Are the Benefits of Normal Births Being Lost due to Rising Caesarean Deliveries?

Infants are frequently delivered by Caesarean section (C-section) in many countries and the rate has reached, or even exceeded, 40% in some regions. These include Latin America, the Caribbean, China, Turkey, Cyprus and Southern Europe. The C-section rate reached 62% in Greece in 2023, according to the latest data from the Hellenic Statistical Authority [1]. C-sections can be indicated if the pregnant woman suffers from e.g., eclampsia or the foetuses are in danger, due to a complicated position. However, most of the C-sections in these countries are elective and carried out for other reasons. Vaginal delivery is regarded as painful and risky for both the mother and her child and the consensus in these countries is that having a C-section is preferable. This opinion also seems to be supported by many obstetricians for practical and financial reasons [1]. Doctors can perform C-sections on weekdays and get paid more, but they don't always inform the parents about the negative effects that a C-section can have on their baby. Vaginal birth is certainly a terrible ordeal for a baby. However, the transition from an aquatic to an atmospheric environment only takes a few hours, compared to millions of years during evolution [2]. The fetus is squeezed through the birth canal for several hours and this puts considerable pressure on its head. It may also be deprived of oxygen if the placenta and the umbilical cord are compressed too much. But being born vaginally is good for the offspring, as it promotes the natural transition from the womb to the air [3]. Vaginal delivery leads to a surge of neurohormones in the fetus, in particular catecholamines and vasopressin. The stress of being born also mobilizes energy, shunts the blood to the brain and stimulates the first breaths of air and the absorption of lung liquid. The newborn infant wakes up and is aroused and conscious of itself and its mother [4]. Pain is alleviated by neurohormonal mechanisms [5]. Infants delivered by elective C-section have lower catecholamine levels, which may delay the absorption of lung liquid. That is why they develop transient respiratory distress more often than vaginal deliveries [3]. Furthermore, infants are more likely to have hypoglycaemia and hypothermia after C-section deliveries and be more sensitive to painful procedures. A Finnish study by Carpén et al. [6] published in Acta Paediatrica, has reported that vaginal deliveries induced the expression of several genes involved in immune and stress responses. These were isolated from neonatal cord blood and were not observed after C-sections. They included the anti-apoptotic gene BCL2A1, which is of particular interest, because an animal study showed that this allowed cells to survive under stressful conditions. The authors of that study reported that the normal process of cell death was paused in mice after vaginal deliveries [7]. Schlinzig et al. reported that epigenetic differences were found after C-sections, namely altered deoxyribonucleic acid methylation in white blood cells [8], which was confirmed in a second study [9]. These epigenetic besides the genetic changes of being born by C-section may affect long-term health leading to allergies, type 1 diabetes [10] and even autism [5] in children delivered by C-sections. Another mechanism that needs to be considered is the effect of exposure to maternal microbes during vaginal deliveries, which could activate the immune system [2]. In conclusion, it is important to reduce unwarranted C-sections making sure that the main information that women receive is objective and provided by official state agencies. Pregnant women should be informed about the long-term effects of elective C-sections on their offspring. They should not be advised to have a C-section unless there are clear medical indications. It would also be desirable to equalise physicians' fees for vaginal deliveries and C-sections and apply the same rules to insurance company reimbursements. The author declares no conflicts of interest. Research data are not shared.