Why a vaginal delivery is better (whenever possible): the cesarean section leaves its mark on the health of the baby

A labor can last many hours.

Up to 12 or 18 if the mother is new.

It depends on each case, the frequency of contractions, the rate of dilation of the cervix, the position in which the child comes or any unforeseen event.

Up the hour, down the hour, everything that is done at that crucial time will be key in the future life of the newborn.

Especially, the final form of delivery: although there are cesarean sections with justification and clear clinical indication, doctors recommend, whenever possible, vaginal delivery.

It is better for the mother and for the newborn.

A recent study published in the journal

pointed out that children born vaginally respond better to pneumococcal and meningococcal vaccines.

Another review stressed that being born by caesarean section increases the risk of certain diseases, such as allergies or asthma.

Every year around 140 million babies are born worldwide, the vast majority vaginally.

But caesarean sections have not stopped growing in recent decades across the planet and the scientific community looks at this phenomenon with "concern" because there are not always medical criteria behind that decision.

According to a study published in

in 2018, one in five births in 2015 was by caesarean section, almost double the number 15 years ago.

For years, experts have argued that the optimal frequency of this technique is between 10% and 15% of deliveries, although the World Health Organization (WHO) now avoids specifying rates in a general way.

The slogan is that it be done as often as necessary to save the lives of mothers and children when complications arise, but without abusing a technique that also carries its risks in the short and long term for both.

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With data from 169 countries,

study shows the disparity between regions of the world and that the number of caesarean sections is higher among wealthy women and in private centers.

An investigation by the World Health Organization also warned that in five countries (Dominican Republic, Brazil, Cyprus, Egypt and Turkey), these surgical procedures already exceed vaginal deliveries.

In Spain, a 2018 Ministry of Health report concluded that almost 22% of births attended in public health (they are the vast majority) and 36% of those attended in private centers were by caesarean section.

'Squeeze' the baby

Among the specialists, there is no doubt about which is the best option whenever possible, says Toni Payà, head of Gynecology and Obstetrics at the Hospital del Mar in Barcelona: “Vaginal delivery has fewer potential complications because it is the physiological route of delivery.

For the mother, the postpartum period is different because a cesarean section is surgery and recovery is slower.

As for the baby, she too adjusts better to the afterlife by going through the birth canal.”

For example, from the outset, he explains, babies born by caesarean section may suffer transient tachypnea —difficulty breathing due to excess fluid in the lungs—: “Amniotic fluid bathes the entire pulmonary tree of the fetus and this helps it to mature of the lungs.

When the fetus passes through the birth canal, it is like a kind of juicer through which it ends up expelling that liquid through the respiratory tract”, explains Payà.

With a cesarean section, there is no squeezing effect and the child can have that "wet" lung until all the liquid is reabsorbed.

C-sections can save lives, but the baby born this way also experiences different hormonal, bacterial and medical exposures "that can subtly alter their neonatal physiology," warns the review published in

.

Although there are articles with conflicting results, the authors of the document conclude that this procedure has an impact on the health of children: “The short-term risks of cesarean section include altered immune development, a higher probability of allergy, atopy and asthma, and a reduction in the diversity of the gut microbiome [the set of microbes that populate the gut].

The persistence of these risks into old age is less investigated, although an association between cesarean section and a higher incidence of obesity and asthma in late childhood is frequently reported.

The hypotheses that the authors use about this greater vulnerability revolve around three biological mechanisms.

On the one hand, they point out, “inadequate transfer of the maternal microbiome to babies born by cesarean section leads to altered immune development.”

This means that children who come into the world by caesarean section are not so exposed to the entire ecosystem of microbes (viruses, bacteria, fungi...) that inhabit the mother and that "abnormal colonization of the intestinal tract" can affect the development of their system. immune and even modulate your susceptibility to certain diseases.

The other hypothesis is that reduced exposure "to mechanical forces and stress hormones" during labor causes babies born by cesarean section to "miss physiological stimuli" important for coping with life outside the womb.

The latest theory, which they admit has not been thoroughly studied, is that the different methods cause epigenetic changes—modifications in the chemical compounds that surround genes and that can regulate or alter their activity—and these can affect children's health. future.

The influence of the microbiome

The microbiome is a key piece in explaining vulnerability to certain diseases, says Teresa Cobo, secretary of the board of the Perinatal Medicine Section of the Spanish Society of Gynecology and Obstetrics: "We live with bacteria, and when there is an imbalance, they appear The diseases.

What has been seen is that the passage of the baby through the birth canal and the fact that it can become impregnated with the vaginal microbiome has consequences: children born by caesarean section have a higher risk of allergic dermatitis or asthma”.

The gynecologist adds, however, that the generation of this microbiome also influences "the state of health of the mother, the underlying diseases, her nutritional situation or the use of antibiotics, which is being irrational and also burdens that flora" .

In this sense, Marcos Cuerva, a gynecologist at Hospital La Paz,

The influence of the microbiome, in any case, is in the spotlight.

A study published in the journal

in 2020 also suggested that the mode of delivery increases the risk of metabolic problems in the long term: after studying more than 33,000 women, those born by caesarean section were 11% more likely to be obese in adulthood and 46% more likely risk of developing type 2 diabetes than those born vaginally.

The mechanisms for why this happens, they admitted, "remain unclear," but they pointed to changes in the gut microbiome, which can be associated with adiposity and glucose metabolism.

“Vaginal newborns are rapidly colonized by microbes from the birth canal and their mother's feces, while cesarean newborns are colonized by environmental microbes.

As a result, newborns delivered by cesarean section harbor a less diverse gut microbiota, particularly less

and less

which have been shown to be protective against obesity”, they exemplify.

Regarding the role of the microbiome, a study published in

in November evaluated the association between the mode of delivery, the formation of the intestinal microbiome in the first year of life, and the response to vaccination against pneumococcus and meningococcus: after studying In a cohort of 120 healthy infants, the researchers concluded that infants born vaginally generated a greater immune response to vaccinations and the presence of certain bacteria associated with vaginal delivery was positively associated with antibody responses against the microorganisms. studied.

Cobo also emphasizes the importance of breastfeeding and how the method of delivery influences adherence to this type of diet: in children born by caesarean section, there is more difficulty establishing breastfeeding, the gynecologist warns.

“The mother has the colostrum [the first milk, denser and yellowish], but she has more problems getting the [final] milk to come in.

In a vaginal delivery it takes 48 hours and in a caesarean section, from three to five days, ”she points out.

There are many variables that play against it, explains Cuerva: “The woman has a more complex recovery in the first hours and she will have more breastfeeding problems.

There may be worse initial latch, more discomfort in the breast and more cracks.

If the hospital does not do skin-to-skin care after a cesarean section, there may be sucking problems and the colostrum may not rise.

after a caesarean section,

Where the scientific evidence is most limited is how persistent all the collateral damage associated with caesarean sections can be.

Cuerva also adds that the results of the studies belong to people born a long time ago and the procedures are changing and refining.

A cesarean section is not the same now as one performed 20 years ago.

“There are changes when performing caesarean sections that we don't know what impact they have.

For example, we haven't been doing skin-to-skin for that long.

We have changed many details, it has been more humanized to resemble a vaginal delivery and we don't know if we will change anything with this ”, he reflects.

more humanized caesarean section

Experts insist on limiting the use of cesarean sections to medical criteria, which are limited situations.

For example, if you suffer from placenta previa, which means that the placenta occludes the cervix and prevents the delivery of the fetus;

or if the baby is breech.

Also if there is a risk of loss of fetal well-being or there is some unforeseen complication (the fetus has bradycardia and does not recover with the usual intervention measures or when the woman is 15 hours into labor, fully dilated and the baby's head is not descends, for example), an urgent caesarean section can be performed.

Another option is that the pregnant woman herself requests it.

"The risks are explained to them, that it is a surgical intervention and that it can condition future deliveries, but if the woman wants a cesarean section, she has the right to have it done," Cobo settles.

Payà recalls that this practice is not exempt from complications, also for the mother: "If the woman asks you for it, due to logistics or a previous experience with vaginal delivery that she does not want to repeat, our mission is to inform her and let her decide.

But people have lost their fear of a C-section, and it's actually a bigger surgery than an appendectomy."

Cuerva assumes, in any case, that, for one reason or another, there will continue to be caesarean sections and the duty is to "do them in the best possible way": "If we are going to do them, let's do them as similar as possible to a vaginal delivery and provinculum, which the woman has a good experience, favoring skin-to-skin contact and stimulating breastfeeding.

Caesarean sections will continue to be bad, but less bad.

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