The Microbiome Effect by Toni Harman and Alex Wakeford is a fascinating book of emerging research that indicates how vital bacteria are for human health. A baby's exposure to them during labour, birth and beyond helps kick-start their developing immune system. This book reveals the impact of babies born via Caesarean Section (C-Section) and how this potentially alters the course of their immune development and makes them more susceptible to non-communicable diseases.
Here is my synopsis, of what I believe is a must-read for all birth educators and expectant parents, to understand the intricacies of a vaginal birth and the vital components that help your baby thrive in the outside world.
Human bodies are comprised of trillions of human cells and microbes (bacteria, viruses, archaea, fungi etc). These cells and microbes live on and inside us. The bacteria inside our body help keep us functioning properly and give us the ability to fight off diseases. However, modern ways of living, such as diet, antibiotics and C-sections - to name a few - are adjusting the diversity of microbiomes in the human body. Current research indicates that this alteration in the way we live is giving rise to many common non-communicable diseases such as allergies, asthma, auto-immune disorders, diabetes, obesity and more.
For a long time, antenatal educators have explained to its parents-to-be the benefits of a vaginal birth vs a C-section birth, in regards to babies breathing abilities. In a vaginal birth, the birth canal compresses the lungs to expel the liquid that has been in them during pregnancy; so that once earth-side, the lungs are fairly clear of liquid and breathing unassisted comes more easily.
The research conducted, which is discussed in this book, digs deeper. It looks into many other vital stages that a baby encounters during a vaginal birth, which can impact his/her long-term health positively. Other scientific tests are indicating that there is a link with an imbalance in the human microbiome (often caused via Caesarean section deliveries) and with chronic non-transmissible diseases.
It is believed that during pregnancy a baby lives in a near sterile environment and exposure to microbiomes is minimal. It is during a vaginal birth, once the amniotic sac had ruptured, that a baby begins to be exposed to bacteria. This is when it comes into contact with vaginal, faecal and skin microbes. These enter the baby's eyes, ears, nose, as well as being swallowed through the mouth. This prenatal exposure is one of the main seeding events for the baby's gut. Once the baby is born it will come into contact with more bacteria - from the air in the place of birth, from the skin of its caregivers and parents etc. All of these encounters help to colonise the baby's gut.
Babies born via a Caesarean section (C-section) potentially miss out on this exposure, if the amniotic sac hasn’t ruptured, because they won’t come into contact with the mother’s vaginal or intestinal microbes. As a result the baby’s gut microbiome composition will be different.
Latest research favours infants that are born via C-section to have skin-to-skin contact and breastfeeding where possible, because the second major influx of microbes is during these two events (babies born vaginally are also recommended to do this too).
During skin-to-skin contact, and when a baby is looking for milk, it will open its mouth and suckle or lick the mother’s skin. A mother’s breastmilk is incredibly rich. It provides essential nutrients for the baby's growth and development, including key immune components and sugars. The sugars not only provide energy for the baby, but it also feeds the bacteria in the gut, quickly colonising it and preventing other harmful bacteria from taking hold. These events and opportunities to come into contact with the right bacteria kick-starts the continued development of the infant immune system. The bacteria teach the immune system to recognise friendly and harmful bacteria, and know what to attack, or not.
In contrast, a baby that is fed formula milk will only receive the nutritional benefits. This milk is missing prebiotics to feed the gut microbes. It also lacks the right bacterial species and immune components that the developing baby needs. These missing components could impact the training of the infant immune system, which could mean health implications later in life.
All the way through pregnancy, labour, birth and infancy things are supposed to happen at certain times. When the birth process is interrupted with medical intervention, the evolution of the immune system is disturbed, which could result in it malfunctioning later in life.
Research has also shown that the microbial profile of a baby born vaginally resembles that of its mother, and continues to do so with each generation that is born vaginally. However when this pattern is interrupted by a C-section delivery, the child may not match the mother’s microbial profile and the child may fail to inherit critical “keystone” species of bacteria to ensure good health. C-sections could be contributing to key microbe species being lost, making us more susceptible to pandemics.
Other evidence suggests a correlation in C-section babies having a higher risk of developing asthma, type one diabetes or coeliac disease, and of becoming overweight or obese. This is not to say that all babies born this way will go one to develop any of these, they are simply more susceptible. What we don’t know yet is the ongoing repercussions of this.
So what can we do about it?
As an antenatal educator, I feel it is my duty to inform my parents of the potential health implications of babies born via a C-section. Parents need to better understand the importance of vaginal births, as a way to ensure that their baby receives the necessary exposure to bacteria, which will help colonise its gut in the right way - to ensure a fully functioning immune system.
There will always be world in which some babies are needed to be delivered via C-section, therefore what steps can the caregivers take to help the baby receive optimal seeding and feeding? Mothers can be tested to see if they are suitable for “swab-seeding” (this is currently under a strict protocol). However for the feeding aspect, there is now no reason why babies cannot be passed to mothers straight away in all elective C-sections (and some in emergency C-sections); so that the baby can have skin-to-skin contact and have the opportunity to begin breastfeeding. This will allow the baby to be exposed to essential bacteria and microbes and helping to kick-start an immune system that could keep them healthy throughout their life.
This article only scratches the surface and highlights the key points of the book. I strongly recommend mothers to read it and learn more about it. Ask your midwife and/or obstetrician how much they know about this subject. If they don’t know too much about this subject, politely ask them to do their research. Your baby’s life is in their hands.
The Microbiome Effect is published by Pinter and Martin.