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Episode 44: The Vagina Microbes: What You Should Know

Just like our skin, gut and mouth, vaginals also have a unique microbiome.
Episode 44: The Vagina Microbes: What You Should Know

If you have a vagina, there’s definitely come a time in your life when you’ve thought, “What the heck is going on down there?” And chances are, that thought arises when something is off with your vaginal microbiome.

Just like our skin, gut and mouth, vaginals also have a unique microbiome. When it’s disrupted, it impacts not only your comfort level, but also your susceptibility to contracting an STI, giving birth prematurely and many other factors that are discussed on this episode. 

Andrea talks with Takiya Ballard, a Certified Nurse Midwife and Board Certified Lactation Consultant. Over the last 20 years, Takiya has practiced in hospitals, birth centers, home settings and led medical mission trips across the globe. 

She is the founder of Sakina Midwifery Service, a private home birth practice serving the NYC region since 2014. Recently, she announced her clinical retirement and now focuses on community education and advocacy.

On this show, they discuss differences in microbes across racial groups, how microbial diversity influences the susceptibility of contracting an STI, methods of birth control, bacterial and yeast infections, Group B Strep, water birth and more. 

Resources mentioned on the show:   

   

On this show, you’ll learn:   

  • How the vaginal microbiome differs from the gut microbiome (2:30)
  • Communication between gut and vagina (3:32)
  • Why are microbes present in the vagina? (5:16)
  • Vaginal dysbiosis (7:29)
  • Treatment for recurrent infections (12:47)
  • Can natural remedies be effective? (16:23)
  • How did our ancestors deal with these issues? (18:20)
  • The impact of birth control on vaginal microbiome (20:31)
  • Microbial diversity and sexually transmitted infections (STIs) (27:21)
  • Differences between racial groups and rates of bacterial infection (28:37)
  • What is Group B Strep (GBS) and why it may be problematic (31:43)
  • Alternatives to conventional GBS treatment (38:37)
  • Water birth and the microbiome (44:09)
  • Vaginal microbiome’s affect on preterm birth (46:01)

Transcript: 

Andrea Wien: Welcome to The Microbiome Report powered by BIOHM Health. I'm Andrea Wein and today I'm talking with Takiya Ballard, a certified nurse, midwife, and board certified lactation consultant. Over the last 20 years, Takiya has practiced in hospitals, birth centers, home settings and led medical mission trips across the globe. She's the founder of Sakina Midwifery Service, a private home birth practice in New York City. Currently, she focuses on community, education, and advocacy as a clinical educator.

On this show, we're talking about vaginas. But don't tune out if you don't possess one. There's plenty of info in here for partners of the vagina carrying public and what you learn can really help answer some of those burning questions. Sorry I had to. We talked about the role of the vaginal microbiome, what's up with recurring infections like bacterial vaginosis and yeast, plus how the diversity or surprisingly the lack thereof of microbes impacts how susceptible we are to STDs. We also take a trip down the baby making lane talking about everything from GBS to infertility to the birthing process. Enjoy the show. Takiya, thank you so much for joining us. How are you?

Takiya Ballard: I'm good. How are you? 

Andrea Wien: I'm good.

Takiya Ballard: Thank you for having me.

Andrea Wien: I'm very excited to be talking about this topic because it's not something that we've spoken about before and also not something I think most people think about and I could see all the men in our audience looking at this episode and going hmm. But really, you should know about this stuff because sex and your partners, and all these other things are all intertwined. So I'm excited to have you on to chat. 

Takiya Ballard: Absolutely. Thank you. 

Andrea Wien: So I think the majority of women don't really think about the microbes that are in their vagina until they're pregnant and they have to go for something called the group B strep test, GBS. Maybe someone thinks about it if they get a bacterial infection or a yeast infection and in all of those cases, the prevailing thought is really just get rid of it. I don't want to deal with this. It's uncomfortable, "bad". 

So we're really not thinking about this complex ecosystem that exists in the vagina until we're experiencing a problem, which is problematic in and of itself. So I'd love to just talk to you for the first question about how the vaginal microbiome differs from what people might know about the gut microbiome. 

Takiya Ballard: Yes. So it does differ in many ways, the gut biome and the vaginal biome are both multi, I guess, populated by different microorganisms. But the vaginal microbiome has specific microorganisms that exist in the vagina. So the difference is, is that there's one in particular called lactobacillus and that really supports vaginal health. However, because of the way that the body is shaped for women and the fact that the vaginal area is very close to the anal area, we do see some crossover of microbiomes or microorganisms that exist in the gut that also potentially exists in the vagina. So they are closely related however different many ways. 

Andrea Wien: So are they connected solely because of proximity or are there other ways in the body that these microorganisms are talking to each other from the vagina to the gut? Do we know that? 

Takiya Ballard: So the research is still very early and how the communication channels happen within our different body systems. There's still information that's being obtained regarding the gut and the brain and the micro connections, the microbiome connections that happen there and the same thing with the vaginal area. We're starting to link trauma and things like that to prevalence of bacterial vaginosis and seeing how the microbiome is affected in that trauma.

So the information is still being obtained through research and so we can't really make definitive statements, but we can hypothesize and say that there is definitely an internal connection that happens through the prevalence of the microbiome that lives and functions and thrives on our bodies and within our bodies and how they are interconnected throughout the body systems. 

Andrea Wien: Well, I'm just thinking too, we've talked in the past on the show about how so much of hormone production happens in the gut and I'm now thinking we have obviously hormones drive a lot of what happens in the reproductive system. So even that connection I'm sure we will uncover more about what is actually happening as that communication takes place. 

Takiya Ballard: Absolutely. So the production of hormones in the gut. There's production of hormones and connections where the brain makes in order to produce also hormones. So all those connections are so intricate and interconnected and we're really just on the cusp of learning what that means for the wellness of human bodies. 

Andrea Wien: So what do we know about the role of the vaginal microbiome, why are microbes present there? What's kind of the prevailing thought of what's going on? 

Takiya Ballard: So the thought used to be that the vagina needed to be cleaned out and that everything above the vagina is sterile. So while we still believe that what's inside the uterus remains sterile and through research we've not been able to isolate any bacterias that exist in the uterus being a closed system, we have really realized that the vagina is an environment that's heavily ladened with microbiomes or microorganism. And what we've realized, is that that area is not to be cleansed or not to be washed away because when we actually do away with those bacteria, we're seeing that we're doing more harm. 

So the understanding has increased in the health and wellness of people who have vaginas to now look at the microbiome as something that is supposed to be there and that we should be living in harmony with and learning how to support that existence, that ecosystem. So we really are seeing that it influences the vaginal health. It helps the vagina to stay healthy. We also see its implications in just overall reproductive health and also that of babies who are being born to mothers who are pregnant who have good reproductive health as well. 

Andrea Wien: Yeah. And it makes me think. It's kind of the same thing of what we thought with the gut microbiome in terms of antibiotics, right?

Takiya Ballard: Right.

Andrea Wien: So antibiotics came on the scene. It's like let's get rid of everything that's there and just decimate that system, and now we're realizing, "Well, wait. That's a big mistake." And I can see that that is pretty much what's happening in the vaginal microbiome too like, "Oh, we have bacteria there. They obviously can't be doing any good. We need to get rid of them." It's like, "Well, no. They're there for a reason." So there's a lot of correlations between the two. 

Takiya Ballard: Right. 

Andrea Wien: So I want to come back to the GBS and the uterus comment in a minute, but let's talk first about how the vaginal microbiome gets thrown off or out of whack. And this is similar to the gut, what we would call dysbiosis. So just an imbalance in the microbes that are there. But how does that happen in the vagina besides just maybe cleaning, something like douching, which we've just spoken about.

Takiya Ballard: Because we've been able to take swabs of healthy vaginal flora and see exactly what the microbiome looks like in terms of its plethora of different organisms, we realize that there is definitely a consistency within that for healthy vaginal flora, specifically the bacteria that sort of keeps all the other organisms in check is called lactobacilli, and there's different strands of lactobacilli. 

But lactobacilli is in abundance in the healthy vaginal flora. So what we're seeing is that this lactobacilli creates or produces two things, hydroperoxide and then also lactic acid, which causes the PH of the vagina to be around 3.8 to 4.5 on the PH scale. So it's really acidic. That acidic environment creates an environment where the microbiomes or the microorganisms that exist are thriving and they're imbalanced. They're in a balance that one is not more prevalent than the other. 

Of course, the one that's the most prevalent that keeps the health overall is the lactobacilli. So what we're seeing, there's multiple reasons why individuals with vaginas are actually experiencing shifts in their vaginal flora that would cause infections like yeast infection or bacterial vaginosis or dysbiosis of the microbiome or the ecosystem. We're seeing it be related to diet, a heavy increase of sugars in the diet. We're seeing that be a potential cause. 

We're seeing the lack of understanding and practice by what I call vagina wearers where we have a situation where we're using a lot of products in that area that have not been PH balanced that are not natural, that are not supposed to be there and it disrupts the vaginal flora. We're seeing a lot of shifts with people who are taking contraceptives or who have sex partners that either have saliva or semen deposit into the vagina. Those things will affect the PH and when the PH is imbalanced, those other bacteria that were other organisms that were otherwise in check, tend to overgrow and become imbalanced and that can disrupt the ecosystem.

Simple things as wearing a thong, that can disrupt the ecosystem. So there's so many reasons why the ecosystem is disrupted. And so what we're just trying to do or some of the things that I'm doing in my practice is just really making people aware of those practices and teaching people to have more of a wellness practice and be mindful of vaginal health more specifically. 

Andrea Wien: Yeah, and I think we do see a lot of the same practices that we talk about on this show all the time for the gut microbiome, skin microbiome, etc. All of those things are supportive of vaginal health as well. So it's not like you have to be doing vastly different things, but there are some considerations like you're saying in terms of birth control or the underwear you're wearing or multiple partners even. Now, there's so many factors associated to that.

Takiya Ballard: So many. 

Andrea Wien: So it's thinking about it, just one step further, but if you have those basics, you're more resilient I would say to some of those other factors. Would you agree with that? 

Takiya Ballard: I would agree. I would agree. I think people need to be more mindful of this. In the old days, we used to be told to wash until we're clean. And the other thing too that I think a lot of people struggle with is that the vagina has fluids, right? So we're constantly trying to clean that up and in those practices we're destroying the ecosystem that is there to thrive and help us stay well. 

Andrea Wien: So when someone's coming to you, a lot of times these infections that we're seeing are recurring. So I'll get very personal on my story. I went through a phase in my 20s where to be honest, I was not eating very well. I was living a lifestyle in New York where I was going out all the time, staying up late, not sleeping, working hard, playing hard, those kinds of things and I was getting these recurring infections. 

So it would be a bacterial infection. I would take a heavy dose antibiotic like Cipro then I would get a yeast infection and it was like right around my cycle every month, this cycle kept happening. And it really wasn't until I met with someone who was more holistically minded and said, "You need to clean up your lifestyle a little bit to start with." That's kind of this basis of foundation, but then it was just basics like going to the bathroom after you have sex, making sure that you're maybe jumping in the shower after something like that. 

I haven't had those issues since, but I think we do see a lot of those recurring infections that can happen frequently, and that can be really tough for people who have vaginas. So when you're seeing a woman who has these recurring infections and honestly hope is being lost, what are kind of your first thoughts for treatment. What are you doing in these tough cases where people aren't improving? 

Takiya Ballard: So very similarly to what you experience, the first thing is just finding out what they're doing in their life, what's their lifestyle like? What are their typical practices whether they're cleansing practices and self-care practices? So just looking at that and sort of doing a reflection of that. Once we figure out what those particular lifestyle practices are, then we try to make some adjustments, because it can be just simple, a simple tweak, especially if we're finding out that certain things are being done more than once or twice.

Sometimes if you review the history and the practice in detail, you can find the culprit in the mix like the use of a razor that's not being cleansed or changed frequently or something just as simple as that causing infection or not cleansing things properly when you're reusing them. So that's one. 

The second thing is really looking at diet. Diet is hugely something that can affect the ecosystem of the vagina. So just having the person review their diet, limiting sugars, decreasing those kinds of things, looking at potentially alcohol consumption. There are many women who report that after a night out with the girls or going out for drinks with their partner, they're realizing that they're having symptoms the next day or a few days later. So just looking at those types of things.

Then the other thing is if someone is really recurrent and has some significant issues, then we look at a potential treatment regimen. And usually, if we're really paying attention to the fact that this is a disruption of the ecosystem and not necessarily that we need to treat it with antibiotics, we are leaving antibiotics out of the picture because that further disrupts the system by remedy or taking out the other bacteria. 

The one thing about antibiotics is they don't have a specific antibiotic target. They don't have a specific micro organism target. They kill all bacteria. So that includes the good ones. The good ones like lactobacillus that keep the vaginal flora healthy. So what we do in this regard is we, again, like I said, look at the lifestyle, make some adjustments there. We look at the diet and we ask the individual to consider taking probiotics to increase the lactobacillus probiotic or the lactobacillus bacteria that should be present in the vagina seeing if we can replenish that. 

Then the other thing is looking at partners. That's the number one thing. A lot of people forget that there's partners that could be transmitting these infections back and forth to the partner who's dealing with the recurrence. So sometimes that is the actual culprit. So just looking at those things collectively, increasing the immunity naturally. So immune boosting regimens and then increasing probiotic intake, specifically lactobacillus usually helps and does the trick.

Andrea Wien: Yeah. When I was going through all of that recurring nightmare of symptoms, I certainly was looking at some more natural ways. And by natural, I mean I was looking on the internet and seeing what people were saying about treating infections and these are things like putting some cloves of garlic up there like maybe getting some yogurt popsicles and sticking those up there. So can those things ever be effective or are there more natural ways to treat this or what are your thoughts on kind of these "natural ways" of going after rebalancing?

Takiya Ballard: Yeah. I think that in the effort to be natural because that's sort of where our society is now. We go in waves of things that are more popular and right now we're in the popular craze of all natural. Everything has to be natural and organic and things of that nature, and that's perfect. But when it comes to the vagina, the vagina does not need our help. It can replenish and fix itself given time and when we control our lifestyle in a way that is producing wellness, then we tend to see the vagina knows what to do to correct itself.

So as a practitioner, I've really never been a fan of putting food in the vagina like garlic and yogurt. I have had people do that before and it's not been a pretty outcome. And the reason is because again those things are not replenishing the normal ecosystem, their food. We don't need an antibacterial in there which is garlic is a natural antibacterial. We don't need a natural antibacterial in there, we need all of the bacteria and the other bacteria that's supposed to be in there. 

Yogurt has plenty of sugar so why would we put yogurt into the vagina for example to heal yeast when yeast thrive on sugar? So it's just simple things of knowing and having an understanding that there is a very delicate ecosystem that exists in the vagina and certain things allow it to thrive and other things will disrupt it. And just being mindful as a person with a vagina, how to care for ourselves is so important. 

Andrea Wien: I always used to think about this when I was going through that as well. What happened in the past when our ancestors had these types of infections? They didn't have antibiotics. Was it just that they weren't getting these or was everyone walking around with a little bit of BV and a little smelly? What was going on? 

Takiya Ballard: Well, I obviously wasn't present during that time, but I'd like to believe that they weren't so super involved with their vaginas and super inflated in our minds about the vagina. I think we do too much to the vagina. I think that the vagina is tired of us. Waxing it and going and getting vajacials and doing all these big super different things to be with the culture. I don't think people were doing obviously those things back then and they just let the vagina be in its natural state. 

I think also we have this thing with smells and we have to understand that every vagina has its natural odor, right? It's specific to that woman. However, we do sweat in those areas. So the sweating is not coming from the vagina or the vulva per se, it's coming from the groin, in the area where the hair is. So that's the area that needs to be washed, not the vagina. 

So I don't really think that the women back then made it a big deal honestly. And if they did, I don't think that they probably practiced what we practiced. I think they probably just took care of the outside perhaps and left the inside alone. I would like to say that I believe that that's true because I think that's where we get our modesty from. I know my grandmothers and my ancestors really, you kept your lady purse clothes. You didn't do anything with your lady purse. That was a secret purse. I don't think that they pay too much attention to it and actually that's how it should be in terms of doing all of the things with it.

Andrea Wien: That's fair. That's fair. Now we kind of breezed past birth control, but I do want to focus on it a little bit because we do know that so many medications even just aspirin impacts the gut microbiome. So how is something like birth control interfering or interacting with the vaginal microbiome and do different birth controls like if someone is having some type of recurring issue and you target it, okay, maybe it is the birth control, is it possible to just switch brands and see an improvement? What does that look like? 

Takiya Ballard: I think with the birth control, obviously there's a hormonal shift that's happening systemically through the whole entire body with the use of the birth control. So we're also seeing that shift happen vaginally. We see it more so with things that are actually present in the vagina and in the uterus and things like that because it's actually shifting or changing the vaginal flora, the vaginal fluids, the cervical fluids. Those are changing and shifting with the presence of for example IUDs. 

So that's something that we're seeing a definite correlations to the risk for BV. So the understanding is just that it's on the actual hormonal level that we're seeing it and we're seeing it more so as a correlation with like I said those birth controls that are more present in the vagina. So those things like NuvaRings, IUDs, things that actually are in the vagina itself or in the uterine or reproductive system itself as opposed to ones that are systemic. 

Those that are systemic like the birth control pills or the patches, they can have some changes in the vaginal ecosystem and you can see that with certain people. So typically, if someone is having a recurrent infection, we would then look at what their birth control regimen is and make shifts or changes there. One of the biggest things that we've seen is the estrogen. 

Estrogen has a huge impact on the vaginal health, lubrication of the vagina and all of the vaginal health of the tissues. So when that area of the body is no longer hydrated well or lubricated well, the skin can become irritated, highly inflamed and that also will lead to shifts in the ecosystem. So we're seeing it hit on different levels if that makes any sense and we're still learning a lot about it still, so the information is still very young in its stages of research.

Andrea Wien: Well, I think you bring up an interesting point that there's already irritation potentially happening there and then you throw something like sex into the mix where obviously there's a lot of friction going on. And the sperm, we talked about the vagina being very acidic, but sperm is very basic. So we're looking at like I think a seven to eight PH on that. So suddenly you're throwing in a huge shift in PH, which I have to imagine, and this is just my guess, you can certainly tell me that the sperm is that basic because it needs to survive the journey, so it's kind of creating a more basic environment so it doesn't get killed by the acid. Is that a theory that holds water? 

Takiya Ballard: That is a theory that holds water.

Andrea Wien: Perfect.

Takiya Ballard: Yes, that is a theory.

Andrea Wien: So there is a reason for it. These guys aren't just trying to make us miserable. 

Takiya Ballard: No, no, no. And typically what we've noticed is that... So you'll probably think, "Well, if anyone has sex with a male then they're going to be destined to get bacterial vaginosis every time they have sex," and that's not the case because what happens is the body gets used to that partner, right? So that ecosystem then learns how to adapt to that particular body. It's when we see multiple partners that we're seeing that correlation of increasing in bacterial vaginosis or disruption in the ecosystem.

I just want to make sure that that's clear because some people might think, "Well, then I guess I can't have sex or that's the problem." It could be an issue of just having multiple partners or not giving the body enough time to get used to a new partner. 

Andrea Wien: That was the case also when I was going through those reoccurring infections. My now husband, it was every time after we had sex and I was like is my body trying to tell me that he's not a good partner for me? I can safely say to all the listeners that everything is fine now. So it was just changing some of those lifestyle practices and getting things back in balance and perhaps my body also just got used to him. But we don't have those issues. So if you are struggling with those, don't worry. Your body is not screaming at you that this isn't the person you're supposed to be with.

Takiya Ballard: It does get better. But I will say this since we're on the topic of male partners is that you have to be very, very careful because male partners could actually be giving yeast infections specifically and also when you're in a recurrent yeast infection or recurrent bacterial infection, you're trying to figure out, "We abstained. I feel like things are better. I'm on a treatment regimen. We have sex and it's back again." 

It could really be your partner. Sometimes males are not really mindful of their body parts in terms of their penises and the shaft, and all those areas. They could have dry patches on their body, on those areas of their body that are reflecting yeast. Yeast can look very different on a penis than obviously when a vagina is infected with yeast. So if your partner is complaining that they have a dry patch or they have a little bit of a jock itch or one person I know was using the same clipping devices and wasn't effectively cleaning it and the wife kept getting a yeast infection. 

We kept treating, we kept treating and finally I started asking more and more involved questions that weren't specifically about her lifestyle, but now we're more about her husband's lifestyle. And this particular person was an avid, working out and wasn't really showering right after workouts because of other things that they had to do and then they were grooming themselves. What was happening was, yeast was getting trapped in these devices and they were passing the yeast infection back to each other.

So once the partner's lifestyle changes were put in place and the wife kept those changes up, they never had that problem again.

Andrea Wien: See, guys? And everyone who's listening to this who doesn't think that vaginas are relevant to them, this is all good advice for you too. Now, what I thought was so interesting, I found this study. So we talk a lot about the power of gut diversity and how a more diverse gut is actually beneficial against disease and all these other things. But I found a study that looked at the diversity of microflora and how it's actually negatively correlated with infection. 

So in a vaginal community that is less diverse and more dominant in that specific strain of lactobacillus like we were talking about. They're less likely to contract an STI. So these are things, herpes, HPV, HIV. So that was so interesting that dysbiosis and actually more diversity is negatively impacting whether or not we're contracting some of these diseases. 

Takiya Ballard: Yeah. It's very interesting, the research that's coming out. I find it, as I read more and more articles, of course being a midwife, I have to take a lot of these articles with a grain of salt looking at the sample size, looking at their research was conducted, what were their findings. So unfortunately not all articles, research articles are created equal, but it is interesting that that information is out there. 

And what we've been finding is like I said with the lactobacilli because it has such a great protective function, we're seeing that the more prevalent that is in the vagina the more we're noticing that there's a protective mechanism in place for STIs, specifically HIV as well. So it's just interesting that that information is coming out about the dysbiosis and how that is affecting STI, acquiring STIs or not acquiring STIs.

Andrea Wien: Yeah. I also think it's interesting when I was doing the research for this show just looking at the studies that have looked across racial groups. So for example black women being more likely to have more diversity in the vagina, but also an increased risk of some of these bacterial infections. Is this something that you've seen anecdotally in your practice? 

Takiya Ballard: I have, unfortunately. I will say that I have seen that. But it's interesting when we look at that, my question would be why? Why is that the case and why are African-American women twice as likely to be diagnosed with BV and also experience preterm birth, which is probably another topic that we'll get into? So it's just interesting to me that they do exhibit a more diverse micro profile, but because of that, they are experiencing more risk of bacterial vaginosis. 

So my question would be then you know why? And a lot of the research doesn't get into that. It just talks about the differences and the correlations between race and the disparities that exist in that. I'm not a researcher, but I've been in the practice for 20 years and my answer to that would be that it's likely because of the disparities and some of the things that we talked about that affect the gut biome that affect the micro organisms in general like diet like overall health, diabetes, all of these things having a hyper sugar state in the body, I think that those would definitely affect the prevalence of what micro organisms exist in the microbiome. 

I also noticed that in some of the research I was reading that there are different strands of lactobacilli that are more prevalent in African-American women versus women of European descent. So that was also very interesting. But like I said before, the research is still very young in that. 

Andrea Wien: Yeah. And it's so great that now science is looking at the women for so long. I think that this topic has been really lacking in the scientific literature just because it's been a lot of men doing science for other men. So now that we do have more women in science, I think you'll start to see hopefully huge strides in what we know about vaginal microbiome in general. 

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So let's switch gears and talk about pregnancy and birth a little bit because that obviously is so important when we're talking about vaginal microbiome health. Let's start with GBS. So group B strep. I think I mentioned before this isn't something that most women know about or even think about until they get pregnant and then they're suddenly subjected to this test, and there's a lot riding on it where you may have to be hooked up to antibiotics during birth. So can you explain just what GBS is and why it may be problematic? 

Takiya Ballard: Yes. So it's one of those microbiomes, right? One of those microorganisms that sort of exists and flourish within our bodies, but we notice it more in the gut. And again, due to the way that our bodies are organized, we see those connections of that bacteria being also present in the vaginal area of the female body. But what happens is that because our bodies are in a way used to this particular organism, we are not plagued by it where we don't have significant infection or problems. 

Once in a blue moon, you might see a woman that has this bacteria present in her bladder, however she may not be symptomatic in having UTI symptoms. So sometimes we find it very incidentally where we're looking at testing and the end of the pregnancy we're finding that it's present in the vaginal flora or we're testing in the beginning of the pregnancy and we're seeing that it's present in the urine. 

So the issue that it poses is not really to the mother, it's more to the baby. Historically science has said and especially the medical community has said that this bacteria needs to be eradicated, give antibiotics so that when a woman is in labor that bacteria is completely removed from the system and from the vagina specifically, so that this baby can pass through the vagina in an environment that is more or less sterile. 

So the idea that birth is a sterile thing has been a long held idea, but it is definitely false. The vagina is literally as we both realize today and understand not a sterile environment. So when this baby is born through this vagina, this baby is picking up those microorganisms and that helps this baby to thrive and immunity to start its process and to get used to the environment that the baby is now going to be born in. 

But when bacteria such as GBS is heavily prevalent, there's concern that there's going to be a transmission of that bacteria to the baby and now because the baby's immune system has never been tested in terms of its exposure to bacteria, there's a risk for what we call GBS disease. 

Now, I will say GBS disease is very real and I've seen the ugly of GBS disease, but I've also seen where women have had GBS disease and their babies. They walk away completely unaffected. So it really is something that we need to look at with different view and learn that we don't necessarily have to eradicate it, but we do need to bring it under subjection to the lactobacilli, into the body so that it's not in heavy quantities that it's going to affect a newborn whose immune system has not really been challenged by the presence of bacteria. 

So it's really the over colonization or the heaviness of the bacteria that's present, the number of bacterial copies that are in the vagina that pose a potential risk. The research is showing that there is about a 43% and I could be wrong on quoting this. It's somewhere around the 40 percentile of chance of transmission of bacteria of this GBS bacteria to the baby. However, less than one percent of these babies actually get sick. 

So that's really important for people to understand that GBS transmission does happen almost half the time, however, these babies are not getting sick because their bodies are now learning to thrive in a heavy microorganized body, right? A body that the babies are born into, that belongs to their mothers, that their mothers have this bacteria that's present and these babies are now getting used to and becoming resilient in. So that's important for people to know.

Now, when we're looking at antibiotics and taking those antibiotics to eradicate that bacteria, we have to understand number one that again, the antibiotics do not have a name or a specific bacteria that they're trying to eradicate, but rather antibiotics just kills all bacteria. So what's happening when we're giving women antibiotics in labor, we're really eradicating their bodies of the good bacteria and we want that bacteria present. We want that ecosystem to be present and thriving so that when that baby passes vaginally that they are able to pick up those microorganisms on their skin, near their face, in their mouth so that they can start to create their own ecosystem of their bodies, and then a presence by which they can have for immune health.

Andrea Wien: Yeah. This was actually something that I... I had a home birth. So I was not going kind of the conventional route that even if I would have tested positive for GBS, antibiotics wouldn't have been available to me at home anyway. But it was something that kind of got me thinking what would I do if it came back positive. Doing this show and knowing everything I know about the microbiome and how important that relationship is to have the baby pass through the vaginal canal and pick up all of those microbes, it really got me thinking and thankfully I did not have those issues, I think in part because of my diet and lifestyle is very supportive of microbiome health. 

So I think living the way that we're talking about can also really buffer you against potentially even having to deal with this issue. But it did get me thinking like less than one percent of babies like you said have this issue. So is it worth the risk to... Let's say, I was going to the hospital to take those IV antibiotics to 99 of the time everything would be fine. I don't think we know yet in science what the implications of that are longterm we're starting to understand.

But to me giving every mother who tested positive for GBS, IV antibiotics during birth seemed to be conventional medicine overreacting a bit to... And not to be too jaded, but I think partially that's because that less than 1% or that 1% that do get sick, they don't want to get sued basically. So I wonder in the future is there something that we could potentially do where it's almost like vaginal seeding transplant. 

So okay, a mother has GBS. When that baby is born, can we then potentially add a bunch of good microbes to the skin of the baby to potentially override any infection that might be there? That could be something. I don't know. What are your thoughts on where that might go? 

Takiya Ballard: Yeah. I have several thoughts having my own home birth practice. Majority of my clients who tested positive for GBS did not treat. I would probably say about a good 95% did not treat. So I'll go back to the first thing. It really does depend on you know like you said the health right of that woman. So this begins early on practicing good health and wellness practices that support the microbiome within the body that is critical during pregnancy. So many midwives will encourage in probiotic and prebiotic use, they will encourage good dietary practices and wellness practices and things that will help to boost the immune system, different herbal remedies and vitamins and things like that. 

So that's first and foremost. Having a good regimen in place will help you to decrease your risk for GBS. Now, I will say I encourage that with all of my clients and the majority of them who were sticking to that regimen did not have GBS in the latter parts of their pregnancy at all. So I did not have to worry about that. Those who didn't stick to the diet as well or weren't really sticking to the regimen, they did have that and some of them were able to eradicate it within the pregnancy still. So we ended up retesting and it was completely gone by time they were ready to have a baby. This is all without the antibiotics. This is with completely changing their diet and increasing probiotic use and just being more consistent. 

So those things can just be can be done immediately to eradicate any situation. However, what we've come to also learn is that the vagina is where the bacteria exists, the GBS. So if you are in labor and you have not broken your bag of water, that means your water has not broken, that bag is intact. So that means that everything inside the bag is unaffected by what's going on in the vagina. So majority of women, only 10% of women break their water before labor. Very less than 10 of women break their water before labor. 

Majority of women will break their water during labor, but a great majority break their water while pushing. So if you have a very, very short transmission window, then your risk for infection to your baby is thoroughly reduced. So just having that understanding and looking at the evidence, lots of women are able to now make that choice especially if they are delivering in environments where they have more of a voice. Unfortunately, in the hospital setting, that is still the standard of care to give antibiotics. 

So women who are delivering in those settings will likely have to refuse treatment which may or may not go over well, but you cannot be given something that you don't agree to have. So if women want to do that, they can and they can simply watch their babies for signs and symptoms, or they can take the antibiotic while in labor. The biggest thing that I would say is there is information about seeding and all of those things and it's again, still very new in the data research. But it's hard to know what everyone... It seems what we're finding is that the ecosystem is specific, right? 

So how do we know that that ecosystem is what we would need to seed onto this particular baby for that particular family or that particular woman? So in that case, I would suggest that the mother or the family bring their clothing, something that has some of that seeding on it already that that microbiome, that environment that it comes from their home, because every home has a specific set of microorganisms. I would bring those things to the hospital and make sure your baby is sort of swaddled in those things and those things are around your baby. 

Also, I would try to decrease as much exposure from the hospital people to the baby as well because you want your baby to sort of be covered in your microbiomes that of you and your partner. So I think that those things would help as the research is still developing for what we can do for women for example who have had cesarean sections and the baby did not pass through the vagina. So I think just knowing that we have our own microbiome that still also lives on the surfaces of our possessions will also be helpful in trying to make sure that we're giving the baby his or her first best start. 

Andrea Wien: Something else I really thought about when I was pregnant is the idea of a water birth and I loved the idea of a water birth and then I started thinking about it in the context of the microbiome. I was thinking, okay, we go through this whole pregnancy and you're wanting to see the baby with good bacteria as it's entering the world. Then what if you're delivering into tap water that's chlorinated and fluorinated and all of these things? You're immediately bringing the small baby into that environment. And so I was thinking is that a consideration for microbiome health? Should women be thinking about that and potentially making sure that pool is filtered of those things? How do you think about water birth in terms of microbiome? 

Takiya Ballard: Yeah. I think you make a very good point and because we're learning so much and so much is so new about the information that's out there about the microbiome, I think practices are beginning to change. So specifically as a home birth midwife myself, we use water that's been filtered water that people are purified and things like that. So it is tap water, but we try our best to make sure that it's filtered down to... As much as possible, it's bare minimum. And then the mother is she's not just pushing out her baby into the water, she's been in that water. She's been laboring in that water. She's in and out of the water. 

The partner is also in the water. So that will help to sort of get as many organisms into that water. However, you have a lot of water to these little tiny micro organisms. Now, one thing is that a mother when she's pushing a whole lot of things come out of her body while she's pushing. So that also will help to get that water filled with microbiomes and it's in the home of the family. So as soon as the baby is born, the baby is born into water, but then comes out and it's in its own environment. The environment where it's going to live. So that also helps to seed that microbiome even if the water does play into the idea that it maybe washes the microbiome away.

Andrea Wien: Yeah. And that's, I think, too why skin to skin is so important for many reasons, especially as we're talking about microbiome.

Takiya Ballard: Right.

Andrea Wien: Now, we spoke about this before the call, but the possible connection between the microbiome and infertility and how we think that will really be an important area of discovery in the coming years. But what do we know about how the vaginal microbiome of the mother impacts the fetus in something like pre-term birth, which you mentioned before? 

Takiya Ballard: Yes. So what we're seeing is again those lactobacilli, I mean we really need to be like worshiping these little buggers because they are really keeping things in check. When we see a low existence of lactobacilli in the vagina, we're noticing that we have a prevalence of more dominant bacteria that becomes more of a multi-seeding of these bacteria that are just thriving in larger numbers than the lactobacilli. And what we're seeing is that those bacteria are connected to the prevalence of preterm labor. 

So we're noticing that women are more at risk for having pre-term contractions and also preterm labor. There's been a connection between bacterial vaginosis and preterm birth. So we're seeing these correlations. We're not quite sure yet what bacteria is the actual causative agent because we're seeing multiple in those vaginal swabs, but we're definitely seeing that correlation and that some of these complications are miscarriage, pre-term birth, things like that. So it's definitely being linked to those obstetric complications and a varied of many ways. 

Andrea Wien: Yeah. So just another reason why women should really make sure that this balance is in a good place as they're getting ready to birth or even before pregnancy.

Takiya Ballard: Absolutely. 

Andrea Wien: And I think it was interesting too not to bring this all the way back to GBS, but there is some research that's now coming out that perhaps the baby is infected with GBS before it passes through the birth canal. So that, I think opens up a whole another realm of well is the uterus sterile. Is the womb someplace that the baby is really protected from all of these things. And TBD, how that mechanism is working, but I think as we learn more about the microbiome around the body, we're learning all these things that we thought were sterile aren't. So I would not be surprised to see that there are some microbial transmissions going on in the uterus as well. 

Takiya Ballard: Right. Interestingly enough, the placenta unit and the uterus, they do a lot of communication. They do not share blood however and so in that communication, that very microscopic communication of the dispensing of nutrients oxygen and iron and things like that, and also the exchange like carbon dioxide and the waste from the baby, those things are being communicated across the placenta. It would make sense to think that potentially microbiomes are doing that same crossing in that placental barrier. But unfortunately again, the evidence is weak unfortunately because I read another article that said that the placenta was completely free of microbiomes when it was a healthy placenta. 

So there's there's a lot of information that's being circulated, I think, and especially when there's something so new in terms of discoveries, we're doing so many isolated research studies and we really just need to get a really big Cochrane review of what's out there to really see what the evidence together is saying. But the information is still very small in terms of validity and strength when it comes down to understanding what's happening on the microorganism level of when it comes down to the actual uterus, what's happening in the uterus, because again the thought has always been that the uterus is sterile. 

We're not in there taking swabs of the uterus on a regular basis because usually there's someone in there or that's a very invasive procedure. So we have to then study placentas as they're delivered and what does that look like. So it's just really interesting, the information that's coming out right now.

Andrea Wien: Well, we'll certainly have to have you back on as this research continues to unfold because I think there's a lot of places that this will go over the next few years. 

Takiya Ballard: Yeah.

Andrea Wien: We thank you so much for coming on the show. This has been great to talk to you and it gives us a lot of food for thought. If people want to learn more about you, learn more about your practice and the work that you do, where can they find you? 

Takiya Ballard: Sure. Right now I've just recently retired so I'm not actually in clinical practice. However, I can be found on Instagram @sakina_health. That's sakina_health.

Andrea Wien: Perfect. And we will link to that in the show notes at biohmblog.com. Again, https://www.biohmhealth.com/blogs/all. Takiya, thank you so much. We really appreciate the time. Have a good day. 

Takiya Ballard: Thank you for having me. You too. Bye-bye.  

Andrea Wien: Thanks for tuning in. Check out the show notes for this episode at biohmblog.com. This episode has been powered by BIOHM Health, the only probiotic proven to break down digestive plaque. I'm Andrea Wein. We'll catch you next time.   

 

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