C-sections are the most commonly performed surgery in the world.
In many high-income countries, up to 30% of babies are born via c-section.
Most of these surgical births occur once labour has already begun.
Few parents want to experience birth as a surgical procedure, and most are grateful for the choice of having their baby born safely.
The number of c-section births, however, continues to rise. Despite warnings from health experts, too many surgical births are performed when there is no medical need.
C-Sections Could Affect Children’s Learning Ability, Research Says
We know c-sections have short-term risks for mothers and babies. They are also being linked to more long-term problems, affecting children’s learning ability as they grow.
According to a world first study, children who are born by c-section appear to perform below their peers in areas such as grammar, reading, writing and numeracy.
What Did This Research Show?
Researchers from the University of Melbourne used NAPLAN results and data from the Longitudinal Study of Australian Children, to measure the cognitive performance of 5000 children, comparing those born vaginally with those born via c-section.
Cognitive performance is the ability to use the knowledge acquired by mental processes in our brains.
The researchers found the children born via c-section performed significantly lower than those born vaginally. It is believed this is due to the different bacteria in the guts of babies delivered by c-section.
How Does Bacteria Make A Difference To Babies’ Brains?
In normal physiological birth, as they pass through the vagina, babies are exposed to, and colonised by, their mother’s beneficial bacteria.
Once they are born, this colonisation is enhanced. Babies are exposed to bacteria on their mother’s skin, through immediate skin to skin contact and early breastfeeding.
Babies born via c-section don’t have this exposure to vaginal bacteria; skin to skin contact and early breastfeeding are often delayed.
Several studies have shown significant differences in gut bacteria between c-section babies and vaginally born babies. C-section babies have fewer bacteria and fewer types of beneficial bacteria.
C-section babies are also at increased risk of acquiring bacteria from the hospital environment. These include bacteria such as Clostridium difficile, which causes infections of the digestive system, and Staphylococci, which cause staph infections.
Women who have c-sections are routinely given antibiotics to prevent possible infections. This affects the levels of beneficial bacteria in both mothers’ and babies’ guts.
For more information read Seeding Baby With Good Bacteria Using Vaginal Swabbing.
There has been a great deal of research into how the mode of birth can influence a child’s future risk of developing diseases such as obesity, diabetes and asthma.
Why Are C-Sections Rates So High?
For years, researchers and public health experts have been trying to figure out why c-section rates are so high and continually climbing.
A lot of the work focuses on what can be done to reduce the incidence of c-section, while ensuring those mothers and babies who do need the surgery have access to it.
The most common theories to account for high c-section rates relate to women being older, heavier, and having increased risk of health problems, compared with women who gave birth 40 years ago.
Yet these factors contribute surprisingly little to the high and ever increasing rates of c-sections in countries such as Australia and the US.
A new study from Harvard T.H. Chan School of Public Health recently looked at how the management of labour and delivery units influenced birth outcomes.
The researchers found low risk women had an increased risk of primary c-section in certain birth environments and hospitals – particularly those with a proactive management of unit culture.
In other words, whether or not a woman has a c-section has very little to do with her age, size or health. It has far more to do with the environment in which she gives birth, and her birth setting.
What Does This Mean For The Future?
Parents will certainly not welcome the news that babies who are born via c-section might be at risk for developmental delays. The researchers have acknowledged this.
As research author Dr Poldstein stressed to ABC News, the developmental delay between c-section and vaginally born children is not enormous; it equates to about 35 days of missed schooling in a year.
The researchers tested the robustness of the results. They excluded women who had high health risks, which led to c-sections and could influence their children’s development. The results remained the same.
However, while the findings show relatively small differences, it is significant to have confirmation that mode of birth has long-term effects on cognitive development in children.
Dr Polidano, who has two children born by c-section, pointed out the study is correlational. It is very difficult to establish exact cause and effect, because it’s impossible to perform randomised controlled trials, which are the gold standard in research method.
“We know there are some factors which predate the delivery date, there may be health complications with the child and also with the mum, and it’s possible that these may have affected the child’s development in utero, but it may have also affected their mode of delivery, so it may have meant they are more likely to get a c-section”.
Dr Polidano says the study underpins the need for caution when women request a planned c-section where there is no medical necessity. He is also keen to reassure parents the research can empower them to have greater choice. They can positively influence their child’s development after birth.
“These effects are relatively small compared to the effects you might expect from the home environment … if you have to go down the c-section path, you provide a secure, supportive environment for your family, with lots of engagement, lots of play, lots of stimulation, these things are going to make more of a difference to your child’s outcome than mode of delivery”.
The Melbourne University researchers hope to test their findings on a larger number of children, to investigate whether the correlation exists within an older age group.
