Antibiotics, Birth, and the Microbiome: A Personal Experience

The new addition to our family!

Well July has shaped up to be an incredible month. In addition to working on some cool projects whose results you will be seeing in the near future, my wife delivered our first child. Her name is Clara and we are very excited to be welcoming her into our family. Unfortunately the road to delivery was a little bumpy (although not nearly as bad as it could have been). One aspect of the process that stood out to me was the use of antibiotics during delivery. I thought this was interesting because we hear so much about the microbiome differences between vaginal and c-section births, but not much about antibiotic treatment. This week I wanted to share my experience with you, both to shed some light on what can happen during delivery, and to provide my own thoughts on the subject.

To jump right in, the delivery process started with my wife's water breaking, just as it does with many women. The only problem here was that labor didn't start after. As you might guess, this is particularly troubling because the open, moist, and incubated amniotic sac is an ideal environment for an infection. So once the water broke, the infection clock started ticking. The standard practice for this situation dictates that labor needs to start within 24 hours of water breaking, whether it be natural, augmented, or induced.

For us the 24 hours came and went, and despite our efforts to get labor started (walking, positions, etc), the contractions were only weakly progressing. This meant the team needed to augment my wife's labor, which involved providing a hormone (pitocin to be exact) to ramp up the contractions and start working the baby out. To cut a long story short, this was a very long process that my wife went through. And remember, this whole time we were racing to avoid an infection.

Because of the infectious risk, my wife's temperature was taken every half hour to an hour. A fever is one immediate indication of a potential infection. After about another day passed (about 48 hours after her water broke), her fever started to spike, which suggested the bacteria finally caught up to us and were starting to infect. Because the goal was to avoid infection (a pretty important goal for both the mom and baby), my wife was immediately administered broad-spectrum antibiotics to kill off the infecting bacteria. Luckily it seemed to work and her fever went back to normal for the remainder of labor.

As a microbiologist and microbiome researcher, I thought this experience was pretty interesting. We are constantly worried about the detrimental effects of antibiotics, and it's certainly true that antibiotics are misused. But I think we also need to talk about situations where a somewhat liberal use of broad-spectrum antibiotics really is the best course of action. If we think about the situation I described, we never actually knew that my wife had an infection. We only knew that she had started a fever (there was not time for culturing at that point, although they did follow up with that). All we knew was that there was a chance of an infection, and the benefits of avoiding such an infection outweighed the risks associated with those antibiotics. An altered microbiome might be bad, but an infected newborn baby is likely to be much worse.

There is a time and place for antibiotics, although
they are still misused.

So what am I trying to say? Should we keep throwing around antibiotics at every sign of a cough? Certainly not. Antibiotics are misused in many ways, and it is clear that we can benefit from more targeted treatment approaches (such as phage therapy of course!). On the other hand I think it is worth pointing out that there are still situations that necessitate the use of broad antibiotics. Antibiotics can cause problems, but they are still a miracle of modern medicine and will have a place in medical practice for a very long time.

In the end, both the mom and the baby left the hospital happy and healthy, and that is what I am grateful for. I am also very happy with the care we received at the University of Michigan hospital. They did a brilliant job!

So that was my recent experience with antibiotics. Thanks for bearing with a different kind of post this week, but I thought it might be interesting to share a personal story that relates to the research I write so much about. As always, feel free to reach out and let me know what you thought, or if you have any questions. Finally, I will wrap things up with a disclaimer that this was our experience, and every experience is different, so be sure to talk with your doctor if you find yourself in similar circumstances.