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Monday, February 19, 2018

Cesarean Section's Unforeseen Consequences

"At the moment, breast-feeding is the best and safest way to expose babies born by cesarean to their mother's bacteria."
"Breast milk contains many of the same beneficial bacteria found in a woman's vagina."
"Even small amounts of formula supplementation [can shift the microbiota away from a breast-fed pattern."
Dr. Suchitra Hourigan, pediatric gastoenterologist, director, Inova Translational Medicine Institute, Falls Church, Virginia

"In vaginally-born babies, the bacteria destined for the gut microbiota originate primarily in the maternal birth canal and rectum. Once these bacteria are swallowed by the newborn, they travel through the stomach and colonize the upper and lower intestine, a complicated process that evolves rapidly."
"Infants born by cesarean section—particularly cesareans performed before labor begins—don’t encounter the bacteria of the birth canal and maternal rectum. (If a cesarean is performed during labor the infant may be exposed to these bacteria, but to a lesser degree than in vaginal birth.) Instead, bacteria from the skin and hospital environment quickly populate the bowel. As a result, the bacteria inhabiting the lower intestine following a cesarean birth can differ significantly from those found in the vaginally-born baby."
Dr. Mark Sloan, pediatrician, author of Birth Day: A Pediatrician Explores the Science, the History and the Wonder of Childbirth
Baby born by caesarean section
Babies born by caesarean section have different gut bacteria to those born conventionally   Lesley Magno/Getty
A Danish study of two million children who were born in the years between 1977 and 2012 concluded that the children born by cesarean delivery were more significantly prone to development of asthma, systemic connective tissue disorders, juvenile arthritis, inflammatory bowel disease, immune deficiencies and leukemia. It is well known that babies fed on their mother's breast milk have a certain immunity to some childhood disorders, but this more widespread connection to serious health complications is something else altogether.

There exists now a number of studies that emphatically suggest cesarean deliveries and limited breast-feeding have the potential to completely disturb microorganisms present in a baby's intestines, going some way to explaining the problematical rise of troubling health conditions arising in children and adults; problems inclusive of asthma, allergies, celiac disease, Type 2 diabetes, and obesity. A move to persuade more mothers to set aside plans for cesarean deliveries and to breast feed exclusively for the first six months of a baby's life to ensure the transference of vital bacteria is now underway.

The issue of the bacterial organisms present in an infant's gut is critical for their capacity to perform necessary functions including digesting unused nutrients, producing vitamins, stimulating normal immune development, counteracting the presence of harmful bacterial, along with fostering maturation of the gut. While in utero, babies are exposed to some of these organisms, but it is those encountered during the birth process and the first months of life that have the greatest influence on babies' health futures resulting from their permanent status in the gut.

Vaginally delivered babies acquire the microbes inhabiting their mother's vagina and bowel, while babies surgically delivered before membranes rupture and labor begins, then acquire microbes for the most part from their mother's skin -- as well as from the personnel and environment present in the newborn nursery. In the performance of an emergency cesarean once membranes have ruptured and labor has been initiated, the baby acquires more of the mother's microbes in this scenario, but still vastly less than it would when a vaginal birth takes place.

According to a study that took place in Finland and was published in 2005, these critical differences in the gut microbiota persisted in children until at minimum seven years of age.  In an effort to amend the situation and make up for the differences in gut microbiota resulting from a scheduled surgical birth, women have been encouraged to ensure that medical staff transfer microbes from the mother's vagina to their infants following birth, with some women undertaking that transfer of the microbe exchanges on their own.

The practise, known as vaginal seeding, has earned a huge cautionary note by an expert committee of the American College of Obstetricians and Gynecologists; that the practise is premature and quite possibly dangerous. The potential risk of transferring pathogenic organisms from mother to neonate was cited by the committee.

Creative Commons
photo by hemangi28
The evolutionary norm represents a twinning of gut microbiota acquired during normal vaginal birth so that when the microbiota is compositionally unbalanced, or germs such as Clostridium difficile are present, the immune system reacts. This results in a low-grade, long-lasting inflammatory response targeting intruders from birth forward, which can lead to "leakiness" of the intestinal lining, weakening it.

 The normal process of absorbing proteins and carbohydrates from intestinal contents, with the inclusion of incompletely-digested food molecules make their way instead into the infant's bloodstream. It is the resulting inflammation along withe abnormal processing of food that apparently increases the risk of developing asthma and eczema, as well as diabetes and other chronic health conditions, as the infant matures into adulthood.
  • Probiotics. Though administering healthful probiotic bacteria to correct an imbalanced microbiota makes intuitive sense, studies to date have been disappointing, with only minor, short-lived changes changes to the gut microbiota. However, research into “good” bacteria and how they become established in the intestine is active and ongoing.
  • Direct transfer of maternal secretions. Placing maternal vaginal and rectal material into the newborn’s mouth has been proposed—more or less mimicking natural colonization—but to date there are no published studies to support the practice.
  • Fecal transplantation. Direct transfer of fecal material from healthy adults into the gastrointestinal tracts of people suffering from Clostridium difficile infections has shown promise. Could healthy parents serve as “donors” for their babies? Applying such technology to otherwise healthy newborns is highly impractical at present, to say the least. Still, refinements may someday make this a viable option.
Mom and baby share a lot, including their microbial ecosystems. (Halfpoint/iStock)


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