The risk of neonatal harm from four alternative birth practices

I’ve often noted that most alternative birth practices — from eating the placenta to lotus birth — have little to no scientific evidence to support them. That wouldn’t be a problem except for the fact that they also have significant, life threatening risks for babies.

A new paper from the American College of Pediatrics, Risks of Infectious Diseases in Newborns Exposed to Alternative Perinatal Practices summarizes the latest data on the infectious harms to babies from the most common practices. The findings are sobering.


The benefits are limited:

Immersion during the first stage of labor has been shown to decrease the use of regional anesthesia, but had no impact on mode of delivery … During the second stage of labor, water immersion did not show any benefits, nor any differences in outcomes, for the pregnant individual.

The risks are serious:

Complications have included hypothermia, drowning or near-drowning, respiratory distress, and infections… There are several reports of infections and deaths from Pseudomonas species and Legionella species.


There is no evidence of benefit:

There is currently no evidence that the transient alterations of the infant’s gastrointestinal microbiome after cesarean delivery will result in long-term changes in the incidence of childhood and adult conditions attributed to cesarean deliveries.

The risks are serious:

The practice of vaginal seeding is not recommended outside of a research setting. When counseling families who are considering vaginal seeding despite this recommendation, the need to minimize exposure to pathogens should be addressed as reasons to avoid this practice. If a mother has any known infections such as HSV with active lesions, GBS colonization, or HIV, providers should make strong recommendations against the procedure.


It isn’t a medical practice at all:

[Lotus birth] is purported by its adherents to allow a more prolonged, and hence easier, transition for the baby to separate in a “nonviolent” way (drying and breaking rather than cutting with scissors).

The risks are serious:

Once the placenta is delivered, there is absence of circulation and, hence, the tissues become necrotic. Necrotic tissue is a source of nutrients to colonizing bacteria. After extrusion from the womb, the umbilical cord and placenta are colonized with myriad bacteria, including bacteria from the birth parent’s genitourinary tract, the caregivers’ hands or gloves, and the surrounding environment (including applied preservatives, salt, and cloth wrappings). Case reports have attributed infections (early-onset sepsis from coagulase-negative Staphylococcus species, neonatal endocarditis from Staphylococcus lugdunensis, and omphalitis) to retained umbilical cord.


There is no scientific evidence to support it:

There are purported maternal benefits of placentophagy, including decreased postpartum depression, increased breast milk production, improved iron status, reduced postpartum pain, decreased uterine bleeding, and a general increase in energy. There have been no human studies regarding these benefits …

There are real risks:

The placenta, once extruded from the body, is colonized with maternal genito-urinary flora… Methods to reduce infectious contamination include heating (steaming) and/or dehydration. The optimal temperature and duration of cooking or dehydration is unclear for eradication of GBS, HIV, HBV, or hepatitis C virus, given that these are not foodborne pathogens, which would be typically tested by food safety organizations…

…Recurrent GBS sepsis in a neonate was attributed to placental consumption by the parent. The placental capsules contained the identical strain identified in both episodes of neonatal sepsis in the infant. Ingestion by the birth parent was believed to increase that individual’s colonization and, hence, increase risk of horizontal transmission of GBS.

Why would natural childbirth advocates and some even midwives adopt practices that aren’t supported by scientific evidence and may even cause substantial harms? Because alternative birth practices aren’t based on science; they’re based on defiance.

Apparently the risk of harm to babies pales into insignificance compared to the delight of defying authority.