had "ownership" of the birth. By ensuring 'natural caesarean' techniques were followed, she feels it was "just as sacred and beautiful" as her previous births.
Much of Rattue's decision-making was based on the award-winning documentary Microbirth. Frederique's midwife and obstetrician had also seen the film and were happy to help with the procedure. "It's logical, as the baby's gut is relatively sterile until birth but then becomes colonized by bacteria within about 30 minutes of birth," adds Maria Mills-Shaw, Rattue's midwife. After Rattue's baby, Diego, was born he was put in skin-to-skin contact with his mother—another opportunity for maternal bacteria to invade the infant. Then, as Mills-Shaw explains, she "passed the gauze swab over his face, mouth and skin to facilitate inoculation with Frederique's vaginal flora."However, the practice remains new, the studies are small, and the theories controversial. Doctors and midwives are exercising caution and many are quick to point out the important role that breastfeeding might play in 'seeding' the microbiome. An article in the British Medical Journal earlier this year called into question the safety of the practice, focusing on the potential for dangerous infections to pass from mother to baby. Supporters argue that these risks are only equal to those of an ordinary vaginal birth, but there is consensus that screening for infections should be offered to people who want to swab seed their babies.
Louise Randall is a midwife who has written comprehensive safety guidelines for vaginal seeding at Buckinghamshire NHS Trust in the UK. "There is not yet any robust research evidence to support or refute the safety of artificial seeding," she explains. Though her hospital is not promoting seeding they feel it is important that they "are able to support a woman's choice, with robust safety procedures."Dr Patrick O'Brien of the UK's Royal College of Obstetricians and Gynecologists echoed this caution, adding: "We would not recommend it until there is evidence that it is not harmful and can in fact improve a child's digestive and/or immune system. It is also important to note that some vaginal bacteria can be passed on to the baby, occasionally causing illness."Despite the unestablished science, 29-year-old Alicia Reid decided that vaginal seeding made sense and sounded "fairly normal" before she had her first baby six months ago. Though her doctor was initially resistant to the idea, they gave the go ahead as long as hospital staff didn't have to get involved. "Actually having the gauze in my vagina was really uncomfortable—I could hardly get it in," Reid explains. Despite the discomfort, she says she would definitely choose do it again.
And vaginal seeding appears to be gaining popularity. The NHS Trust in the UK, where baby Diego was born, has since supported several more women choosing to 'seed' their babies at birth. Whether researchers will swiftly match theory with more evidence to underpin the practice remains to be seen, but women are opting in nonetheless.Putting potential health benefits aside, those who swab-seeded their babies all characterised the impact on them as a positive. Giving their babies bacteria from inside their bodies was in part an emotional decision; words like 'control' and 'power' came up again and again.Neatly spanning the usual divide between a natural and medical birth, it's perhaps unsurprising that women are attracted to a practice that puts their bodies on equal footing with the hard edges of technology and science. Medicine has made huge strides in improving our health. But wouldn't it be something if the secret had been living invisibly inside our powerful, bacteria-filled vaginas all along?
**Read more: The Broadly **Guide to Pregnancy