Monthly Archives: November 2011

Hospital births for healthy women? What does the research say?

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The recent Birthplace Study was the first of its kind to compare outcomes for low-risk, healthy women who gave birth in midwife-led units (both alongside and freestanding), obstetric units and at home. My previous blog post described the findings for first-time Mums birthing at home, but what did the findings say about hospital birth?

The study is extremely positive and shows that birth is generally very safe for mothers and babies who are low risk and healthy. In fact, the chance of something going very wrong for the baby was so low that the researchers had to combine mortality and morbidity to get any meaningful data. There were so few deaths in the study (38 out of nearly 65,000 births) that they had to combine a host of adverse outcomes in order to come up with any statistically significant results. Therefore the “primary outcome” included baby deaths and serious morbidity (injury / illness) to the baby. Overall, a low risk woman had a 4.3/1,000 risk of having a “primary outcome” (that is, death or serious injury to the baby). For women birthing in hospital, the figure was 4.4/1,000 and was actually lower for babies born at home and in midwifery-led units. Imagine that: the risk to the baby overall was highest in hospital!

Breaking this down further, if we look at first-time Mums separately to second and subsequent time Mums, the figures look different. First time Mums had a 5.3/1,000 chance of a “primary outcome” overall. This rose to 9.3/1,000 for women who planned to birth at home, and fell to 4.5 for women birthing in a midwifery-led unit. It was 5.3/1,000 for first-time mums who birthed in hospital. Again, we see that hospital birth confers some increased risk for first time Mums.

Now looking at women birthing for the second (or subsequent) time, we find that the overall risk of a “primary outcome” was very low: 3.1/1,000. This was higher in an obstetric (hospital) unit at 3.3/1,000, lower in a midwifery-led unit (2.7/1,000) and lowest for women birthing at home (2.3/1,000). So once again, the study is showing that hospital is not the safest place to birth a baby if you are a low-risk, healthy women.

If you are having your first baby and are low-risk, the safest place to birth is in a midwifery unit, and if you have birthed before and are low-risk, the safest place to birth is at home.

Of course, midwifery units have limited capabilities to provide higher levels of care, and as labour and birth are unpredictable, there needs to be robust transfer arrangements in place. Some 10-45% of women transfer in birth. This figure is lowest for women who have birthed before, and highest in first-time Mums. As well as robust transfer arrangements, women – particularly first-time Mums – need to be aware of the chance of transfer and to be comfortable with this possibility. This is best accommodated if the woman can transfer in with her own midwife.

What were the intervention rates like?

Not surprisingly, intervention rates were highest in women who planned a hospital birth. 93% women who planned a homebirth had a normal birth, versus only 74% women in the hospital. 11% had a caesarean in the obstetric (hospital) unit, versus a mere 2.8% in women who planned a home birth. 24% women had their labours sped up with a syntocinon drip in the planned hospital birth group, versus only 5% in the women who planned a homebirth. 31% women had an epidural in the planned hospital birth group, versus 8% at home. And of course, episiotomy rates were lowest at home.

It is clear that being in hospital greatly increases risks for all low risk mothers compared to being at home or in a midwife led unit (either alongside or freestanding).

It is clear that low-risk women have much to gain by planning a birth with midwives in a birth centre or some other form of midwifery-led care. Planned homebirth does increase the risks to the babies of first-time Mums, with an increase in adverse outcomes for babies from about 0.5% to just under 1%. But what is it about planning a homebirth that increases the risk to the baby? The study used intention to treat analysis, so we are not able to know how many of those adverse outcomes occurred in those who transferred to hospital after a planned homebirth, versus those that happened in the births that actually occurred at home. We do know that the outcomes of homebirth transfers are generally worse than those who had been planned to occur in hospital, and first-time Mums are more likely to transfer. We also know that birth is generally riskier for a first-time Mum than a woman who has birthed before.

Regardless, the study is extremely positive in supporting the role of primary midwifery care and the excellent outcomes that low-risk women can achieve when they choose a midwife as their care provider. Imagine the benefits as well for high-risk women who receive midwifery care with appropriate and timely obstetric care.

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New NHS Guidelines to Bring Down Caesarean Birth (caesareans on request)

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The National Institute for Health and Clinical Excellence (NICE) issued guidelines to the NHS asking that no woman, who prefers caesarean delivery, should be refused, but health care providers should explain to the woman the health risks of a surgery.

It is expected that such information would bring down the rate of surgeries performed.

NICE committee believes most women would choose a vaginal delivery if they are given proper information and the latest guidelines do not recognise that women choose a caesarean because they were “too posh to push.”

Contrary to the phrase often used by media “too posh to push,” most women opted for a caesarean for reasons related to physical or mental safety, the Nice committee said.

Once women have a discussion about the risks and benefits with health professionals, “they want to opt for the safest option. A lot of the anxiety is related to lack of information and lack of knowledge,” …

Women may have the wrong impression from listening to friends and relatives or using the internet …

… The Guardian reports that new recommendations to the NHS will bring the numbers down marginally …

… Some women fear vaginal delivery … usually during first birth or those who have suffered a traumatic experience during an earlier delivery.

… Lack of midwife support can contribute to a traumatic delivery and cause women to seek a caesarean next time …

“Our services fail women badly at the moment … We hear from too many women who have found their experience traumatising in some way.”

“If caesarean rates go up following the change to the guidelines, it will be evidence that women are not getting the quality of midwifery support they need to instill confidence and feelings of safety while giving birth.”

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Homebirth for first-time Mums: what does the research say?

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…Homebirth carries a higher risk for the babies of first-time mothers, according to a landmark study published in the British Medical Journal.

However, the chance of harm to the baby is still under 1% …

For a second birth there was no difference in the risk to babies between home, a midwife-led unit or a doctor-led hospital unit.

Midwife-led care was in general much more likely to lead to a natural birth.

The Birthplace study is the largest carried out into the safety of different maternity settings – comparing births at home, in midwife-led units attached to hospitals, those that are stand-alone and doctor-led hospital units.

All the women followed had healthy pregnancies and began labour with no known risk factors.

It found that, overall, birth is very safe wherever it happens.

The rates of complications, including stillbirth or other problems affecting the baby, was 5.3 per 1,000 births in hospital compared with 9.3 per 1,000 home births (for women having their first baby).

Rate of complications for first-borns per 1,000

Stand-alone midwife unit – 4.5
Hospital midwife unit – 4.7
Hospital – 5.3
Home – 9.3

… About 45% of women planning to have their first baby at home were transferred during labour, although this was mainly because of delays in giving birth and the need for an epidural pain-relief injection, rather than because the baby was in distress.

Rates of normal birth

60% hospital obstetric unit
76% hospital midwife unit
83% freestanding midwife unit
90% home

The transfer itself was not thought to be responsible for the difference because there was no raised risk for women moved from stand-alone midwife units to hospital during labour.

There was no difference in risk when women were having their second baby, whether that was at home, in a midwife unit or a traditional hospital setting.

The rate of transfer from home to hospital was much lower too, at just 12% (for women having their second and subsequent babies).

… [This study] reveals an unexplained difference in the rate of normal birth between units run by midwives and those run by doctors. The disparity on emergency Caesarean sections is particularly striking. It suggests a different culture in the way midwives and doctors see birth, with doctors concerned about risks and midwives focused on normality.

… this research should drive an an expansion in midwife-led care, either at birth centres or at home for the half of women expected to have a low-risk birth.

… The research also confirms that midwife-led care is much more likely to lead to a normal birth – without any interventions, including forceps or ventouse.

That was true whether the baby was born at home or in a midwife-led unit.

The emergency Caesarean rate for the low-risk women in the study was 11% in doctor-led units compared with only 2.8% at home, and 4.4% in a midwife led unit on a hospital site.

… “Where a woman needs an emergency Caesarean section for their first birth, they will not be regarded as low risk for the next birth, and won’t have the choice of going outside a medically-led unit.”

The Key Findings of the study:

Giving birth is generally very safe

For ‘low risk’ women, the incidence of adverse perinatal outcomes (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, and specified birth related injuries including brachial plexus injury) was low (4.3 events per 1000 births).

Midwifery units appear to be safe for the baby and offer benefits for the mother

… there were no significant difference in adverse perinatal outcomes compared with planned birth in an obstetric unit.

Women who planned birth in a midwifery unit … had significantly fewer interventions, including substantially fewer intrapartum caesarean sections, and more ‘normal births’ than women who planned birth in an obstetric unit.

For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother

For multiparous women, there were no significant differences in adverse perinatal outcomes between planned home births or midwifery unit births and planned births in obstetric units.

For multiparous women, birth in a non-obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.

For women having a first baby, a planned home birth increases the risk for the baby

For nulliparous women, there were 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.

For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth

For nulliparous women, the peri-partum transfer rate was 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births

For women having a second or subsequent baby, the transfer rate is around 10%

For women having a second or subsequent baby, the proportion of women transferred to an obstetric unit during labour or immediately after the birth was 12% for planned home births, 9% for planned FMU births and 13% for planned AMU births.

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Delayed Cord Clamping

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Delayed cord clamping refers to the practice of clamping the umbilical cord after it has stopped pulsating. The usual hospital practice is to clamp and cut the cord straight away, however new wisdom (practiced for many years by private midwives) challenged the usual practice.

Soon after a baby is born, the umbilical cord is clamped. But just how long those minutes should be, in between birth and clamping, is the subject of some controversy.

New research from Sweden shows that a delay in clamping the cord, by just a few minutes, results in improved iron levels for babies … iron is crucial for healthy development of the brain and central nervous system.

… For the babies whose clamping was delayed, there were fewer instances of anemia two days after birth. By four months of age they showed a 45 percent higher mean ferritin concentration … and a lower prevalence of iron deficiency than the babies who had been clamped early.

In the early clamping group, researchers noted that the degree of iron deficiency was moderate, rather than mild. All infants, from both groups, had similar weights and lengths as well as similar levels of hemoglobin.

Delayed cord clamping permits additional blood, including iron, to reach the neonate. The controversy comes in, however, because … later clamping can have a potential for … maternal hemorrhage …

In the event of excessive bleeding, the cord could be clamped and cut and Syntocinon administered to stem the bleeding. Delayed cord clamping is my usual practice. I do not generally cut or clamp the cord until after the placenta has been born.

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Expecting mothers prefer midwife-led labour

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Most women should be offered midwife-led care that uses fewer interventions and is just as safe as the consultant-led model, a major study recommends.

The study, commissioned by the Health Service Executive and conducted by the School of Nursing and Midwifery at Trinity College Dublin, found most women prefer midwife-led units.

It also discovered the number of babies requiring resuscitation at birth or admission to the special care baby unit was the same for both groups of women.

Almost six in 10 women in the consultant-led units (57%) had their labours speeded up by either having their waters broken or having oxytocin given intravenously by a drip, compared to only four in 10 women in the midwife-led units.

The study involved 1,653 women who had babies in the HSE Dublin North-East region from 2004 to 2007 and compared the consultant-led maternity care with a new model of care provided in two integrated midwifery-led units in Our Lady of Lourdes Hospital in Drogheda and Cavan General Hospital.

The two midwife-led units, which have hotel-like private rooms with birthing pools, were opened in response to recommendations made in the Minder Report in 2001 to provide more choice in maternity care in the north-east.

… fewer women in the midwifery-led unit group chose pain-relieving epidurals in labour.

Despite having fewer epidurals, 83% of women in the midwife-led units were satisfied with their pain relief compared with 68% of women in the consultant-led unit.

“When women are supported by one-to-one midwifery care, are encouraged to labour gently at their own pace and have the pain-relieving benefits of relaxing in warm water, they are far better able to tolerate pain and labour more effectively,” …

The study found that 85% of women attending the midwife-led unit would recommend the care they had received to a friend, compared to 70% having the usual care.

Although facilities in the midwifery-led units were quite luxurious, the cost of care for each women was €332.80 less than in the usual hospital system.

A recent KPMG report on maternity care in the greater Dublin region also recommended the introduction of midwifery-led units throughout the country.

These results have been found in other studies, particularly the claim around pain relief. It is interesting that epidurals don’t equate with a more positive birth experience; rather, a woman who feels well-prepared and who is supported with one-to-one midwifery care in a drug-free birth, will rate her birth as being highly satisfying.

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Should I have a caesarean section?

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In the UK, the National Institute for Health and Clinical Excellence (NICE) is considering allowing women to access maternal choice caesarean on the NHS, that is, with public funding. Currently, this option was not available to women and the idea that it might soon be available is causing a lot of debate.

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What every mother wants most is a healthy baby. And not to have her pelvic floor wrecked by a prolonged and painful vaginal delivery. Already one in four babies is removed surgically from their mother’s womb for inconsistent reasons, and at considerable expense to the NHS. Now, the latest National Institute for Health and Clinical Excellence (Nice) guidelines (albeit in draft form) say that all women can have caesarean sections if they want one. But should you opt for it if there’s no medical reason to do so? What’s best for your baby and you?

Nice says that women usually ask for a caesarean section because they are scared of giving birth …, they’ve had a bad birthing experience or a previous section. Nice … have now changed their guidance to suggest that a section is also a reasonable option for any women who have weighed up the risks and benefits.

Research now shows there is little difference in risk between a planned vaginal and a planned caesarean section. The planned bit is important though: both an unplanned vaginal delivery (for example a woman who was meant to have a section but went into premature labour) and emergency section (for example if the baby is showing signs of distress during labour) will usually have worse outcomes than planned procedures.

Nice divides the evidence into risks and benefits for mothers and babies. Fewer women who have had caesarean sections will still be breastfeeding their babies by three months. They will, however, take the same time to have sex again as women who have had a vaginal delivery, despite being less likely to have damaged their vagina. Women who had a planned section (not having had one before) will have less perineal pain … and less risk of vaginal bleeding after the baby is born. But they will have an increased risk of needing a hysterectomy, … developing a blood clot … and having a cardiac arrest … Generally the risk of anything bad happening in labour is very small.

The evidence is also poor on which mode of delivery is safest for the baby. One study found an increased risk of babies dying after a section … another did not find that. … it is not easy to obtain good research in this area because you can’t randomise women to plan to give birth vaginally or by a section.

What Nice doesn’t tell you is that having a caesarean, even with regional anaesthetic, feels as if someone is doing the washing up inside your abdomen. When the baby is born, it is tricky to have good skin-to-skin contact. A section is a surgical procedure with all that entails, including a catheter at the time, and afterwards a scar and flappy bit of skin under your scar. It is hard to pick up a toddler, and pretty painful to pick up your newborn in a hurry. However, Nice now says you can drive when you feel you have recovered instead of waiting for the traditional six weeks.

Giving birth vaginally is variable: some women have a quick, painless labour, others have prolonged agony. It is not as controlled as a caesarean … Some women feel they do not get enough support from midwives when they are in labour … For most of us, it hurts and you can’t sit down easily afterwards for a couple of days. The evidence as to what wrecks your pelvic floor – delivering a baby through it or simply carrying it around in your womb for nine months – is not clear.

So what should you do? You should look at the evidence – Nice presents all of the statistics online – and then decide. As a default, I would say that nature gave us a channel for childbirth and it wasn’t a zip on our bikini line. When the writer Sheryl Feldman said: “There is power that comes to women when they give birth. They don’t ask for it, it simply invades them, accumulates like clouds on the horizon and passes through, carrying the child with it,” she wasn’t talking about a caesarean section.

Pregnancy is not a medical condition so it seems counter-intuitive that it could routinely end in a surgical procedure. There are no prizes for bravery in childbirth but there is now good pain relief, and Nice found no evidence that epidurals increase the risk of needing an unplanned section …

Having had a section myself (and given birth vaginally – which, on balance, I preferred), the most significant part of Nice’s new recommendations is that women should have a say in what music is played in the operating theatre.

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Midwifery as a self-regulating profession?

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There is some debate about private midwifery, in particular the desirability – or even the need for – insurance and regulation. It is an interesting debate to follow. One side argues for no Medicare funding – we never had it anyway, no insurance – we haven’t had that for a few years, and no regulation. I would ask – if there was no regulation – are we indeed a profession? Does it matter?

A friend sent me an article recently that has fascinated me: “Why is UK medicine no longer a self-regulating profession? The role of scandals involving “bad apple” doctors.”

It was a very interesting article to read. The article identifies the role played by a series of medical scandals in the UK that basically ended the model of self-regulation of the medical profession that had been in place for 150 years. The original motive for professional self-regulation was “to resolve the principal-agent problem inherent in the doctor-patient relationship. The profession, in return for its self-regulating privileges, undertook to act as a reliable guarantor for the competence and conduct of each of its members”.

This is perhaps what is lacking in midwifery, and perhaps why we are seeing a huge amount of regulation at the moment. Midwifery has never really had a process of self-regulation. Midwives have not held each other to account for preventable outcomes. The collegial model adopted by the medical profession “left it fatally vulnerable to the problem of “bad apples”: those unwilling, incapable or indifferent to delivering on their professional commitments and who betrayed the trust of both patients and peers”. I wonder if this is what we are seeing in midwifery?

In the UK, it was the convergence of social and political conditions and public anger and shifts in social attitudes that presented an opportunity for imposing standards for accountability. Private midwifery has, until recently, been untouched. I remember leaving hospital employment to move to private practice and being amazed by the lack of processes, accountability, systems, structure … hospitals are full of these things but they were lacking in private practice. If I did these things, it was up to me. If not, it was no problem. I set up many processes and systems and dedicated a lot of resources to ensure that these were robust, practical and worthwhile. I have found he process of eligibility and meeting the requirements of the Quality and Safety Framework to be relatively ok because I already had much of this in place.

However, to those who argue against the need for increased accountability, insurance, regulation – professionalism – that is thrust upon us, I would venture to say that those attitudes are the precise reason why we have been thrust into the position of such intense regulation and accountability. If we did not have these, would we be members of the profession that is midwifery? For those who could care less about professionalism, I would ask why they completed their degree and applied for registration. Anyone can be with a woman in pregnancy and birth, but the title and practice of midwifery is one that we should hold dear and be proud of: it is one that is made stronger by regulation and accountability and one that gives the public an assurance of a certain standard of care.

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Doctors claim homebirth risks ignored

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WA doctors have attacked a new policy for State Government-funded homebirths, saying it sidesteps serious concerns about the increased risk of newborn deaths.

The draft document says women have a right to choose a home delivery at taxpayers’ expense provided they are at low risk of complications and give their consent.

But women with risk factors such as a previous caesarean, obesity or a history of blood loss in childbirth should be excluded from publicly funded homebirths.

… Australian Medical Association WA said the policy fudged serious concerns raised by former members of the committee, who found the risk of death in babies born at home was almost four times higher and called for funded homebirth to be banned.

“Not only is the taxpayer entitled to think public monies are going to things that are evidence-based, if the evidence suggests it’s more dangerous they should have even greater concerns.” …

The WA homebirth policy is a very considered and thorough document that supports low-risk homebirth for women who are attended by experienced midwives with a back-up hospital booking and obstetric consultation. Unfortunately the doctors quoted in the above article seem to have mixed their research. Studies clearly demonstrate that low-risk homebirth is at least as safe as hospital birth, and with fewer interventions for mothers in labour. It is high risk homebirth that is associated with excess perinatal mortality and this is not supported under the WA policy, or any other publicly-funded homebirth programs.

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Caesarean link to respiratory infections in babies

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A new study from Perth has found that babies born by elective caesarean are more likely to be admitted to hospital with a serious respiratory infection, bronchiolitis, in the first year of life.

This was a ten-year study that analysed the birth data of over 212,000 babies.

Bronchiolitis is generally caused by respiratory syncytial virus (RSV), and is one of the most common reasons for babies to be admitted to hospital. Bronchiolitis also has been shown to be associated with an increased risk of asthma in children, and it is known that babies born by elective caesarean experience more asthma than babies who were born vaginally or born by caesarean after labour had commenced.

Previous research found an increased risk of hospital admissions for respiratory infections in children less than 2 years of age, delivered by elective caesarean.

It is thought that labour stimulates the baby’s immune system and strengthens it. babies who are born by elective caesarean do not experience labour, and therefore their immune systems are not primed in the same way.

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New study on risk factors for gestational diabetes

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… One type of diabetes, gestational diabetes (GDM), is first diagnosed during pregnancy. It can cause complications to the mother and fetus during pregnancy and can develop into type 2 diabetes following pregnancy. A new study … reported that age and body mass index (BMI) are significant risk factors in whether a woman will develop GDM. Furthermore, those factors are particularly relevant in Black African and South Asian women. Early detection is essential for the effective treatment of GDM. Known risk factors include BMI, advanced maternal age, previous GDM, delivery of a large infant, family history of diabetes, and race. … despite knowledge of these risk factors, few studies have looked at how they interact to influence GDM risk; therefore, they conducted a retrospective study of associations between GDM and maternal age, BMI, and race, as well as how the factors interact with one another. The study compared 1,688 women who developed GDM between 1988 and 2000 with 172,632 women who did not …

… The researchers found an association between greater maternal age and risk of GDM and between increasing BMI and risk of GDM; however, the effects varied greatly between women of different races. The baseline comparison group was white Europeans aged 20 to 24 years. White European women aged 30 to 34 years had twice the risk of developing GDM; furthermore, those 40 years of age and older had a four-fold increase in risk. Increasing age was associated with a much larger increase in risk among black African women. Compared to baseline women, those aged 25 to 29 years had 3.40 times greater risk, those aged 35 to 39 years had a 13.67 times greater risk, and those aged 40 years and older had a 59.20 times greater risk of developing GDM.

Compared with white Europeans with normal BMIs, black Africans and South Asians were more likely to develop GDM regardless of BMI. The authors concluded: “Advancing maternal age and BMI are more important risk factors for GDM in South Asian and Black African women than in White European or Black Caribbean women.”

This study contributes valuable information for the detection of gestational diabetes. Much work has been done in this area on the past two years and testing recommendations are in the process of being changed.

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Evolution Offers Clues to Leading Cause of Death During Childbirth

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Unusual features of the human placenta may be the underlying cause of postpartum hemorrhage …

… postpartum hemorrhage accounts for nearly 35 percent … of the 358,000 worldwide annual maternal deaths during childbirth.

Despite its prevalence, the causes of postpartum hemorrhage are unknown … While common in humans, postpartum hemorrhage is rare in other mammals …

… Previous studies on postpartum hemorrhage have focused on how it can be treated and on recognizing its associated risk factors …

In humans, the invasiveness of the placenta into the uterine wall and the subsequent takeover of maternal blood vessels appear to be greater than in nonhumans … This suggests a link between placental invasiveness early in pregnancy and blood loss at delivery, when the placenta separates from the uterine wall.

Research by Abrams and Rutherford suggests that hormones produced by trophoblasts — cells formed during the first stage of pregnancy that provide nutrients to the embryo and develop into a large part of the placenta, and that guide the interaction with the uterus — may provide an early predictor of risk.

“Biomarkers of postpartum hemorrhage that could be used early in pregnancy would allow women to make informed decisions about their choice of birthing site and medical care based on their risk,” Abrams said. This biomarker hypothesis has not yet been studied.

… In a normal birth, the placenta begins to separate from the uterine wall before delivery. Bleeding at the site is normally stopped by the constriction of blood vessels due to the contraction and retraction of uterine muscles …

There are two major risk factors for postpartum hemorrhage … The leading factor is uterine contractions that are too weak to stop bleeding. The cause of this is unclear …

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Caesarean link to infant respiratory infections

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Babies born by elective caesareans are more likely to suffer a serious respiratory infection in their first year of life …

The decade-long study into the incidence of Bronchiolitis found that babies born by elective caesarean were 11 per cent more likely to be hospitalised with the infection than babies delivered by other means.

Researchers at Perth’s Telethon Institute for Child Health Research analysed birth data and hospital records for 212,068 babies over a 10-year period in WA for the study …

… while the increase was relatively modest, it highlighted the risk to a child’s immune system when elective caesareans were the chosen birth method.

“We compared elective caesareans with other modes of delivery because with elective caesareans we could be confident that labour had not begun and therefore the baby would not have been exposed to [natural] chemicals that are released during the labour process,” Dr Moore said.

“It is increasingly plausible that delivery without labour could impair a newborn’s immune system and may also explain the known link between c-sections and an increased risk of asthma.”

… Bronchiolitis is generally caused by the common respiratory synctial virus and is one of the most common reasons for babies to be admitted to hospital.

She said that while most children recover from the infection quickly, it can make the child more prone to other respiratory illnesses such as asthma later in life.

… the research … pointed to the need for more research into the suspected role of various chemicals that are produced by mothers during labour in priming a newborn’s immune system.

“Given that caesarean rates are rising in Australia, this potential impact on the immune system might be another factor that parents and doctors may consider if choosing a caesarean for other than medical reasons,” she said.

“As it’s the first time we have reported such an association, it’s really important that the message get out there that women and their clinicians need to consider this when opting for a caesarean.”

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