I recently perused your front-page report addressing the escalating prevalence of C-section deliveries in Kashmir, shedding light on the departure from the natural process of childbirth. Traditionally, normal deliveries have been the norm, with surgical interventions reserved for specific circumstances. However, the growing trend toward C-sections has ignited debates in both medical circles and society, transforming childbirth into a high-stakes event. Prompted by these ongoing discussions, I pondered whether babies born through C-sections differ fundamentally from those born through natural delivery. In pursuit of an answer, I delved into the scientific literature available in standard journals and online libraries. Here’s a summary of what existing research reveals regarding this dilemma.
Concurrent with the trend of increasing caesarean deliveries(CD), there has been an epidemic of both autoimmune diseases such as type 1 diabetes, Crohn’s disease, and multiple sclerosis and allergic diseases, such as asthma, allergic rhinitis, and atopic dermatitis.
During a normal delivery, the contact with the maternal and intestinal microbial flora of the mother is an important source for the start of the infant’s gut colonization. During CD, this direct contact is absent, and non-maternally derived environmental bacteria play an important role for infants’ intestinal colonization and postnatal development of the immune system. Thus, if the intestinal flora develops differently depending on the mode of delivery, the postnatal development of the immune system might also be different.
Available data shows that allergic diseases appear more often in infants after caesarean delivery than after normal delivery. CD has been associated with a significant increased rate of asthma, especially in females, and allergic rhinitis. These conditions are prevalent throughout life and consume significant resources by leading to work loss and morbidity.
It has been observed that lung development reaches its peak in the last phases of pregnancy. CD especially elective ones are pre-decided well in advance which hampers lung maturity in later life. This is backed by plenty of scientific data as well as observed currently in the form of an ever rising trend of respiratory disease like COPD, Asthma and allergic conditions. An underdeveloped lung is subjected to further damage by air pollution and noxious stimuli adding insult to the injury. A world where kids are carrying inhalers in their school bags and elderly connected to oxygen concentrators is already a reality. A vast number of people are taking antiallergic tablets round the year and many more are on nasal sprays these days. Environmental conditions certainly are to blame but if the major insult was struck at birth itself, the situation will only aggravate with time.
The mother’s microbial flora is swallowed by the baby while passing through the birth canal. This collection of microorganisms in the infant gut protects against a number of diseases in later life. But CD babies lack this natural gift as they are directly taken out of the womb. Children born by CD are significantly more likely to suffer from celiac disease and to be hospitalized for gastroenteritis. There is an increased risk of inflammatory bowel disease as well as coeliac disease in adults – both male and female – who are been born by C-section.
Diabetes Mellitus has been on the rise in recent decades, mirroring the rise in CD. An analysis found a 19% increase in DM in caesarean children. Data suggests that women born by caesarean delivery may have a higher risk than women born by normal delivery of being obese and developing type 2 diabetes during adult life.
During a normal birth, the babies brain is subjected to positive stress while passing through the birth canal and this has significant impact on later development. There is plenty of evidence that caesarean delivery may be associated with a shift in brain development, at least during early infancy. Caesarean birth is associated with negative child brain development especially autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) which are quite commonly seen these days in pre-school kids. Caesarean-born children have a 14% higher risk of being identified as developmentally high risk at school starting age.
Caesarean section is associated with a 15-30 % increase in the risk of obesity in kids and adult life. The relation is similar across different ages and remains consistent in a large number of sensitivity analyses. There is an association between caesarean delivery (CD) and stunting in children though.
CD does not spare the cardiovascular health either. Young adults born by CD have a higher blood pressure than counterparts born normally, with nearly twice the likelihood of elevated systolic blood pressure.
Caesarean birth may be associated with selected cancers, including lymphoma and sarcoma early in childhood. The risk of early-onset colorectal cancer is greater in female individuals born by caesarean delivery
C-section delivery is associated with higher amounts of eye sight abnormalities like astigmatism too.
It is clear that the process of normal delivery is a significant stimulus to the neonate at a point in time when the respiratory, metabolic and immunological systems in the infant need to change markedly to adapt to the outside world. The stimulus of normal birth is also extremely strong and the hormones that are increased in response to birth are known to drive the differentiation of numerous cell types and commence multiple physiological processes. It therefore seems likely that this phenomenon is necessary for the adaptation of biological systems to the postnatal environment. The stress response to birth prepares the baby not only for the challenges of extra-uterine life but also long-term health and well-being. In the absence of the hormonal changes created by the process of labour, the maturation of the baby is altered leading to an increased susceptibility to a number of diseases in later life.
The route of birth is a defining moment for later life health. Normal delivery is an important programming event with life-long health consequences. Mother nature has designed every aspect of human life with precision and it seems there is only one definition of ‘normal’. Any modification of the system is bound to lead to adverse effects. Hence the decision to perform a surgery should be the last resort based on solid reasoning and clear benefit both to the mother and the baby.
Note: This article is sourced from the latest standard journals of medical science. Any reference can be provided on specific request.
By Dr Waseem ud Din
Dr Waseem ud din, MD Pulmonary Medicine.