Children born after a medical intervention such as drugs to induce labour, a vacuum extraction or caesarean section, are more likely to have health problems. This has been revealed by an analysis of data relating to almost 500,000 Australian children born to healthy mothers between 2000 and 2008 after a straightforward pregnancy. Although the study establishes a clear link, more research is needed before it can be stated categorically that interventions during delivery are a direct cause of poorer health. However, the researchers have endorsed a call from the WHO urging caution when considering interventions during labour and delivery. Researchers from the UMCG, VUmc and AVAG Midwifery Science Academy, together with fellow-researchers from Australia, Ireland and Great Britain, have published their findings in the medical journal Birth.
It is a global tendency that has become increasingly popular in the Netherlands: fewer children are being delivered naturally. The percentage of children born by caesarean section is rising steadily. In Europe, the figure is currently 25 percent, in Australia 33 percent and in Latin America and the Caribbean it is a staggering 41 percent.
The number of ‘instrument-assisted deliveries’, such as forceps and vacuum extractions, are increasing, as is the use of drugs to induce contractions and other pharmaceutical interventions. The research only reviewed data relating to healthy women who delivered healthy babies without congenital abnormalities, had a healthy pregnancy and had no medical reason to expect complications during labour. Just 38 percent of these women gave birth naturally without any kind of medical intervention. Although the rate of intervention during childbirth in Australia is higher than in the Netherlands, where fewer than half of all children are born without medical interventions, the conclusions also apply to the situation in Europe.
The study shows that the risk of a child developing health problems in later life is significantly higher if a medical intervention was used during the delivery. All intervention methods are linked to health problems, but the nature of the health problems vary per intervention. The study also shows that higher levels of intervention give rise to greater health problems. The biggest risk to health is when drugs are used to induce labour and the baby is then delivered by emergency caesarean section.
Babies born by caesarean section are more likely to suffer from serious post-natal hypothermia, for example, and there were more cases of jaundice and feeding problems among babies delivered using an instrument when labour had also been induced. Children born by caesarean section were more likely to develop a metabolic disorder (such as diabetes and obesity). The risk of gastric disorders was highest among babies born after an induced labour, and after a planned caesarean section. All interventions during labour can be linked to a heightened risk of respiratory infections, metabolic disorders and eczema.
The results of this research show a clear link between interventions during delivery and poorer subsequent health outcomes for the child, but do not address the reasons. In 2012, one of the Australian researchers developed the hypothesis that a vaginal delivery is an opportunity to ‘sow’ a healthy microbiome (all the micro-organisms living in and on our body) and that the stress of a normal delivery has an important impact on how babies’ immune systems are programmed. Too little stress (no contractions and a caesarean section) and too much stress (being induced or the use of delivery instruments) can cause a chemical change in the DNA. Due to this chemical change in the DNA, certain genes (and their mechanisms) can be switched on and off, leading to a wide range of health problems. These hypotheses are now being studied.
This is the first large-scale study of the link between interventions during delivery and the subsequent health of children. Further research will show whether these interventions are a direct cause of poorer health. The researchers are, however, endorsing an earlier call from the WHO urging caution when considering interventions during delivery until more is known about the long-term consequences for children. They recommend that women are given more time during the various phases of pregnancy and labour, if this is medically possible. It is essential that women and their partners are given all the information about the effects of interventions on the health of their child in order to make an informed decision during labour.
Ymkje Stienstra (UMCG), Joram Tarusaria and Ajay Kottapalli receive an NWA Idea Generator Grant .
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