Unnecessary C-sections are costlier than natural births and raise the risk of complications for the mother. C-sections have reached "epidemic proportions" in many countries worldwide.
Reasons for elective C-sections vary globally, but increasing rates in many developing countries coincide with a rise in patients' wealth, improved medical facilities and convenience.
In the U.S., where C-sections are at an all-time high of 31 percent, the surgery is often performed on older expectant mothers, during multiple births or simply because patients request it or doctors fear malpractice lawsuits. A government panel warned against elective C-sections in 2006.
The WHO, which reviewed nearly 110,000 births across Asia in 2007-2008, found 27 percent were done under the knife, partially motivated by hospitals eager to make more money.
In Latin America, C-section rates in all eight countries surveyed earlier by WHO were 30 percent or higher -- similar to the U.S. rate. In Paraguay, 42 percent of deliveries were by cesarean, and in Ecuador 40 percent.
Most women are unaware that babies born by elective C-section are much more likely to develop health problems that many newborns who are delivered naturally do not experience. The babies may miss out on critical hormonal and physiological changes during labour which help babies develop.
A Danish study examining 34,000 deliveries suggests babies born by C-section were up to four times more likely to have respiratory problems than those born naturally.
Women who have their first child by caesarean are also more likely to have placenta-related problems in their second pregnancy, research suggests. A Caesarean section increases the risk by 50-fold that a woman's uterus will rupture during a subsequent vaginal delivery, research suggests.
A recent study also showed that caesarean born babies are also at double the risk of becoming obese children as those delivered naturally
Women who give birth by caesarean section take longer on average to become pregnant again, according to the results of a large British study
Women having a non-emergency caesarean birth have double the risk of illness or even death compared to a vaginal birth, according to a study from Latin America.
In a recent study, Yale School of Medicine researchers found that protein expression is impaired in the brains of offspring delivered by C-sections. The team, led by Tamas Horvath, the Jean and David W. Wallace Professor of Biomedical Research and chair of the Department of Comparative Medicine at Yale School of Medicine, studied the effect of natural and surgical deliveries.
Newborns delivered by caesarean may miss out on critical bacterial molecules that help their gut grow healthily--something that seems to be effectively accomplished through vaginal births.
Infants who are delivered by C-section may have an increased risk of developing food allergies, according to a previous report published in the August issue of the Journal of Allergy and Clinical Immunology.
Researchers in Sweden and Scotland have followed gut macrobiota development in 24 children up to the age of two in the Swedish provinces of Ostergotland and Smaland, nine delivered through Caesarean and 15 delivered naturally, through vaginal birth. They used a type of molecular biology analysis, which gives a broad overview of the varieties of bacteria present in the intestines.
The results are presented in the scientific journal Gut, with Anders Andersson of the KTH Royal Institute of Technology and Science for Life Laboratory as the senior author. Other researchers in the study come from LinkOping University, Karolinska Institutet (KI), Orebro University and the University of Glasgow, Scotland.
Those that were delivered by Caesarean section had a less diverse gut microbiota during their first two years of life than those born vaginally. Particularly clear was the low diversity among the group Bacteroidetes that, according to earlier observations of the research groups, are particularly linked to protection against allergies. Thus, these children may run greater risk of developing allergies, but diabetes and irritable bowel syndrome are also more common among children born by Caesarean.
"Sometimes Caesarean sections are necessary. But it is important that both expectant mothers and doctors are aware that such a delivery may affect the child's health," says Maria Jenmalm, professor of Experimental Allergology at LinkOping University and one of the authors of the article.
Everything indicates that right up until the moment of birth the child's gut is completely sterile. Colonisation by many different bacteria is believed to be necessary for the immune system to develop and mature over the first years of life. If this does not happen there is a risk that the system can overreact against innocuous antigens in its surroundings, for example foodstuffs. Children affected by such allergies run a six times greater risk of developing asthma in their school years.
With natural birth the child is exposed to bacteria in the mother's birth canal, a good start to the formation of the child's own gut microbiota.
For those who entered the world through an incision in their mother's belly, different measures need to be developed.
"It might not be so good to have six months of only breast feeding. Earlier exposure to ordinary solid food may stimulate a higher diversity of the gut microbiota," Jenmalm says.
A more radical idea is now being tested by researchers in Puerto Rico. In the study a number of pregnant women have their vaginal microbiota screened before their planned Caesarean. After the birth the midwife takes a compress with secretions from the mother's vagina and smears it over the baby's face. The theory is that in this way the important bacteria may be transferred to the child. A similar study in Sweden is being planned.
Besides a greater diversity in their intestinal flora, children delivered vaginally in the LinkOping study also had higher blood plasma levels of substances linked to Th1 cells, a kind of "chief cells" in the immune system, which can inhibit allergic immune responses.
The gut microbiota may be regarded as the biggest organ in the body. In the small and large intestines of an adult, there are at least ten times more bacteria than there are cells in the body. The number of species in a human exceeds 100. They use the nutrients in what we eat and in return for the food they provide a range of services. For example, some of them produce antibiotic-like substances which can kill off other unpleasant bacteria.
"One condition for these new insights into this fascinating universe of bacteria is the recent advances in biotechnology. With modern DNA sequencing and computer analysis methods we can determine the species composition in hundreds of samples at the same time, and even get an idea of what characteristics the bacteria have," says Anders Andersson, researcher in metagenomics at the KTH Royal Institute of Technology and Science for Life Laboratory.
C-Sections No Safer Than Vaginal Deliveries Even For Complicated Pregnancies
According to research from a multi-site trial led by University of Toronto researchers, even complicated deliveries such as twins are just as safe via planned vaginal births as they are by planned cesarean section.
"Our findings show that planned vaginal birth is the correct method for delivering twins in a pregnancy that is otherwise uncomplicated, and when the first baby is facing head down," says Professor Jon Barrett from the Department of Obstetrics and Gynecology. "We found that there is no reason for doctors or women to be planning to deliver twins by cesarean section, as the babies' outcomes remain the same regardless of how they are delivered."
"People are often not sure what the right delivery method is and sometimes default to cesarean section because they perceive it to be safer. However, we now know that is not the case," says Barrett, who is also Chief of Maternal-Fetal Medicine at Sunnybrook Health Sciences Centre and Director of the Women & Babies Research Program at Sunnybrook Research Institute.
Karen Foster is a holistic nutritionist, avid blogger, with five kids and an active lifestyle that keeps her in pursuit of the healthiest path towards a life of balance.