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Gut Flora of Babies Delivered by Cesarean Altered for At Least Six Months

Thursday, September 5th, 2013

One of the things I discuss in my book, Inside Information for Women, is the modern trend of cesarean on demand, or elective cesareans. For many women, cesarean delivery sounds like a simpler, easier alternative to labor and pushing, and to the many doctors who agree with them, it sounds like a good time management technique – preventing their sleep or other activities from being disrupted by inconvenient spontaneous labor. Women should remember that cesarean delivery is major surgery and carries the same significant risks of all major surgeries. Besides, the postoperative recovery period is more difficult following a cesarean than the recovery period following a vaginal delivery. And now, new studies show an additional reason to avoid cesarean whenever possible – the altered gut flora of babies born this way.

The early bacterial colonization of the intestine in newborns is an essential part of development, and now we have a new understanding of what factors can affect this colonization – and what effect altered colonization has on a child. A recent study shows that babies delivered by Cesarean have disturbed intestinal flora for up to, and sometimes longer than, six months after delivery. Two dozen babies were tested and then followed for up to two years. Fecal samples were tested one week after birth, and for up to 24 months in order to identify certain types of bacteria.

The results were striking. A particular type of bacteria known as Bacteroidetes was found less often in babies delivered by cesarean compared to those delivered vaginally, with a delayed colonization of this bacteria and significantly lower immune responses.

Those lower immune responses could mean a higher incidence of the development of allergies or asthma later. This could be because intestinal microbes influence and regulate certain parts of immune function all through the body. There was also less microbial diversity in the babies delivered by cesarean. That this off-balance mix is linked to allergies and other problems later is the conclusion of several recent studies.

There are factors that still need to be studied, but this is an interesting first step in understanding the link between gut flora and allergies and is a testament to the benefits of natural vaginal birth – Mother Nature knows what she is doing. So, as if there weren’t already enough reason to avoid unnecessary cesareans, the new information gleaned from the studies on intestinal flora confirm that women should avoid surgical birth any time it is safe to do so.

– Yvonne S. Thornton, M. D., M. P. H.

Don’t Forget to Ask

Monday, August 6th, 2012

When you are pregnant, there are a lot of things running through your mind at once, most of them being questions.  As the date of delivery approaches, those questions become all the more important and all the more difficult to remember to ask.  Here are a few important ones that you should add to your list.

What if My Doctor’s Unavailable?

Although your physician may have set a due date, that is only a best guess as to when you will actually deliver.  Normally, your doctor will try to be available for a delivery in the week before and after that date.  However, extenuating circumstances or a very early delivery could cause them to be unavailable when you need them.  Instead of panicking when the time comes and taking whoever happens to be available, plan for this situation ahead of time.  Speak with your doctor about potential back-ups.  Ask who they recommend and if you can get their numbers for your on-call list.  It might also be a good idea to meet them, so if they do end up delivering your baby, you will have already established a relationship with them, making for a more comfortable experience.

 Who Can Come with Me?

Back in the day, women would bear their pain alone but for the doctors and nurses in the delivery room, but now, most moms want to bring in the father, or at least some trusted family member or friend.  For a standard delivery, this shouldn’t be a problem, but if there are complications, they may be asked to leave so that doctors have more room to work.  Normally, they will ask you to restrict access to the delivery room to one or two people and with all the chaos birth can bring, you’ll appreciate not having too many people around.  If you will be having a C-Section surgery though, having someone in the delivery room may or may not be possible.  Be sure to ask before promising access to anyone.

 Will Someone Be There to Show Me?

Some women panic a bit after going through delivery and finally getting the chance to be alone with their new baby.  They suddenly realize that they don’t know how to change a diaper or that breastfeeding is harder than it looks.  Luckily, there are people on staff at the hospital who can guide you through your first attempts at these tasks.  They can give you tips to help you get your baby to latch for breastfeeding and show you the proper way to take care of their sanitary needs as well.  Ask your chosen hospital about who they have available to go through these questions with you once you have delivered.

If you have more questions, be sure to join me for my live webcast, Inside Information for Women, every Thursday at 1pm Eastern.  I can take your call and do my best to answer any burning questions you might have regarding your pregnancy, delivery, or women’s health in general.  In the meantime, if your due date is approaching, be sure to write down the questions you have, so you will remember to ask each one at your next pregnancy check-up.  That way, when your baby and body are ready to deliver, your mind will be ready too.


– Yvonne S. Thornton, M. D., M. P. H.


Time to Deliver? Mother Nature Knows Best

Thursday, December 30th, 2010

For years, I’ve been sounding the alarm about Cesarean delivery on-demand, and have persuaded my patients that childbirth isn’t something you can simply pencil into your schedule when convenient. It’s not just that a baby needs all the time nature gives her within the womb to develop, and that delivering just a few days early can mean that lung development and other functions may be potentially compromised. Cesareans are major surgery, which brings inherent danger to both mom and newborn. Necessary Cesareans are often life-savers. Unnecessary Cesareans can be just the opposite.

And now, at last, the word is spreading.

The San Jose Mercury News reports:

Babies born early through induction or C-section without a medical reason are nearly twice as likely to spend time in the neonatal intensive care unit, researchers say. They also are more likely to contract infections and need breathing machines, according to a 2009 study in the New England Journal of Medicine and a number of other reports.

“We are finding out that the last weeks of pregnancy really do count,” said Leslie Kowalewski, an associate state director for the March of Dimes.

“At 35 weeks, the brain is only two-thirds of what it will weigh at 40 weeks.” Many organizations are responding with programs designed to eliminate early elective deliveries. Most significantly, chapters of the American Congress of Obstetricians and Gynecologists have begun to notify doctors about the serious consequences of performing early elective births.

With luck, as information about potential consequences spreads, expectant mothers and their doctors will decide to let nature take her course, for the sake of the mom’s health and her baby’s.

– Yvonne S. Thornton, MD, MPH

Why is the Maternal Mortality Rate in the U.S. So High?

Thursday, May 27th, 2010

In the richest nation on earth, with an advanced health care system, and the technology available to monitor and treat mothers and their babies, you’d expect the United States to have among the lowest rates of maternal mortality. So it’s distressing to learn that, although it’s still relatively rare for mothers to die as a result of pregnancy and childbirth, it happens here more often than it should. The U.S. is ranked 41st in maternal deaths among 171 nations analyzed by U.N. experts. That’s a worse record than virtually any other developed country — even worse than a good number of under-developed countries. What’s even more distressing: the death rate is rising.

The question is why? Why is pregnancy so risky in such a rich nation?

Often, the reason is a pre-existing disorder that complicates pregnancy, such as obesity, high blood pressure, or diabetes. The lack of access to good quality care among the uninsured also puts women at risk, leaving them without diagnosis and treatment for conditions that can cause problems until the condition gives rise to a full-blown emergency.

But there’s one contributor to maternal death that might surprise you. Our wealth, itself, could be contributing to the risk, because it encourages the prevalence of Cesarean-on-demand.

According to the CDC, in 2007, 31.8 percent of births were by Cesarean section. The rates of births by C-section have risen every year for at least eleven years.

While C-sections can be, and often are, life-saving, it’s difficult to justify that high a rate. The World Health Organization estimates that the U.S. rate is twice what would be medically necessary.

Cesarean births are now treated as routine, but major surgery is never routine. Major surgery comes with the risk of complications, including hemorrhage. And the C-section, as common as it has become, is still major surgery.

Childbirth is usually very safe, but it could be safer. Giving all women access to pre-natal care and preventive medicine is an important start. But it’s also important to remember that a woman’s body was designed to deliver babies the old-fashioned way. And choosing unnecessary surgery instead could be inviting trouble.

– Yvonne S. Thornton, MD, MPH