The Truth About Elective C- sections

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The rate of cesarean sections (C-sections) has increased 10-fold worldwide in the past few decades (1). Diabetes, ulcerative colitis and celiac disease have been on the rise and parallels with the increasing rates of c- sections. C- sections are overused and often are used without full patient disclosure of the potential risks.

Vaginal delivery is a baby’s first exposure to microbes of the outside world and is an important stage in the development of the microbiome.  Research is now showing that use of C- sections is altering the microbiomes of neonates and increasing the risk of immune system problems. (2).

C- sections have detrimental consequences for the infant, including:

  • Two-fold higher risk of developing type 1 diabetes than those born vaginally (3)
  • Decreases in gut beneficial bacteria (4).
  • 2% increased risk of developing ulcerative colitis before the age of 15 (5).
  • 8% increased risk of celiac disease (6)
  • 10% increased risk of being hospitalized for bronchiolitis (a respiratory condition) (7).

For a majority of human existence, infant’s mouths and skins have been coated with their mother’s vaginal bacteria during delivery. This early life exposure of microbes plays an important role in shaping their immune system to distinguishing “self” from “non-self”.

During a C-section, the neonate bypasses exposure to the bacteria that resides in the mother’s vagina. Infants born via C- section harbor intestinal bacteria similar to that found on the skin and nearby surfaces in the operating room, whereas vaginally born infants harbor bacteria that closely resembles that of the mother’s vagina (8).

Additionally, infants born via C- section harbor fewer number of the beneficial bacteria Bifidobacterium compared to those born via vaginal births (9). Infants born via C- section had a reduction in intestinal bacterial diversity and richness (10).

Alterations in gut flora are probably the reason for the increased risk of the aforementioned autoimmune diseases.

When are C-sections appropriate

Clearly, C-sections, when used appropriately, have played an important role in decreasing infant and maternal mortality. Appropriate uses of C-sections include but are not limited to:

  • fetuses in breach position
  • fetal distress
  • ruptured amniotic sack
  • collapsed umbilical cord
  • high BP in the mother
  • macrosomia

When should C-sections be reconsidered with your doctor

Elective C- sections are used too frequently without medical necessity and may cause biological harm to the newborn. Drivers of the increase in C-sections include:

  • For the mother to meet a deadline
  • To avoid the wait of labor
  • Maternal preference

The world health organization published a study of 137 countries and determined that 6.2 million unnecessary C- sections were performed in 2008 costing 2.3 billion dollars (11). Today, Medicaid and Medicare are on the verge of going broke and it is important that we find solutions to decrease cost of care.

A study in Brazil showed that 70-80% of mothers interviewed before birth preferred a vaginal delivery, however, C- section delivery was decided in 64% of the patients before admission. This study showed that a majority of women in Brazil preferred to have a vaginal delivery but were urged to have a C- section. (12)

What if you have to have a C section?

Researchers are investigating new methods to reduce harm to the infant’s microbiome during C- section delivery. In one study, doctors inserted a sponge, or gauze in the mother’s vagina 1 hour before the C- section was performed. After the C- section was performed, the gauze that was in the mother’s vagina was then swabbed in the infant’s mouth and skin to facilitate bacterial colonization of the infants gut similar to vaginal birth.

The results of this study were overwhelmingly positive. The gut microbiome of the swabbed babies that were born via C-section looked more similar to the gut microbiome of a vaginally born infant. (13)

Immune dys-regulation, maybe in part a result of our overzealous use of C-sections and a disregard for the ecosystem that lives in us. Patients and medical professionals must take the necessary steps forward to preserve the complex ecosystem in the human gut.

Categories: Ulcerative Colitis

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