Let Them Eat Dirt. B. Brett Finlay

infection. As one can imagine, with the surge in C-sections, there has been a similar increase in the use of antibiotics during birth. In this instance, the antibiotics are truly necessary, as 10–15 percent of women that undergo C-sections will develop an infection. But it’s up for debate whether the antibiotics have to be administered before surgery, or if it can wait until after the baby has been delivered. If given before the C-section, the baby will likely be exposed to the antibiotics, further compromising her microbiota at birth. If given after, the mother will still get the treatment she needs to prevent an infection and the baby will not be directly exposed to the antibiotic.

      This was the case for Carley, now the mom of a healthy three-month-old daughter. During a doctor visit early in her third trimester, Carley learned she would have to deliver her baby via C-section (an umbilical cord abnormality made a vaginal birth too risky). As a naturopathic doctor herself, Carley had hoped for a vaginal birth, but she was aware of the need for a C-section for the safety of both her and her baby in this case. At the same time, Carley was aware that C-section babies have an increased risk of developing allergies, asthma, and obesity, with current research showing that a difference in microbial exposure influenced this risk. She had been taking daily probiotics throughout her pregnancy, but knowing that she would receive antibiotics before her birth, she was concerned that her baby would not received the optimal amount and type of microbes during birth. Carley explained her concerns to her obstetrician, who agreed to administer the antibiotics after her baby was born. They also agreed to “seed” her baby with her vaginal secretions after birth. Carley’s C-section went smoothly and she recovered very well from it. She continued to take probiotics and to eat a healthy and varied diet to help restore her microbiota afterwards.

      As in Carley’s case, doctors are getting an increasing number of requests to administer antibiotics to the mother only after the baby is delivered, and even to forego antibiotic treatment altogether. While delaying the administration of antibiotics is a reasonable proposition, eliminating antibiotics during a major surgical procedure puts the mother at a very significant risk of infection. Like all medical decisions, the risks must not outweigh a patient’s benefits. In this case, the desire to protect the mother’s microbiota is outweighed by the increased risk of a severe infection acquired during surgery.

      Another common use of antibiotics at birth is the application of antibiotic ointment (erythromycin) in the eyes of newborns. This is routine in the US and Canada, aimed at preventing the development of eye infections from the bacteria that cause gonorrhea and blindness caused by chlamydia. Because the possible outcome of these infections in a newborn is so severe, it is a medical indication in all births, although countries such as Australia, the UK, Norway, and Sweden forego the practice. In the US, thirty-two states are required by law to administer this treatment, regardless of whether the mother has chlamydia or gonorrhea, or whether the baby was born vaginally or via C-section (the infection can occur only during a vaginal birth). Recently, the Canadian Paediatric Society stopped recommending routine eye prophylaxis; however, this has not yet filtered down to common practice and many children still receive this treatment.