I did then what I knew how to do. Now that I know better, I do better. ~ Maya Angelou

Our intestinal ecology is comprised of an estimated 100 trillion diverse microorganisms, collectively called the microbiome. To give you perspective on the volume this number represents – your microbiome weighs more than 2 pounds (1 kg), about the weight of your brain. These organisms have a profound impact on nutrient absorption, detoxification, the health of your gut lining, even your moods, appetite, food cravings, how many calories and nutrients you extract from your food, and mental function, and when out of balance, can lead to inflammation, neuro-inflammation, obesity and diabetes, hormonal problems, anxiety, depression, and brain fog. Healthy forms of microorganisms prevent leaky gut.

The development of the adult microbiome begins at birth, and to some extent, the influences on the health of the microbiome from birth to age 2, set the potential tone for lifetime health. From the time of birth, the microbiome influences the development of our immune system, and when it is disrupted, we run the risk of all manner of inflammatory and allergic conditions developing sooner or later, including allergies, food intolerances, eczema, asthma, and autoimmune diseases. Overweight, obesity, and diabetes can also be consequences of faulty microbial colonization.

Proper microbial colonization by vaginal birth and breastfeeding set the tone, through a complex network of immune and neurologic developments, for how well we are able to respond to stress. In other words, the health of your microbiome from your earliest life has a role in how well you response to stress and whether you’re more likely to find yourself an anxious, depressed adult, and whether you develop intrinsic stress resilience. Further, once the foundation is set, it isn’t something you can change retroactively, which sheds light on the importance of understanding the factors that impede healthy microbiome development, and avoiding those whenever possible, both during pregnancy, and after birth, for mom and baby.

The biggest risk factors that can interfere with the health of the microbiome are:

  • Dysbiosis (the overgrowth of potentially harmful bacteria, yeasts, and other organisms, or lack of ample amounts of healthy microbes)
  • Antibiotic exposure of mom in pregnancy/labor or while breastfeeding
  • Cesarean birth
  • Lack of breastfeeding for at least the first 4 months of life, and ideally the first year
  • Antibiotics given to baby in the first 2 years of life

Given that women in the U.S. have a 1 in 3 chance of a cesarean section, and children 2 and under are likely to have at least 2 courses of antibiotics, statistically it’s likely that your baby will take a hit to his or her microbiome somewhere in those precious first years of life. In this article, we are going to focus on those exposures and things you can to do protect baby during pregnancy and birth. To learn more about avoiding antibiotic and medication overuse that can damage the microbiome, and healing and restoring your child’s important gut environment, please see my children’s health programs here at www.healthiestkids.com.

Please know this article is absolutely not about judging the type of birth you had, mom judging, or mom shaming. It’s simply about the fact that microbiome disruption in early life is a set-up for a host of problems that I know you want to avoid for your baby. If you’ve had an antibiotic – whether it was needed or unnecessarily prescribed, if you had a cesarean, necessary or not, that is not the issue for this article. This article is simply me reviewing what you can do to help your baby’s microbiome, right now.

What’s a Mom to Do?

Protecting Baby Before Birth

Enough of a body of research demonstrates that mothers receiving a probiotic in the 3rd trimester have babies with lower rates of atopic conditions (particularly eczema and allergies), particularly in the event of a cesarean, that I now recommend all pregnant women take a probiotic at least through the 3rd trimester of pregnancy. However, further data shows that disruptions in mom’s vaginal flora may play a role in preventing preterm birth, which can occur prior to 3rd trimester, and also urinary tract infection and Group B Strep infection, both risk factors for preterm birth and the need for antibiotics in pregnancy or labor. Therefore, in my own practice, I consider it optimal standard of care to start women on a probiotic when they realize they are pregnant, and continue it throughout.

The organisms found to be most protective for mom and baby are a wide variety of Lactobacillus and Bifidobacterium species, and for the prevention of Group B Strep and UTI. I also make sure the mother is getting Lactobacllus reuteri and Lactobacillus rhamnosus, often available in combination on their own. The dose is usually at least 15 billion, but up to 50 CFUs daily in any product.

When you have to be on an antibiotic

Sometimes it’s necessary to take an antibiotic in pregnancy – you get that UTI, you develop an unexpected infection of another sort – and it’s the safest thing to do. In this case, start a probiotic along with the antibiotic, and continue for the remainder of pregnancy. Look, we can only do our best to stay free of pharmaceuticals and other exposures to baby, but life happens and we have to roll with it. Do your best to not beat yourself up and remember, not every baby that has an antibiotic exposure develops consequences – many are just fine. And the consequence of not treating an infection is potentially much worse!

GBS

Group B Streptococcus (Streptococcus agalactiae), or GBS for short, is one of the trillions of organisms that normally inhabit the human intestinal tract. By migration from the intestines, it colonizes the rectum, bladder, and vaginal tracts of many women and can thus be identified in cultures of combined rectal and vaginal swab samples. GBS doesn’t seem to play a particularly beneficial role in human health, nor, when kept in check by healthy gut flora, does it usually cause harm. However, in a very small percentage of exposed babies, infection can cause serious illness and even death. Therefore, all women who test positive in pregnancy, and who meet a variety of criteria in labor, receive an IV antibiotic in labor to prevent baby from developing infection. I discuss the pros and cons of this at length in my article Group B Strep (GBS) in Pregnancy: What’s a Mom to Do? as well as the controversy around this approach.

In all likelihood, if you do test positive, you will receive the antibiotic – which is not at all inappropriate. But what can you do? Well, for one, you can support the health of your gut and vaginal microbiome, thus preventing GBS overgrowth, ideally before and certainly during pregnancy by eating a diet that is low in sugar, processed foods, and processed carbohydrates (i.e., white flour products, baked goods), and if you suspect you are gluten intolerant, go strictly gluten free. These steps can remove triggers that directly and indirectly (via harming the gut lining and causing leaky gut) harm the microbiome. You can make sure to get about 35 grams of fiber daily from vegetables, or if needed, through the addition of 1-2 TBS. of freshly ground flax seed added to your food or a smoothie daily, and add lactofermented veggies to your diet. And important, you can take a probiotic daily, even starting in the first trimester. For preventing GBS I not only recommend a probiotic containing a wide variety of Lactobacillus and Bifidobacterium strains, but in addition, one that specifically contains Lactobacillus rhamnosus and Lactobacullus reuteri. If you’ve had GBS in the past, or have a history of yeast infections, BV, or chronic urinary tract infections, this is especially important. Giving mom Lactobacillus rhamnosus [strain GG (ATCC 53103)] also reduces the incidence of atopic eczema in at-risk children during the first 2-years of life.

The Cesarean Epidemic

It is an unequivocal fact, acknowledged even by the American College of Obstetricians and Gynecologists, that the cesarean section rate in the United States is excessive. In fact, according to a number of sources, including the World Health Organization, no nation’s cesarean rate should exceed 15%. Yet we average 34% nationally. Numerous books and articles have been written about this phenomenon, and a number of methods are known to reduce the cesarean rate, including maintaining a healthy, low risk pregnancy, including maintaining a healthy weight, not being unnecessarily or prematurely induced, and having your baby with a midwife. However, given the number of women likely to still have a cesarean in the current obstetrics climate, and the benefits of at least 3rd trimester use of a probiotic by the mother in preventing atopic disease in her baby, I now recommend all pregnant women take a probiotic in pregnancy, at least throughout the 3rd trimester.

Protecting Baby After Birth

Probiotics

Numerous studies including thousands of infants treated with a probiotic starting shortly after birth, and through the first 6 months of life, particularly in babies born by cesarean, show reduced likelihood of developing antibodies to common allergens, as well as eczema.  The data in fact, is so overwhelmingly supportive, that I now routinely give a probiotic to all newborns, continuing through 6 months old, if they were born by cesarean, if mom received and antibiotics for any reason during labor, or if baby needed an antibiotic at or after birth.

What Probiotic is Best for Baby?

In my practice and for friends and family, I recommend an infant probiotic by a company named Klaire (Klaire Infant). It contains the variety of strains that have been found to be most beneficial in helping to colonize the optimal organisms needed for baby’s healthy immunologic, neurologic, and metabolic development. Other companies that are often recommended include Jarrow, Now Foods, and Flora Udo’s.

When to Start and How Often to Give a Probiotic

Studies show that starting in the first few days after birth and continuing for 6 months is optimal for colonization of healthy gut flora species in infants. It is generally given daily.

How to Give the Probiotic

The two most common, and effective ways to give a breastfeeding baby a probiotic is to mix the powder into a couple of tablespoons of expressed breast milk, and administer to baby via an eyedropper. I generally recommend putting the dropper next to your nipple while you’re nursing and letting baby swallow the milk-probiotic mix while nursing. But baby can also just take it directly from the dropper between nursings.

Another way to give it to baby is to put the dose of probiotic into a clean dish, dip your clean pinkie finger into the powder, and let baby take it off of your finger until the full dose has been taken. Don’t dip your finger directly into the probiotic jar – you might damage the strains. 

Probiotic Safety

Given the volume of use, and over 26,000 reports in the medical literature, with only a very limited number of case reports of adverse effects, probiotic use in overall healthy infants is considered quite safe. Their use is not recommended in infants with indwelling catheters or who are immune-compromised.

Vaginal Swabbing

Research being done into “vaginal swabbing,” or what some are referring to as “microbiome seeding,” has shown promise in helping to at least partially restore the flora of babies born by cesarean section. The procedure is quite simple: A sterile gauze is folded into a ‘fan’ shape. This is then moistened with sterile water and inserted into the vagina and left to ‘colonize’ for one hour. The gauze is then removed and put into a sealed bag until the birth of the baby. At birth, given to the swab is wiped over the baby’s face to mimic passage through the birth canal.

The leading researcher in this emerging area is Maria Dominguez-Bello, who in a 2012 study enrolled 7 women who delivered vaginally and 11 who were going to have a C-section. Four of the women who were having a C-section prepared the microbial transfer in advance. Within 2 minutes of birth by cesarean, a gauze, “inoculated” as described above, was swabbed all over their newborn’s body. The four babies who received the swabs harbored skin, gut, anal and oral bacterial communities that were more like those of infants delivered naturally, compared to the C-section-delivered babies who did not go through the procedure. Dominguez-Bello says that these effects are long-lasting, and her team is now working on a study looking at the effects in about 75 babies after a year.

Most physicians, midwives, and scientists recommend waiting until more evidence is available before commonly practicing vaginal seeding. All agree that women should be tested for GBS, HIV, Hepatitis B & C, and VDRL before assuming that seeding is optimally safe.

Some families, however, are not waiting for conclusive research to try the procedure for themselves.

Of note, not everyone is jumping onto the vaginal seeding trend. French obstetrician and long-term natural birth advocate Michel Odent is an outlier, for example, cautioning that babies born “in the caul” (with the amniotic sac still intact at birth) would not have received inoculation from direct contact with the mother’s vaginal flora, and postulates that this was much more common in traditional, undisturbed births with no vaginal exams in labor. However, there’s no evidence that being born in the caul was at all common; in fact, it was rare enough that many cultures considered it to have magical import for the baby. There’s also no evidence to suggest whether these babies did, or didn’t have, the problems associated with lack of microbiome exposure. Further, the lifestyles of people living in traditional cultures (being born in the non-sterile home environment, living close to the land, interacting with soil, animals, and each other in close proximity) also supported the development of an optimally intact microbiome.

In my opinion, microbiome seeding of the newborn is quite promising, and with proper testing for infections in mom, is likely quite safe. But it’s important to remember that other epigenetic, metabolic, and neurologic shifts happen as a result of vaginal birth that cannot be replaced by vaginal swabbing, so this technique cannot become permission to tolerate the high rate of cesareans we are seeing; vaginal seeding is not compensation for missing a healthy vaginal birth. It is a potentially valuable stop-gap method for when cesarean is needed.

Forgiving Ourselves (and Doing Our Best)

We are not to blame for the social, economic, and political factors that have led to the massive overuse of medications and surgeries, and for some time to come, many women will continue to experience unnecessary treatments. Also, sometimes an antibiotic or a cesarean is necessary. The best thing we can do is to be educated and have the support we need to stand up and say “Enough is enough,” and have the tools we need, like the information in this article, to help nature restore what may be disrupted.

If you’d like to listen to my podcast on this topic, click here to listen to Baby’s Microbiome: Right From the Start Natural MD Radio

 

REFERENCES

Callaway, E. (2016). Scientists swab C-section babies with mothers’ microbes. Nature. doi:10.1038/nature.2016.19275

Camilleri, M., Madsen, K., Spiller, R., Meerveld, B. G., & Verne, G. N. (2012). Intestinal barrier function in health and gastrointestinal disease. Neurogastroenterology & Motility, 24(6), 503-512.

Dinan, T. G., Stilling, R. M., Stanton, C., & Cryan, J. F. (2015). Collective unconscious: How gut microbes shape human behavior. Journal of Psychiatric Research, 63, 1-9.

Dominguez-Bello, M. G., Jesus-Laboy, K. M., Shen, N., Cox, L. M., Amir, A., Gonzalez, A., . . . Clemente, J. C. (2016). Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer. Nature Medicine Nat Med, 22(3), 250-253.

Hempel S, Newberry S, Ruelaz et al Safety of probiotics to reduce risk or prevent disease. Evidence Report/Technology Assessment No. 200. AHRQ Publication No. 11-E007, Rockville MD Agency for Healthcare Research and Quality April 2011.

Hill, Milli, Meet the Casesarean Mums Who are “Seeding their Babies Microbiome.” http://www.positivebirthmovement.org/pbm-blog/meet-the-caesarean-mums-who-are-seeding-their-babys-microbiome

Huh, S. Y., Rifas-Shiman, S. L., Zera, C. A., Edwards, J. W., Oken, E., Weiss, S. T., & Gillman, M. W. (2012). Delivery by caesarean section and risk of obesity in preschool age children: A prospective cohort study. Archives of Disease in Childhood, 97(7), 610-616.

Kau, A. et al. Human nutrition, the gut microbiome and the immune system. Retrieved April 10, 2016, from http://www.nature.com/nature/journal/v474/n7351/full/nature10213.html

Neu, J. (2011). Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Yearbook of Neonatal and Perinatal Medicine, 2011, 198-200. doi:10.1016/j.ynpm.2011.04.004

Osborn DA, Sinn JK. Probiotics in infants for prevention of allergic disease and food hypersensitivity. Cochrane Database Syst Rev. 2007;17: CD006475.

Romm, A. 6 Ways to Avoid Unnecessary Antibiotics & Why You Should. https://avivaromm.com/avoid-unnecessary-antibiotics.

Romm, A, Stop Killing the Good Guys. https://avivaromm.com/protecting-childs-microbiome.

Schulfer, A., & Blaser, M. J. (2015). Risks of Antibiotic Exposures Early in Life on the Developing Microbiome. PLoS Pathog PLOS Pathogens, 11(7).

Vliagoftis V, Kouranos V, Betsi G, Falagas M. Probiotics forthe treatment of allergic rhinitis and asthma: systematic review of randomized controlled trials. Annals of Allergy, Asthma & Immunology 101:6, 2008

Zuccotti G, Meneghin F, et al. Probiotics for prevention of atopic diseases in infants: systematic review and meta-analysis12700.Probiotics for prevention of atopic diseases in infants: systematic review and meta-analysis. Allergy 2015; DOI: 10 1111/ ll

 

30 Comments

  1. Oh thank you so much for posting this article including all the specifics on how and how much!! Exactly a year ago in October/November I became a true fan and follower of yours because of this very issue. I was expecting the birth of my 3rd child in November 2015 (she’ll be 1 in a week!) and had tested positive for GBS (as I had with my two prior births), but was in agony– TEARS!!– over what to do about receiving antibiotics in labor. I’m one of those women who has chronic yeast/BV infections and I HAVE to take probiotics or the infections come back. I have taken a more natural approach with my body over the past few years, including changing my eating habits, and I adored your balanced approach. I was able to forgive myself for taking the antibiotic in labor, but I was also able to express to my caregivers how anxious I was about it and why. I’m glad this info is out there for those future babes yet to come. Thanks for all you do, Aviva!!

  2. Hi Aviva, I appreciate so very much your thoughtful and thorough analyses of complex topics. I too am very careful about protecting the microbiome of newborns and infants. You mentioned an infant probiotic called “Klaire Infant.” Is there a particular probiotic for adults, i.e. pregnant women that you would recommend which contain the most beneficial bacteria mentioned in your article?

    • Hi Ellie,
      Take a peak at Aviva’s supplement dispensary where you can get a sense of some of the products that she works with. Aviva is not able to give specific recommendations unless you are a patient in her clinic or in one of her programs, but you are free to look at the dispensary!

      I hope this helps!

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant & Functional Health Coach

  3. Sadly, all 3 0f my babies 4,5 and 6 weee csections. I wish all the time I could change that. I did breastfeed them for almost a year each. I recently started giving them probiotics. Is this still beneficial for them long term? I wish I had known more. ? Are the brands you’d recommend at this age different than the ones in the article?

    • Hi Kelly,

      Firstly, you are an amazing mama who gave life to three wonderful children, what a gift! Please click here for the brands that Aviva mosts works with and probiotics through food are also wonderful!!

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant & Functional Health Coach

  4. So thankful for your information, Aviva. This will give me peace of mind when I have my next baby. It was so hard to find info like this when I had my first and I was so fearful that I was going to test positive for GBS (thankfully I didn’t) and have no other option but to take antibiotics and compromise my baby’s health off the bat. I wish there were more doctors like you!

  5. I was just telling my husband about a c-section negatively impacting a newborn’s mircobiome, or gut health. He then asked me, “How?” To which I do not have an answer. Can you offer up any resources on discussing this? Or, do you have an answer that I can relay to him?

    • Hi Jessica,

      Much of what Aviva talks about in this podcast will have the answers you are seeking!

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant & Functional Health Coach

    • Hi Amy,

      Please see some of the other responses to this same question in the comments! Congrats on baby!!

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant & Functional Health Coach

    • Hi Amber,

      Have you had a chance to take a peak at Dr. Romm’s supplement dispensary? It is loaded with products that she trusts and works with.

      I hope this helps!

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant & Functional Health Coach

  6. Hi Doctor, I have been following your site for a while, LOVE your work.
    I unfortunately had both my kids via C-Sec. I breast fed 11 months, and drank lots of raw milk Kefir from my dairy farm during this time and both my kids are so healthy they never have any medication of any sort, no vaccine, never see a doctor except for few routine check ups during first year of life. We fed both kids kefir in their diet via green smoothies. The kids are both 6 and 8 with maybe 2-3 colds total and they both got over it in 2 days. We do keep them dirty on the farm and exposing them to our farm animals daily to also build up the skin’s microbiome. We rarely bathe them and use homemade soaps for private areas. Simple water rinse is perfect.
    I have done lots of research about probiotic (I have a Biology and a Law Degree). One of the top probiotic manufacturer had even confirm this. Most probiotics on the market are active at the time of production, but then as they travel through so many hands (distributors, wholesalers, store, web stores etc.) and get stored on shelves that by the time a consumers gets the product it is almost 90% dead and the weak 10% remaining barely can survive the strong stomach acid.
    We always recommend live raw milk Kefir, from state inspected farms that 100% grass feed and pasture raise cows (A2 type cows) or goats, like our Raw Dairy Farm. Over 7 years thousands of people, including many Houston Doctors MD, Oncologists, Cardiologists, ND, DC, each month buy our milk and get the live Kefir cultures for free to make their own at home fresh daily or weekly. We find that this is the best and cheapest way to get live probiotics.

  7. Hi Aviva,
    Which probiotic would you recommend for pregnancy that has the two strains and enough billions of them. I searched a bit, but got discouraged as the two strains are not present in that high of a dose in most probiotics. Hoping you can point me in the right direction.

    Thank you!

    • Hi Arune,

      Take a peak at Aviva’s supplement dispensary where you can get a sense of some of the products that she works with. Aviva is not able to give specific recommendations unless you are a patient in her clinic or in one of her programs, but you are free to look at the dispensary!

      I hope this helps!

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant & Functional Health Coach

  8. Hi Dr. Aviva, I’ve just recently discovered your site and can’t thank you enough for all the amazing, super important, life-changing info you have on here!! I’m a new mommy with a 4 month old and am already putting it to good use. (My husband caught a cold.)
    I was wondering, can childhood vaccines interrupt the baby’s microbiome? Do you have recommendations for before and after?

    • Hi Anna,
      You’re so welcome! There’s no evidence that I’ve ever heard of or seen of vaccinations having an impact on baby’s microbiome. Stress can have an impact on the microbiome, but that’s the only connection I can possibly think of… Warmly, Aviva

  9. Thank you for this! I wonder–do you recommend the use of probiotics vaginally? Will the “good guys” colonize the vaginal canal when taken orally?

  10. I usually have 4oz of breast milk from my let down that I capture and use to mix the probiotic in. Is this ok? or do I need to reduce the breast milk ounces to probiotic ratio?

    • Hi Frances,

      This is great, so long as baby is getting all the milk!

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant & Functional Health Coach

  11. Hi! I unfortunately just had to have cesarean with my first child. Was not by choice and want to give my baby the best possible start esp having missed that important part. I asked our pediatrician about probiotics for our newborn at a recent check up, my baby girl is only 6 days old. He said he did not recommend it until at least 6 (I think he said weeks) old since most newborns are somewhat immune compromised anyways. Because of a report of cases where infants became infected by bacteria from the probiotic. And you are recommending start right away at least up until 6 wks old? She had no complications from the birth and is checking out healthy and thriving. Any advice to that? Thank you! Love your website and your work. Lea

    • Hi Lea, If your little one is healthy and thriving no probiotic may be needed at all. In my practice I do recommend starting at birth and giving it until 6 months, or starting anytime you realize there might be a need and continue for 6 months from that point. Warmly, aviva

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