Vaginal Microbes Can Be Partially Restored to C-Section Babies

UCSD: In a small pilot study, researchers at University of California, San Diego School of Medicine and Icahn School of Medicine at Mount Sinai determined that a simple swab to transfer vaginal microbes from a mother to her C-section-delivered newborn can alter the baby's microbial makeup (microbiome) in a way that more closely resembles the microbiome of a vaginally delivered baby.

Umbilical cord ‘milking’ improves blood flow in preterm infants

A technique to increase the flow of blood from the umbilical cord into the infant’s circulatory system improves blood pressure and red blood cell levels in preterm infants delivered by cesarean section, according to a study funded by the National Institutes of Health.

The study, published online in Pediatrics, was conducted by researchers at the Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns in San Diego, and Loma Linda University, Loma Linda, California. It was supported by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The technique, known as cord milking, consists of encircling the cord with thumb and forefingers, gently squeezing, and slowly pushing the blood through the cord to the infant’s abdomen. For infants delivered by cesarean, cord milking appears to offer benefits over the standard practice of waiting 45 to 60 seconds before clamping and then cutting the umbilical cord. These benefits, which include greater blood flow to and from the heart, higher red blood cell level, and higher blood pressure, were seen only in the infants delivered by cesarean. Among a smaller number of vaginal births, the researchers found no difference in blood volume between infants undergoing cord milking and those undergoing delayed cord clamping.

“The study results are very encouraging,” said Tonse Raju, M.D., chief of NICHD’s Pregnancy and Perinatology Branch. “The findings need to be confirmed in a larger number of births, but at this point, it appears that umbilical cord milking may prove to be of great benefit to preterm infants delivered via cesarean.”

The study authors note that in 2012, the American College of Obstetricians and Gynecologists recommended External Web Site Policy a 30 to 60-second delay before clamping the umbilical cord in all preterm deliveries. The organization has not made a recommendation on when to clamp the umbilical cord in term births, and so physicians typically use their best judgement on the timing of cord clamping in term infants.

NIH: Delaying umbilical cord clamping by 30 to 60 seconds is thought to allow sufficient time for blood from the umbilical cord to fill the blood vessels in the infant’s lungs, Dr. Raju explained in an earlier podcast. Among preterm infants, the delay is believed to protect from intraventricular hemorrhage, or bleeding in the ventricles — the cavities inside the infant’s brain. The hemorrhage is thought to result from low blood pressure, brought on by having too little blood in the circulatory system. Bleeding in the brain may result in developmental delays, cerebral palsy, and in severe cases, death.

Study Examines Cesarean Section Delivery and Autism Spectrum Disorder

JAMA: The initial results of a study suggested that children born by cesarean section were 21 percent more likely to be diagnosed with autism spectrum disorder but that association did not hold up in further analysis of sibling pairs, implying the initial association was not causal and was more likely due to unknown genetic or environmental factors, according to an article published online by JAMA Psychiatry.

Do kids born by C-section have a higher risk of chronic disease? A new study looks at the evidence

TheConversation: In many parts of the world, rates of cesarean delivery are too high, and growing. In the UK, for instance, about one-quarter of babies are born by cesarean. In the US, the rate is one-third, and in Brazil, it is one-half. The World Health Organization recommends that no more than 15% of deliveries be by cesarean. The reasons behind these variations and growing numbers are complex, and beyond my scope here. Whatever the reason, more and more babies are entering the world surgically. We need to understand the potential consequences.

Dramatic increase in Caesarean sections

WHO: For most women, giving birth is a pleasurable and exciting experience and, with great care and support, it is a safe procedure. However, improved technology and increased knowledge about childbirth have also brought a dramatic increase in the number of Caesarean sections (C/S). Medical interventions such as C/S, fetal monitoring and ultrasound are increasingly being used unnecessarily in some countries and women are pressurized into giving birth in a hospital when a home birth may be the best option.

Inducing Labor at Full Term Not Associated with Higher Caesarean-section Rates

Jefferson: As cesarean section rates continue to climb in the United States, researchers are looking to understand the factors that might contribute. There has been debate in the field about whether non-medically required induction of labor leads to a greater likelihood of C-section, with some studies showing an association and others demonstrating that inductions at full term can actually protect both the mothers and babies. In order to tease apart the evidence, a new analysis pooled the results from five randomized controlled trials including 844 women, and found no link between induction and rates of C section in uncomplicated pregnancies of singleton babies at full term. The results were published online April 13th in the American Journal of Obstetrics & Gynecology.

Women’s magazines could play a role in promoting natural births

TheConversation: Reading just one magazine article promoting childbirth without medical intervention makes women want a more natural birth. This is the finding of research recently published in the peer-reviewed journal Women and Health. Our research suggests the media could play a role in reducing rates of unnecessary medical intervention in childbirth.
Such intervention is associated with preventable maternal and infant ill health, and it places an extra burden on the health-care system.
Epidural, for instance, is associated with increased risk of the mother having very low blood pressure and fever, as well as the use of forceps and vacuum extraction. And caesarean section in low-risk births is associated with increased risk of babies needing intensive care.

Caesarean sections should only be performed when medically necessary

WHO: Caesarean section is one of the most common surgeries in the world, with rates continuing to rise, particularly in high- and middle-income countries. Although it can save lives, caesarean section is often performed without medical need, putting women and their babies at-risk of short- and long-term health problems. A new statement from the World Health Organization (WHO) underscores the importance of focusing on the needs of the patient, on a case by case basis, and discourages the practice of aiming for “target rates”. Caesarean section may be necessary when vaginal delivery might pose a risk to the mother or baby – for example due to prolonged labour, foetal distress, or because the baby is presenting in an abnormal position. However, caesarean sections can cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications.