A child born in the United States today has a one in three chance of entering this world through a surgical incision rather than a birth canal. A recent WHO report found C-section rates in private hospitals in Latin America and Asia could top 50 percent, with rates in China nearing “epidemic proportions.” With rates rising by 53 percent between 1996 and 2007 in the U.S. alone, there has been a lot of finger pointing to causes that might explain the dramatic increase. Whether its from being to posh to push or doctors wanting to schedule deliveries between golf rounds, virtually nobody is addressing the global health ramifications of what can happen when a mammal skips the time-honored “seeding” of microbes when passed through the birth canal.
Upon natural delivery, a human fetus is passed through an ecosystem of microbes that immediately cover and begin to colonize the newborn. A baby is born with an immunological tolerance that allows for the acceptance of these microbes that will soon assist the newest member of our species in defending against a daily onslaught of challenges from the microbial-dominated biosphere it just entered. Importantly, the microbes handed from mother-to-child will play an important role in the physical and immunological development of the gut and set the tone for a more complex and stable adult microbial ecosystem to come.
However, studies of birthing method have clearly shown that a child born c-section acquires a less desirable bacterial population more similar to the mother’s skin, which is very different from the pioneering colonizers acquired during a natural birth. This disconnect with nature, possibly among all others, is unmatched in human history in its extent and its potential consequences to human health.
Our initial microbial colonizers have much to do with who we are, or about to become. According to Finnish researchers, c-section babies are at greater risk of becoming obese later in life, a finding consistent with the study of 284 infants by Harvard researchers. In both studies, researchers speculate early inoculation of microbes at the center of the problem. Further studies reveal a link between bith method and rates of asthma, And there are many more studies that suggest the same.
But how we enter this world is just the beginning of what it means to pull away from nature. Dropping breast feeding rates are adding injury to our biological insult of c-sections. While anthropologist have show us that modern humans evolved on exclusive breast milk for a year or more, and extended breast feeding for two or more years, the CDC reports that 50 percent of the children born in Louisiana today will never breast fed. And of the ones that do, only seven percent are still doing so at one year. Breast feeding matters as it contains not only a well known suite of nutrients needed by a growing baby, but indigestible oligosaccharides the newborn’s gut microbes need to flourish and defend against infection. Something not contained in the majority of the baby formula being peddled by predatory tactics in the maternity wards of every U.S. hospital.
The average child in a developed country will receive 10-20 courses of antibiotics by their 18th birthday. While life-saving in some situations, researchers believe the over zealous use of antibiotics may be leading to an unprecedented rise in irritable bowel disease from a disruption in gut microbes that can often stay out of balance for years.
We are rearing entire generations on a medical system not well trained in the principals of evolutionary medicine, not to mention a portion of the general public is still not completely comfortable with our evolutionary past. Our modern lives are out of synch with our ancient bodies and mammalian rituals, and while our overconfident anthropocentric worldview has allowed us incredible control of the modern world, it is doing so at the expense of our microbial defenses and sacrifice of healthy years in life.
We desperately need an integrated public health approach that understands that our cradle to coffin strategy must begin with a restoration of our ancestral microbial ecology. We need to reduce c-sections, or at least empower parents with the information they need to make an informed decision. We need to improve normalization of breastfeeding in public and work spaces, making mothers more comfortable or able to provide her little mammal what it needs. And we need to think harder about the consequences of the greatest experiment ever imposed on the human-microbe population: antibiotics.
The First Lady has inspired a nation with a few vegetables grown on the South Lawn. Maybe its time a nursery was opened as well, so mothers working in the White House could tend to the microbial garden of their children. Doing so will only improve the health of any nation.