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Ages & Stages

7 Alternative Birth Practices & What You Should Know About Them

By: Dawn Nolt, MD, MPH, FAAP

As an expectant parent, you may have heard about childbirth practices that fall outside of standard labor, delivery and newborn care. Some may offer possible benefits to you or your baby. However, some can also raise the risk of certain infections for your newborn.

Here's a rundown of seven different alternative practices, and what you should know.

1. Water birth

A water birth involves going through labor or delivery while soaking in a tub of warm water. Most childbirth centers now have birthing tubs available, though typically only for use during labor. Home water births are sometimes planned with the help of a midwife.

Scientifically, water births appear to improve comfort in the early, first stage of the labor, but not beyond that. There is no known benefit of water birth to the newborn. In contrast, there may be bacteria in water that could infect a baby born in the tub. Although rare, infections which occur in babies following a water birth can be serious.

2. Vaginal seeding

This is when a baby born by cesarean section has their nose, mouths, and skin swabbed with vaginal fluid from the birth parent. The goal is to give the baby exposure to vaginal flora (bacteria) they would have had going through the birth canal.

Babies born by cesarean section do appear to have increased risk of allergies, asthma and obesity later in life. Some suspect this may be result of having a different microbiome (balance of bacterial and other microbes that live in or on the body). But there is no scientific evidence that vaginal seeding effectively changes that risk.

Also, while there may be bacteria in vaginal fluids that may be good for a baby's microbiome, it can also contain harmful microbes. For example, babies should not have vaginal seeding if the cesarean section was intended to avoid an infection from the birth parent (such as HIV, group B Streptococcus, or genital herpes).

3. Lotus birth

You may hear a medical term for this, "umbilical nonseverance." It's when the umbilical cord (and the placenta) is left attached to the baby, rather than being cut and removed right after birth. With a lotus birth, they are allowed to dry until the cord detaches on its own, usually within 3 to 10 days.

A lotus birth may seem a "non-violent" way to transition the baby from the womb into the real world. But there is no evidence that it has any effect on the baby's emotional development. If the attached cord or placenta becomes rotten, this allows bacteria to grow rapidly, and possibly travel from the tissue to your baby. There are known instances of babies with lotus births becoming very sick.

4. Eating the placenta (placentophagy)

Placentophagy is the practice of eating your own placenta. The placenta delivers oxygen and nourishment to the developing baby during pregnancy. Also called "afterbirth," it's consumed raw, cooked, or dried and powdered in capsules.

While placentophagy is considered a way to reduce post-partum depression, boost breast milk production or replenish nutrients, there is no scientific proof of these benefits. In fact, there is a risk of food poisoning from consuming placenta if it has started to spoil. Also, the Centers for Disease Control and Prevention has warned against taking placenta capsules after a newborn got seriously ill from group B streptococcus (group B strep) infection on two separate occassions. The baby's mother had taken placenta pills containing group B strep, likely passing the bacteria to her baby.

5. Skipping the birth dose of hepatitis B vaccine

Some families may feel that the hepatitis B (hepB) vaccine is not needed right after birth, preferring to delay it a few weeks or months. While this may seem reasonable if the birth parent is negative for Hepatitis B, anyone with Hepatitis B may infect the baby if close enough. The hepatitis B vaccine should be given as soon as possible to protect the baby against anyone (not just the birth parent) who may be infected. Babies infected with hepatitis B virus may not show symptoms right away, but the virus can eventually damage the liver.

6. Declining newborn erythromycin eye ointment

Erythromycin eye ointment will prevent a specific bacteria (Neisseria gonorrhea) from causing a serious infection that can lead to blindness. If the birth parent has tested negative for this bacteria during the pregnancy, it is extremely unlikely that the baby needs this ointment. However, some states have laws requiring that eye ointment be used.

7. Delayed bathing

The sooner and longer a newborn can have skin-to-skin contact with the birth parent, the better. That's why the World Health Organization now recommends delaying a newborn's first bath until 24 hours after birth in most cases. This can help keep the baby's body temperature and blood sugar in control, and promote breastfeeding and bonding. However, if the birth parent has a genital rash from HSV during delivery, or has HIV, hepatitis B, or hepatitis C, it is important to bath the baby as soon as possible to remove infected fluid from their skin. There are no other known risks of infection if the bath is delayed.

Should I tell the pediatrician about alternative practices for my baby's birth?

Yes. Alternative birth practices may expose your baby to germs not typically covered in the usual tests or antibioticss. It is important to mention any that were part of your baby's birth, so the doctor can adjust any tests or antibiotics as needed.

Where can I learn more about ways to improve the birth experience or health of my new baby?

Your pediatrician should be a trusted source of information. Have a clear discussion with your pediatrician about whether a birth practice may benefit or harm your child before the delivery.

More information

About Dr. Nolt

Dawn Nolt, MD, MPH, FAAP, is a Professor of Pediatrics in the Division of Infectious Diseases at Oregon Health & Science University School of Medicine. She is lead author of the American Academy of Pediatrics Clinical Report, Risks of Infectious Diseases in Newborns Exposed to Alternative Perinatal Practices.

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American Academy of Pediatrics Section on Infectious Diseases (Copyright © 2022)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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