When a microbiologist and an immunologist discuss their birth plan, the microbiota isn't left out. Ok, maybe not always, but at least not in our home, where dinner table talk commonly revolves around the links between microbes and immune cells. We're expecting a baby boy in a couple of months, so it is starting to feel real, and in a few weeks we do need to talk to our midwife about our birth plan. There are tons of things that the NHS tells you to think about, but the microbiota isn't one of them. But one of the items in that long list is the mode of delivery, and I was actually surprised to find out that, in the UK, 1 in 4 births occurs via a C-section (although this varies widely across Europe). Now, there has been no formal causation demonstrated between C-section birth and health problems later in life, but there are epidemiological studies that point to an increased risk of immunological and metabolic disorders, including asthma, allergies and obesity. And even though the cause(s) are unknown, we feel that this could be influenced by the microbiome, which has been shown to differ between infants born vaginally and infants born by C-section: the microorganisms found in the first group resemble those found in the maternal vagina, whereas the composition of the microbiome of the second group is more similar to that found in mother's skin. Interestingly, Maria Dominguez-Bello and colleagues just published a microbial restoration procedure to colonize C-section delivered babies with the maternal vaginal microbiota. The procedure sound straightforward and involves swabbing the infants within the first 3 minutes after birth with gauze that was incubated in the maternal vagina for an hour before the C-section, starting with the mouth, then the face and finally the rest of the body. And even thought this doesn't completely restore the microbiome composition to what is found in vaginally delivered infants, it does provide partial restoration throughout the first month of life. The article describes 4 infants, and the authors acknowledge that their work "represents a proof of principle on a small cohort and with limited follow-up over time", but we think that, for now, this was sufficient and we'll definitely write it down in our birth plan, should a C-section come our way. And if it does, we may even get in touch with the authors, you never know if they need more samples.
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