Infants born by c-section are more likely to be born premature, have problems with their lungs and become more susceptible to illness than if they were born naturally.
What are some reasons women have C-sections versus vaginal delivery?
Dr. Gregg Rubinstein: Well, there are a lot of different reasons. Some of them are good reasons, and some of them, in my opinion, might not be so good. The first one is always going to be baby’s safety. Making sure that everything is safe. If the mom is low on amniotic fluid, then they might want to start thinking about C-sections pre-term. Sometimes they say if the baby is too big, if the baby is too small. There’s a host of different medical reasons that they give, and some of them are valid and are emergency situations, and C-sections can actually save lives.
The issue is that more, almost 50% of women in New York, are having C-sections. I just can’t believe that the possibility and the level of complications is that high. Some of the women are having them for convenience. Some of them are having them just because the doctors have major malpractice concerns. One of the things that really leads to it is the actual birth process themselves, because when a woman goes into the hospital, she is first of all probably a little nervous, especially if it is the first time. When they are lying there, and their contractions are starting to come, and they are in pain, the nice nurse is going to come over and say, “You know, gee, Liz, I see you are a little uncomfortable. I can give you something for the pain.” Well, once you start to take pain medications, then you start to deaden the nerves that actually cause the contractions, that actually push the baby out, which causes dystocia, or what is basically a slowing of the birth process.
Then they’re like, “Oh, well we can give you some pitocin, and that can speed up the contractions, and the baby will come out quicker.” Well, when you give a baby- I’m sorry- give the expecting mom pitocin, the contractions that are caused are a much longer and stronger type of contraction than the natural wave type of contractions that a woman is going to have. It actually squeezes the baby, and if the baby is hooked up to a heart monitor, the heart monitor is going to go a little crazy with every one of those long, strong contractions, and then they are going to say, “Oh, the baby is in fetal distress.”
Trying to have a natural childbirth and actually planning for a natural childbirth will actually slow down the rate of women actually having these C-section deliveries. The other thing is time, you know? Some women are super busy, and they actually opt to have the elective, scheduled C-section.
There are a lot of different reasons. Some of them are medically necessary. Some are over convenience, and some of them are just part of the natural birthing, not the natural birthing process, but the common birthing process that women see in hospitals. I believe that it is definitely more of a medicalized procedure instead of this beautiful, natural, physiological procedure that should be happening on its own with the care of a midwife or a doula.
If a C-section is planned and takes place before the actual due date, what are the risks to the baby?
Dr. Gregg Rubinstein: Well, planned C-sections and what they call late pre-term birth have a lot of risks to the baby. Mother Nature knew an awful lot, and created us, and the body has a wisdom, and knows how to take care of it. Babies know how to come out and deliver. Moms know how to deliver the babies. I mean, it has been going on for tens of thousands of years before medicine was even introduced. But now, a lot of them are scheduled even before labor, and the newborns can be put at risk. The birth can take place a few weeks before the due date, and late pre-term is basically anything before 37 weeks of complicated gestation, and babies born in that term, there are some risks, particularly the fetal maturity.
Being born one week early can make a difference in the amount of complications that a baby is likely to suffer. Usually it’s related to the lungs. Most common, you will see difficulty breathing, because the lungs, when they are fully mature, then the baby sends a signal to the mom via the baby hormone, endocrine, and neural systems. The mom receives the message, and then the mom’s body starts the cascade of events to deliver the baby. Usually, the lungs are the last thing to develop. There are a lot of different things related to that, but in a nutshell, it’s usually related to the lungs, when their babies are born pre-term.
That leads right to my next question. Do babies delivered via C-section have more breathing problems after birth than those delivered vaginally?
Dr. Gregg Rubinstein: Yes. Absolutely, and even more common when the babies are premature. The breathing difficulties often can result in admission to intensive care. If a baby goes into intensive care, they can be there for two to three weeks, which has an average cost of almost $100,000, if not more. The cost and the length of the hospital stay can be surpassed, those of even people who have heart attacks or heart valve disorders and leukemia. The contractions of labor help prepare the baby’s lungs for respiration at birth. It’s really important to understand that the contractions will reduce the amount of oxygenated blood that’s passed through to the placenta, and that causes the baby’s heart to slow down a little bit, and that is a survival mechanism, because the baby requires less oxygen.
Also, when the babies are born premature and via C-section, there are less catecholamines that are produced. Now, catecholamines are produced with each contraction, and it’s very important that the baby have enough catecholamines to drive proper respiration, so it increases the risk of asthma. Studies show that newborns that are delivered via C-section have almost double the chance of having asthma than a child born vaginally. It also changes a difference in the bacterial makeup inside the baby’s intestines, because if they don’t pass through the birth canal, which really populates the baby with a multitude of different bacteria that are good for the baby- the good flora, or the probiotics, so to speak, that are given to the mom- the baby will have a lot of only one or two types of bacteria in the digestive tract, and that contributes to asthma, and also other digestive issues, like gluten sensitivity and these things, which are becoming more common now.
There’s a host of different things that can be related, and there’s tons of research out there showing increased risk for asthma and breathing difficulties.
After a C-section delivery, is the baby separated from the mother for an extended period of time?
Dr. Gregg Rubinstein: It really depends. An uncomplicated, an elective C-section, the mom says, “Hey, I want to be back to work in three days, and I don’t want to miss this.” There are people who actually do that. Often, if they have the C-section, usually the baby can be taken right out and put in skin to skin contact with the mom right on the belly, which is very important. But in other cases, where the baby might not be breathing, the lungs, the baby can be taken right away to the NICU, and then there is no connection between the mom and the baby, and that can have some deleterious effects on the health problems later as well. It really depends on the individual situations. It is not across the board. It depends on the reason that they’re doing the C-section. If it was a true emergency, if the baby is not in perfect health, then it might require longer times of separation from the mother during that time, which is crucial for bonding.
Are babies delivered via C-section more susceptible to illness or other health problems later in life?
Dr. Gregg Rubinstein: Absolutely. There are a lot of studies. The Lamaze Institute, for one, they talk about how nature prepares mother and her baby, they need to be bonding from birth. The oxytocin hormone, the hormone that causes a woman’s uterus to contract, also increases the temperature of the breast, so the baby, it’s easier for them to find them. It helps keep them calm and responsive. That hormone also stimulates a lot of the mothering feelings. There are some studies out that talk about when the babies are born C-section, there is less of a bond between the mom, and we all know that that bond between the two of them is really important. High levels of adrenaline, which are normal in babies at birth, make the baby alert and prepare him to look for his mother, and find his way to the breast, and breastfeed.
There are a lot of different things that can definitely contribute to those things and other health problems. They talk about breastfeeding is likely to be delayed with C-section. Planned Caesarians also can increase the risk of neonatal death. They found that babies just passing away in the first 28 days of life is more common in babies born via C-section than the kids born in vaginal birth. I do want to close and say that there are certain times where it is important to have a C-section. When the mother’s health is at risk, or the baby’s at risk. But mothers should be educated in the best way to have a natural birth, to plan how to have a natural birth using a doula or a midwife. Someone who is educated, to make sure that you make the choices, because if you have a plan, you are more likely to stick to the plan than if you just go in there willy-nilly and just go whichever way the nurses and the doctors and the wind blows.
Another thing that contributes to the high C-section rate, that I didn’t mention before, is malpractice. The OB-GYNs and gynecologists, they carry a very high malpractice insurance just for that reason, because there’s a lot that could go wrong, and if they don’t follow the standards of care and err on the side of caution, a lot of times they have more exposure at risk. A lot of times during a complicated birth or something, they might be extra cautious and always lean towards doing more interventions than less, because if you do the proper interventions and you follow the standards of care, there is no malpractice, even if there is a loss of life. If you don’t follow the standards of care and there’s even a minor complication, you are significantly at risk for malpractice. There are a lot of different things that come into play in that.
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