Washington, DC—Due to the lack of data regarding the safety and efficacy of vaginal seeding, the American College of Obstetricians and Gynecologists (ACOG) does not encourage or recommend it outside of the context of institutional review board-approved research, according to new guidance issued today. Vaginal seeding is the practice of inoculating a cotton swab with vaginal fluids to transfer the vaginal flora to the infant.
There has been growing interest in vaginal seeding due to evidence that suggests the frequency of asthma, allergies and immune disorders in children is increasing at a rate that mirrors that of cesarean delivery. When infants are born via cesarean delivery and with intact membranes, or before the water breaks, the new Committee Opinion states there is often a lack of maternal vaginal bacteria transferred to the baby, which helps to stimulate the immune system, prevent the growth of dangerous bacteria and regulate the gut.
“Understandably, patients who may need to undergo a C-section are increasingly seeking counsel from ob-gyns on whether vaginal seeding is appropriate,” said Christopher Zahn, M.D., vice president of Practice Activities. “However, due to the lack of sufficient data, the very real risks outweigh the potential benefits. By swabbing an infant’s mouth, nose or skin with vaginal fluid after birth, the mother could potentially, and unknowingly, pass on disease-causing bacteria or viruses.”
Much of the research that exists regarding the link between cesarean delivery and incidence of allergies and autoimmune diseases has found an association with mode of delivery. However, there is still not enough evidence to prove causation due to the environmental, dietary and genetic factors that also impact the development of conditions, such as asthma. Additionally, the microbiota of infants born by C-section will cause a variation in the research findings because some may have had contact with maternal vaginal bacteria if the procedure was performed after the onset of labor or rupture of membranes.
“Breastfeeding for the first six months is the best way to overcome the lack of exposure to maternal vaginal flora at birth,” said Zahn. “The bacteria present in breast milk and on the nipple is sufficient for natural colonization or seeding of the gut. There may be some initial difference in the gut microbiota of infants based on mode of delivery but research has shown that difference disappears after about six months.”
Should a patient insist on performing the procedure herself, ACOG recommends ob-gyns have a documented discussion of the potential risks.
The Committee Opinion #725, “Vaginal Seeding” will be published in the November issue of Obstetrics & Gynecology.
Other recommendations issued in the November Obstetrics & Gynecology
Committee Opinion #724, “Consumer Testing for Disease Risk”
With the increased emphasis on patient-driven health care and readily available access to patients through the internet and media, many genetic testing companies have begun to market directly to consumers. Direct-to-consumer genetic testing raises unique concerns and considerations, including limited knowledge among patients and health care providers of available genetic tests, difficulty in interpretation of genetic test results, lack of oversight of companies that offer genetic testing, and issues of privacy and confidentiality. When undergoing any direct-to-consumer genetic testing, the consumer should be apprised of risk from screening or susceptibility test results that can neither prove nor eliminate disease potential. Because ordering an appropriate genetic test and interpretation of genetic test results are complex, an obstetrician–gynecologist or other health care provider with knowledge of genetics should be involved in ordering and interpreting the results of any genetic test with medical implications. When an individual presents test results to a health care provider from a direct-to consumer genomic test that putatively assesses the risk of specific diseases, the patient should be referred to an obstetrician–gynecologist or other health care provider who is skilled in risk assessment for the diseases of interest and interpretation of genetic testing results in the context of the individual’s relevant medical and family history. Because of these considerations and in view of the fact that the interpretation of the results requires specific training and medical knowledge, direct-to-consumer genetic testing should be discouraged because of the potential harm of a misinterpreted or inaccurate result.
Practice Bulletin #184, “Vaginal Birth After Cesarean Delivery”
Trial of labor after cesarean delivery (TOLAC) refers to a planned attempt to deliver vaginally by a woman who has had a previous cesarean delivery, regardless of the outcome. This method provides women who desire a vaginal delivery the possibility of achieving that goal—a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient’s preference for vaginal delivery, at an individual level, VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level. However, although TOLAC is appropriate for many women, several factors increase the likelihood of a failed trial of labor, which in turn is associated with increased maternal and perinatal morbidity when compared with a successful trial of labor (ie, VBAC) and elective repeat cesarean delivery. Therefore, assessing the likelihood of VBAC as well as the individual risks is important when determining who is an appropriate candidate for TOLAC. Thus, the purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and to provide practical guidelines for counseling and management of patients who will attempt to give birth vaginally after a previous cesarean delivery.
Practice Bulletin #185, “Pelvic Organ Prolapse”
Pelvic organ prolapse (POP) is a common, benign condition in women. For many women it can cause vaginal bulge and pressure, voiding dysfunction, defecatory dysfunction, and sexual dysfunction, which may adversely affect quality of life. Women in the United States have a 13% lifetime risk of undergoing surgery for POP. Although POP can occur in younger women, the peak incidence of POP symptoms is in women aged 70–79 years. Given the aging population in the United States, it is anticipated that by 2050 the number of women experiencing POP will increase by approximately 50%. The purpose of this joint document of the American College of Obstetricians and Gynecologists and the American Urogynecologic Society is to review information on the current understanding of POP in women and to outline guidelines for diagnosis and management that are consistent with the best available scientific evidence.
Practice Bulletin #186, “Long-Acting Reversible Contraception: Implants and Intrauterine Devices”
Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARC), are the most effective reversible contraceptive methods. The major advantage of LARC compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the patient for long-term and effective use. In addition, after the device is removed, the return of fertility is rapid. The purpose of this Practice Bulletin is to provide information for appropriate patient selection and evidence-based recommendations for LARC initiation and management. The management of clinical challenges associated with LARC use is beyond the scope of this document and is addressed in Committee Opinion No. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org