{"id":17269,"date":"2019-07-20T15:08:37","date_gmt":"2019-07-20T15:08:37","guid":{"rendered":"https:\/\/www.lifeandnews.com\/articles\/?p=17269"},"modified":"2019-07-21T06:33:37","modified_gmt":"2019-07-21T06:33:37","slug":"home-birth-may-start-babies-off-with-health-promoting-microbes","status":"publish","type":"post","link":"https:\/\/www.lifeandnews.com\/articles\/home-birth-may-start-babies-off-with-health-promoting-microbes\/","title":{"rendered":"Home birth may start babies off with health-promoting microbes"},"content":{"rendered":"

Joan Combellick<\/a>, Yale University<\/a><\/em><\/p>\n

For all of human history, babies have been born where their mothers lived \u2013 whether in a house, hut or cave. Only in the last century has birth moved out of the home and into the hospital. How has that changed the types of microbes that live in and on our bodies \u2013 collectively known as the microbiome \u2013 which we know are vital to human health?<\/p>\n

To find out, our group of researchers from New York University, University of California San Francisco and Sejong University in Seoul, South Korea compared different kinds of fecal bacteria from babies born at home to babies born in the hospital. Our results suggest that hospital births can change the gut microbiome of newborns<\/a>, perhaps placing these babies at higher risk for certain immune or metabolic disorders. So how do we respond? And why do I, as a hospital-based midwife, care?<\/p>\n

Starting with the midwife part: There is a bas relief at Angkor Wat in Cambodia that depicts a woman giving birth. She is supported from behind, a midwife kneels in front and a newborn lies across her chest. It looks just like many midwife-attended births today, despite the fact it comes from halfway around the world and is 800 years old.<\/p>\n

I like to think about what it means to do the same work that midwives did centuries ago. Whether by necessity (then) or by choice (now), the midwives\u2019 philosophy of care is pretty much the same. Namely, to support an undisturbed birth \u2013 where interventions are used only when absolutely necessary. Increasingly, research suggests this is a good approach to care<\/a>.<\/p>\n

\"\"
A bas relief on a temple at Angkor Wat shows a woman giving birth with the help of a midwife.<\/span>
\nRobin Hayes<\/span>, CC BY-SA<\/a><\/span><\/figcaption><\/figure>\n

Babies\u2019 first inheritance<\/h2>\n

In the last decade, researchers have discovered many ways our health depends on the trillions of bacteria<\/a> and other microorganisms that reside in and on our bodies. Exposure to vaginal bacteria at birth starts an important colonization process in the newborn. In the beginning, bacterial colonies on different parts of babies\u2019 bodies are similar and tend to match their mothers. Over time, different body habitats, like the skin, mouth and gut, develop their own distinct microbial communities.<\/p>\n

The baby\u2019s intestinal microbiome plays a key role in initiating immune and metabolic function. That is why we wanted to investigate how hospital factors might shape the early gut microbiome. We compared feces from healthy, breastfed babies who were born vaginally at home to similar babies born in the hospital. Then we determined which microbes were most likely to flourish in which babies during the first month of life.<\/p>\n

Here is what we found: Babies born at home were more likely to be colonized with \u201cbeneficial\u201d microbes<\/a>, the kinds associated with normal immune, metabolic and digestive functioning. Babies born in the hospital were more likely to be colonized with microbes associated with interventions like cesarean section, antibiotic treatment and formula feeding even though none of those things happened to the babies in our study.<\/p>\n

Then we wanted to see if these differences in the microbiome made epithelial cells \u2013 which line the colon \u2013 behave differently.<\/p>\n

So we exposed these epithelial cells to fecal material \u2013 which contains a sample of the baby\u2019s microbiome. We found that cells exposed to material from hospital-born babies were more likely to show an inflammatory response when the baby was one month old. While inflammation is an important defense mechanism, chronic inflammation at the cellular level can also contribute to inflammatory diseases later in life.<\/p>\n

To be clear, we observed this only in the lab, not in a living baby, so we can\u2019t speculate on the significance of this finding for the long-term health and well-being of babies.<\/p>\n

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A midwife examines her patient preparing for a home birth.<\/span>
\nMonkey Business Images\/Shutterstock.com<\/a><\/span><\/figcaption><\/figure>\n

Undisturbed birth<\/h2>\n

Research suggests that babies benefit<\/a> from undisturbed exposure to their mother\u2019s bacteria, including vaginal and fecal bacteria at birth, then ongoing exposure to the mother\u2019s milk and skin bacteria while breastfeeding during the first year. Disruptions in early mother-to-baby transmission are associated with changes in the infant microbiome which, in turn, have been associated with health problems later in life.<\/a> Thus, supporting an undisturbed birth process makes sense.<\/p>\n

But, undisturbed birth isn\u2019t always possible. Complications arise, and microbiome-altering interventions \u2013 like antibiotics or cesarean section \u2013 can save a mother or baby from life-threatening emergencies. These interventions may impact the baby\u2019s microbiome, but no one would recommend any other course of care.<\/p>\n

However, what about interventions performed without medical necessity? For example, one in three babies in the U.S. is delivered by cesarean section. That\u2019s around double the rate we would expect<\/a> if responding to medical need alone. Women in the U.S. frequently experience many interventions while giving birth<\/a>. Too much intervention used too soon<\/a> doesn\u2019t help, and in many cases may harm, mothers, babies and their microbiomes<\/a>.<\/p>\n

The mothers of the babies in our study did not experience overt interventions at birth. All mothers who had antibiotics, a cesarean delivery or a water birth were left out. That meant our study was small, only 10 babies in the hospital and 10 babies at home. Yet a large study of over 1,000 babies came to the same conclusion: full-term, breast-fed babies born vaginally at home had the most \u201cbeneficial\u201d microbiomes. That is, they were colonized with microbes that have been associated with normal health and development<\/a>. Further research is needed to understand the implications, but thinking through a typical hospital birth may suggest areas to study further.<\/p>\n

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Are hospital births too sterile?<\/span>
\nLolostock\/Shutterstock.com<\/a>, CC BY-SA<\/a><\/span><\/figcaption><\/figure>\n

Birth in the hospital: Too clean?<\/h2>\n

One reason hospital births differ from those at home is that hospitals prioritize cleanliness. Hand washing, bactericidal scrub and frequent cleaning limit the spread of germs. As the baby nears delivery, a sterile drape may be placed underneath the woman and sometimes over her legs and abdomen to create a \u201csterile field\u201d around the baby.<\/p>\n

In some hospitals a bactericidal soap may be used to wash the vagina before delivery, destroying almost all the bacteria. This practice reflects just how little we value the robust microbial habitat of the mother\u2019s vagina which, interestingly enough, changes during pregnancy to promote an abundance of healthy flora<\/a>. There may also be frequent vaginal exams performed during labor that carry small amounts of antiseptic lubricant into the vagina.<\/p>\n

After birth, the baby may be taken to a semi-sterile warmer instead of having contact with the mother\u2019s skin. Antibiotic ointment is usually applied to the baby\u2019s eyes. A full-body bath to \u201cclean\u201d the baby is also common, constituting another source of potential damage to microbial colonies on the newborn\u2019s body.<\/p>\n

But even for babies who \u201croom in,\u201d contact with the outside world is limited compared to home where a baby might get licked by the family dog or passed around to an array of visitors. The \u201chygiene hypothesis\u201d suggests that we, as humans, need early and frequent exposure to diverse organisms<\/a>. We tend to restrict this in the first few days of life in the hospital. Is that the right approach?<\/p>\n

In the U.S. only 1% of births occur at home. Our research suggests a previously unrecognized benefit of home birth. Might this information also lead to a redesign of hospital care? When we start to value the power of babies\u2019 first inheritance \u2013 bacteria from their moms \u2013 we may end up with a different view of what \u201cbest practice\u201d really is.<\/p>\n

[ Deep knowledge, daily.<\/em> Sign up for The Conversation\u2019s newsletter<\/a>. ]\"The<\/p>\n

Joan Combellick<\/a>, Assistant Clinical Professor of Midwifery, Yale University<\/a><\/em><\/p>\n

This article is republished from The Conversation<\/a> under a Creative Commons license. Read the original article<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

Joan Combellick, Yale University For all of human history, babies have been born where their mothers lived \u2013 whether in a house, hut or cave. Only in the last century has birth moved out of the home and into the hospital. How has that changed the types of microbes that live in and on our […]<\/p>\n","protected":false},"author":44,"featured_media":17263,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[42],"tags":[1070,6682,6681,6679,2727,6680],"_links":{"self":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/17269"}],"collection":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/users\/44"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/comments?post=17269"}],"version-history":[{"count":3,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/17269\/revisions"}],"predecessor-version":[{"id":17272,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/17269\/revisions\/17272"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/media\/17263"}],"wp:attachment":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/media?parent=17269"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/categories?post=17269"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/tags?post=17269"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}