Vaginal seeding and lotus births - consensus statement

Please note that some guidelines may be passed their review date. The review process is currently paused. It is recommended that you also refer to more contemporaneous evidence.

Safer Care Victoria, in partnership with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Victoria, have developed this consensus statement regarding Vaginal Seeding and Lotus Birth.

Key messages

• Women requesting a lotus birth and/or vaginal seeding, should be identified in the antenatal period and appropriate measures taken to provide them with counselling and support. Counselling should be provided by a clinician with experience in the birth practices being requested.
• The practice of vaginal seeding is not recommended or encouraged outside of the context of a research protocol.
• There is no empirical data to support lotus birth and therefore it is not a recommended practice.
• This is an acknowledgement that some women will request these practices and that clinicians should have the knowledge and processes in place to support women to make informed choices.

Vaginal Seeding

Vaginal microbe seeding is the process of initiating maternal vaginal microbe exposure for newborn babies born by elective caesarean section.

• The practice of vaginal seeding is not recommended or encouraged outside of the context of a research protocol. It is recommended that vaginal seeding otherwise not be performed until adequate data regarding the safety and benefit of the process becomes available.1
• There is a risk with vaginal seeding of causing potential harm to the neonate by increasing the risk of sepsis. Seeding is contraindicated if there is an increased risk of sepsis including neonates of women who have risk factors for infection
• Should a woman insist on performing the procedure herself, a thorough discussion with the woman should be held, emphasising the potential risk of transferring pathogenic organisms from the woman to the neonate. Safe practice of vaginal microbe seeding should include an assessment of the risk of infection including, but not limited to, Group B Streptococcus screening and HIV screening with negative results.
• It is further recommended that the care provider make contemporaneous notes of the discussion. Because of the theoretical risk of neonatal infection, any health care provider caring for the infant should be made aware that the procedure was performed.
• The paucity of data on this subject supports the need for additional research on the safety and benefit of vaginal seeding. Long-term benefits for these exposed newborns have not yet been established.
• Other proven practices to support the newborn’s developing microbiome, including skin to skin contact and early breastfeeding, should be supported.2
• If vaginal seeding is carried out, the newborn’s first bath should be delayed until mother and baby are discharged home. The first bath should be with water only (no soaps or antibacterial washes) as this helps keep the vernix on the baby. Vernix is known to have antibacterial and antifungal properties.3

Lotus Birth

Lotus birth is the practice of leaving the umbilical cord intact until it separates naturally from the baby. This is a process that can take between 3 and 10 days.4 Newborn safety and appropriate infection control processes must be followed in the event of a lotus birth.

There is no empirical data to support lotus birth, and it is not a recommended practice.5 However, women who request this practice should receive appropriate support from clinicians to ensure the practice is performed as safely as possible.

Counselling for women who request a lotus birth should include:

• Advice regarding the risk of postpartum haemorrhage and neonatal resuscitation.
• Discussion regarding physiological third stage.
• That the practice may not be possible if the birth is by caesarean section or if the baby requires resuscitation. In the case of an elective caesarean section, leaving the cord uncut may be possible if the baby is well at birth. This should be discussed with the obstetrician on admission and contingency plans made.
• Planning for early transfer home after birth:
  1. The woman should be advised that early transfer home is recommended (if safe to do so) to reduce the risk of cross-infection to others.
  2. If the woman cannot be transferred to postnatal care in her home for clinical reasons, she will require a single room to reduce the risk of cross-infection.
• The woman’s plans for placenta disposal should be discussed. If she plans to bury the placenta, then the woman should receive advice to ensure that the placenta is disposed of within existing legislation.

References

1. American College of Obstetricians and Gynecologists. Practice advisory: Vaginal seeding.
2. Dunn AB, Jordan S, Baker BJ, Carlson NS. The maternal infant microbiome: considerations for labor and birth. MCN. The American Journal of Maternal Child Nursing. 2017 Nov;42(6):318.
3. Tollin M, Bergsson G, Kai-Larsen Y, Lengqvist J, Sjövall J, Griffiths W, Skúladóttir GV, Haraldsson Á, Jörnvall H, Gudmundsson GH, Agerberth B. Vernix caseosa as a multi-component defence system based on polypeptides, lipids and their interactions. Cellular and Molecular Life Sciences CMLS. 2005 Oct 1;62(19-20):2390-9.
4. Crowther S. Lotus birth: leaving the cord alone. The practising midwife. 2006 Jun;9(6):12.
5. Bonsignore A, Buffelli F, Ciliberti R, Ventura F, Molinelli A, Fulcheri E. Medico-legal considerations on “Lotus Birth” in the Italian legislative framework. Italian journal of pediatrics. 2019 Dec;45(1):1-6.

This consensus statement has been developed by Safer Care Victoria, in partnership with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Victoria.