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!
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
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.
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.
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