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general interest
article
C-sections, breastfeeding, and
bugs for your baby
by Jeff D Leach
Paleobiotics Lab
There I was, with a camera in one hand and
wiping the tears from my eyes with other. It was delivery day – I was
going to be a dad. Like an eerie scene from a B-rated alien movie, out
popped his little head from an amazingly small incision in my ‘then
wife’s’ stomach. The flash from my camera filled the room – this was the
happiest day of my life.
Since that day over 11 years ago, my ‘then
wife’ and I had another beautiful child, also through cesarean delivery. I
had not given much thought to the fact that both my children entered this
world through a small incision rather than the birth canal until a few
months ago, when the CDC’s National Center for Health Statistics released
its update on births in the US.
Since my first child was born, the rate of
c-section deliveries appear to have been rising at a steady clip, jumping
over 40 percent since 1996. In 2004, 29.1 percent of all children born in
the US were delivered through c-section – that’s nearly 1.2 million
incisions. The reasons for the increase are complicated, but have a lot to
do with medical malpractice associated with vaginal deliveries, parental
preference, health of the mother and or the unborn child, and just plain
old convenience.
In the days following the release of the CDC
report, I scoured the media outlets that picked up the story to see if
anyone mentioned an interesting and potentially alarming consequence of
the rise c-sections. I was looking for the mention of words human biology,
bacteria, mammals, and the new nine-letter curse word of 2005 –
evolution. Nary a mention from a single report – not one.
As a right of passage – a vaginal right of
passage that is – the delivery of a fetus through the vaginal canal of the
mother completes one of the most important cycles in the evolutionary
history of humans. From an evolutionary point of view, our sudden
adoption of c-sections as an increasingly preferred mode of child
delivery, may be tinkering with some very important processes that took
millions of years to develop. Let me explain.
In what famed British ‘Darwinist’ Richard
Dawkins calls an evolutionary stable strategy, humans have evolved
a symbiotic relationship with a particular and complex set of bacteria in
our intestinal system – a.k.a. the gut. The 500 or so species of bacteria,
whose numbers are measured in the trillions, occupy every inch of our gut
– with most of them living in an ecological niche they literally carved
for themselves in our colon. As the evolutionary stable strategy
suggests, the presence of these few hundred species, among all the tens of
thousands of species of bacteria found in the air, water, and soil
throughout the world, that theoretically have access to our “open”
intestinal ecosystem (think mouth to anus), is not random. This means our
established intestinal ecosystem is composed of a set of bacteria that can
live in nutritional and physiological harmony with us. Importantly,
current members make it their evolutionary determined job to keep out new
members – i.e., pathogens that seek to do us harm.
The intestine of the unborn fetus in the
mother’s womb is sterile – devoid of any bacteria at all. However, during
vaginal delivery the newborn comes in contact with bacteria-rich vaginal
and fecal matter of the mother. These bacteria quickly invade and populate
the newborn child. Saving of umbilical cords and the creepy ritual of
eating the mother’s placenta aside, this cycle links the co-evolution of
intestinal “microflora” of the mother to child, and may represent a more
significant bond for those who understand it exist. This evolutionary
bacterial right of passage has been and continues to be critical to the
success of our species – and all mammals for that matter.
A child born through c-section essentially
skips this critical evolutionary process. Though a c-section baby does
receive bacteria from the mother, it’s not the diverse and dense “base
population” that it would have received from the vaginal fluids and fecal
matter via a traditional birth. In either birthing method, the baby is
subject to all the bacteria in the room – that even means the weird
looking rubber-gloved fellow in the corner – who appears to be assisting
the delivery staff in some way. But who can be sure.
Once this truly amazing and scary ritual of
child birth is completed, the newborn is typically cleaned, shown to the
mother for short period, and then whisked off to some warm place to spend
some quality time with other new members of our species. The mother
usually settles in for some much needed rest and the new father anxiously
paces the corridors mumbling to his self all the things his is going to
change or do better in his life. Seems some things are timeless.
But the next 24 for 48 hours pose another
critical evolutionary step for mother and child – breast feeding. Like all
other mammals – and that includes are tree swinging cousins – the
secretion and release of fluid from breasts (mammae) is the sole
nourishment or food for the newborn child. Yet, over 30 percent of new
mother’s do not breast feed in the hospital. It is often the case that
some mother’s never get their milk, others have problems getting the
newborn to suckle, and others are just not interested.
At six months of age, the number of baby’s
receiving breast milk drops to around 31 percent, and at 12 months it
drops further to 17 percent. The number of baby’s receiving some level of
breast milk at 24 months hardly makes a blip on the radar.
C-sections and short-term breast feeding
have no precedence in our evolutionary past. Before insurance companies
and organized medicine, all children entered this world via the birth
canal and participated in the time honored cycle of transfer of bacteria
from mother to child. Like our tree swinging cousins and a few of the
modern forager groups that still follow traditional lifeways today, breast
feeding by the mother or other women in the group (wet nursing) continued
for 24 to 36 months, sometimes longer.
Breast feeding newborns, like the
evolutionary process of vaginal birth, is about bacteria. The breast milk
of a human mother, like other mammalian mothers, is species-specific,
having been adapted over eons to deliver specific and sufficient
nutrition to guarantee proper growth, health, and immunity development.
Researchers have long known that breast fed babies possess an intestinal
flora that is measurably different than formula-fed infants. Of specific
interest is a group of bacteria known as bifidobacterium. Some of you may
immediately recognize the name, as they are often added to dairy-based
foods such as yoghurts – often advertised as “live cultures” on the
packaging. These are probiotics.
Studies have shown that at one month of age,
both breast-fed and formula-fed infants possess bifidobacterium but
population densities in bottle-fed infants is one-tenth that of breast-fed
infants. The presence of a healthy and robust population of
bifidobacterium throughout the first year or two of life contributes
significantly to the child’s resistance to infection and overall
development of defense systems – not to mention the physical development
of the intestinal system in general. Aside from the substances secreted by
these specific bacteria that are known inhibit the growth of pathogenic
bacteria, they also work to make the intestinal environment of the infant
more acidic, creating an additional barrier against invading pathogens. In
short, breast-fed babies are sick less, are less fussy, have fewer and
shorter duration of bouts of diarrhea, and have more frequent – and softer
– bowel movements.
The dominance of health-giving
bifidobacterium in breast-fed babies is due the presence of special
carbohydrates in mother’s milk known as oligosacchrides. These special
carbohydrates are virtually absent in cow’s milk. From a physiological
point, these special carbohydrates escape digestion and absorption in the
small intestine of the infant, and thus reach the colon intact – where
they serve as food for, among other bacteria, the all important
bifidobacterium. As the bacteria thrive on this “food” from mother’s milk,
they grow in number and absorb water, resulting in more regular and soft
bowel movements. It’s important to know that the bulk of infant feces are
made up of live and kicking bacteria. Look next time if you don’t believe
me!
Baby formula manufacturers are catching on
and creating products that contain these special carbohydrates – which are
known as prebiotics (remember, prebiotics are food for bacteria and
bacteria are called probiotics). While it’s virtually impossible to mimic
the exact composition of mother’s milk, it is possible to mimic some of
the physiological effects – specifically targeting the growth of select
bacteria through the delivery of oligosacchrides. One Belgium-based
company (www.orafti.com) in particular, has developed a natural variant of
the mother’s oligosacchrides from chicory roots (think chicory coffee).
After years of careful study and peer review, they are being added in
greater and greater frequency to formula for infants. They love this stuff
in Japan. Any company that wants to stay in the lucrative baby formula
business will need to adapt their products to include these ingredients,
or else be left in the dust.
In the dozens of doctor visits my ‘then
wife’ and I made during pregnancy, and through two births, never once did
the doctor or any other person involved tell us what I just told you. In
all of the “how to be a new parent” and “how to take care of your new
baby” books we read, not one detailed reference to the critical passing of
mother’s microflora to the child via the birth canal or the importance of
feeding bifidobacterium, was ever provided.
In many cases, c-sections are absolutely
necessary and should be performed. But a 40 percent increase in just the
last ten years? This makes no sense. As a father of two, I am acutely
aware of the physical and emotional toll that breast feeding has on an
active mother – the little creature literally sucks the life right out of
you. Face it we live in a very different world than our not-so-distant
ancestors occupied. Things are hard, but in different ways.
It’s important that expecting parents
understand some of the basic evolutionary processes of bringing a new
member of our species into the world. A few snips and stitches, followed
by only by a small number of sips, ain’t going to cut it. The physical,
nutritional, and metabolic features that make us uniquely human have been
shaped by millions of years of evolution.
The debate in this country over evolution
should not preclude health practitioners from understanding the basics
of evolutionary biology. While we are culturally and socially modern,
driving around in hybrid cars and arguing about stupid things, we are
literally and biologically ancient hunter-gatherers. Ignoring our
evolutionary past and its role in modern medicine and health, not just in
birthing but for all ailments and diseases of modern civilization, is
nothing short of medical malpractice.
Ignoring and tinkering with nature has
consequences, it always does.
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