The health implications of birth by Caesarean section

Abstract

Since the first mention of fetal programming of adult health and disease, a plethora of programming events in early life has been suggested. These have included intrauterine and postnatal events, but limited attention has been given to the potential contribution of the birth process to normal physiology and long-term health. Over the last 30 years a growing number of studies have demonstrated that babies born at term by vaginal delivery (VD) have significantly different physiology at birth to those born by Caesarean section (CS), particularly when there has been no exposure to labour, i.e. pre-labour CS (PLCS). This literature is reviewed here and the processes involved in VD that might programme post-natal development are discussed. Some of the effects of CS are short term, but longer term problems are also apparent. We suggest that VD initiates important physiological trajectories and the absence of this stimulus in CS has implications for adult health. There are a number of factors that might plausibly contribute to this programming, one of which is the hormonal surge or "stress response" of VD. Given the increasing incidence of elective PLCS, an understanding of the effects of VD on normal development is crucial.

The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population‐based cohort study

“…There is evidence of short‐term health impacts for the infant after a cesarean delivery, such as hypothermia, impaired lung function, altered metabolism, altered blood pressure, and altered feeding, which is consistent with our results 7, 27, 28. Some of these changes might be due to a lack of labor stress, associated with physiological maladaptation after birth.…”

“…Short‐term adverse health outcomes included jaundice, feeding problems, and hypothermia and often are part of the adaptation of the infant to being outside the uterus 7, 27, 28. The longer‐term adverse health outcomes included asthma, respiratory infections (eg, common cold, pneumonia, bronchitis), gastrointestinal disorders, other infections (eg, sepsis, streptococcus, cystitis), metabolic disorder (eg, hypoglycemia, neonatal diabetes mellitus, diabetes mellitus type 1 or 2, localized adiposity), and eczema, based on the potential effect that mode of birth has on immune‐related diseases 5, 6, 7, 12, 13, 14, 15, 16, 17, 18. An overview of all adverse health outcomes and other covariates with corresponding ICD‐10‐AM codes are presented in the Supporting Information.…”

“…Studies have demonstrated that children born vaginally at term have different short‐ and longer‐term physical health outcomes than those born by cesarean, particularly when there has been no exposure 4, 6, 7. Epidemiological studies that analyzed population‐based registry data, reported conflicting associations between operative birth interventions, and the increased risk of several immune‐related diseases, including asthma, type 1 diabetes, obesity, and inflammatory bowel disease 12, 13, 14, 15, 16, 17, 18.…”

Cesarean Section and Chronic Immune Disorders

“…28 The birth setting around cesarean delivery is different from vaginal birth with respect to several factors including anesthetic agents and antibiotics during birth, physiologic effects on the newborn, and the hospital environment after birth. 29 It may be speculated that the effect from cesarean delivery is mediated by changes in the microbiome of the newborn. The normal delivery canal exposes the child to a composite microbiome different from the one encountered during a cesarean delivery in an operation theater resulting in differences in microbiome of the newborn.…”

Natural Childbirth and Breastfeeding as Preventive Measures of Immune- Microbiome Dysbiosis and Misregulated Inflammation

“…Instead they are representative of reported health risk associations. An additional discussion of the shortand long-term implications of CD can be found in Hyde and Modi [22] and Hyde et al [117].…”