Birth Planning for Future Health

Birth Planning for Future Health

There comes a point in your pregnancy when you realise that this baby actually has to come out. You might laugh thinking back, but often we are so excited to be pregnant that we haven’t thought further than being pregnant. When you type “Birth Plan” into your search engine, immediately there are 13 300 results. Each of these has excellent advice on preferences and options that you should think about in order to make a positive birth experience. Some are very practical in the sense of what to pack, who should be allowed into the labour ward and when should you have an enema so not to poop on the table; but what if some of these decisions could impact the long term health of your unborn baby. Suddenly, how scary that we not only have to plan for beyond the pregnancy, but the responsibility of decisions made at birth could have far reaching impact.

Recent terminology that is starting to filter into these plans is the Microbiome. "Two amazing events happen during childbirth. There's the obvious main event which is the emergence of a new human into the world. But then there's the non-human event that is taking place simultaneously, a crucial event that is not visible to the naked eye, an event that could determine the lifelong health of the baby. This is the seeding of the baby's microbiome.” (1). The human microbiome consists of trillions of microbes – bacteria and viruses—the balance of which largely determines our health and well-being throughout life. The largest microbiomes in women are located in the mouth the gut, the uterus, the vagina, and the skin. Breastmilk also provides a vital microbiome for the infant.(2). The microbiome is normally transferred from mother to baby via the placenta during pregnancy; the vaginal canal during birth; and the mother’s skin, breastmilk, and lips in the hours, days and weeks after birth. The microbes and their genetic material play an essential role in the child’s health, development, and metabolism. Disruption in the transfer of the microbiome in the perinatal period due to changes in the way  pregnancy and birth are managed in the hospital have led to the increase in many diseases, such as allergies, asthma, diabetes, gastrointestinal diseases, obesity, autoimmune disorders, and some mental disorders. Until the past few years, the connection between the altered microbiome and poor health was virtually unknown. With newer technologies that allow for the study of microbes that were previously impossible to study, these connections are beginning to be discovered. (3).

Let’s go back to looking at just a few things on our birth plans while keeping the maintenance of the microbiome as our heading:

Mode of delivery – Unfortunately cesarean delivery (CD) is no longer reserved for medical reasons, but the massive increase in elective CD sitting in the 80% in some private clinics, has put this on the list of birth planning. During vaginal delivery, the contact with the vaginal flora is an important start to the infants colonization, this is absent in CD. Studies are showing that babies born vaginally are colonised with lactobacillus, whereas cesarean delivery babies were colonized by a mixture of potentially pathogenic bacteria typically found on the skin and in hospitals, such as Staphylococcus and Acinetobacter. The effect of this appears to be most robust in the area of immune mediated diseases. CD has been associated with a significant increased rate of asthma and allergic rhinitis.(4).

Skin to skin (STS) – Placing the baby immediately on the mother’s chest and leaving the baby there is what is needed. Almost all necessary interventions can be performed with the baby on the mother’s chest. Wrapping the newly born baby in hospital blankets and placing in an incubator means the baby has no chance to acquire the skin microbiome of the mother, through direct contact, including skin to skin holding, licking and nuzzling. Instead the baby is exposed to the hospital microbiome via the blankets and the handling by the nurse. (5). Even if CD is necessary, immediate STS should be done.

Antibiotics, widely used for the mother during pregnancy and birth and for the infant afterwards, destroy helpful microbes. Even though this is not usually the choice of the mother, as prescribed, but by just discussing risk vs reward with prescribing physician can go a long way to avoiding unnecessary usage.

Breastfeeding / Formula feeding and the consistent use of the formula top up. Infant formula deprives the baby of the rich breastmilk microbiome, and impairs the normal development of the newborn’s immune system and maturation of the baby’s gut microbiome. (5). Exclusive breastfeeding has a protective role of breast-feeding against the development of diarrhoea and necrotizing enterocolitis in the newborn and allergic and autoimmune diseases in childhood, including coeliac disease type I diabetes and atopic dermatitis. Later in life, breast-feeding has been associated to a reduced risk of inflammatory bowel diseases, cardiovascular diseases, obesity, and type-2 diabetes. (7).

Many woman are exclusively breastfeeding, oh ja, except for that top up or 2 that baby received in the hospital, or some choose for various reasons to mix feed. Breastfed and formula fed infants have different gut flora. The science bit: Breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci. Babies fed formula have a high gut pH of approximately 5.9-7.3 with a variety of putrefactive bacterial species. When formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached. Breastfed infants who receive supplements, develop gut flora and behavior like formula-fed infants, the dominance of bifidobacteria during exclusive breastfeeding decreases when infant formula is added to the diet. (6). Exclusive and partial formula-feeding have been shown to alter the gut microbiome toward adult patterns, increase proinflammatory bacteria,  and increase gut permeability, and result in lower concentrations of fecal short-chain fatty acids compared with exclusive breastfeeding. (8).

Now you are thinking so what? What all this leads to is that just one bottle can have a long-term consequence on immune health as well as reduced protection against overweight and obesity.

These are just a few examples of how the microbiome can be altered at birth, and as research in this field expands, there will be an impact on our birth plans and how we are treated in maternity care facilities. You are the advocate for your baby, when you are putting together your birth plan, add microbiome to the google search, and insist that your health care team THINK GUT.

Samantha Crompton RN.RM.RCM.RP. SACLC

References

1.    http://articles.mercola.com/sites/articles/archive/2014/12/27/seeding-baby-microbiome.aspx. The Importance of Reducing Your Toxic Burden When Planning to Start a Family. December 27, 2014. Dr. Mercola

2.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340594/. The Human Microbiome and Its Potential Importance to Pediatrics Coreen L. Johnson, PhD^a and James Versalovic, MD, PhD^b

3.    https://healthfinder.gov/News/Article.aspx?id=711974. Antibiotics, Formula Feeding Might Change Baby's 'Microbiome'. C-section birth may also diminish diversity of these colonies of helpful microbes, study shows.

 

4.    Cesarean versus Vaginal Delivery: Long term infant outcomes and the Hygiene Hypothesis. Josef Neu, MD^a,b,a,b and Jona Rushing, MD^. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/

 

5.    How the 'Microbiome' Affects Your Baby's Birth and Health. https://www.bastyr.edu/news/health-tips-spotlight-1/2015/06/how-microbiome-affects-your-babys-birth-and-health. By Penny Simkin, PT, CCE, CD(DONA)

6.    Supplementation of the Breastfed Baby “Just One Bottle Won’t Hurt”---or Will It? Marsha Walker, RN, IBCLC. January 2014.

 

7.    Effect of Breast and Formula Feeding on Gut Microbiota Shaping in Newborns. Federica Guaraldi¹ and Guglielmo Salvatori², https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472256/