The first thousand days
We must acknowledge the beauty but also the power embodied in pregnancy, childbirth and childrearing. For those of us who witnessed or experienced childbirth, we are faced with the realization of the incredible drive for life that is knitted deeply in our fabric from our very beginnings.
As parents, there is no greater desire than to see our children in good health. Certainly, we are the ones that can create this opportunity by raising our awareness to the various influences which are of paramount importance in setting the stage for the pursuit of life long well-being. Creating a healthy foundation for childhood starts in the preconception phase and continues through the very few days and weeks of fetal life to solidify into childhood. As we consider our current chronic disease epidemic that is now affecting 50% of our children, we have to take an authentic look at what our current health care practices and lifestyle habits are doing to erode this foundation of health for our children. From C-section trends to antibiotic use during childbirth and childhood to the use of highly processed items that constitute their diet among others, we notice a shift towards disease producing practices.
The rate of Caesarian Sections has increased in the last years to constitute 30% of deliveries in the United States despite the World Health Organization’s recommendation that c-sections should not exceed 10-15% of total deliveries. There is absolute and sometimes relative indication for surgical delivery which is discussed by the physician with the patient based on serious risks for the mom and baby that vaginal delivery could entail. These cases are, however rare and include chorioamnionitis, maternal pelvis deformity, gross cephalo-pelvic disproportion, eclampsia or HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome, fetal asphyxia/acidosis, umbilical cord prolapse, placenta previa, obstructing labor or uterine rupture, among others.
Most women are not aware that C section deliveries come with health consequences for both mother and baby, many of which have long term negative effects. Some concerns for the mom, include the risk of infection or injuries to other organs, extensive scaring of the endometrium or pelvic organs with consequences for future pregnancies, bladder infections or inflammatory pelvic/bowel disorders. The administration of antibiotics before the surgery creates concerns for the delivery of these drugs through the placenta to the baby and interfering with the formation of the baby’s microbiota. The human gut microbiota is assembled and diversified during infancy and is the key driver of the gut and the immune system development, playing a huge role in brain health and behavior. The establishment of the microbiota of the beginning of life is a process that is heavily influenced by the mode of delivery or birth. It has been observed that children born via c-section who are robbed of the exposure to the maternal vaginal microbiota have an altered microbial makeup compared with vaginally delivered babies. These distinct differences in microbial colonization set the stage for the development of acute and chronic disease later in life including allergic diseases, ear infections, upper respiratory infections, celiac disease, obesity, type 1 diabetes, hypertension in young adults among others.
Nutrition Reviews, Volume 75, Issue 4, April 2017, Pages 225–240.
Although aberrant microbial colonization in c-section deliveries sets the stage for disease in childhood or later in life, it is also known that there is a window of opportunity from conception to 2-3 years in which, through nutritional interventions the microbiota can be reprogramed. Breast milk is the best modulator for reestablishment of microbiota and maturation of the immune system. In cases in which the mother cannot breastfeed, there are successful supplementation programs which can support long term health for babies who were delivered via c-section.
At NMR we believe that parent education in preconception is foundational to healthy procreation and healthy, resilient children. The preparation of the mom’s body before conception is of paramount importance for setting up the stage for a healthy child. Nutrition comes to mind first and foremost because food is not only related to energetics but also to the development of the trillion of microorganism which reside symbiotically within us and modulate our immune response, hormonal balance, emotions and much more. In preparation for birth, we stress the importance of vaginal delivery when possible and provide opportunities in our practice for education and support in preconception, pregnancy and in preparation for delivery in the pursuit of health for our future generations.
Arboleya S, Suárez M, Fernández N, Mantecón L, Solís G, Gueimonde M, de los Reyes-Gavilán C, G: C-section and the Neonatal Gut Microbiome Acquisition: Consequences for Future Health. Ann Nutr Metab 2018;73(suppl 3):17-23. doi: 10.1159/000490843
WHO/RHR/15.02: World Health Organization 2015. Statement on Caesarean section rates, 2015.
Signore C, Klebanoff M: Neonatal morbidity and mortality after elective cesarean delivery. Clin Perinatol 2008; 35: 361–371, vi.