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New Report in AAP Pediatrics Journal Urges Caution in Trending Alternative Birth Choices

Alternative birthing choices such as water births, consumption of placenta (Placentophagy), lotus birth (umbilical nonseverance), vaginal seeding (the practice of inoculating an infant born by cesarean section with a sampling of fluid from the vagina of the birth parent), and deferring newborn vaccinations have gained popularity in recent years. This week, a new clinical report was published in Pediatrics, the peer-reviewed journal of the American Academy of Pediatrics, that examined seven emerging birth trends.

As of publishing, few or no clinical studies researched most of these birthing trends, however the report referred to incidents in which these practices resulted in medical emergencies.

Lotus births, which entail leaving the umbilical cord and placenta attached to an infant until the cord detaches naturally, as opposed to cutting it when a baby is born, was not found to have any clear benefit. In rare cases, however, has resulted in sepsis in newborns, according to the report. Water births, while shown to be beneficial during the first stage of labor, pose risks of serious waterborne infections, according to report, which also cited instances of drownings or near-drownings of babies born underwater.

While many birthing parents and birth workers promote these and other alternative birth practices, it is important that parents are fully educated on the risks of such birth choices in order to make a fully informed decision in their birthing plan.

The summery and conclusion direct from the report:

Awareness of emerging alternative peripartum and neonatal practices helps pediatricians provide counseling to families before birth and to appropriately evaluate and treat neonates who have been exposed to these practices.

  • Water immersion for labor and birth has been shown to improve comfort of the pregnant person in the first stage of labor but has not shown benefit for the second stage of labor or delivery. Potential neonatal infections associated with this practice, such as with Legionella and Pseudomonas species, are rare but serious.

  • Vaginal seeding may expose infants to vaginal pathogens such as GBS or HSV and has no known benefits. Evaluation of symptomatic infants born by cesarean section after exposure to vaginal seeding should be the same as for those who are delivered vaginally.

  • Umbilical nonseverance has no clear benefit to date and may possibly increase risk of neonatal sepsis attributable to the presence of necrotic umbilical or placental tissue.

  • Placentophagy should be avoided because there is no evidence of benefit to the caregiver, and one case report links this to recurrent GBS sepsis in a neonate. Evaluation of symptomatic infants exposed to this practice should not differ from other neonates.

  • The birth dose of HepB serves as a critical safety net for prevention of HBV infection, and nonmedical deferral of the birth dose should be discouraged.

  • Ocular prophylaxis is effective for treating some causes of ophthalmia neonatorum, particularly in high-risk situations, such as limited prenatal testing for causative organisms in high-risk populations and in areas with high endemicity. Adequate prenatal testing significantly reduces the risk of ophthalmia neonatorum. Deferral of ocular prophylaxis may be considered in low-risk situations but may be impacted by state legislation.

  • Delayed bathing may have benefit in promoting initiation and exclusivity of breastfeeding. Delayed bathing in neonates exposed to active HSV genital lesions or with known history of HIV infection in the birth parent should be discouraged.


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