The Lamaze International-ICEA 2015 Joint Conference is a little more than a month away and I am excited about all of the learning opportunities and connections that will be happening in Las Vegas. I remember attending the last Lamaze-ICEA joint conference five years ago and it was very memorable. Over the next month, I would like to introduce you to the four plenary speakers at the conference. We are lucky to have these experts sharing their wisdom and expertise with us. Today, we meet Joan Combellick, CM, MSN, MPH. Joan is a midwife and researcher who is interested in the microbiome and the newborn. She will be sharing relevant information about this new field of research and how it is related to birth in her plenary session: Watchful Waiting Revisited: Birth Experience and the Neonatal Microbiome. Meet Joan in this brief interview as she shares some thoughts on her topic. Join us in Las Vegas to hear the session and learn more about this important new field of research. To register for the conference and find out more about the Lamaze International - ICEA 2015 Joint Conference visit the conference website.

Sharon Muza: The microbiome and the newborn have been getting lots of attention in the mainstream press in recent months. Parents are coming to class with lots of questions about this topic for their childbirth educator. What do you think are the most common questions expectant families might have on this topic as they prepare to birth?

Joan Combellick: I have found it is a topic that is variably known and understood among the women I care for. Many have never heard the term microbiome and think about bacteria primarily as "germs" that we need to rid ourselves of through the use of bactericidal wipes or soap, etc. With these women it is important to start with the concept that bacteria is not always dangerous, rather we actually need and depend on the trillions of bacteria living in all different parts of our bodies. Further, that initial bacterial colonization at birth and in the newborn period is an important developmental process.

Other women have done extensive reading on the subject. With these women it is important to help ground their knowledge in the current state of the science. For example, the lasting effects of probiotic supplements are not well understood or documented. The relationship between alterations in the newborn microbiome and subsequent disorders, such as asthma and allergies, is an association only, not a causal relationship. The exact characteristics of a "healthy" microbiome for any given person have not yet been clearly defined. These are just a few examples of areas within microbiome research that need further illumination.

SM: How should the childbirth educator respond when parents ask these questions?

JC: I think it is important to reflect this is an emerging science with much more to come. There is a lot of media attention on this topic right now, much of which suggests that the microbiome is the key to all human health. But many answers are still out. Certainly it seems the microbiome may play a role in shaping human health or disease, yet health promotion and disease prevention must also be recognized as a multi-factorial processes.

SM:What role do childbirth educators play in helping families to understand the role of the microbiome on their newborn?

JC: Childbirth educators are uniquely positioned to engage with women and their families in deep and meaningful ways on microbiome-related issues, as they are with many issues related to pregnancy and birth. This is a new topic for health care providers as well as women receiving care and I suspect it is not very thoroughly discussed during pregnancy, partly due to lack of knowledge on the part of health care providers, but also partly due to lack of time during typical prenatal appointments. Childbirth educators can very effectively open this discussion with women, respond to questions and clarify concerns and practices. They can also support women in a more active pursuit of information and a more robust discussion on this topic with their health care providers.

SM: What changes have you observed in families' choices and birth preparation plans as their awareness of the importance of their newborn's microbiome increases?

JC: In my clinical work I have had only one patient who underwent a scheduled cesarean delivery for breech presentation ask for help in exposing her infant to vaginal bacteria. She had already done research on this experimental intervention and carried it out largely on her own. I mostly just helped her navigate the hospital environment while she did so..

I have encountered many women taking pre-, pro-, or syn-biotics, though their goals in taking these supplements is not well defined.

SM: Do you think that hospitals are recognizing and addressing this issue with changes in procedures and protocols that support a healthy microbiome in all the babies born in their facilities?

JC: I believe there is very little discussion about this topic and I have not seen any changes in procedures and protocols at the institutions where I work. I think there is openness on the part of providers to learn more, but I think demand for information from women receiving care may actually lead the way on this.

SM: If families could do one thing prenatally and during labor to help ensure their newborn's microbiome is the healthiest it could be, what would that one thing be?

JC: Follow a path of normal pregnancy, labor and childbirth to the fullest extent possible. When medications or interventions are suggested, understand why they are medically necessary. Avoid interventions done electively or without medical reason.

SM: How has what you know and have studied about the importance of the newborn's microbiome changed the way you practice?

JC: I try to scrutinize all of my own clinical practice more thoroughly in both big and small ways. For example, have I made sure that mother and baby have prolonged skin to skin contact immediately after delivery? Have I educated women to the fullest extent possible about the benefits of breastfeeding and then do I offer the practical support that is needed in the first weeks after delivery when breastfeeding is established? Do I need to prescribe that antibiotic prenatally, or is this a case when watchful waiting is more appropriate? Am I at all times following protocols that prioritize vaginal delivery whenever safe for mother and baby?

SM: It has often been suggested that it takes 17 years to go from "bench to bedside," when the research can be applied to wide-spread clinical procedures. What do you think can be done by both professionals and consumers to speed this process along as it pertains to the microbiome and the newborn?

JC: As educators and clinicians it is our responsibility to stay up to date on the most current research. But this is often difficult. Professionals and consumers alike can speed this process by opening the discussion, just asking questions and pursuing answers. This can help everyone learn more about the topic and most importantly, insure the most up to date care is given and received. Women should always feel empowered to lead the discussion about this topic with their care providers.

SM: What are you looking forward to most about being a plenary speaker and presenting to the Lamaze/ICEA 2015 conference attendees?

JC: I am both a midwife and a researcher. In my clinical world, I know that it is very difficult to stay up to date on current research. And in my research world, I know that research is all too often not well informed by clinical practice. The two worlds often have a lot of distance between them. This is an exciting conference to me because it is an opportunity to bring research and care together. I hope to clearly present the research I am working on, but I also hope to be better informed about the issues childbirth educators encounter in their work. Childbirth educators often have the best opportunity to know the concerns, knowledge and practices of women and their families. I very much look forward to the sharing of information in all directions.

SM: Is there anything else you would like to share with the readers of Science & Sensibility and attendees at the upcoming conference?

JC: We have observed alterations in newborn bacterial development that are associated with interventions used at or around the time of birth (such as cesarean delivery, antibiotic use, and formula feeding). Further, these alterations have been associated with subsequent health outcomes like obesity, allergy, eczema, asthma, and diabetes. While all of these interventions can be truly life saving when used appropriately, it is also clear that in the US and around the world the use of cesarean delivery, antibiotic treatment and formula feeding is occurring at rates that vastly exceed what is medically necessary. It is important for women to ask for and be told in a way they understand the true medical indication for any and all interventions. It is also important for women to understand that birth is not something that should be scheduled into a busy calendar merely as a matter of convenience. Microbiome research suggests that our normal human birth process, as variable and unpredictable as it may be, is important to promote and protect to the fullest extent possible.

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