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Midwifing the Perinatal Microbiome.

P erinatal nurses and midwives play a central role in preserving the microbial health of women and newborns. Until just over 100 years ago, women gave birth in their own homes and infants were exposed to the microbes of their mothers, family, and the immediate environment. In the early 1900s, birth moved to the hospital setting in the United States and women and newborns were exposed to numerous nosocomial microbes. Efforts to reduce exposures to pathogens led to a variety of hospital practices such as shaving, enemas, and vaginal and perineal scrubs prior to the use of sterile drapes in a misguided effort to protect neonates from exposure to their own mothers. Over the past 3 decades, these practices have been abandoned and an improved understanding that neonatal exposure to the mother’s vagina and skin is critical for the seeding of the infant microbiome and early immune system development. Until recently, researchers have focused on the bacteria, viruses, and fungi that cause disease, illness, and pathologies such as preterm birth. While it is crucial to understand these organisms, it may be just as important to focus on microbial friends as well as foes. The past 20 years have seen increased interest in the human microbiome, which are the beneficial microbes and DNA that not only coexist with humans but may also contribute to human health.