By Jessica English, LCCE, FACCE, AdvCD/PCD/BDT(DONA)
When colleagues around the country and the world ask me what our birth culture is like in Southwest Michigan, I tell them that overall, things aren’t too bad. Birth here is better than a lot of places, occasionally great, and we’re still working toward total fabulousness. We have a lot of providers who care deeply, and for the most part, we’ve managed to avoid some of the most harmful practices — you know, the ones that make evidence-based providers and birth professionals gasp in disbelief.
Unfortunately, we do occasionally see a local resurgence of practices that are outdated and not evidence-based. The most recent examples include a midwife at one hospital who used hibiclens (chlorhexidine) squirted into warm water to clean several women’s vulvas during pushing (specifically the perineum, that stretch of skin between the vagina and anus), and a nurse at another hospital who used soap inside the vaginal canal to lubricate and “give baby their first shampoo.”
Hibiclens doesn’t belong on your vulva, and soap doesn’t belong in your vagina.
Hibiclens is a powerful antiseptic cleaning solution, often used as part of a pre- or post-operative skin-washing plan. According to the manufacturer’s website, “The active ingredient in Hibiclens binds safely to the skin, providing a germ-killing field that can last for up to 24 hours.” One 1980 study from the Journal of Reproductive Medicine found that Hibiclens killed “over 99% on skin bacteria of groin and perineum ten and 30 minutes after… application.” If you hadn’t learned much about birth, you might think that was a good thing, right? Killing germs? Nope. These are the good germs, and your baby needs them.
Over the past decade, there’s been growing awareness that babies born vaginally are exposed to a host of healthy bacteria as they come through the birth canal. These bacteria are part of the vaginal microbiome. Vaginal birth, skin-to-skin contact and breastfeeding help to “seed” a baby’s own microbiome, so that they can develop proper gut health and immunities both for the short- and long-term. Researchers believe babies that aren’t colonized with a healthy microbiome at birth are at higher risk of asthma, allergies, diabetes and obesity. The microbiome even impacts brain development. (For just $4, you can rent the film “Microbirth” at Microbirth.Teachable.com; medical professionals can also find webinars there on the microbiome and Group B Strep, which include contact hours. We can have compassion for the professionals in question and know that they probably didn't mean to do harm. But they need accurate and up-to-date information on current best practices.)
Vaginal birth, skin-to-skin contact, and breastfeeding all promote a healthy microbiome.
So what does Hibiclens do? As noted above, it kills the microbiome. That’s right, not only is an antiseptic wash completely unnecessary for a vaginal birth, it can also be harmful, by removing important bacteria that babies are meant to come into contact with for ideal lifelong health. Even if the Hibiclens is only applied to the vulva or even just the perineum, the potential exists for it to get inside the vaginal canal, and for the baby to be exposed to it. If Hibiclens gets on the baby’s skin, it could certainly kill the healthy microbiome that was just laid down — if it hasn’t already done away with the vaginal microbiome altogether.
The vagina and the vulva aren’t dirty, and they aren’t meant to be sterile. Babies need those bacteria! Stop killing our microbiomes.
The Hibiclens package insert also includes a warning to “keep out of eyes, ears and mouth,” noting that exposure “may cause serious and permanent injury” to the eyes in particular. Guess which parts of a newborn baby might come in direct contact with the vulva? Eyes, ears and mouth, friends. Even if it's diluted in water, Hibiclens doesn't belong on tender newborn babies.
To add insult to injury, Hibiclens is also irritating to delicate tissues. You know, delicate tissue like YOUR VULVA. The package insert warns that it may cause hives or a rash when used on any body part, much less some of the most tender parts of our bodies. The package insert and the website clearly state, “Do not use in the genital area.”
We’ve got enough tenderness going on down there after birth. Keep your stingy, rashy, microbiome-killing, unnecessary Hibiclens away from our vulvas.
So we’ve tackled Hibiclens, what about this soap business?
Some birth professionals around the world have reported that hospitals in their area routinely use baby soap, often Johnson and Johnson, to pour inside of the vaginal canal to help lubricate the path for a baby being born, with the “bonus” of cleaning the vagina before birth. This is typically happens in facilities that are also less evidence-based in other areas of care. Nurses and providers often cheerily share that they are giving the baby their first hair washing. It’s always been to our horror to hear these stories, but thank goodness in 14 years we’d never seen it happen here in Kalamazoo. Until this year. We never thought we needed to bring it up with our students and clients, but now we do.
You just read about the importance of the microbiome. Soap can also kill those good bacteria meant to colonize your baby and optimize their lifelong health. During a medically necessary cesarean, we accept that a baby might miss out on that microbiome colonization, but it’s an acceptable tradeoff for a lifesaving procedure. (We’re starting to see some early research on “vaginal seeding” for babies born by cesarean, but more data is needed.) But for a baby born vaginally? There’s zero excuse to deprive that baby of their microbiome.
So if cleaning the vagina is out, what about using soap for lubrication to theoretically help the baby slide out more easily? It’s highly debatable whether any lubricant is needed inside the vaginal canal during birth (some providers do use a vaginal lubricant like Astroglide, Good Clean Love or UberLube), but it is without a doubt that soap doesn’t belong there, ever. Your vagina has a very delicate, specific and acidic pH balance. The vagina is self-cleaning and soaps of any kind can throw off your body's natural balance, leading to infection and irritation.
In the experience we witnessed, it was not even Johnson and Johnson that was used, it was a standard hospital soap packet, which is likely to be even harsher on tender tissues (Johnson and Johnson is not a particularly gentle soap, but it’s probably milder than a general hospital soap option). Combine soap inside the vagina with the aggressive perineal massage and vaginal "stretching" that some providers do during birth, and it’s kind of like rubbing some Dial or Irish Spring into a rug burn.
Ouch! No! We experience enough intensity during birth, you are not lathering up our vaginas.
So what are parents to do? Here are our suggestions:
Again, we’re generally very lucky in Kalamazoo that most nurses and providers aren’t using these antiquated and harmful techniques. But because it has happened, we needed to give you a heads up, so you can be informed of the risks and ready to advocate if needed. Don't panic, but be aware.
Change comes from consumers, and your voice matters. We insist on better, consistently evidence-based care.
Jessica English is the owner and founder of Birth Kalamazoo. She is an advanced certified birth doula, certified postpartum doula, and certified childbirth educator. Jessica has advanced training in using the rebozo during birth, preventing and treating birth trauma, Spinning Babies, VBAC and cesarean prevention, pregnancy and birth after infertility, and cultural humility. In her sister business, Heart Soul Birth Pros, Jessica trains new doulas for DONA International and new childbirth educators for Lamaze International. She's also a frequent speaker at national conferences and is hired often by hospitals and nursing organizations to train nurses in hands-on labor support skills. As a doula, she loves helping women find strength that they didn't even know they had. Jessica is comforted herself by having lots of information, and the Type A mamas are her people.