Childbirth and the Microbiome - with and Toni Harman | The Empowering Neurologist EP. 44

Hello everybody, and welcome once again to The Empowering Neurologist. I'm Dr. David Perlmutter. Here's the book that we're going to be talking about today called Your Baby's Microbiome. Author Toni Harmon and her husband Alex Wakeford have written a terrific book. Tony Harmon is a filmmaker turned author, obviously. She's a graduate of Exeter University and London Film School. She has spent the last 20 years producing and directing films. Her credits include a feature film in Hollywood, as well as several documentary films called Douala: Freedom from Birth and her multi-award-winning documentary Microbirth, which is also about the critical importance of what she calls seeding and feeding your baby's microbiome involving things like method of birth. Why is vaginal birth so important, as well as the importance of breastfeeding for the best possible lifelong health of a child? Her extensive research for the film Microbirth led her to co-author this new book with her husband called Your Baby's Microbiome. It's a terrific book. I'm really looking forward to this interview, some terrific information for all of us, especially, however, for parents and parents-to-be. So here we go. Well, hello, Toni. Thank you for joining us today.

Thank you for having me. I'm really excited to be here.

Well, first let me say that your, your book and your films were definitely needed and are still needed, but I'd like to start off by asking you, what is it that provoked you to get so involved with Spreading the word of the importance of vaginal birth and breastfeeding. Why did it appeal to you?

I didn't set out on this journey. I thought I was off to Hollywood making feature films. I just directed my first feature film. It got picked up by a Hollywood studio. I thought I was all set. And then I had a baby, which kind of changed the course of my life, and I started becoming interested in making documentaries about childbirth. And through making films about childbirth, I started hearing about the microbiome and started hearing that there's things that happen during childbirth that could have lifelong effects on a baby's health. So I started researching and started filming interviews with scientists, and that set the course of the last 5 years, really. So we, we made the film Microbirth, and then we've been making a follow-up to Microbirth Since, and it's—I mean, you know this. Once you get into the microbiome, it kind of grips you. There's—it's like layers of an onion. You start unpeeling, unpeeling the layers away, peeling the layers away, and there's a whole new universe almost that opens up. Suddenly, everything connects in terms of—for me, I mean, so about vaginal birth and breastfeeding and paying attention to the first. 3 years of life and how that could have lifelong effects. So it wasn't a path that I deliberately took, but I'm glad I'm on this path.

Now, here in America, our rate of C-section birth is around 30%. What is it in England?

About 25%.

So similar. And, you know, the contention I think that you make in your book, and I think that I've made in the past as well, Is that there's very little discussion with parents-to-be when they're trying to decide whether, for whatever reason, to undergo a C-section versus vaginal delivery. There doesn't seem to be any real discussion of the long-term consequences on the baby in terms of this choice. But it seems to me that your book was just filled with information about why this choice is really fundamental in terms of determining that child's health destiny. Can you explain that?

You're absolutely right that this, to me, is just this lightbulb moment of actually what happens during pregnancy, birth, and the first 2 to 3 years of life is absolutely critical to a child's lifelong health because the baby's exposure to microbes during that critical period That trains the immune system, and it trains the immune system to recognize what's good. So which which what bacteria should be tolerated, and what what are pathogens? What what bacteria might be harmful? And it's this critical period over the first two two three years of life, and whether it is because The healthcare professionals haven't quite caught up with the science yet. I mean, people are starting to, so there's lots of informed doctors, there's lots of informed midwives. I mean, the work that we're doing in terms of writing a book and making films about it, we're creating a stir about the importance of this critical period. But right now, people don't, for whatever reason, don't feel confident talking to parents about this amazingly critical period. I mean, the reason why it's important is because during birth, during vaginal birth, a baby is supposed to be exposed to the mother's bacteria through the birth canal and then through exposure to the mother's fecal microbes through contact with the mother's poo. All of those exposures from the mother's microbes, they help train the baby's immune system. With a baby born by C-section, the baby might not be exposed to the same set of the mother's microbes. It might not be exposed to the microbes in the birth canal and might not be exposed to the microbes from the mother's fecal matter, from her poo. The baby is brought out, it's lifted out through the abdomen. So the first exposure the baby receives to the world of microbes is different from vaginal birth. And this, scientists believe that this could prime the baby's immune system in a slightly different way. And they're linking this to a particularly increased risk for certain lifelong health conditions. Yeah. It's this amazing science that has come about in probably the last 3 or 4 years that could determine a child's lifelong health, yet the health professionals aren't quite up to speed with that science. People like you are absolutely full-on up to speed with it, but it takes a while for that science to filter out to to doctors, to midwives, to other sort of clinicians.

Well, it's certainly a bit— the information is certainly a bit disruptive, and therefore you are a bit of a disruptor, as am I, and I don't mind that one bit. But, you know, I think that the data is clear that children born by C-section in general have a significantly increased risk for allergic issues, inflammatory issues, autoimmune conditions including celiac disease and type 1 diabetes, Adult obesity, ADHD, autism, etc. And we know that by and large, these are immune/inflammatory disorders, and that the microbiome of a person is really characterized early in life by these exposures that you were talking about. So, you know, there are people like yourself, like, like I am, and, and very few others who are really out there Talking about this importance, but, you know, again, that's the reason we're having this discussion today. So what's it going to take, do you think, for more doctors to become aware of the fundamental importance of vaginal birth versus C-section?

For me, I think it comes down to 2 things. There's pressure from the top, so there's pressure from governments, from hospital managers, from, you know, kind of the The people in power at the top. So absolutely, they dictate hospital policy, they dictate what happens within that hospital. And obviously, the most important thing is that the mother and the baby are safe and everything is done to protect their health, both the short-term health and the long-term health. But okay, so you've got pressure from the top, but also, I think, you can have pressure from the bottom. So you can inform mothers and you can inform your doulas and your healthcare professionals that support the clinicians. You can inform them about the amazing, the wonders of optimally seeding and feeding a baby's microbiome for the best possible lifelong health. You can inform them with it. You can give them the information so that they feel empowered to make choices that are right for them. So I've got this idea that if every mother was informed about the optimal seeding and feeding of a baby's microbiome and they say to their healthcare provider, their clinician, their doctor, they say, how can you help me seed and feed my baby's microbiome? And if the doctor says, I don't know. I don't know what you're talking about.

What's a microbiome?

They can kind of go upwards. They have to kind of go and look for themselves. So there's pressure from the top and there's pressure from the bottom. And somewhere in the middle, that's how we kind of change the world between you, me, and everybody else who's kind of talking about the microbiome, is that you kind of— you empower people with knowledge.

Well, you know, we've recognized for a long time— truthfully, it's not been a long time— that genetics are really important in determining a person's health and risk for disease, that we inherit mom and dad's genes. that have been passed down generation to generation. That is what we call vertical transmission of information. But we really haven't appreciated this horizontal transmission of information. Really, in its finest way, what is happening at the time of birth is transmission of instructions and information. When we recognize that that vaginal flora It changes based upon mother's diet, mother's environmental issues, and is really loading the apps on the computer, if you will, of that child being born at that point. And we call that horizontal transmission of information. And in biology, that is a very highly conserved event. We see that in, of course, mammals. We see it in rodents, insects, fish, birds. We even see it in sponges. So we know this is a process that is highly conserved that dates back a couple hundred million years. And now suddenly we're having babies in a sterile operating room where they're inoculated with whatever germs happen to be on the surgeon's gloves and gown, or happen to be floating around in the operating room. So it's really a lot of work has to be done in order to allow people to really get their arms around, you know, this whole event. Now, I know that you've done some work with Dr. Maria Dominguez-Bello, or at least you've interviewed her, and she is at NYU, done some terrific work. In fact, we quoted some of her studies in a couple of our books. Explain to us what she's working on in terms of the reinoculation technique and how you see that and what that might hold in terms of future promise.

Okay, so Dr. Maria Gloria Dominguez-Bello is a researcher at NYU. We were lucky enough to film her, and she's brilliant. She's fantastic. She's working on something called swab seeding. So she's looking at the potential of giving a baby that's born by C-section the mother's exposure to the mother's vaginal microbes. So what she's looking at is inserting a kind of a sterile swab into the mother's vagina prior to the C-section and then taking out the swab and then wiping the newborn baby with this swab, which is inoculated with the mother's vaginal microbes, wiping it over the baby's mouth, over the baby's face, over the baby's body, with the idea of introducing the mother's vaginal microbes to the baby. It's the microbes the baby would have received had the baby been born vaginally. This is not a recognized medical procedure yet. This is only research. At the moment, she's only got the preliminary research results. And so there's strict protocols for her research. So only mothers who need to have an elective cesarean, low-risk mothers, those mothers that test negative for any pathogens, whether that's GBS or any other kind of pathogens. So these are low-risk groups. So I've got to say all that. But the her preliminary results, she seemed to indicate that she is partially partially restoring the baby's microbiome to be like it would have been if the baby had been born vaginally. So I mean, so the I mean it it could present an opportunity for the future. I mean, it's it's still a subject of research, and the baby doesn't receive the mother's. Exposure to the mother's fecal microbes, doesn't expose— the baby isn't exposed to the mother's poo. And there's— I mean, you touched on this when you're talking about the kind of the vertical transmission and basically epigenetics. So there could be changes within the baby, epigenetic changes, so changes above the gene relating to the mother's, like, the stresses of being pushed through a mother's pelvis, the release of hormones, all of those things that could result in epigenetics. But anyway, so Dr. Maria Gloria Dominguez-Bello, so her research, her swab seeding research, could be something for the future. It's not yet, but something in the future.

Well, let me just say to our viewers that while it was made very clear that this is purely experimental and research-related, In Brain Maker, I fully describe how the process is done. Of course, that's just there for you to talk to your healthcare provider about. But you just touched upon something I think that is very interesting, and that is that there are differences in health outcome as well as differences in the microbiomes of children born by C-section versus those born vaginally, and it not— it doesn't all necessarily relate to the child picking up the specific microorganisms at the time of passage through the birth canal, but that other events occur as well, like being exposed for a longer period of time to the stress hormones of mother, and also the head compression and body compression that happen when a child actually passes through the birth canal. So there are other, you know, factors that need to be considered. Dr. Maria Dominguez-Bello actually published a report Several months ago in the journal Nature, and she described how she was able to prove that mother's organisms, some of them, were actually recoverable from the infant stool many months after he or she was born. So we do know that the technique at least goes so far as to transmit some viable organisms that then, you know, prove to be the seeds of that child's upcoming microbiome. Now, as far as breastfeeding goes, you know, we're almost convinced these days that infant formula that you see on the shelves at the grocery store is probably just as good as mother's milk. I mean, that's what mothers, I think, are convinced of. We know that, for example, when our children were born, my wife and I fully intended to breastfeed. I didn't have much of a role to play in that event, but— You were there. We we did receive a bag of infant formula as we left the hospital, which I thought was very interesting. That was you know 28 years ago. But that said, there's still a push, I think, to get women away from breastfeeding. And we know that breast rather infant formula contains a certain amount of fat and carbohydrates. Now a little bit of DHA, and now even some galactosaccharides trying to mimic. breast milk, but I think, you know, as you talked about in your book, we're a long way away from being able to really emulate a product like human breast milk. So why is breastfeeding so darn important?

Okay, I know this is a really sensitive subject for some mothers, and like me, I mean, I had an emergency C-section with my daughter. I struggled to breastfeed, and within an hour of my daughter being born, I'm not even sure who she was, whether it was a nurse or maternity support worker, gave my daughter formula milk just because she said it's for the sake of the baby. Now I know that actually the breast milk is— well, you can't emulate it at the moment. Formula milk is good. It provides a baby with nutrition, so the baby will survive. But actually, what the breast milk and with what formula milk doesn't have are the the and you touched on this the human milk oligosaccharides. These are special sugars that are meant to feed the microbes within the baby. So the the microbes that have just arrived from the mother, that the the these special sugars within breast milk, they're supposed to feed the the microbes. And it's this beautiful kind of seed and feed process. You've got the the seeding from so the the mother is providing. Then within breast milk, you have the exact food to feed those microbes.

Who knew? Somebody must have really done a good job designing this.

It's just such a beautiful system, and that's the thing. With this food, these microbes, they proliferate. They multiply, and they colonize the infant gut, and they colonize it with the kind of Well, you know, there's no such thing as good or bad bacteria, but for, you know, the type of bacteria that you'd want, that an infant would want in order to train the— optimally train the immune system. And also they crowd out— they colonize with fed— suddenly these like hungry bacteria get these like perfect food and they colonize quickly, which crowd out all nasty pathogens. So it's just a beautiful system and we've evolved to be like this. I mean, every single mammal have evolved to be like this. For whatever reason, we start giving our babies formula milk. As someone who gave their baby formula milk, I know this is a difficult subject and I know that some mothers can feel guilty about this, but actually, the reality is there's no replacement for breast milk. I mean, it's not just the immune components and the antibodies and these special sugars, the human milk oligosaccharides. It's all the other living components, the 700 species of bacteria that are contained within breast milk. All of this is just a beautiful, exquisitely designed, perfect food and a perfect food to feed the baby. And I get Don't I know. Oh, I just— I mean, it's a difficult conversation to have with a new mother saying the way to— the best way to feed your— even to say the best way to feed your baby is an explosive thing to say, but it is scientifically. The best way to feed your baby is with your breast milk, and if for whatever reason you can't feed your breast milk, then there's peer-to-peer sharing or donor breast milk. These are They're all possible alternatives. I'm not saying that formula milk is bad because it does provide all the nutrition. It just doesn't have all the living components that breast milk does.

Exactly. And the bacteria on the skin of the areola and the nipple as well are imbibed by that infant aggressively and also, you know, help to form that microbiome.

I mean, that's the thing. When a baby's born, if you look at those kind of videos of an undisturbed birth, Where you see a baby put on the mother's chest and it kind of nuzzles its way up the chest and it kind of latches onto the nipple completely on its own. And as it does so, it licks in it and it sort of lingers. And all of those are microbial exposures. I mean, you know, when, when a baby's born vaginally, the mother— and this is fantastic— the mother's going to be coated in all those fantastic vaginal juices and all the kind of the juices that come with birth. And the baby's just kind of, you know, all of them up. I mean, it's just a beautiful process. And that's how we've dissolved. That's how we've evolved. I mean, if you look at kind of a lamb being born, it's a messy, beautiful process.

It's the messy part that so many people object to. And I know that, you know, when a baby is born, the first thing they do is they wipe its face clean as quickly as possible with a towel. And then they present that clean, white, shiny face to the mother when in actuality, that's the home run stuff there on that baby's face. That's inoculating that child, setting that child up for health for the rest of his or her life. And it's worked for a long, long time.

That's it. I mean, just that those— I mean, it's quite difficult to say to a mother, actually, all the vernix and all the mess and everything else is fantastic for the baby's skin microbiome. All stuff that needs to be kind of rubbed into the— to colonize the baby's skin microbiome. Skin-to-skin contact and the messiness of birth, that's how it's supposed to be.

In summary, what you've talked about in your book with your husband is that this is hugely important and unfortunately underrecognized. in terms of providing a child with the greatest health benefits for his or her rest of their life. And I'm just thrilled that you wrote this book. I know that you had some involvement with Dr. Martin Blaser as well, and he wrote a wonderful book called Missing Microbes where he talked about how exposure to antibiotics, which is so prolific here in America— I don't know how it is in England, but probably as bad— in childhood and adolescence changes the microbiome in such a way as to pave the way for obesity, which is epidemic here in America in our adolescent children and teenagers. And that said, really recognize how important it is to cater and protect— cater to and protect our microbiomes as best we can. You know, your work, of course, starts at the very beginning. And, you know, you are what we call a citizen scientist. You know, you probably didn't know a whole heck of a lot about this, but now having read your book, gosh, you know so much. It's just, it's wonderful. But it's written in such a way that everybody can read this. So I'm hopeful that people are going to buy this book and really understand why this is so important. How can we, how can our viewers find out more about what you do and follow you?

Lovely question. Thank you. So we've— so I'm a filmmaker and an author. So go to my— so our film that was— our book is called Your Baby's Microbiome, and it's based on the research we did for our film. So go to microbirth.com. And at the moment, we've got—

okay, we'll definitely— yeah.

And yes, microbirth.com. And at the moment, we're doing some workshops, some online courses, written the book. It's all— I've got this bee in my bonnet. And I mean, it's become more than a bee. It's like a hive. Just this thing that this information is so important, so vital. It needs to get out there. So whatever I do as a filmmaker, as an author, as a, you know, whatever I can do to spread the message. So it's about kind of telling people like you, telling people, telling your audience to just find out about this amazing thing. That, you know, and it starts early. It starts, you know, from, you know, conception through pregnancy, birth, and those first 3 years.

Yeah, we're actually seeing a fair amount of literature now that talks about the importance of using prenatal probiotics. In other words, encouraging mothers— mothers-to-be while they are pregnant to take a good wide-spectrum probiotic. We're starting to see some Evidence in terms of reduction of inflammatory issues and things like eczema in the newborn. So all good work. Well, listen, I want to thank you for being with us today and just praise your work is fantastic. And you know, if you can do it and make it happen, then anyone can do it. And that's the message of your book—that this is so vitally important. And we didn't get a chance to talk to your husband, but give him our thanks as well for all the work he's done in bringing this about. And I hope to talk to you soon.

I hope— because I'm on my next chapter of what we're doing, and we're going to— we're making a follow-up to Microbirth at the moment. So yes, I want to talk to you about that because that's like, wow.

Great. Well, I like wow. So count me in for that, and all the best. Talk to you soon.

Thank you so much. Thank you. I've really enjoyed our chat.

Okay. Bye-bye. Well, again, here is the book, Your Baby's Microbiome, Toni Harmon. A terrific bit of information we learned today, really focused on the importance of vaginal birth, really seeding that new person's microbiome. That is a rite of passage. It is a time of anointment that that child gets The seeds of his or her microbiome, then the importance of breastfeeding to nurture that microbiome. Very, very important for lifelong health. Interesting interview. Hope you enjoyed it. I'm Dr. David Perlmutter. Thanks for joining us. Thank you.