Scientific efforts to demonize C-sections bear an ugly resemblance to scientific efforts to demonize abortion

embryo in woman hand

What’s the difference between:

We argue that a detailed assessment of these risks should be taken into account in guidelines …

And this:

… [W]e are committed to educate … patients, the general public … and our medical colleagues regarding the medical and psychological complications …

Sounds pretty similar, right? But the first comes from a new paper on the “risks” of C-sections and the second comes from the mission statement of Prolife OBGYNs. We know for a fact that anti-choice advocates start with the conclusion that abortion is “bad” and look for evidence to support it. Unfortunately, many people now writing about C-sections approach the topic in a similar way. They start from the premise that C-sections are “bad,” and then search for evidence to support the predetermined conclusions.

Why do I bring this up?

Apparently it’s Hate on C-sections Week in the scientific journals.

First we had the doctor who described C-sections as airbags that explode in women’s faces , stung when it was pointed out that he had written a journal article encouraging homebirth in the US without having read the existing scientific literature on the death rate at US homoebirth.

Now we have this piece in the BMJ, Time to consider the risks of caesarean delivery for long term child health, by Blustein and Liu. There are a lot of problems with this piece, starting with the title.

To understand my objection, try this thought experiment: what would be your first reaction to a journal article entitled “It’s time to consider the risks of abortion on long term women’s health”? I suspect it would be immediate recognition that the piece was agenda driven with the conclusion determined long before the data was analyzed. This piece bears an uncomfortable resemblance although in this case the predetermined conclusion is not that abortions are “bad” but that C-sections are “bad.”

Our knowledge of the human microbiome is in the earliest stages of infancy. We have literally no idea what constitutes the normal human microbiome. We have no idea whether differences between individuals in the microbiome reflect genetics, environment or simple chance. We have literally no idea of the relationship (if any) between the microbiome and chronic disease.

Our knowledge of epigentics is also in its infancy. We know precious little beyond the fact that information encoded outside the genes can affect the expression of those genes.

No matter. Everyone “knows” that C-sections are “bad” even though existing scientific evidence does not support that view. The microbiome and epigenetics represent new opportunities to find “risks” to support predetermined conclusions.

What about long term beneficial effects of C-sections? Be serious; what journal is going to publish a paper about the benefits of C-sections? In an age where journals send out press releases to garner favorable public attention, it is imperative to publish headline generating papers that capture the contemporary zeitgeist. And the contemporary zeitgeist is that C-sections are “bad.”

Blustein and Liu demonstrate their bias at the outset:

…[I]n cooler moments, such as repeat or maternal choice of caesarean, it makes sense to consider the risks and benefits of caesarean versus vaginal delivery, just as we would for other medical treatments. Both modes of delivery are associated with well known acute risks. For the neonate, for example, a caesarean is associated with increased risk of admission to a neonatal intensive care unit and vaginal delivery with a greater likelihood of cephalohaematoma. To date, concerns around long term child health have largely focused on neurological impairment. But recent research points to latent risks for chronic disease: children delivered by caesarean have a higher incidence of type 1 diabetes, obesity, and asthma. We argue that a detailed assessment of these risks should be taken into account in guidelines for caesarean delivery.

What are the benefits? The authors can’t be bothered to mention those.

The scientific evidence on risks is so weak as to be practically non-existent.

Much of the evidence linking caesarean delivery to chronic disease is observational…

The absolute rates derived from these relative increases depend on many assumptions, including local rates of caesarean and disease prevalence. For example, using the US caesarean rate of 32.7% and an overall childhood obesity rate of 17%, the estimated rate of obesity is 15.8% among children delivered vaginally and 19.4% among children delivered by caesarean. With an overall childhood asthma rate of 8.4%, the rate of asthma among children delivered vaginally is estimated at 7.9% compared with 9.5% in those delivered by caesarean. And an overall childhood type 1 diabetes rate of 1.9/1000 translates to rates of 1.79/1000 children delivered vaginally and 2.13/1000 children delivered by caesarean.

In other words, risks (if they exist at all) are trivial.

What does this have to do with the microbiome or epigenetics? Funny you should ask. There’s no evidence it has anything to do with either. They are merely speculative mechanisms to explain speculative risks. We may not know why or how, but we “know” that C-sections are bad.

The truth is that we know nothing about the association between C-sections and chronic disease. The authors themselves acknowledge this repeatedly using the word may:

… When a caesarean is done after labour has started it may be preceded by rupture of membranes, with exposure to maternal microflora. The risks to long term child health might then vary between caesareans done before and after labour has started. Similarly, intrapartum stress may be higher in emergency caesarean and instrumental vaginal delivery than in unassisted vaginal delivery. Comparing outcomes in various settings allows a test of the relative importance of stress versus caesarean delivery itself. These (and other) more nuanced approaches may lead to better understanding of the dynamics underlying risk. This in turn may lead to clinical approaches to mitigating risk.

Of course may implies may not, but agenda driven research does not allow for that possibility.

If someone claimed that abortions had a long term risk of chronic disease, we would rightly be suspicious of an agenda. We’d want to see proof, solid proof, of causation not merely correlation. We’d demand large population based studies, definitive data and a detailed causal mechanism. In the absence of that information, we’d have little choice but to conclude that the authors were driven by the agenda of preventing abortions and we would be angry at the attempted manipulation.

Is the C-section rate too high? Possibly.

Do C-sections lead to chronic disease? We have no idea.

Are papers speculating on long term risks of C-sections in the absence of solid data manipulative and irresponsible? Undoubtedly!

  • Eater of Worlds

    The WHO is apparently back to saying c-sections should be no more than 10-15%

    http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/

  • Taysha

    Of course there is an increase in diabetes in children born from c-sections.
    Large numbers of diabetic mothers are having c-sections to prevent complications. Children of diabetic mothers tend to have more diabetes.
    Same goes for asthmatics, chronic disease suffering mothers and just about everyone that at one point got told to sit down, shut up, and not even think about having kids.
    We’re having kids now. And c-sections are helping.

  • RodneyRBratten

    Reset your job with skepticalob Find Here

  • Kq

    It’s hard for me to even read this one, let alone participate in the conversation. I’ve had an abortion – the late term kind that the anti choice lobby likes to REALLY demonize. And I’ve had a c section. And here I am, healthy and happy and undamned. The worst I suffer from these procedures is assholes who try to demonize them and insist I must be evil, stupid or deluded.

    • Cobalt

      I’ve said it before, but it bears repeating until those lobbyists grow up and actually look at what they’re seeing.

      Late term abortion, although it shares a lot of clinical medical terminology with early abortion, really isn’t close to the same in reason or emotion in the overwhelming majority of cases. It’s done in the same spirit as removing a terminally ill child from life support to prevent their suffering. It’s an excruciating choice for the parents that saves the child pain. The fact that the child is still within the mother just adds extra pain to her loss.

      I am so sorry you lost your son. We had to make the choice for our daughter who was brain dead from an accident. It hurts, like no other pain in this world, to lose a child.

      • Daleth

        Oh god, Cobalt, I’m so sorry.

      • momofone

        I am so sorry.

      • Sarah

        I’m very sorry for your loss, and glad you told us about your daughter.

      • Michelle

        Exactly, mid- and late-term terminations are a small percentage and normally done because the pregnant woman is seriously ill (e.g. a friend of mine who had HELLP at 18 weeks) or the foetus is at risk. It’s a hard thing to go through that sort of loss, and it’s so sad to hear of this happening to anyone. They forget about this and that at the later stages medical reasons apply, especially when they do those ‘thought experiments’ implying that this sort of decision would be made at the drop of a hat.

  • NatashaO

    speaking of demonizing abortion…and the prolife people giving inaccurate information…. the picture in this article shows what looks like a full term fetus, but the size (4-5 inches) would be that of a 15-16 week fetus… which in reality looks more like this…..

    • The Computer Ate My Nym

      Actually, a fetus which was aborted at 15-16 weeks probably wouldn’t look like that either. Most elective abortions happen by 8 weeks and the vast majority of elective abortions happen by the 12th week. So any fetus that is aborted at 15-16 weeks is likely to look grossly deformed and even less like a baby.

      • Kq

        You want to see a 24 week fetus who has been aborted? Can’t help you. Want to see pictures of my beloved first son who I mourn in my heart to this day? Those I got.

        • The Computer Ate My Nym

          I’m very sorry for your loss. No one wants a late abortion and if we had a way to make them unnecessary and therefore never happen that would make everyone happy. But somehow the “pro-life” movement never seems to be pro-medical research that might save fetuses with congential anomalies that are currently fatal.

        • momofone

          I am so sorry for your loss. How devastating.

        • Daleth

          So so sorry.

      • Roadstergal

        “Most elective abortions happen by 8 weeks”

        And elective abortions should indeed happen that soon. All the stalling tactic legislation intended to delay a wanted abortion is unconscionable from _so_ many angles.

  • The Computer Ate My Nym

    Hi. Stupid question here, but I want to make sure I have something right: If a woman who had a c-section for the first baby and wants a c-section for the second rather than try a VBAC then the reason for the c-section would be listed as “maternal request” or? If so, then MRCS is not a good proxy for “c-section for no medical indication” because many, if not most, MRCS would be requested because of prior c-sections and therefore higher risk second pregnancies. Which means that the small but significant increase observed in some studies in various conditions (asthma, diabetes, etc) is probably meaningless: the c-section patients are almost certainly higher risk at baseline.

    • MaineJen

      It would be listed as “elective CS,” which is not the same thing as ‘maternal request.’ Elective CSs are any CS that is scheduled, rather than emergent. Elective CSs are still done with medical indication, such as breech, twins etc. In this case, the medical indication would be ‘prior CS’ or ‘repeat CS’. Maternal-request CSs are, in theory, only those done without medical indication (or, purely based on preference).

      I think a lot of people confuse ‘elective’ with ‘maternal request.’

  • Liz Leyden

    So many unanswered questions. Do C-sections really lead to more NICU stays, or do babies end up in the NICU because of factors that led to a C-section? Does it matter if the C-section is elective instead of emergency?

    ” But recent research points to latent risks for chronic disease:
    children delivered by caesarean have a higher incidence of type 1
    diabetes, obesity, and asthma.”

    I know the jury is still out out on asthma and obesity, but I’m pretty sure Type 1 diabetes has a genetic component. How many people with Type 1 diabetes would’ve developed it if they were born vaginally? Is there any way to tell?

    • Roadstergal

      See my comment near the bottom.

    • Sue

      Also, if I understand correctly, the vast majority of those NICU stays are for observation for benign and short-lived TTN – not for invasive, life-saving treatment.

      Any NICUs here to confirm or correct?

  • The Computer Ate My Nym

    Hey, Dr. Tuteur, want to write a letter to the editor of the BMJ responding to this one?

  • The Computer Ate My Nym
    • Roadstergal

      I love the hover-text on that one.

    • Sue

      Love it!

  • yentavegan

    Hmmm.. so let’s review the choices for me were A. wait for labor to begin for dd2 and risk herpes transmission? or B. Have that planned c/sec and Run the risk of dd2 developing diabetes, asthma,?
    And with dd5 I could have waited until labor kicked in but I was already post date and I was already starting to have psychotic episodes so perhaps I should have waited for her to die in utero rather than run the risk of her being fat? You know NCB industry ? You are eugenicists.

    • KeeperOfTheBooks

      That they are. In spades.

  • The Computer Ate My Nym

    But recent research points to latent risks for chronic disease: children
    delivered by caesarean have a higher incidence of type 1 diabetes,
    obesity, and asthma.

    As Dr. Tuteur already pointed out, the correlations are pretty small. Without seeing the original research, it’s hard for me to know for sure whether the differences are even statistically significant. Assuming they are, though, the jump from correlation to causation is a very dubious one in this case. Take obesity, for example. Obese women are at higher risk for needing a c-section. It seems far more likely that there is a higher rate of obesity in children of obese women because of common genetics and lifestyle between mother and child than because of mode of delivery. Asthma can also be an indication for c-section and again, has a genetic or early environmental component. Diabetics, either type I or type II are at higher risk for complications and therefore for c-section as well.

    Also, BMJ seems to publish a lot of rather dubious stuff.

    • The Computer Ate My Nym

      OK, I don’t have time to look at this in detail, but quickly wanted to quote from the conclusions of one of the papers they cited, “An increased risk of asthma medication in the group born by emergency
      CS, but not elective, suggests that there is no causal effect due to
      vaginal microflora.” And the point estimate for relative risk was 1.10 which is practically nonexistent to start with. I am unimpressed with the riskiness of c-section as demonstrated here.

  • ersmom

    THANK YOU!!!!!
    As an OB, thank-you. I am sick and tired of having to work around the fear of interventions – I tell my patients. These are my tools. Not everything needs a hammer when you’re building a house and not everything needs fill-in-the-blank, whether it be pit or a section or internal monitors. But to let me do my best job, I need to use the appropriate tool.

    And I am one, if the NCB would look at numbers, that they would want to come to – 6% primary section rate. Around 17% overall section rate (including ERLTCS). And yes, I do maternal request sections too, since I believe that a woman can use her brain and her uterus at the same freaking time.

    • KeeperOfTheBooks

      If I didn’t already have an awesome OB whom I adore, I’d want to be one of your patients. You sound a lot like him…and that’s a compliment, I assure you.

      • ersmom

        Thanks! Funny, the woo-folk in my neck of the woods dislike me but loooooove one of my partners…who has a 30% section rate last quarter. I’m not as feely as she is. Not my style.

        • KarenJJ

          Your lucky partner…

          (maybe need the sarcasm font there).

  • Michael Clark

    I wonder how much of this is due to medical education. When I did my OB rotation in med school, there was a strong emphasis on reducing C sections. One attending even referred to vaginal birth as “the right way.” Patient preference or wishes were completely irrelevant. If medical students and residents are taught that C-sections are bad, they are going to treat this as given.

    • Allie P

      While at the same time my (older) OB laments the fact that the whippersnappers are not being taught breech vaginal delivery or forceps use, but just being told that it’s safer to go for the CS. And my older OB is NOT into woo or NCB.

  • Sue

    Does the correlation reported for cesarean birth and later obesity control for maternal obesity or DM, which predispose to the need for C/S?

    Maybe it’s the maternal DM which correlates with later increased BMI, and the C/S is not causative.

    How would it be plausible that a few hours representing exit from the uterus – a highly variable process anyway – would affect so many long-term outcomes. (Please explain the pathophysiology without vague use of the word ‘microbiome’).

    Does any research stratify the rates of asthma, allergy, obesity in later life by birth position, or length of the second stage, or use of castor oil, etc?

    What if we found that vaginal breech birth was associated with a higher rate of asthma, or allergy, and that C/S improved it?

    • me-ish

      Then they would say that vaginal birth improves “bonding”. It’s the word of last resort for the woo pitchers.

      • Azuran

        I always found this ‘bonding’ thing so ridiculous. You basically carried the little critter INSIDE of you for 9 months. If you need to rub it’s face inside your vagina (or have instant skin to skin contact) to bond with it, there is a problem with you.

        • Allie P

          And it’s offensive to non-biological (and non-maternal) parents, too. My husband bonded plenty with our daughter, without giving birth to her or feeding her from his body. Adoptive parents also “bond”. Personally, I didn’t “bond” with my kid for a few months, despite both vaginal childbirth and breastfeeding. Doesn’t seem to have hurt her any.

          • demodocus

            I had trouble bonding early too, in large part because of breastfeeding.

          • Kelly

            Me too and I had two vaginal deliveries.I don’t bond with my kids until they start to smile and have a personality. I love them but that swelling in my chest does not happen until then. I am ok with it. I would still do anything for them but they are boring potatoes.

          • Gatita

            My son’s pediatrician describes infants as lumps of protoplasm you keep alive until they grow into something interesting.

          • Allie P

            I concur. Boring potatoes. Feed ’em, change ’em, rock ’em, shush ’em, and then they become humans.

          • Azuran

            That’s about how my boyfriend feels XD

          • Kelly

            I like that explanation. It sounds so much more scientific.

        • Daleth

          Ha! Exactly!

        • rh1985

          My CS-born toddler is glued to me. She recently figured out hugging and now she keeps climbing on me to give me a hug.

      • Rosalind Dalefield

        I bonded to all my children long before they were born.

  • Rosalind Dalefield

    Those statistical differences are miniscule. Talk about junk science!
    Some of an infant’s microbiome is transferred prenatally across the placenta, and there is evidence that the mother’s dental flora can make a difference to the baby’s microflora. The belief that passing through the vagina makes a functionally significant different to the microbiome is outdated.
    However attention is shifting from the microbiome to the metabolome, i.e. it is less important what species of gut flora a person has and more important what metabolic pathways the gut flora are capable of. This change in attention reflects the realization that many different species of gut flora have metabolic pathways in common.

    • Sue

      “The belief that passing through the vagina makes a functionally significant different to the microbiome is outdated.”

      Any references you have for this would be great – I’m always reading and hearing this stuff, even amongst medical professionals.

    • The Computer Ate My Nym

      A brief review of the original papers (I haven’t done an in depth analysis, I will admit), shows me two things: I have yet to see a RR over 2 and the 95% CI often contain a RR of 1. The differences are unimpressive, at best, nonexistent at worst.

    • Darkling

      Not to mention their conclusion doesn’t follow their evidence. If asthma etc. was caused by unbalanced gut flora, shouldn’t we avoid women with these conditions from giving birth vaginally and giving their kids their ‘bad’ flora? If anything, this would mean these women should give birth only by C section so their kids can be inoculated with good flora later on…Of course, that’s not the conclusion they wanted from their cooked data.

  • Gatita

    OT: Does my baby likes me only for my boobs?

    I want to say that while breast-feeding often felt oppressive, it made me feel powerful, too. I could change my son’s mood immediately, and change mine, too, both of us awash in hormones. I could get him back to sleep at 6 a.m. for another hour. I could calm him down when nothing else would, get him to eat when he wouldn’t eat anything else. I could feed him anywhere and for free. It didn’t make me lose weight, it destroyed my sex drive, and I don’t believe it raised his IQ or magically cured him of allergies, but I did enjoy the automatic bond I got with my son, which in less vague terms means he likes me better than anyone else and it’s not necessarily for my personality. I was undeniably maternal, whether I liked it or not. Our bodies were tethered to each other, our separation was a problem to be solved, or at least planned for; he relied on me in the most obvious sense.

    I wasn’t able to breastfeed and reading this makes me not regret it. I’m really glad my son wasn’t so completely dependent on me, that I had other people who could help keep him fed and alive.

    • Ceridwen

      When my husband arrived to pick my daughter up from daycare she would grin and run to him to get a hug. When I arrived to get her she would smile for a split second and then start crying and run away from me…to the chair that I used to nurse her. When we stopped nursing she started giving me the same response he got, and damn, it was a hell of a lot more rewarding. Not to mention put her in a better mood for the drive home than the angsty edge she always had after realizing she had been deprived of boobs all day.

      • yentavegan

        My infants did not smile at me first. That big shit eating grin from ear to ear was reserved for Daddy. I was the one who nursed and stunk like sweat and baby puke. Daddy was and still is their hero. Oh well. I am carving out a new existence for myself other than Mommy.

        • Kq

          I vividly remember my son only giving s shit for me when he needed food but going happy apeshit for DAAAADEEEEE the second he appeared

    • SporkParade

      Yeah, breastfeeding does tend to sort the parents into “the one who plays with me” and “the one I go to for business.” I’m pretty sure that the ability to give formula when it was more convenient is the only reason I actually enjoyed breastfeeding.

    • Sarah

      Oh yes. Fair enough if this is the sort of thing you like, but for plenty of us it’s really not.

      • Dr Kitty

        Put it this way.
        I followed all the advice and kiddo didn’t get a bottle until she was 6 weeks old in order to prevent nipple confusion. And that child refused bottles, from anyone, until she was 6 months old when I went back to work and she accepted them because it was either a bottle or absolutely no fluids for 8-12 hours.

        It was not fun.
        I would go out to dinner or the movies with DH and leave 2-6 month old kiddo with her grandparents and several bottles of EBM, and come back 3 or 4 hours later to find her screaming in hunger having refused everything. We tried various brands of bottles, cups, syringes- you name it- kid wasn’t interested.

        So…the next kiddo is getting bottles from day one, nipple confusion be damned.

        • Sarah

          You do what you need to do!

        • KeeperOfTheBooks

          Anecdata, and all that, but my MIL had 8 kids. Some were breastfed, some not. However, with *all* of them she introduced a bottle by 2 weeks and had them get a meal from it every so often so that a) she could have a break and b) she’d know that if the kid needed to drink from a bottle, he or she would. According to her, the reasons she stopped nursing (or didn’t start in the first place) varied from kid to kid, but not a one of them couldn’t figure out that a boob was different from a bottle and that you could get food out of both, and YAY FOOD.

          • Cobalt

            I started out doing that with the last one, but got tired and started skipping the bottle (breastfeeding was genuinely easier and faster in the moment) and the little bugger forgot the wonderfulness of bottles after a few weeks and it took months to get him over that.

            Don’t stop the relief bottles!

          • Toni35

            That! With babies #1&2 I bought the whole nipple confusion notion and didn’t introduce bottles until around 4-6 weeks, by which time they wanted nothing to do with them. Fortunately by about 3 months they were willing to accept a sippy cup (valve removed), so we did have a back up feeding method in place (nothing worse than running late in coming home from an appt or whatever and to be worried that you newborn is starving and screaming 🙁 the relief when we figured out the sippy cup thing was palpable!). With #3 I introduced a bottle at around 2-3 weeks, and she took to it very well, but given the demands of taking care of two older children and a newborn the bottles just didn’t last long. By then bottle feeding was a bigger PITA than just popping her on the tit, especially given that I was still wanting to exclusively bf – so bottle feeding meant pumping and pumping is way more time consuming than bfing.

            This time I’m not sure what I’ll do – definitely intro bottles by 2-3 weeks, but even tho I know formula is safe and reasonable, part of me still feels “guilty”(?) at the notion of giving this child formula (even once in a while) while her sisters were all EBF…. It’s something I either need to work out in my own head so I can be okay with it, or I need to accept another baby who won’t feed by any other means than the boob for a good 3 months. The ‘breast is best’ campaign is pretty powerful stuff. I know my feelings aren’t logical, but there they are…. I imagine if I just get over myself and do it, I’ll be perfectly fine with baby #4 getting supplementary formula… I’ll probably kick myself for not doing it that way with my first 3 kids.

          • Cobalt

            I got weird about breastfeeding, and I LIKE formula. It SAVED my older son. I blame lactation hormones for the mental “milk obsession”. If I were doing it over, I would:

            Pump once daily during engorgement phase for comfort and to build a small freezer stash. Stop when no longer needed for comfort. Don’t pump again unless needed for my physical comfort.

            Save the milk in the freezer for “just in case”. This is the milk I can obsess over. I’ll hardly ever use it, and when it runs out, it runs out.

            Give the baby one bottle every day of ready to feed formula. It’s more expensive, but I don’t need much of it. It would be good if it was the first feeding after I go to sleep and someone else does it. Either way, the ready to feed is fast and easy, just screw a nipple on top and go.

        • Allie P

          My kid never got nipple confusion, no matter which bottle brand or human nipple we tried. (A friend nursed her once.) If milk came out of it, she was good to go. I can’t promise this will happen every time, but I think the dangers are overstated.

          • KarenJJ

            Same. Uninterested in a dummy, but if there was milk coming she was content.

    • MegaMechaMeg

      I thought it was kind of a sweet article? Like it captured the ambivalent fog of a woman who was able to breastfeed easily and wanted it to be done. While it isn’t the life I would choose for myself, it is nice to hear a nursing mother talk about breastfeeding from a neutral, reality based place. She was able to breastfeed. It was difficult in some ways, it made other thing easy, she is glad it happened and will be glad when it is over. It honestly made me think of a good friend of mine who is in the process of weaning her daughter.

      • Gatita

        I can understand that it’s sweet but my visceral reaction was to feel suffocated while reading it. But that’s just my own baggage in play. I can see why someone would be touched by the article.

    • The Computer Ate My Nym

      I thought the evil baby monkey study had settled this one for good: Your baby needs you for your boobs or boob substitutes (s/he’s got to eat), but s/he loves you for your cuddles.

  • Sue

    In Australia, the incidence of childhood asthma peaked in the late 1990’s, and has been declining ever since, while Cesarean rates have gradually increased.

    Asthma is a highly inherited condition. How likely is it that those few hours around birth affect the incidence?

    • Amy M

      And for some reason, asthma always seems to be listed alongside autism and adhd, as though all three disorders are equivalent. The same people who think autism is worse than death, also seem to think asthma is worse than death. I have no direct experience with autism, but I do have asthma (as does my mom, sister, husband, one SIL, and children), and the treatments for it have only improved over time, making it so that most asthma patients only have to think about having asthma when they are sick or during a very severe allergy season. I wasn’t born by Csection either. I just don’t get the stigma there—if you or your child has asthma, see a doctor and the vast majority of the time, it can be under control.

      How can a C-section, being a short-term physical action, possibly affect various neurological or pulmonary issues, especially long-term? I’m not a doctor, so maybe I’m missing something due to lack of education, but I thought autism, adhd and asthma all had strong genetic components?

      • namaste863

        I’m sure Temple Grandin has a field day with this. Her autism is precisely what gifted her with the unique perspective to become one of the world’s foremost experts on animal behavior.

        • KeeperOfTheBooks

          Oh my gosh, I hadn’t thought of Temple Grandin, but I’d LOVE to be a fly on the wall while she dealt with this kind of silliness. 😀

        • Rosalind Dalefield

          Personally I don’t believe that. Many of the things about stockyard design etc that Temple Grandin ‘discovered’ were known to New Zealand stockmen twenty years before anyone had ever heard of Temple Grandin.

          • Poogles

            “Many of the things about stockyard design etc that Temple Grandin ‘discovered’ were known to New Zealand stockmen twenty years before anyone had ever heard of Temple Grandin.”

            Have any links/evidence of that? I would be very curious to see more.

          • Rosalind Dalefield

            I know that as a preteen and early teenager I was reading about them in a handbook on stockyard design that we bought in New Zealand (where it was published) in the late 60s and 70s, but whether I can still find the handbook, I’m don’t know. Certainly things like having curved races, surfaces their hooves can grip, consideration of what they can or can’t see and how they perceive it, how the light falls, and that animals prefer to go uphill, were all old hat to NZ farmers in the 70s and you can find plenty of stockyards built that way in NZ that date from the early 70s.
            I toured new slaughterhouses in the USA and Brazil a couple of years ago and the management people were bragging about how Temple Grandin had designed their yards and put in all those features, and I was singularly unimpressed because they were all features I had seen adopted several decades before in NZ. I’ve yet to hear of anything Temple Grandin ‘discovered’ that someone else, who didn’t have autism and didn’t claim autism gave them some sort of special advantage, had not already discovered.

          • Poogles

            “Certainly things like having curved races, surfaces their hooves can grip, consideration of what they can or can’t see and how they perceive it, how the light falls, and that animals prefer to go uphill, were all old hat to NZ farmers in the 70s and you can find plenty of stockyards built that way in NZ that date from the early 70s.”

            Best I can find, it seems that these systems/designs were developed independently in a few countries all around the same time that Grandin was coming up with them in the US (~1974):

            “Modern curved races and round crowd pens evolved independently in Australia, New Zealand and the USA. During the early to mid-1960’s, the construction of large feedlots in Texas stimulated the design of truly modern systems with curved single-file races, round crowd pens and long, narrow diagonal pens.)” (pg 96)

            https://books.google.com/books?id=O8eWBAAAQBAJ&printsec=frontcover#v=onepage&q&f=false

            “I toured new slaughterhouses in the USA and Brazil a couple of years ago and the management people were bragging about how Temple Grandin had designed their yards and put in all those features, and I was singularly unimpressed because they were all features I had seen adopted several decades before in NZ.”

            To be fair, many slaughterhouses in the US had also adopted these features several decades ago and those numbers are only increasing; currently about half of the slaughterhouses in the US have adopted the Grandin systems/designs so the ones you toured had probably just recently installed theirs, and so were showing it off. I have no idea how many slaughterhouses/stockyards are in NZ compared to US, but I’d be curious to see how many slaughterhouses/stockyards in NZ use Grandin’s designs vs other “modern” designs vs “old-fashioned” styles, since hers are used in NZ (and several other countries) as well.

            “I’ve yet to hear of anything Temple Grandin ‘discovered’ that someone else, who didn’t have autism and didn’t claim autism gave them some sort of special advantage, had not already discovered.”

            It seems like the claim that Grandin’s autism gives her a unique perspective on animal behavior bothers you for some reason?

            As I mentioned previously, it seems the changes in designs for slaughterhouses etc. were “discovered” by Grandin in the US around the same time they were being “discovered” in NZ and Australia (in the 1970s) – so it’s certainly doesn’t seem like she was copying anyone. It also seems unlikely that this was all “old-hat” to all of NZ’s farmers by then.

            Grandin has accomplished much more than just designing some of the modern slaughterhouses/pens/corrals/stockyards, which is probably why namaste863 said she is “one of the world’s foremost experts on animal behavior” as opposed to, for instance, “one of the world’s foremost experts on slaughterhouse/pen/corral/stockyard designs”. Has her scoring system and other research also all been “discovered” by others before her, as well? I see no evidence for that.

            “[…]her writings on the flight zone and other principles of grazing animal behavior have helped many people to reduce stress on thier animals during handling. She has also developed an objective scoring system for assessing handling of cattle and pigs at meat plants. This scoring system is being used by many large corporations to improve animal welfare. Other areas of research are: cattle temperament, environmental enrichment for pigs, reducing dark cutters and bruises, bull fertility, training procedures, and effective stunning methods for cattle and pigs at meat plants. ” https://www.lexiconoffood.com/users/temple-grandin

            List of her livestock-related publications: http://www.grandin.com/livestock.publications.html
            http://www.grandin.com/professional.resume.html

          • Rosalind Dalefield

            As it happens, yes, I think her claim that her autism gives her a unique perspective is rubbish. She has no way of proving that and I think any number of people who do not have autism have just as much insight into how animals perceive and feel as she does. I think her claim that her autism gives her a superior grasp of those things is conceited and dishonest. She wants to believe her autism makes her special. No it doesn’t.

          • Poogles

            “I think her claim that her autism gives her a unique perspective is rubbish. She has no way of proving that and I think any number of people who do not have autism have just as much insight into how animals perceive and feel as she does.I think her claim that her autism gives her a superior grasp of those things is conceited and dishonest.”

            Hm, I guess I just don’t see what the big deal is. There are other people who claim that various disorders/illnesses give them a unique perspective on various things, I’ve never perceived it to be a conceited or dishonest type of claim. It’s not like she claimed that no one else could possibly understand the things she does/designs/researches, just that she feels the way her brain works makes it easier for her. You are correct that there is no way to prove or disprove that, since it is a very subjective sort of thing; I don’t know why anyone would even want to, though.

            “She wants to believe her autism makes her special. No it doesn’t.”

            I guess that would depend on what you mean by “special” – she is certainly not “ordinary” or “usual,” due to her autism. I don’t believe that she has ever claimed to be better than other people because she is autistic, just different. In general, she seems to promote the message that we need both autistic and nuerotypical people to do our best, as a society/world, since each type has their own strength and weaknesses.

          • Rosalind Dalefield

            She can’t possibly know whether her autism makes it easier for her. I don’t accept that it does. Her work should be able to stand on its own merit without her making a big deal about being autistic. As it happens, it does, but equally excellent work in animal behavior and perception has been produced by neurotypical people. I accept that autistic people do seem to have an edge in some fields, such as programming, but I don’t believe her autism contributes anything to her field.

          • Squillo

            I don’t necessarily believe that her autism gives her unique insight, just that it tends to make those kinds of insights easier to access than it is for most neurotypicals. She’s capitalized on her talents in the same way neurotypicals do. I don’t think it’s inaccurate or dishonest to say that autism has helped her. Autistic math prodigies aren’t doing something neurotypicals can’t do; I suspect it’s just that autistic brains are more likely to be “wired” for that kind of talent than are neurotypicals.

          • Rosalind Dalefield

            I think it is both inaccurate and dishonest to claim that her autism helped her because
            1)she has never been anything but autistic, so she has no way of knowing whether being autistic helped her or whether she would have had good understanding of animal perception anyway
            2)there are plenty of neurotypicals who have done animal behavior work as good or better than hers; how does she explain that? Oh that’s right, she doesn’t bother
            3)a statistical sample of one person is junk science at its worst, and there is zero evidence that autistics as a group are better than neurotypicals at perceiving how animals will respond.
            In short, I think her claim that being autistic helped her is scientifically unjustifiable, conceited, and self-delusional. It appears to be just a ploy for attention and a ‘sympathy vote. I think it is all very poor behavior for an academic, particularly a scientist.

      • Gatita

        One of my husband’s childhood friends died of asthma so when our sin was diagnosed he freaked. But the meds are so good plus thankfully our son has such a mild case, he’s hasn’t needed his rescue inhaler in almost a year. It’s such a different disease now than it used to be.

      • Mac Sherbert

        It’s all nonsense really. I had two C-sections. My kids sometimes need asthma meds due to colds or allergies. However, my husband also has asthma…so are my kids issues due to the C-sections or genetics? I like being alive and I love that kids’ did not suffer from birth trauma . Thus, I can.deal with some mild asthma symptoms.

  • Allie P

    I was a CS baby. I’m 36. I have no allergies, have never been obese or had asthma, have never had any other serious health concerns, have above-average intelligence, was a state-ranked athlete in high school, attended a top college, have no fertility problems, and had a vaginal childbirth myself a few years ago. I’d like someone to point out to me what my long term struggles were as a result of my mode of birth.

    Oh, wait, my mom breastfed. Obviously, that solved all problems.

    • momofone

      You’re obviously in denial–that must be your problem!

    • demodocus

      I’m 38, obese, had asthma as a child, clumsier than the 3 Stooges on a bender, have an allergy to dust, and Mom had me au natural. (She had a really high threshold for pain, and didn’t like the way pain meds made her feel)

      • Allie P

        I am clumsy, which my child seems to have inherited. Must be the CS!

        • demodocus

          I just want it known that I’m considered the graceful one among my mother and sibs! The blind man is more graceful than the rest of us. hahaha

  • CanDoc

    My head hurts.
    I think it’s really important to have these discussions and ask these questions, questions like: Are there any long-term implications to health and well-being of women and children related to mode of delivery? The answer requires a lot of thoughtful reflection and exploration of possible mechanisms. And a LOT of science.
    But article titles with implicit bias and excessive speculation get published because they sound “sexy”, not because they have good science. Which makes me super angry.

    • Azuran

      It’s sad that we don’t have more information on those. Given, we can’t actually do blinded studies on birth. But with today’s technology, we could gather just so much more data and made extensive national database that would make it a lot easier to find possible links.

      We have the rate of C-sections, do we know how many were elective? Why was an elective c-section chosen? What there an emergency? what kind of emergency? what was the outcome? How many babies are birth damaged? why? How? What health problems did the mother have? The father?

      Sadly, all we have is a comparison of ‘all c-section’ to ‘all vaginal birth’ Which makes any statistical comparison pointless because of the ridiculous variation from case to case between CS and VB.

  • Gatita

    OT: James Titcombe continues to take shit from midwives.

    Pretty miffed that a v senior person has written to CQC to express concern about my tweets following Kirkup report. Why not discuss with me?— James Titcombe (@JamesTitcombe) June 8, 2015

    • Gatita

      Not to mention this assholery.

      @HPIAndyCowper This is typical of the vitriol I mentioned Andy… Quite unpleasant stuff. pic.twitter.com/cXVJyZoonK— James Titcombe (@JamesTitcombe) June 9, 2015

      • Dr Kitty

        Gosh, Milli Hill is unpleasant, isn’t she?

        She’s literally asking why the opinion of someone who lost their baby because of systemic failures and has spent years campaigning to bring that to light and improve maternity services carries more weight than a random person who had a nice Water Birth at an NHS MLU.

        Also, the whole limiting free speech and freedom of association thing.

      • Sarah

        Milli Hill is quite a revolting human being.

        • Ash

          Dolores Umbridge comes to mind.

          • KarenJJ

            yes..

      • Azuran

        Let’s see if I get this right, They wrote a letter to the CQC to complain about him. And now they are mad because he has been informed about it?
        I mean, it seems common procedure to me that when someone write a complaint about someone, the concerned person usually is informed of the complaint.

    • Cobalt

      I hope he costs them an awful lot of money. It won’t ever make up for what they’ve done to him, but it would be gratifying to see.

      • KeeperOfTheBooks

        DH and I were (rather morbidly) discussing something like this a few months ago. There was a story locally in which a drunk-driving teenager hit another car and killed one of the kids in it. Now the drunk kid (no doubt with the encouragement, assistance, and backing of his parents) is suing the parents of the dead kid because of the emotional trauma he supposedly sustained from the accident. I have no doubt that it will be thrown out of court, though I suppose it’s too much to hope for that the drunk kid’s attorney will get disbarred for bringing such an asinine suit in the first place.
        DH and I pretty much decided that while we aren’t exactly litigation-happy, if we were in a similar situation then may God have mercy on that drunk driver, ’cause we, not to mention the nastiest, most expensive lawyer we could find, sure as hell wouldn’t.

        • Cobalt

          That’s evil.

        • Mel

          I would go bat-shit crazy. I would have to turn myself into the police for some kind of mandatory detainment because if I was sued by the kid who killed my offspring, I’d be going after the kid and his parents and NOT in a legal (or ethical) way.

          • The Computer Ate My Nym

            I really don’t think I’d turn myself in until after I was satisfied with whatever I’d done with the kid and especially his parents. Sorry, but I don’t think I could stop myself in that situation. But since it’s not my kid (yet-one never knows these days), I’d say that a lawsuit by the best lawyer you can come up with is a reasonable and indeed measured and proportionate response.

        • The Computer Ate My Nym

          I don’t drive and rarely ride in cars, so maybe I’m nastier than average about people driving and accidents, but if I were evil dictator of the world, drunk drivers (BAL>detectible) would get automatic prison time and vehicular homicide while drunk would be premediated murder. And the parents, lawyer, and anyone else who helped in this lawsuit would be arrested as accessories after the fact. What a scumbag.

        • Who?

          My guess is there will be an insurance company in there somewhere-perhaps the surviving kid has long-term injuries the insurance will otherwise have to pay for, and the one who died was ‘in the wrong’ ie on the wrong side of the road. And the suit is likely ultimately against the deceased’s parents’ insurance company.

          In that case you’d get no say in lawyers, both companies would appoint and instruct them.

          But yes, the bald facts as you tell them are not a good look.

  • guest

    Shouldn’t we have *some* idea of the long-term effects of c-sections? We’ve been doing them for decades. Cesarian-born babies have lived and died their entire lives for several generations now. Can you take ten sets of medical records (excluding mode of birth) and at adulthood pinpoint which were vaginally born and which cesarean?

    Sure, fine, there may be slight increased risks for this and that, but I think we would have noticed if cesarian sections were negatively impacting people’s health by now.

    • guest

      I meant to say “massively negatively impacting overall health.”

      • Cobalt

        Well, we do know a lot more babies are alive, and a lot fewer are brain damaged or have major physical injuries, so there’s that.

    • CanDoc

      Probably not… the research hasn’t really been done yet. And small effects would be a) difficult to notice, and b) difficult to tease out: e.g., is the increased risk of type 1 diabetes related to the cesarean section itself, OR to the pre-existing medical condition that predisposed to Type 1 diabetes, that also increased the risk of caesarean section?

      • Mel

        But to a certain extent, the difficulty in teasing the data out suggests the overall safety of CS.

        The potential data sets are huge. You could grab thousands of older baby-boomers who have passed away already. Getting consent from extant family members would be a pain, but it is possible. Many of the patient records may have gaps, but if the researchers stuck to big, noticeable disorders like obesity or asthma, it’s unlikely that you need the entire medical record.

        Because the data set is huge, the statistical power available is immense – intoxicating, actually. Oooh, and you can control for SES, race, occupation etc….

    • demodocus

      They’ve been around a lot longer than a few generations, just extremely rare before that and the mother was usually dying/dead already. Was it Ceasar’s grandpa or great-grandpa that it’s named for?

  • rh1985

    I am sick of the c-section hate. If an individual mom wants to try and lower her chances of needing a CS, by choosing a qualified provider who will support her, fine. Her body, her choice. But I loved my CS delivery and wouldn’t change a thing. It was the best choice for us and I have zero regrets. If a woman wants a maternal request CS or doesn’t want to attempt a VBAC – her body, her choice! Make changes that will improve access for moms who want to attempt VBAC in a hospital but have difficulty finding a provider or facility. But stop trying to force vaginal births on women who have made a personal decision that a CS is the best choice for themselves and their babies.

    • momofone

      This may be my favorite comment ever.

    • Sue

      Well said, rh. Because anti-cesareanism, like anti-vax, isn’t REALLY “pro-choice” – it’s just another type of paternalism, thinly disguised, and often in female clothing.

    • guest

      Yeah, and I wish it had been presented to me as a neutral possible outcome of my birth (which was high risk of cesarean because of twins). That way, instead of refusing to think about it, perhaps I could have discussed with my health care providers ways to make the experience less frightening. Minor thing, but they can still transform a moment.

  • Roadstergal

    I mentioned on FB, but I went to look at the T1D reference, because I was interested in how they got a risk from delivery method from such a highly genetic disease. If you look at the original meta-analysis, maternal diabetes is a hefty risk factor, >4 OR with a tiny p-value, and they ‘correct’ that away to get the tiny delivery method ‘risk.’ It definitely looks to me like they started with a conclusion and monkeyed their way to it.

  • Cobalt

    Even if cesarean delivery, completely unrelated to any confounding variables (like the maternal health conditions that create higher need for cesarean, such as obesity or diabetes), made the baby 10 times more likely to develop asthma or diabetes, or be obese, or was guaranteed to knock off 15 IQ points, it would still be better than the risk of death or major disability for mother and baby in a likely to be troubled vaginal delivery.

    Diabetes, obesity, asthma, not being a rocket surgeon, these can be survived comfortably for decades. Intrauterine hypoxia will reduce a lifetime to mere minutes.

    What’s really important here?

    • Sue

      Yep. Not really a fair trade, is it?

      And maternal complications – wound infection, the occasional bladder puncture, the rare pulmonary embolus – rarely serious or long-term. As opposed to neonatal hypoxia.

      • Daleth

        Not to mention, as opposed to a 4th-degree tear and lifelong fecal incontinence!

        • Sue

          Indeed. Accidnetal puncture of the bladder is often reported as a “terrible” complication, but few people know about suprapubic catheters, inserted through the lower abdominal wall and into the bladder, when the urethra is completely blocked. This is not considered terribly invasive, and the bladder wall, being very muscular, seals and heals quickly.

          AND wound infections can occur in complex vaginal tears too. Are they counted and reported?

          • Daleth

            One of my doctors’ PA’s warned me about wound complications when I requested a CS. I told her I would much rather have complications with a clean surgical incision on my belly than with a horrific tear in my privates.

          • Roadstergal

            I can’t imagine. I’ve had a very minor wound in a place where urine could hit it, and until it healed it hurt like a sonofabitch when I peed. Something bigger, something that feces could get into contact with – oh lordy.

    • guest

      Yep. Hi! I have moderate to mild asthma (depends on where I am living). I have a strong family history of asthma and was born vaginally (thought I shouldn’t have been). Guess what? My life is pretty damn cool. I was a high school and college athlete. I ran an half-marathon in my late 30s. I do have an increased risk of death as a result of an acute asthma attack at basically any time, but with the medications available today, this is a pretty rare occurrence. My day-to-day lived experience is that I’m just like anyone without asthma – I can do all the same things and enjoy my life just as fully. All I need is some medication (that the drug companies are being total fucking assholes about preventing generic versions from being released, but that’s a different story).

      • Kelly

        Yeah, that sucks. I just found out about it when I had to get my first inhaler in ten years and it cost way more than any other drugs I have gotten. Thankfully, it has helped me a lot.

        • guest

          Yes, they work really well for me too, but I’m currently not taking them because of the cost. The rescue inhalers are cheaper than the maintenance ones, so I still have that. My doctor is not going to be pleased when she hears this, but I can’t go to see her until I’m “sick” or my insurance won’t cover it.

          • Kelly

            Your insurance sucks. I thought they were all about preventative measures because it was cheaper?

          • guest

            So did I? And Obamacare was supposed to mandate well visits for all adults, but my insurance has a number of policies that were grandfathered in.

            It actually doesn’t completely suck, though. It doesn’t cover adult well visits until age 45, but it did cover infertility treatments, including injectable drugs – for which I will be eternally grateful, because I could never have afforded it otherwise. But it wasn’t a medical *need* the way asthma medication is, and much more expensive.

          • Kelly

            That is quite backwards but I am glad it helped you on the fertility treatments. Those are super expensive and I don’t know how people afford it. Hopefully, you will be able to get your meds at some point.

      • Azuran

        Well, sucks about the price but there is a reason behind it. It cost an average of 2.6 billions and over 10 years to develop a new medication (without counting all the drugs that did not made it all the way, yet still cost millions in test and developpement). If you allow other companies to start selling generics right away, the company that invented the drug will never be able to pay back the cost of inventing it. Then, no one will ever want to do research for new medication because it’s a huge loss of money.

        • Liz Leyden

          Medicare Part D expressly forbids Medicare from negotiating prescription drug prices, though the VA and Medicaid still can. Other countries with national health care regulate drug costs, so drug companies charge Americans as much as they can. That’s why an inhaler that costs $6.75 in Greece can cost $125 in the US.

          http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html

          • guest

            Yes, that article mentions the pumps and other parts than the drug itself too. They don’t cost a lot because the pharmaceutical companies spent a lot of research money on them (they did, but that was a long time ago) – they cost that much because it’s an incurable diseases that requires daily medication. We’re guilt-free cash cows for them because their drugs work so well without curing us. They’ve got us hooked for life, and do everything they can to prevent the drugs being available generically.

        • guest

          No, that’s not the reason. When the government banned CFCs, the drug companies had to stop using them to propel the inhaled steroids. They used a change in the delivery system as a means to renew the patent (or whatever) on the drug. Prior to that, my doctors had been telling me the meds were just about to become eligible for generic production. I’m taking the same medication, it just has a different propellant.

  • sdsures

    <3