Popular Birthing Trends and the OB/GYN
/What are some birthing trends that we have seen rise in the United States?
Obviously, there are many, but unfortunately, we don’t have time to address all of them, and not all of them have robust scientific literature. Therefore, we will focus on some that are more controversial and may come up more often to help our colleagues navigate these trends with their patients that might desire them.
Please see our other episode on limiting interventions in birth to look at some other trends that we fully support, like having a doula or other support person in labor and nonpharmacologic methods for coping.
Today, we will discuss:
Lotus Birth
Vaginal seeding
Placentophagy (ie. eating the placenta)
Lotus Birth
What is a lotus birth?
Practice of leaving the placenta attached to the umbilical cord and baby until the cord falls off on its own
Anecdotally, this can take up to 3-10 days
Conventional practice, as we know, is for delayed cord clamping for 30-60 seconds
What are the perceived benefits?
Modern resurgence is thought to be credited to Claire Lotus Day in 1974
She observed that apes don’t sever their infants from placenta
Delayed cord clamping does have many benefits, as we reviewed in previous episode Delayed Cord Clamping
Increased hemoglobin levels, improved iron stores in first few months of live, increased red blood cell volume, decreased need for blood transfusion, and decreased risk of NEC and IVH
There isn’t a lot of research about the benefits of lotus birth, but those that practice it believe it can:
Increase blood and nourishment from the placenta
Decrease injury to the belly button
Be a gentle, less-invasive transition for the baby to the world
Be a ritual to honor the placenta (though there does not appear to be written record of cultures that leave the cord uncut), and gives patients autonomy on their desires for delivery
The way it is done:
The cord is not detached during birth and the placenta is usually kept in a cotton bag with a drawstring that contains herbs or salt to dry and preserve the placenta
What are the risks?
Qualitative studies show that many patients who practice lotus birth view the placenta as belonging to the baby and that it is something the baby should release when they are ready. They also discuss it in spiritual and ritualistic terms, but medical benefit and cleanliness were often secondary concerns
Overall, very little data about lotus birth
However, there is currently no evidence regarding effects on cognitive or emotional development of infants or possible benefit
There are case reports suggesting potential for infection, such as endocarditis from staphylococcus lugdenensis and omphalitis
No data available regarding late-onset sepsis
How should we counsel our patients regarding umbilical cord nonseverance?
First of all, we should always respect the wishes and decision of patients
It is important to review patient’s beliefs and why they desire lotus birth
Discuss current evidence (very little) and society recommendations
Important to realize that right now, there are no formal recommendations available from professional societies.
From the American Academy of Pediatrics:
Providers should conduct routine assessment and management of ill-appearing neonate
Any placenta and umbilical cord attached to affected child should be immediately removed if child is ill appearing (esp if necrotic tissue is evident)
Tissues should be cultured
Antimicrobial coverage with anaerobic bacteria and vanc may be needed to be included to usual regimens
Ultimately, the biggest risk is infection and patients should be counseled by us and pediatrics about signs of neonatal infection
Overall, there does not appear to be significant medical benefit to lotus birth and there are possible risks, but if it is highly desired by your patient, it is not unreasonable to achieve
Things to consider:
Cesarean delivery - it is possible to do lotus birth with cesarean
Postpartum hemorrhage - if there is hemorrhage, in order to save the woman’s life, lotus birth may not be possible
Non-vigorous infant or preterm infant - there is not a lot of data in these cases, but should review with patient that in order for expeditious pediatric evaluation, the cord may need to be clamped and cut
Placental pathology (ie. accreta, vasa previa) - lotus birth is likely not possible
Review placenta disposal - placenta should not be flushed down the toilet or buried close to the surface of the ground; if it is buried, then it should be disposed of in a location that adheres to local laws and sanitation guidelines
Be careful of buying placenta bags – not sure what the material is made from, not sure what the herbs that are included are, and realistically, not sure if what is included can actually harm babies
Vaginal Seeding
What is vaginal seeding?
For babies who are born via C-section, inoculation using cotton gauze or swab with maternal vaginal fluid applied to the newborn’s mouth, nose, and/or skin
What are the purported benefits?
Thought is that it can restore the newborn’s microbiome that is more typical of vaginal delivery
Epidemiologic studies show that there is a relationship between cesarean sections and increased risks for various conditions such as allergies
Nonvaginal delivery may be associated wit changes in the infant’s microbiome (though changes do not appear to persist)
What are the risks?
Vaginal seeding has potential to transfer pathogens to newborns that are associated with vertical transmission (ie. GBS, HIV, HBV, syphilis, etc)
There are other factors that may be related to initial colonization beyond the mode of delivery (ie. gestational age, transfer via breastfeeding)
Of note, both AAP and ACOG recommend against vaginal seeding outside of research settings:
Families should be counseled regarding the risk of exposure to pathogens that may occur despite negative screening because of possible false negative results or acquisition of the pathogen after the screening is done
Concerns are compounded by increased risk of infections in preterm infants
How do I counsel my patient?
Again, it is important to discuss the patient’s beliefs and motivations
We should review that currently, there is no data to suggest that vaginal seeding leads to benefits, but there is data about possible harm
Of course, we can’t control what patients will do when we get home, but would recommend against vaginal seeding per ACOG and AAP
Placentophagy
What is placentophagy?
Eating the placenta, usually prepared by steaming, followed by dehydration and then grinding to a powder and then encapsulated
However, there are also practices of eating the placenta raw, cooked, or blended in liquid extracts
What are the purported benefits?
For spiritual reasons
Claims that it will increase milk supply or improve energy and decrease postpartum depression, though these results have not been substantiated
What are the risks?
There are no human studies beyond self-reported surveys regarding benefits
There is literature with evidence of direct neonatal harm involving GBS due to horizontal transmission
Risks include bacterial contamination either from maternal genito-urinary flora or during preparation
Optimal preparation temperatures to eradicate various viruses and bacteria are unknown and there is no industry standard
How do I counsel my patients?
As always, review the patient’s beliefs and motivations
Discuss the current literature and data with the patient and that we ultimately don’t recommend eating the placenta
If someone really wants to do it:
Review that the placenta should be professional prepped if possible - do not do it at home
The process should ensure that the placental tissue gets to high enough temperatures to kill viruses and bacterias
Really recommend against it if there is infection of certain things that can be vertically transmitted (ie. GBS, HIV, Hep B, etc.)
Monitor yourself and your baby closely - if either one gets sick, please seek professional help
Similarly, if patient begins to have symptoms of PPD, don’t wait for the purported benefits of the placenta to kick in; should seek medical help