More on the Microbiome, Birth and How To Get Your Baby The Good Goop That Live On You

Here’s another great piece about the way childbirth affects a baby’s microbiome (the bacteria that live on and in her), this time an essay by a microbiologist who was all prepared to “inoculate” her newborn if a c-section was necessary.  Inoculate, here, means:  ”take some vaginal discharge and swab the baby’s mouth and nose with it to try to replicate what the baby would have been exposed to during birth.” Check it out.  For more on this topic, see here and here.

The Straight Poop

I’m sharing today’s post from Brain, Child’s new blog for several reasons:

  1. Because it is a hilarious short piece about pooping during childbirth, which also involves a brief misunderstanding about whether the author’s midwife reached orgasm during the labor.
  2. Because Brain, Child is an excellent magazine you should all subscribe to if you are interested in thinking and parenthood.  (I thought this long, long before I had an essay published in it).
  3. Because it fascinates me that this woman took a childbirth class where Pooping During Pushing only came up incidentally and quietly and kind of indirectly.  Did her teacher say “fecal matter”? Ladies, come to my class and we will be real and talk about All The Things. 
  4. Speaking of which, here’s the real scoop on the poop: 

 If you’re pushing something large down the birth canal (i.e. your baby), in all likelihood you’ll also push some stool out, too.  The same muscle groups control all the exits down there. You’ll probably squeeze some pee out, too, while we’re mentioning Things. 

You might not even know it happens:  If you have pain medication, you won’t feel it; if you don’t have pain medication, you may have so much sensation that you don’t particularly register a bit of poo on top of everything else.  In both cases, if your partner isn’t looking, s/he may not see your midwife or doctor wipe it away briskly.  She will wipe it away quickly because she, like the rest of us, does not want to hang around beside a steaming pile of poo while we wait for the rest of your baby to emerge.  This may be what happened in the author’s first two births. 

The thing is, it’s really all OK.  This is not a parenting fail, at all.  At all.  In fact, to the contrary: I hate to gross you all out even more, but it’s actually really OK if a tiny bit of poo is on your baby.  Think about it people:

  • lets say no actual visible turd emerges.  Do you really think that your anus is sterile?  If your baby is born with her nose essentially pressed against your butt hole, she is going to get some particles of poo on her no matter what you do.
  • What is in that poop?  A whole lot of your gut bacteria.  And yes, it goes up your baby’s nose and possibly into her mouth, and from there it gets into her gut.  And that (plus her trip through the birth canal, where, to be clear, your vaginal microbes get on and into her) is what helps “colonize the infant gut with protective microbes” (translation: all the good-guy germs that live inside your tush and vagina go into her nose and mouth and then start growing inside her). And this, despite the lemon face you may have just made, is a very good thing. These great, helpful, protective gut bacteria keep her healthy, protect her against infection, regulate the immune system, and neural development, and apparently affect her metabolism for the rest of her life.  In short, it may be one of the best things you ever do for her!

As my great friend, certified childbirth educator Ceridwen Morris says, “It’s not a mistake that human babies are born with their face an inch away from their mother’s asshole.”  Chew on that for a while.

UPDATE, 5/16/13:  This excellent article in this weekend’s NY Times Magazine discusses the importance of gut bacteria and the “fine patina” of poop that, for better or for worse, coats basically everything.  It’s an awesome piece, but even the intrepid Michael Pollan glosses over the birth-poop-connection.  He says:

Most of the microbes that make up a baby’s gut community are acquired during birth — a microbially rich and messy process that exposes the baby to a whole suite of maternal microbes. Babies born by Caesarean, however, a comparatively sterile procedure, do not acquire their mother’s vaginal and intestinal microbes at birth.”  

It’s a funny world when you can have a feature article about how important your poop-bacteria are, but not be clear that Vadge-And-Butt-To-Nose-Transfer is where it all begins.

More about germs! Yay germs!

Yesterday I blogged about the importance of gut microbes, and recent news showing that birth mode (vaginal vs c-section) and infant feeding (breastmilk vs formula) affect babies’ development of good bacteria for long term health.  Today there’s another piece about this in the Times.  The article covers a Canadian study which found, again, that babies born by c-section and those who don’t have a breast milk diet have less protective gut bacteria at four months old, and more of the harmful germs that make you sick.  The authors of the study believe that this is a pathway for various autoimmune problems in older people.  

You can read the full study here.  I don’t love this study because the total number of infants is low.  More importantly, it, like so many studies that start to examine the nursing relationship, doesn’t really clarify what “breastfeeding” means.  They differentiate “formula feeding” from “exclusive breastfeeding” and “partial breastfeeding” at the time they took the samples, but there’s no apparent guidance about how to use those terms. My concern is that without good definitions, we can’t properly interpret the results. For instance: if a baby was given one bottle of formula on day 1 in the hospital (as so many are) but went on to have nothing but breast milk for the next many months, is that baby “exclusively” or “partially” breastfed?  If we are looking at the effect of early exposure to nonnatural microbes, it seems wrong to compare that baby to one who has had nothing but breast milk from birth.  But if we are looking at whether a protective effect of breast milk is dose-dependent, it seems wrong to lump that baby in as “partially” breastfed with another who has had half breast milk and half formula for four months. These distinctions are rarely made in studies that purport to look at the ways infant feeding affects health outcomes.  But if we’re going to learn anything real, we need to look closely at what it is we’re trying to study. “Breastfeeding” isn’t just one thing.

Germs are Great

If you’ve talked to me in real life for more than five minutes this year, you already know that I am currently obsessed with bacteria.  

I’m not a germophobe — quite the contrary: a host of new research shows that “good guy” bacteria — and there are billions of them on us — are extremely important in keeping us healthy.  I blogged about this  about a year ago after a report came out indicating that babies born by c-section are twice as likely to be overweight later in childhood.  Apparently, the difference is that since those babies didn’t go through the birth canal, they weren’t exposed to the good bacteria that live there, which “paint” a newborn’s skin, and get into her nose and mouth (and down into her gut) in a vaginal birth.

More recently, an article in the New York Times outlined how bacteria may also explain why breast-feeding may be protective against celiac disease and gluten intolerance:  probiotics (“good guy bacteria”) in breast milk, and pre-biotic oligosaccharides in breast milk (sugars in breast milk that exist not to feed the baby but to feed the good-guy bacteria that live in her gut) apparently help protect an infant’s gut from developing an inflammatory autoimmune response to gluten.

So, and here, today is another good piece, at Double X Science, called The Vaginal Ecosystem, which talks about changes in the bacteria that live in your birth canal during pregnancy.  The plain language explanation is:  the goo that lives in you changes while you’re pregnant because your body knows that a baby will be passing through and he’ll need to get a good coating of all your good gunk to get the best start in the world.

I guess the idea that you’re covered in germs (and that that’s a good good thing) is gross to some folks, but I think it’s awesome.  Truly, you’re the Mother Ship, and your crew are the billion germs that keep you in good condition. Go hug and kiss your kid: he’ll be all gooped up with your protective good-guys!

Why The C-Section/Obesity Study Makes Me Feel Reverence for Bodies and Bacteria and Even, Kind of, Poop

In the past few years, I’ve become fascinated with “good guy” bacteria — the bugs that live on and inside us, and keep us safe from disease and infection.  It’s kind of awesome that we’re home to zillions of microbes.  You’re a walking Starship Enterprise and the crew is doing maintenance and defense work on you even as we speak!

(Let me pause and say that if that concept make you a little squeamish, you may find the rest of this blog post grody).

Along these lines, I was fascinated to read of a recent study which concluded that gut bacteria may be the reason that babies born by c-section are twice as likely to be overweight later in childhood, compared with babies born vaginally.  The study, in the Archives of Disease in Childhood, found a large disparity in childhood obesity rates between kids born by c-sec and those born vaginally, even after considering other factors such as mother’s weight, baby’s size and the length of time they were breastfed.  

We already knew that babies born by c-section have an increased risk of post-birth infection vs. babies born vaginally, in part because of good-guy bacteria:  as babies travel through the birth canal, and all the good bacteria that live there (yes, your vagina is filled with bacteria! It protects you from illness) coat the baby’s skin, providing your baby with an initial coating of anti-germ protection even as he’s being born.  (A baby born by c-section on the other hand, comes out of the sterile amniotic sac, directly into a germ-filled operating room.  Germs that cause illness have the opportunity to colonize his skin before mom’s good anti-sick bacteria can colonize and protect him.  This is why skin-to-skin contact is especially important for babies born surgically — frequent contact helps the baby get a nice coating of protective bacteria from the “Mother Ship.”)

So, but here’s how this plays out with the obesity thing.  Apparently the presence or absence of different gut bacteria play a role in how we use energy, respond to insulin and lay down fat.  And babies born by c-section have different gut bacteria than those born vaginally, even years later.  Why? 

Take a step back.  There’s bacteria in your gut, right?  What happens to it?  Mostly it lives inside you.  Also, some of it comes out when you poop.  So, you can find traces of it around your bottom.  Pan the camera back and let’s think for a minute about how babies born vaginally could come into contact with their mom’s gut bacteria?  As a another childbirth educator once quipped, “it’s not by accident that babies are born with their face an inch from your asshole.”  They’re designed, apparently, to meet that part of you first so they can get exposed to your gut bacteria and, yes, ingest some (microscopic) amount, so it can colonize their gut.  And that is apparently going to help them for the rest of their lives.  Next step for the newborn is to be placed on mom’s belly, where he can get colonized with her external, protective skin bacteria, and after that onto mom’s breast where the colostrum in her breasts is filled with immune factors so that with the first swallow her body tells him:  “all the stuff you were just exposed to is harmless for you, so don’t use your energy mount an immune response to any of it; you can use your energy to grow, stabilize temperature and sugar, and get acclimated, not for defense.”  Her breastmilk also contains pro- and pre-biotics to further colonize his gut and protect him from the inside.

I think this is kind of awesome.  Not the image of a baby with her nose in your rear end — sure, that’s kind of eww-y when you stop and think.  But what’s totally magnificent to me is the way our bodies are designed to do this right.  There are so many small things, invisible until we study them, which turn out to have tremendous lasting significance.  

What can you do?

Don’t feel bad if you had a c-section, that kind of backward-focus doesn’t help.  If you had a c-section, focus on behaviors that lean against any increased potential for obesity; we should all do that anyway.   C-section can be a very, very important surgery, and when it’s medically necessary, it is a tool we are very lucky to be able to use, and to have such phenomenally good results from most of the time.

But what we all can do, I think, is maintain a kind of reverence for the body, and remember that no matter how sophistocated we are, and how good our technology, how advanced our medications, and how grateful we are for the way they save lives, nothing we can invent compares to the complicated beauty and grace of a functioning human body. 

There is much we do not understand.  When it comes to a body that is healthy, we should be very reserved about elective surgeries.  And we ought to manage labors to minimize the likelihood of c-section, not just for all the reasons we know, but, even more, for the reasons we don’t know yet.  

UPDATE, 7/13/12:  Here’s a great article exploring the science of this issue, from Science and Sensibility.