C-sections can be lifesaving for mothers and babies but what are the potential effects? By Kate Sidley
According to the latest data from 150 countries, currently 18.6% of all births occur by C-section worldwide. Latin America and the Caribbean region has the highest caesarean rates (40.5%), followed by Northern America (32.3%), Oceania (31.1%), Europe (25%), Asia (19.2%) and Africa (7.3%).
The World Health Organization recommends that a nation’s caesarean section rate should not be higher than 10 to 15%, but many countries greatly surpass this recommendation.
A C-Section can save the life of the mom and/or baby. But increasingly, the procedure is a choice. Without a pressing medical reason, moms may elect to have a C-Section instead of a vaginal delivery.
In an attempt to lower their C-section delivery rate, Brazil’s new pro-natural birth initiative now requires doctors to inform women about all the risks associated with C-section births. Moms also have to sign a consent form before the operation will be performed. The new ruling also requires doctors to justify why they have to perform a C-section delivery.
In light of this, one has to consider whether a C-Section is best for baby.
Risks of C-sections
- A C-Section is usually scheduled to take place 7-10 days before the due date, around 39 weeks. This gives the baby the longest possible time in utero, without running the risk of mom going into labour in the middle of the night.
- Occasionally, delivery is scheduled earlier for medical reasons. There’s also a small chance that the due date might have been miscalculated and that the baby is younger than previously thought. The baby would then be at risk of preterm problems such as jaundice, respiratory problems, or low birth weight.
- Babies breathe amniotic fluid in and out of their lungs in utero, which is important for the normal development of the lungs. However, after birth the baby must start to breathe air, and this is more difficult if there’s still a lot of fluid in the lungs. During a vaginal delivery, the baby is pushed, squeezed, and the pressure of contractions helps to expel fluid from the lungs. The chemical and hormonal changes that occur during labour cause the baby to stop breathing in amniotic fluid, and the fluid that is there gets absorbed leaving the lungs drier at birth. C-Section babies may retain more fluid in their lungs.
- Gynaecologist Dr Bronwyn Moore, says the most common problem affecting C-Section babies is transient tachypnea of the newborn (TTN), a breathing problem marked by abnormally fast breathing. “The baby has to absorb the fluid, which usually happens within an hour, and there are no long term consequences. If the lungs are immature, and have insufficient surfactant, perhaps because of premature delivery, there may be an increased risk of respiratory distress syndrome or hyaline membrane disease (HMD).”
Long-term effects on your baby
Studies show that babies delivered by C-Section may be at higher risk of certain conditions later in life.
“There are reports that certain conditions, such as colic or sensory integration problems, may be more common in babies delivered via C-Section, but often these studies are small and we can’t realistically extrapolate from them,” says Moore.
Childhood obesity. In a US study, published in the Archives of Disease in Childhood, researchers found that a C-Section delivery was associated with the possibility of obesity by the time the child was three years old. Just under 16% of children delivered via C-Section were obese by the age of three compared with 7.5% of those born vaginally. Dr. Susanna Huh, director of the growth and nutrition programme at the Children’s Hospital in Boston, and an assistant professor of paediatrics at Harvard Medical School, said that differences in gut bacteria between babies delivered vaginally and via C-Section may be significant.
Asthma. Differences in gut bacteria are thought to play a role in the elevated risk of asthma among children delivered via C-Section. A number of studies have noted that these children are at greater risk for asthma and allergic rhinitis. The theory is that babies born vaginally are exposed to more bacteria than those born in the more sterile operating theatre environment, and that this helps them fight allergies.
Benefits of a C-section
C-Sections, when medically required, are lifesaving for moms and babies. Moore advises C-Section birth if the following are indicated:
- Baby is breeched
- Placenta praevia
- Prolonged labour
- Difficult delivery anticipated
- Hypertension risk to mom or baby
- Some multiple births
- Prolapsed cord
- Active herpes or HIV.
In the case of a planned C-Section, the medical team is booked in advance. A paediatrician will be on hand to assess the baby. If there are particular risks or concerns, appropriate medical specialists will be present.
According to Moore, some women opt for ‘spontaneous labour C-Sections’, waiting to go into labour before having a C-Section. This is less predictable, as it may be the middle of the night and the preferred medical team might be unavailable. Unplanned emergency procedures also do have a higher complication rate compared with elective procedures.
Lower risk of oxygen deprivation
During labour, various factors can reduce the amount of oxygen transferred to a baby. If the unborn baby isn’t getting enough oxygen during labour, an emergency C-Section will be scheduled for foetal distress. However, if this only becomes apparent during the second stage of labour (when it’s time to push), the doctor might need to assist delivery with a vacuum or forceps to speed it up and reduce the time taken to get baby out.
Lower risk of birth trauma, either from passing through the birth canal or from forceps or vacuum extraction.
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