Vaginal Seeding

Vaginal seeding also called Vaginal microbiota transfer (VMT) is the practice of wiping a baby’s mouth, face and skin with their birth mother’s vaginal fluids after C-section. This process transfers vaginal microbes to the baby to help establish the baby’s own microbiome to promote good health and fight disease.

• Evidence from population-based studies and mechanistic studies in animals has shown that the commensal microbiome plays a crucial role in immuno- and neurodevelopment during early life.^[1]

• The infant gut microbiota undergoes drastic changes in early life, beginning with facultative anaerobes such as Escherichia coli and Streptococcus, followed by the accumulation of obligate anaerobes such as Bifidobacterium, Bacteroides, and Clostridium.^[1:1]

• Many studies have reported that the gut microbiota could affect health in early life through immune regulation or the microbiota-gut-brain axis.^[1:2]

  • For example, Bifidobacterium-derived indole-3-lactic acid (ILA) could upregulate immunoregulatory galectin-1 in Th2 and Th17 cells during polarization and showed beneficial effects in infant regulatory immunity.^[1:3]
  • Animal data suggested that the introduction of Lactobacillus (L.) reuteri could reverse social deficits in autism spectrum disorder (ASD) models by rescuing synaptic plasticity via the vagus nerve.^[1:4]

• Klebsiella overgrowth in the gut has been correlated with proinflammatory T cell responses, characterized by elevated γδ T cell levels and the subsequent reduced secretion of neuroprotectants, resulting in brain damage in premature neonates.^[1:5]

• Preclinical evidence from mouse models indicated that even short-term changes in microbiota composition during the first few weeks after birth could have subtle but enduring effects on circulating immune cells and brain neurophysiology in early life.^[1:6]

• Infants delivered vaginally acquire bacterial communities resembling their mother’s vaginal microbiota, dominated by Lactobacillus, Escherichia, and Bacteroides, whereas infants delivered by C-section harbor bacterial communities similar to those found on the surface of maternal skin and in the operating room, dominated by Staphylococcus, Enterococcus, and Klebsiella.^[1:7]

• Vaginal microbiota transfer (VMT) to newborns may reverse C-section-related microbiome disturbances.^[1:8]

Study Results^[1:9]

• Sixty-eight cesarean-delivered infants were randomly assigned a VMT or saline gauze intervention immediately after delivery in a triple-blind manner.^[1:10]
• Adverse events were not significantly different between the two groups.^[1:11]
• Infant neurodevelopment, as measured by the Ages and Stages Questionnaire (ASQ-3) score at 6 months, was significantly higher with VMT than saline.^[1:12]
• VMT significantly accelerated gut microbiota maturation and regulated levels of certain fecal metabolites and metabolic functions, including carbohydrate, energy, and amino acid metabolisms, within 42 days after birth.
• Overall, VMT is likely safe and may partially normalize neurodevelopment and the fecal microbiome in cesarean-delivered infants.
• VMT significantly improved neurodevelopmental scores in infants delivered by C-section compared with those in the Con group.^[1:13]

Metabolome: The metabolome is defined as the entire collection of all metabolites contained in a biological cell compartment, cell, tissue, organ, or organism, resulting from various metabolic processes. It represents the products of biochemical activities such as protein synthesis and enzymatic reactions within living cells.

Procedure

• A gauze soaked with vaginal fluids should be prepared before antibiotics are given prophylactically.^[1:14]
• Two hours before the C-section, a folded sterile gauze moistened with 3 ml of sterile normal saline was inserted into the lower vagina of all included women undergoing a C-section for approximately one hour and then removed before prophylactic antibiotics were administered, which occurred approximately 30 minutes before the C-section.^[1:15]
• Infants were exposed to the gauze within 1-2 minutes after birth, starting on the lips, followed by the face, thorax, arms, legs, genitals and anal region, and finally the back. The swabbing process took approximately 15 seconds. The babies were not bathed for 12 hours.^[1:16]
  • Take care not to wipe it in their eyes.^[2]

Materials

• Sterile gauze (folded, tampon-sized; e.g., 4x4 inch sterile cotton gauze pads).
• 3 mL sterile normal saline (0.9% sodium chloride, no additives; obtained from CVS as you mentioned).
• Sterile container for storage
  • specimen cup with lid
• Sterile gloves.
• Timer or clock.

Steps

Preparation (2 Hours Before Scheduled C-Section)

• Wash your hands thoroughly with soap and water.
• Put on sterile gloves.
• Fold a sterile gauze pad into a tampon-like shape (about 1-2 inches long).
• Moisten the folded gauze with exactly 3 mL of sterile normal saline using a sterile syringe or dropper to ensure it’s damp but not dripping (this helps absorb vaginal fluids without diluting them excessively).
• Insert the moistened gauze into your lower vagina (as you would a tampon), ensuring it’s positioned to collect fluids. Leave it in place for approximately 1 hour.
  • This step should occur before prophylactic antibiotics are administered (typically ~30 minutes before incision).

Removal of Gauze (After 1 Hour, ~1 Hour Before C-Section)

• Remove the gauze gently using sterile gloves or clean hands (avoid squeezing to preserve fluids).
• Place it immediately into a sterile, lidded container (e.g., specimen cup) to maintain moisture and prevent contamination. Seal tightly.
• Store at room temperature (68-77°F/20-25°C); do not refrigerate or expose to heat, as this could affect bacterial viability.
• Label the container clearly (e.g., “Vaginal Seeding Gauze”) and transport it to the operating room with your birth partner or provider.
• Storage time is typically 30-60 minutes until delivery.

During the C-Section

• Proceed with your standard C-section procedure.
• Ensure your provider or a designated person (e.g., partner, nurse) has the stored gauze ready in the operating room.
• The gauze remains sealed until immediately after birth.

Application to the Baby (Within 1-2 Minutes After Birth)

• Once the baby is delivered and stabilized (e.g., after initial assessment and cord clamping), open the container using sterile gloves.
• Swab the baby with the gauze in this order:
  • Start with the lips/mouth, then face (including nose and eyes), thorax (chest), arms, legs, genitals and anal region, and finally the back.
  • Use gentle wiping motions to transfer fluids without rubbing harshly.
  • The entire swabbing should take about 15 seconds.
• This should be done by a healthcare provider or under their supervision to ensure sterility and safety.

Post-Application Care

• Do not bathe the baby for at least 12 hours to allow microbial colonization.
• Promote additional microbiome support:
  • Immediate skin-to-skin contact
  • Breastfeeding (if possible)
  • Avoid unnecessary antibiotics.
• Monitor the baby closely for signs of infection (e.g., fever, rash, irritability) in the first 24-48 hours and follow up with your pediatrician.

Notes

• Exposing a newborn to maternal vaginal fluids might transfer not only the vaginal microbiota but also vaginal metabolites, mycobiome, virome, and other materials, rendering the exact components and mechanisms that mediate the efficacy of VMT somewhat unclear.^[1:17]
• A more explicit method for the transfer of maternal vaginal fluids needs to be established.^[1:18]