G, 29, a first-time mum, requested to have a Cesarean Section (CS) done at her 38 weeks of gestation. Her reason: So that she could celebrate her birthday together with her baby on the same day in future.
G was not alone with her request. Social indication for planned CS is on the rise and has contributed to the increase in the overall CS rate in Singapore which has risen from 10-15% of total births in the early 1990s to about 40 % of all births now. This is probably because CS has become a very safe procedure in Singapore with very few maternal and fetal complications. Some mothers are frightened of the pain during birth while others may want to schedule the birth to suit the convenience of the families. CS also allows mothers to choose the auspicious time and date of birth to ensure a bright future for their babies. For some mothers, CS prevents trauma to the pelvic floor muscles. This will ensure a better sexual life and prevent urinary incontinence later on in life.
While CS is deemed necessary for medical reasons such as for fetal distress, maternal request on its own is not an indication. Many mothers may not be aware that babies delivered by CS may have a delay in the development of their immune system which is important in protecting them against diseases in later life.
When babies are in their mother’s womb, they are free of germs or microbes. But as soon as they are delivered normally and exposed to the outside world, they begin taking in good microbes, which rapidly colonize organs in the body, particularly in the large intestines. This early colonization helps initiate and develop the infant’s immune system.
Studies have shown that babies born by CS do not get a good blend of microbes that come from a vaginal birth. They lack the strains of gut bacteria found in healthy children and adults. Instead, their guts harbour more harmful microbes which will delay the development of the immune system. Immaturity of the body's defenses make these infants more vulnerable to infection. The incidence of metabolic and allergic disorders such as asthma and obesity also increases in later life. This observation has led some parents to swab infants born by CS with vaginal fluids in an attempt to restore the missing microbes. But the practice, known as vaginal seeding, has been found to be unsafe and with unproven effectiveness.
Fecal Microbiota Transplants (FMT)
Studies have revealed that the ecosystem of microbes in the gut of the newborns delivered vaginally derives from maternal fecal matters and not from the vaginal fluid. The babies presumably pick up mum’s poop at the moment of birth.
To find ways to improve the immune system of CS babies, a group of researchers from Helsinki recently performed FMT on these babies. FMT refers to the procedure in which a small amount of well-screened mother’s poop is given orally to the baby after birth. They found that this early-life bacteria could “normalize” their gut microbes and give the infant’s immune system a healthier start.
However, these experts warned that the babies were monitored cautiously in a hospital and the procedure should not be tried by anyone at home. Long term studies of FMT are ongoing.
G was counselled on the disadvantages of CS on social grounds. With the support and persuasion of her husband, she finally abandoned the idea of having the same birthdate as her baby and delivered a healthy boy vaginally at full term.