There is a widespread belief that being born vaginally is healthier for a baby than being removed from the womb by caesarean section. We decided to check whether this position is supported by scientific data.

About what childrenborn during vaginal birth, significantly superior born as a result of caesarean section, write many Media. It is reported that babies born differently have intellectual, psychological And physical differences. Thus, the “Caesareans” supposedly have a harder time with mathematics, they are capricious and do not complete the task, their nervous and immune systems work worse. Some of the problems are associated precisely with the lack of experience of passing through the birth canal: for example, “when a child passes through the birth canal, he inevitably encounters the maternal microflora - and normally it helps him populate the intestines with the most beneficial bacteria.” Barotrauma is called barotrauma, which is especially dangerous for those born via cesarean section. Her describe like this: “Under normal conditions, the fetus slowly leaves the mother’s body, the amniotic fluid around it disappears and it gets used to atmospheric pressure. During a caesarean section, the baby may suffer brain damage due to the sudden change in pressure.”

To begin with, we note that the delivery options are by no means limited to vaginal birth and cesarean section, each of them has its own subspecies. Yes, vaginal birth can be complicated and uncomplicated, normal or rapid, performed with or without epidural anesthesia, instrumental (using forceps and/or a vacuum extractor) or not, in a special chair and without it (for example, in water). Caesarean section, in turn, can be emergency and planned; planned can occur before the onset of the labor process and during; during the procedure, epidural anesthesia or anesthesia can be used. Moreover, in the vast majority of cases, the way a baby is born depends minimally on the wishes of the expectant mother - even if she is inclined towards a caesarean section, the operation in most countries will be prescribed only for a combination of indications, and if rapid vaginal labor begins, she will still not be able to slow down the process.

Therefore, it is generally incorrect to compare the “benefits” of different scenarios from the point of view of both the child and the mother - the set of conditions for each woman in labor is individual. For example, if in case umbilical cord prolapse a woman refuses an emergency cesarean section and prefers a vaginal birth, everything will most likely end in intrapartum fetal death. There can be no talk of any benefit in such a situation. Or consider another option, which does not directly threaten the life and health of the child, is placenta accreta. During a vaginal birth, the placenta, which has grown into the muscular layer of the uterus, will not be able to separate on its own, and manual separation will most likely cause massive bleeding, which will lead to the death of the woman. Physiologically, the child is not in any danger in this case, but it is hardly possible to measure the experience of orphanhood with the concept “useful.” Conversely, with placenta accreta, a planned cesarean section along with a hysterectomy (removal of the uterus) performed at 34 weeks saves the life of both mother and child - moreover, this period provides them with the least risks.

In some countries, caesarean section allowed carried out at the request of the woman in labor without the presence of appropriate indications. Main cause This choice, according to WHO, is “the desire to avoid unbearable pain and speed up the process of childbirth.” Such a reason may also be rational from the point of view of benefit for the child. Experienced labor pain and childbirth injuries significantly raise risk of postpartum depression for the mother. She, in turn, has a serious negative impact influence on a child for many years: it provokes delays in language and emotional development, increases the risk of dangerous behavior and obesity, increases the frequency of mood swings and emotions for various, often minor reasons, causes problems with anger control and complicates social adaptation.

A valid comparison between vaginal birth in general and caesarean section in general is also not possible because it cannot take into account all the other aspects of the birth process that can affect the baby. These include the ratio of the diameter of the fetal head and the mother’s birth canal, the position of the fetus in the uterus, features of placenta previa, features of the location of the umbilical cord relative to the fetus, etc. Such a detailed comparison is a topic for complex scientific research in the field of obstetrics and gynecology.

Nevertheless, there are scientific works devoted to the advantages and disadvantages of one or another method of birth in the presence of one or more of the conditions listed above. Let us note that most of the available studies include data of varying quality. This is explained by the fact that it is simply impossible to obtain truly reliable evidence for a number of reasons. For example, scientists cannot create conditions for twin research (this method is considered one of the best in medicine and related fields), when one of the couple would be born vaginally, and the second by caesarean section solely at the request of the woman, and not for medical reasons. Carrying out double blind research is also impossible for ethical reasons: both the doctor and the patient must know what tactics will be used and why.

Therefore, we turned to meta-analyses and reviews of the Cochrane Collaboration as a base that collected the most complete and reliable information about all aspects of human life and health from the point of view of evidence-based medicine. The following data can be found in publications of the Cochrane Collaboration:

for preterm birth in women with a singleton pregnancy, neither vaginal birth nor cesarean section do not affect on the incidence of birth asphyxia, respiratory distress syndrome, or child injury during childbirth;
in case of a second pregnancy, if the first one ended with a cesarean section, none of the methods of delivery (planned vaginal birth and planned cesarean section) didn't show statically significant advantages over another in terms of infant mortality or morbidity;
with breech presentation, caesarean section is reliable reduces infant mortality and risk of serious injury, but is likely to cause debilitation before the age of two years. Science does not know how a breech caesarean section affects children as they get older;
type of anesthesia (epidural or general anesthesia) no effect on breastfeeding, the mother's relationship with the child and the length of time required for full inclusion in the child's care;
No data about whether caesarean section can reduce the risk of mother-to-baby transmission of hepatitis C virus compared with vaginal birth;
unknown, which is better - a planned vaginal birth or a planned cesarean section for the health and life of the mother and child in case of severe preeclampsia;
there are no sufficient data, to determine what is better from the point of view of the child if premature labor begins: to be born by cesarean or vaginally. In both cases there are many variables, the most correct tactic is to allow the doctor to study them and leave the decision to his discretion;
no clear answer recommendations regarding the preference for vaginal instrumental birth or cesarean section for weak labor in the second stage;
none of the methods of childbirth (induced and non-induced vaginal, instrumental, surgical) wasn't more dangerous or, on the contrary, more reliable for children born to women with gestational diabetes mellitus;
If the mother has hypertension, then giving birth at 34 weeks by induction of labor or cesarean section is safer for the woman and doesn't have static significance for the child, compared with being in the hospital before the onset of spontaneous labor.

As can be seen from these materials, giving birth vaginally does not provide any significant benefits to a child. Information on the long-term health status of children born in one way or another was not found in the database. However, there are several large population studies comparing different aspects of the lives of children who were born in one way or another.

Image PublicDomainPictures from the site Pixabay

For example, in 2017, scientists analyzed the school performance of nearly 1.5 million Swedish adolescents born between 1982 and 1995 through unassisted vaginal birth, vacuum and forceps birth, elective caesarean section (before the onset of labor) and emergency caesarean section. It turned out that there was no statistically significant difference in school performance between these children.

Another major study concentrated on the characteristics of the neurodevelopment of children born in different ways. Scientists noted that those born by cesarean section were 1.33 times more likely to have autism spectrum disorder and 1.17 times more likely to have ADHD. While these results may seem scary, scientists warnthat they must be interpreted with caution. First, it's worth considering the general population prevalence of these conditions—1% for autism and 7% for ADHD. That is, a child born through vaginal birth has a 1% chance of being diagnosed with autism, and a child born via cesarean section has a 1.33% chance of being diagnosed with autism. Secondly, the study does not indicate cause and effect, but only notes correlation. The influence of a third factor cannot be excluded - for example, knownthat cesarean sections are more often performed in women with obesity, asthma, autoimmune diseases and at an older age. Each of these features may be the reason not only for the decision about the need for surgery during childbirth, but also a factor predisposing the child to neurodifferences. In the article, scientists summarize: “Future studies should include further adjustment to avoid spurious associations and account for genetic factors. Such studies could be comparisons of siblings, twin studies, or studies of adopted children. The mechanisms underlying the observed associations remain unknown and require empirical investigation to determine whether cesarean section plays a causal role in the development of neurodiversity and psychiatric disorders.”

There is also no reason to believe that the lack of contact with the mother’s bacterial microflora at the time of passage through the birth canal seriously affects the health of children born by cesarean section. A meta-analysis conducted by Chinese scientists showedthat by the third month of life, children born during vaginal birth have a richer microflora, but by the sixth month there are no longer any differences.

In 2008, scientists from the University of Bergen (Norway) published results of a population-based study covering more than 1.7 million births between 1967 and 1998. It turned out that planned and emergency caesarean sections are associated with an increased risk of severe asthma in the child. However, the increase was insignificant: in the general population, asthma occurs with a frequency of four cases per 1000 people, while in children born by elective cesarean, this figure was 5.6 per 1,000, and in those born during an emergency cesarean - 6.3 per 1,000. Moreover, asthma plays a significant role in the list of causes of asthma. plays genetic predisposition, and for women suffering from severe bronchial asthma, doctors prefer avoid vaginal birth. That is, there is a possibility that it is not the birth by cesarean that plays the main role in the future development of asthma, but the fact that the mother has it.

Regarding barotrauma: the pressure in and outside the uterus does not differ as significantly as, for example, when a diver dives under water. No scientific evidence was found that the child may be at such risk. But for the mother there is a risk of barotrauma exists - however, mainly when flying long distances on an airplane immediately after a caesarean section. In 1991 there was described an isolated case of barotrauma in a woman who was undergoing a caesarean section at the time of her injury. Unfortunately, only a brief description of the case is publicly available, which does not allow more complete conclusions to be drawn.

In summary, large meta-analyses from the Cochrane Library show no advantage of vaginal birth over cesarean section. The results of large population studies demonstrate that school performance in children does not have statistically significant differences depending on the method of their birth. There is little correlation between caesarean section and the risk of autism and ADHD, as well as asthma. However, firstly, the data obtained indicate the presence of a very symbolic difference in risks, and secondly, these scientific works do not adjust for the characteristics of the mother’s health before birth. Finally, each birth is relatively unique based on dozens of different indicators, and scientists have not yet been able to conduct a sufficiently reliable study that would contain generalizable conclusions.

Cover image: Iuliia Bondarenko from the site Pixabay