The Case Against Cesareans on Demand: What doctors don't tell you
KEY POINTS
In many countries all over the world, cesarean birth rates are rising. In the US, 1 in 3 women give birth by C-section every year.
C-sections and antibiotics disrupt the developing immune system of the baby with potentially detrimental long-term effects.
Women who deliver by cesarean section can have more negative perceptions of their birth experience, themselves, and their infants.
Introduction
In many countries all over the world, C-section birth rates are rising. In some countries, like Brazil or Taiwan, cesarean birth rates are skyrocketing up to 60%, because giving birth this way is considered to be fashionable. In the USA, more than one million women, 1 in 3, give birth by cesarean every year. The WHO has stated that about 10-15% of all births should be C-sections. This raises the question about what factors play a role in rising C-section rates and in these differences.
Reasons for Ever More C-sections
Factors that seem to influence the rising C-section rates are: the growing average age at which women become pregnant, better-insured women being able to afford more C-sections, higher socio-economic status of the women making C-section more likely, medical protocols like: "once a C-section always a C-section," or "breech is equal to C-section," the surging rates of electronic fetal monitoring, escalating health problems in women, e.g., diabetes and obesity, more prenatal stress being linked to more birth complications, role models like media stars and "influencers" who choose a C-section as a "lifestyle choice," women and their partners who want to keep the "honeymoon vagina" intact, and finally, and perhaps most importantly because cesareans are seen as "the easy and comfortable way" not only by the woman but also by her doctor.
Negative Impact of C-sections
Many women choose to be delivered in hospitals by C-section due to the belief that this method is safer and less painful than vaginal-unassisted delivery in the hospital or at home. These women, like their doctors, are unaware of how such a decision may negatively impact the health of their child. One of the reasons for that is that women in labor routinely receive antibiotics to ward off infection after a C-section. Antibiotics are also used to prevent serious infection in newborns caused by Group B strep, a bacterium that 25-33% of U.S. pregnant women carry. Antibiotics are broad in their effects, not targeted. While they kill Group B strep, they also kill friendly bacteria, thus selecting for resistant ones.
Another reason is due to the fact that the first microbes colonizing the newborn begin a dynamic process. They instruct the developing immune system about what is dangerous and what is not. In this way, we develop adaptive immunity that will clearly distinguish self from non-self. C-sections and antibiotics disrupt this process with potentially detrimental long-term effects.
We need to remember that the founding populations of microbes found on C-section infants are not those selected by hundreds of thousands of years of human evolution. Babies born by C-section harbor bacterial communities found on the skin, dominated by staphylococcus, corynebacterium, and propionibacterium. Their gastrointestinal tracts do not get colonized by their mother’s lactobacilli. As a result, these babies will have difficulty digesting their mothers’ milk, which will lead to further problems.
Looking at C-section through the prism of mental health the following brief report speaks volumes. After 19 hours of labor and an eventual C-section, Kristen Kjerulff, Ph.D., a professor of public health sciences and obstetrics and gynecology at Penn State College of Medicine, in Hershey, Pennsylvania, said, “I felt as if I had failed, while the women I knew who delivered vaginally were quite proud.”
Kate Winslet reportedly said of her C-section: “I was so completely traumatized by the fact that I hadn’t given birth.”
Women who deliver by cesarean section have more negative perceptions of their birth experience, their selves, and their infants, exhibit poorer parenting behaviors and may be at higher risk for postpartum depression compared to women delivering infants vaginally.
By restricting the control that they can under normal circumstances exercise over birth, cesareans often violate women's expectations about childbirth.
Following most C-section births the first body contact between mother and baby is delayed for several hours. This flies in the face of attachment studies well established for a long time. Undergoing a cesarean does not trigger the release of oxytocin which plays a key role in shaping maternal attachment behaviour. Therefore, cesarean birth not only increases psychological risk factors in women as described above, but also interferes in their bonding to their babies, and thereby increases the likelihood of child neglect and child abuse.
Summary
The main reason for the increasing rates of cesarean deliveries is a universal lack of understanding of the basic needs of women in labour and the long-term psychological consequences for them and their children. Based on the evidence, C-sections, unless indicated for medical reasons such as breech presentation, prolonged labor, fetal distress, etc. should be avoided at all costs.
References
Shane, A. L. (2014). Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues. Emerging Infectious Diseases, 20(11), 1961. https://doi.org/10.3201/eid2011.141052.
Emma L. BARBER, Lisbet LUNDSBERG, Jessica L. ILLUZZI, et al., (2011). Contributing Indications to the Rising Cesarean Delivery Rate. Obstet Gynecol. 118(1): 29–38.
Marshall H. Klaus, John H. Kennell and Phyllis H. Klaus (1996). Bonding: Building The Foundations Of Secure Attachment And Independence. Harpercollins
