​One of the most in vogue topics today is the importance of the gut microbiome and how important it is for your health.  An altered gut microbiome can contribute to poor immunity, obesity, allergies and even cognitive and mood issues.  A question I get asked frequently is “If I have a cesarean section and my baby does not pass through the birth canal, will it affect my baby’s gut microbiome?”  There is some truth to this.  If your baby does not pass through the birth canal, its mucous membranes (the mouth, gut lining) will not likely get exposed to the microbes of the mom’s vagina.  Can vaginal seeding after a cesarean section help?  If you've had a cesarean section (C-section) and are curious about vaginal seeding, you're not alone. Many parents are exploring this practice to support their newborn's health, especially concerning gut microbiome development. Here’s what you need to know.

What is Vaginal Seeding?
Vaginal seeding involves swabbing a newborn with the mother’s vaginal fluids immediately after birth, particularly if the baby was delivered via C-section. The idea is to introduce beneficial bacteria from the mother’s vagina to help colonize the baby's gut, like what occurs during a vaginal delivery.

Why Consider Vaginal Seeding?

1. Microbiome Development: The gut microbiome plays a crucial role in a baby’s immune system, digestion, and overall health. Babies born vaginally are exposed to their mother's vaginal flora, which helps establish a healthy microbiome.
   
2. Potential Benefits: Some studies have indicated that vaginal seeding may help reduce the risk of allergies, asthma, and certain autoimmune diseases, although more research is needed in these areas.

How is Vaginal Seeding Done?
Vaginal seeding typically involves the following steps:

1. Swabbing: After the C-section, a healthcare provider or the mother swabs the baby's mouth, face, and skin with a sterile cloth or gauze that has been in contact with the mother’s vaginal fluids.
   
2. Timing: This procedure is usually done within the first few minutes after birth.
   
3. Safety: It’s important to ensure that the mother is free from infections that could be transmitted to the baby through this method.  If you are positive for group b strep, sexually transmitted diseases, or developed an infection during labor, I would strongly encourage you to stay clear of this practice! 

Do Studies show that vaginal seeding after a C-section helps the development of the baby’s microbiome?
Yes, there have been several studies exploring the concept of vaginal seeding and its potential effects on a baby's microbiome.  They have shown that infants who undergo vaginal seeding tend to have a microbiome composition more similar to that of vaginally delivered babies. This suggests that they may receive some of the beneficial bacteria typically acquired during vaginal birth.  Preliminary research indicates that these early microbial exposures could play a role in developing the immune system, may help lower the risk of certain conditions, such as allergies and asthma and improved overall gut health (less gastrointestinal distress).  However, there have been very few studies with very small sample sizes (very few people participated to confirm it works) and the results were variable.  I think more robust randomized controlled trials with a larger sample size and consistent vaginal seeding techniques are needed to ensure that vaginal seeding is worth the hassle and will help the baby’s microbiome. 

Conclusion
Vaginal seeding is an emerging practice that some parents consider following a C-section to support their baby’s microbiome. While the potential benefits are intriguing, it's crucial to discuss this option with your healthcare team to ensure it aligns with your health and that of your baby.
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If you have any further questions or concerns about vaginal seeding or your delivery options, feel free to reach out. Your health and your baby’s health are our top priorities!

​One of the toughest challenges as an ob/gyn is trying to determine if a patient needs evaluation in the hospital or if it’s ok to wait out the situation and follow-up in clinic.  Sometimes it’s pretty self-explanatory, but most of the time it’s not.  Below are some of the symptoms that definitely merit a check in the hospital setting.

In early pregnancy, some of the biggest concerns for patients that may require evaluation are vaginal bleeding and lower abdominal pain.  Occasional spotting or a small amount of blood with wiping may be normal, particularly after intercourse; however, heavy bleeding (soaking through more than a pad per hour) with or without passage of clots or tissue may indicate a miscarriage and usually requires an emergency workup.  Unfortunately, our ability to intervene and save a pregnancy is pretty limited until the baby can survive outside of mom (around 23-24 weeks at the earliest), but it is important to determine if surgery is necessary to treat the bleeding.  The same sort of evaluation may is also indicated in a woman who has lower abdominal or pelvic pain despite rest, hydration, change in position or extra strength Tylenol.  If the pain goes away with any of those measures, it generally isn’t expected to have a negative effect on mom’s or baby’s health, but if the pain continues despite those interventions, the number one priority is confirming that the pregnancy is inside the uterus.  Ectopic pregnancies (those outside the uterus) can’t result in delivery of a baby, but they may require surgical (or in some cases medical) intervention to prevent maternal heavy bleeding into the abdomen.  Additionally, non-pregnancy emergencies may also present with worsening pain.

In addition to heavy bleeding and persistent pain, there are a few other considerations that require evaluation at the hospital later in pregnancy.  I can’t count the number of calls I’ve had where someone asks me if she’s in labor, but no matter how many times I’m asked, I can’t know for sure unless a patient has an exam and is monitored over time.  I have learned how to text finger emojis, but I still haven’t figured out how to do a cervical check over the phone ;)  Generally, painful contractions every 5 minutes or so are a good indication of the onset of labor, although this may vary from person to person.  Monitoring of the baby’s response to contractions as well as their frequency helps let us know how to manage your care.  Even if you came to the office, you’d generally still require evaluation on labor and delivery for persistent contractions as your cervix may change over the course of a few hours.  Besides, my staff would kill me if they had to clean up after a delivery in the office :O  Other than labor checks, if there is concern your bag of water has broken, then you should go in for evaluation.  This is important even if you aren’t having contractions because you may need medicine to augment labor.  Even if your group B strep test was negative, if delivery is delayed for too long after your water breaks, you can still develop an infection in the uterus that can negatively affect the health of both mom and baby.  Lastly, if you feel that your baby isn’t moving, and he/she hasn’t moved enough to be adequate according to the guidelines of your provider, then monitoring and testing of your baby is indicated, either in the office or on labor and delivery.

While the blog doesn’t cover every potential situation, this should be a helpful start on deciding whether or not to go in for evaluation.  That being said, be sure to also pay attention to any other specific warnings given by your provider, as these may vary from patient to patient.  Also, it is generally to err on the side of caution, so if you have a specific concern that’s not in this guide, either call your doctor or go in to have it checked out.  Even if it’s frustrating to be sent home after everything checks out OK, it’s still better to be sent home than not to be seen for something that change the course of your care.  That being said, the majority of pregnant women and their babies do very well, and even if you develop some of the above symptoms, it doesn’t necessarily mean your pregnancy won’t be successful.  Good luck with your pregnancy, and let us know if we can be of help!

Dr Nick

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​How do I know my Rh status and what does it mean? At your first prenatal visit, you will have a lab test to determine your blood type and your RH status.  The Rh status tells us whether you have a particular protein on the surface of your red blood cells.  This is kind of like a pirate flag to Rh negative blood cells.  90% of Caucasians are Rh+ and have this protein.  This frequency varies somewhat with other ethnicities.  However, if you are Rh negative and don’t have this protein, you will need to take special precautions during the course of your pregnancy.  

Why is being Rh negative a problem when you are pregnant? If you are Rh negative, there is a high likelihood that your baby will be Rh positive.  This is simply based on the fact that your partner is likely Rh positive (a pirate!).  Essentially, this means that your blood and your baby’s blood will likely be incompatible.  This incompatibility will not likely have any effect during your first pregnancy; however, if your baby’s blood leaks into your blood, which is a frequent occurrence during labor (and occasionally sooner if you have bleeding), your blood will develop antibodies against the Rh factor.  Much like you would keep a lookout for pirates after you saw them the first time, these antibodies patrol and attack any proteins that they see in the future.  This is called Rh sensitization.  In a future pregnancy with an Rh positive baby, your blood can attack your baby’s blood. 

What does it mean that my blood can attack my baby’s blood?  Once your blood has developed antibodies against the Rh factor, it can attack your baby’s red blood cells and kill them.  If this happens, it would essentially cause your baby to have anemia and can cause jaundice (yellowing of the skin), as well as more serious complications, such as brain damage, miscarriage or even stillbirth.  

How do we prevent sensitization?  If you are Rh negative, you will receive a shot called Rhogam during the time that your blood is most likely to be exposed to your baby’s blood (essentially, it provides a diversion for all of those pirate cells). This will prevent your body from developing antibodies and attacking your baby’s blood.  Rhogam is administered at 28 weeks because it will protect you from antibody formation for 12 weeks (essentially up until delivery).  Once you deliver, we will check the baby’s Rh status from a blood sample; if your baby is Rh positive then you will receive another dose of Rhogam to prevent any antibody formation that could have happened during bleeding from delivery. 

Would I need Rhogam any other time during the course of my pregnancy if I am Rh negative? Most women only receive Rhogam at 28 weeks and after delivery if their baby is Rh positive.  However, if you know that you are Rh negative and have had any of the following complications, you will likely need Rhogam to prevent sensitization: miscarriage, abortion, ectopic pregnancy, stillbirth, molar pregnancy, vaginal bleeding in early pregnancy, or abdominal injury during pregnancy. 

Bottom Line: If you are pregnant, you need to know your Rh status! If you happen to be Rh negative, make sure that everyone that takes care of you while you are pregnant (especially urgent care or the ER) is aware so they do not forget to administer Rhogam to prevent your blood from becoming sensitized!Pam