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This is the reason for the most significant difference between a cesarean and a normal birth

So far, researchers have speculated that the passage in the birth canal causes the passage of bacteria from the mother to the baby that form the basis for the microbiome it will develop, but a new Israeli study proves - the birth canal, it is not.

But it's near

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• Birth

• Microbiome

• Cesarean

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Wednesday, 30 December 2020, 08:58

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"The first intestinal bacteria that develop in the baby have significant immune effects."

Newborn in normal birth (Illustration: shutterstock)

Studies have shown that the form of birth (vaginal versus cesarean) affects the bacterial population that develops in infants.

It has previously been claimed that the bacterial population is affected by the passage in the birth canal and the fluids to which the baby is exposed when it is released into the world through the vagina, but a new study led by Dr. Moran Yasur from the Hebrew University rejects these findings. To the rectum and intestinal function that occurs during childbirth.

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The study found that the intestinal bacteria of babies born by caesarean section are indeed different from those of babies born in a normal birth, but not as a result of passage in the birth canal.

The international study was led by Dr. Yasur of the Faculty of Medicine and the School of Computer Science at the Hebrew University, and last week was published in a scientific paper in the journal Cell Reports Medicine. This study is considered groundbreaking and innovative because until now the prevailing belief was that the birth canal was the main factor helping infants. The study suggests that the reason for the difference in maternal bacterial exposure between a normal birth and a cesarean delivery is mainly related to contact with the rectal area or secretions from it. "This finding is of high importance because the baby's first gut bacteria, the microbiome, There are significant and other immune effects, "says Dr. Yasur.

It is possible to identify from a stool sample of six-month-old children, who were born in a vaginal birth and who in a cesarean.

Cesarean delivery (illustration: shutterstock)

Numerous studies in recent years have shown that the bacterial populations in infant gut are affected by the form of birth (vaginal versus cesarean).

A strong example of this is the existence of a fairly clear bacterial signature in children born in a vaginal birth, compared to that of children born in a cesarean birth.

The signature is so unique that it is possible to identify by a stool sample of six-month-old children, who were born in a vaginal birth and who in a cesarean (with about 80 percent accuracy).

The difference in bacterial populations in babies born by caesarean section has been known for almost a decade, and now the question arises as to how this population affects a child's health.

Epidemiological studies have shown that among children born by caesarean section the incidence of autoimmune diseases is higher, but it is not clear what causes it and whether it is related to the bacterial population.

Another burning question in the field deals with the causes of difference in the bacterial population.

In the intestines of children born by caesarean section there is a greatly reduced presence of Bacteroides bacteria.

The reason for this is still unclear.

Although the prevailing hypothesis is that exposure to bacteria in the birth canal is the significant cause of the unique bacterial population, vaginal bacteria are mostly Lactobacillus, and usually do not contain bacteria of the type that differentiate between forms of birth, so this hypothesis was questionable.

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Dr. Yasur's new study, conducted in collaboration with researchers from the MIT Broad Institute at Harvard University and Mass General Hospital, sought to understand how birth can affect the composition of infants' initial bacterial population in the first weeks of life, and where exactly babies are born during birth. Be exposed to bacteria that affect the development of their microbiome (gut bacteria).

Cover of the issue of the journal Cell Reports Medicine in which Dr. Meital Yasur's study on microbiome differences in cesarean and vaginal births was published (cover art: Peanuts creative studios)

The study examined 73 mothers and their children born at Massachusetts General Hospital in Boston - 38 of them were born vaginally, 19 in a planned cesarean birth (with no exposure to the birth canal at all), and 16 children born in an unplanned cesarean birth (after unsuccessful vaginal birth experience, But included exposure to the birth canal before surgery).

The researchers collected vaginal and rectal samples from the mothers before birth to evaluate maternal microbial sources at birth.

In addition, daily stool samples were collected from the newborns during their stay in the hospital (for 2-4 days) and one additional stool sample at the age of two weeks, after their discharge from the hospital.

The study compared the bacterial populations between infants born by caesarean section versus vaginal delivery, and in addition, compared infants born by planned cesarean section with those born by unplanned cesarean section.

Where is the bacterial signature formed?

The researchers found that the bacterial signature typical of infants born by planned cesarean section was also found in those born by unplanned cesarean section.

That is, exposure to bacteria in the birth canal in an unplanned caesarean section was not sufficient to “produce” a bacterial signature like the one usually obtained in a vaginal birth.

"The study does not in any way establish that cesarean section endangers infants."

Dr. Moran Yasur (Photo: Hebrew University Spokeswoman)

Second, similar to previous studies, it was found that infants born in a normal vaginal birth received most of their gut bacteria from their mother, while infants born by caesarean section received only a few bacteria from their mother.

Third, the researchers found that the strains of bacteria that passed to the babies came from the mother's womb and not from the birth canal.

Therefore, the conclusion is that the passage of bacteria from the mother to the baby does not occur at the entrance to the birth canal, but rather at the exit from the birth canal, close to the rectum, or as a result of intestinal action that occurs during birth.

The relationship between the form of birth and the health of the child

"The study does not in any way establish that cesarean section endangers infants, and it should not deter women from giving birth in this way," Dr. Yasur clarifies and emphasizes. "The study clarifies that the form of birth does affect the bacterial populations in infants, and may have an effect in the future. However, we do not yet understand what effect the form of birth has on the health of the child, nor is it clear whether any medical intervention can help. There is no doubt that this study is still in its infancy. "

Dr. Yasur even goes against the" vaginal seeding "trend that we also wrote about here, in which mothers whose baby is born by caesarean section seek to apply it to their vaginal fluid immediately after birth, to develop a stronger immune system. . "Our research shows that this is not necessarily the recommended practice, as the source of the bacteria in the newborn is not vaginal but rectal," concludes Dr. Yasur.

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