Cesarean Section & Newborn Immunity

With the proliferation of unnatural birth by cesarean section in the United States it is only to be expected that new data on the consequences of this intervention will be forthcoming. We have now had about 30 or more years of rising “elective” cesarean section rates in the U.S. which gives us a good petri dish from which to see good scientific evidence of its effects. One of the negative effects seems to be the rise in respiratory ailments in neonates and children. In a recent review by Cho and Norman, (Cho CE , Norman M. Cesarean section and development of the immune system in the offspring . Am J Obstet Gynecol. 2013;208:249–254), they conclude: “Recent epidemiological studies provide evidence that elective cesarean section (CS) is associated with aberrant short-term immune responses in the newborn infant, and a greater risk of developing immune diseases such as asthma, allergies, type 1 diabetes, and celiac disease. However, it is still unknown whether CS causes a long-term effect on the immune system of the offspring that contributes to compromised immune health.” They conclude that more emphasis should be placed on discussion and counseling amongst professionals and childbearing women. In the same issue of the AJOG is a corresponding article by Romero and Korzeniewski from Wayne State University that discusses the likely causation of Cho’s findings. http://www.ajog.org/article/S0002-9378(12)02261-2/abstract?elsca1=etoc&elsca2=email&elsca3=0002-9378_201304_208_4&elsca4=obstetrics_and_gynecology I strongly suggest reading the full article as it goes into depth explaining the importance of microbial exposure at birth and its correlation to the newborn’s immune response. They cite a sentinel work by Hugo Lagercrantz and Theodore Slotkin that emphasized the importance and adaptive value of intrapartum stress in their seminal article “The ‘Stress’ of Being Born.” In it, “The authors described 4 main transitions that occur at birth: (1) emergence from an aquatic environment where oxygen is acquired through the placenta to a dry environment in which respiratory exchange occurs through the lungs, (2) change from a warm environment in which the fetus has a temperature that is 1 degree higher than the mother on average to a cooler environment at room temperature, (3) moving from a continuous supply of nutrients through the placenta to intermittent feeding in the neonatal period, and (4) going from a sterile bacterial environment to the establishment of the neonatal microbiome (eg, skin, respiratory tract, gut). Lagercrantz and Slotkin's views have gained relevance with time and are now buttressed by a considerable body of work suggesting that the microbiome plays an important role in the developing immune system.” It would seem the body of evidence is beginning to weigh heavily that there are consequences to the route of birth. For those of us that support vaginal birth options this comes as no surprise. Nature does have common sense sometimes. The ethics of informed consent should imply that obstetricians include this information when counseling patients on the RISKS and benefits of an elective cesarean section. One final article in the same edition of the AJOG takes a different tack. Authors Lynch and Iams state: “we fear that their (Cho, et al) limited review of a very complex literature leads the reader to a naïve conclusion: that the cesarean procedure itself might be bad for infants and children.” http://www.ajog.org/article/S0002-9378(12)02262-4/abstract?elsca1=etoc&elsca2=email&elsca3=0002-9378_201304_208_4&elsca4=obstetrics_and_gynecology They take a critical look at the methodology and cannot agree with Cho’s conclusions. It seems they think that prematurity and its effects on the immune system may play a role in skewing the data and that cesarean section cannot be isolated as having a direct role in causation. While I applaud the AJOG for publishing all three of these articles and bringing the problem of a rising cesarean section rate into the limelight, I cannot ignore the contradiction to when the Wax paper was published. If you recall, the Wax paper criticized the safety of home birthing and was immediately adopted as gospel by ACOG and critics of home birth. There was no such corresponding critique of its methodology in the same issue of the Green Journal despite a myriad of cited authors who found great flaws in his methodology and conclusions. Maybe I am overly sensitive but it seems clear that these two articles, one critical of elective cesarean section and one critical of home birthing, are being responded to in different fashions, both of which seem to favor and support the expediency of the current medical model of obstetrics. I mean, here you have compelling data of the risk of surgical birth on newborns and whether or not scientists and researchers believe it fully isn’t it worthy of informing mothers of this research and letting them decide? A peaceful Easter to you. Dr. F