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March 17, 2015

Sowing the seeds of future health

‘Microbirth’ told us of the importance to our immune systems of seeding the microbiome.  Independent midwife Sally Randle describes how the theory is making its way into practice for some of her clients.

Last year I attended the screening of One World Birth’s film Microbirth organised by a local Bristol AIMS member.  A couple of weeks before I had watched a fascinating BBC Horizon programme about allergies in young children, in which it was discovered that a 5 year old boy with severe, sometimes life threatening allergies, had none of the many bacteria in his body that he was supposed to have as a human being but plenty of those he shouldn’t,  i.e. hospital acquired bacteria. He had been in special care after birth and was not breast fed.

This was the first time I heard about the microbiome and its importance to our immune systems and basic structure of our human bodies.  Fortune Magazine has declared 2015 ‘The Year of the Microbiome’, and there is significant research going on to fully understand its complex relationship to health and disease, notably the multimillion-dollar five-year Human Microbiome Project. The Microbirth documentary told us that babies pick up many of these vital bacteria on their passage through the birth canal, with skin to skin contact with their mother and when breastfeeding, as well as in utero. The study mentioned in the film was not completed (although preliminary evidence was showing good results) but I decided that I would bring this issue up with my clients when we have our initial birth plan discussion at around 30 weeks. They could then explore the issue further  for themselves and incorporate the suggested method of seeding the biome into their caesarian section birth plan, if they felt convinced by the emerging evidence. I suggest to all my clients that they consider caesarian section as a possible outcome at this stage (although with IM care it is considerably less likely than the 20 – 25% of most hospitals) in terms of writing down how they would like it to go, then put the whole subject away literally and emotionally.

microbirth_web__large[1]

I fully expected to encounter some puzzled looks and even flat out refusal to consider it, from health professional colleagues, if ‘seeding the biome’ was brought up, but as an IM I am used to shouldering these reactions on behalf of my clients. I remembered we had already sometimes experienced these attitudes in the past, when we asked surgeons to avoid premature cord clamping at caesarian section and leave the cord to pulsate as long as possible.  I reminded myself that now a few years on this practice is generally accepted as beneficial to the baby and is widely practised.

So cue my most recent client, Ursula. She experienced a powerful VBAC labour, which got so much further this time than it did last time. Her body went into labour by itself and worked so hard along with her baby to get her born. Ursula decided, after many many hours, that another caesarian section was the right action to take. She hadn’t written a birth plan, but once she had made the decision for another caesarian, she told the surgeon her wishes as far as the operation went: which were for immediate skin to skin contact in theatre, early breastfeeding, avoiding premature cord clamping and for her baby’s micro biome to be seeded immediately after birth. She and the obstetrician turned to me for an explanation of how this is done.

“I fully expected to encounter some puzzled looks and even flat out refusal to consider it, from health professional colleagues, if ‘seeding the biome’ was brought up but as an IM, I am used to shouldering these reactions on behalf of my clients”

I explained the method suggested in the film: that you take a large surgical swab and fold it fan like (for largest surface area) and insert in the mother’s vagina at the start of the operation.  Take it out when baby is born and wipe it downwards over the baby from the head, including the face and very importantly inside the mouth. The surgeon listened attentively and then turned to the hospital midwife who had been caring for my client and who would accompany her into theatre (I am not allowed to do this at this hospital) and asked how they might best facilitate this for Ursula and Barney. They agreed that since they would have “vaginal access” when the midwife inserted the urinary catheter it would be at this point they would put the swab in.  They also discussed the immediate skin to skin and leaving cord to pulsate with my client and agreed that these things would happen as long as the midwife assessed the baby’s condition as good when she was born. I also suggested that Ursula put a towel down her front next to her skin, if she could, so the first towel baby had (after sterile one used to receive baby in sterile field of operation) would be one covered in her skin micro bacteria.

By the way hospitals are rightly very strict about swabs in operating theatres and will want it back as soon as possible for their vital swab count, but this should not be a reason to refuse to give you one.

Courtesy of Pacific Northwest National Laboratory

Courtesy of Pacific Northwest National Laboratory

An hour and a half later they returned from theatre with their gorgeous baby girl in arms. Everything had gone well and all their wishes had been met. Someone in theatre had decided that Barney should be the one to seed his baby’s biome (this may have been defensive I guess, but was an inspired idea whatever the motive) because Barney was so proud and pleased to have been able to do this for his child; to overcome the limitations of caesarian section in this area and potentially give his daughter’s immune system this huge boost. What a brilliant role for the birth partner to play. I will never forget the look of joy and pride on his face as he held his daughter in his arms and told me how he had done this.

Personally I would like to thank the obstetrician and the midwife who cared so wonderfully for Ursula and Barney and their baby. My IM colleague’s will know that it is not always such an easy and straightforward path to help our clients gain the support of other health care professionals for their intentions and plans. This lovely obstetrician and midwife listened to my clients, worked out the best way of helping them and respected their wishes to the letter.

“What a brilliant role for the birth partner to play. I will never forget the look of joy and pride on his face as he held his daughter in his arms and told me how he had done this”

For more information about the body’s bacteria and the importance of contact with the birth canal for the baby click here and here.

Sally Randle offers individualised maternity care from one midwife for pregnancy, birth and afterwards for women living in Bristol, Bath and the surrounding area.

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‘Microbirth’ told us of the importance to our immune systems of seeding the microbiome.  Independent midwife Sally Randle describes how the theory is making its way into practice for some of her clients. Last year I attended the screening of One World Birth’s film Microbirth organised by a local Bristol AIMS member.  A couple of […]

 
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