About 20% of babies born by C-section are vulnerable to chronic health problems such as asthma and type 1 diabetes (T1D), said Nahid Khodakarami, secretary of health, sanitation, and environment workgroup at the Vice-President’s Office for Family and Women’s Affairs, and head of the Iranian Association of Midwifery.
“The risk of having T1D is 20% higher in children whose mothers choose to deliver via C-section, and mothers should discuss the risk with their doctor when weighing whether to proceed with a C-section, particularly when a natural delivery is possible,” she told IRNA.
The incidence of T1D is increasing worldwide at an annual rate of 3.9%. Early life factors have been shown to be associated with increased T1D risk and in the development of the immune system.
Cesarean section deliveries have increased by 50% since the 1990s with a parallel increase in the incidence of T1D.
Ideally, no more than 15% of all deliveries should be C-section, according to the World Health Organization. That is the approximate proportion of births that require surgical intervention to protect the mother or infant in situations such as prolonged labor, fetal distress or a breech baby.
In many countries – including the US, Mexico, Brazil, Australia, and Italy, C-section rates are more than double or triple of what the WHO recommends. In Iran, the rate stands at nearly 50% of all births.
A recent meta-analysis of 20 studies worldwide in the US National Library of Medicine reported that C-sections, independent of maternal age, birth weight, and breastfeeding, contributed to a 20% increase in the risk of T1D.
“The best way to prevent T1D, particularly its childhood-onset, is to encourage mothers to embrace natural birth,” Khodakarami noted. “Natural birth ensures that children are not born preterm.”
There are approximately 4.5 million registered cases of diabetes in the country, and nine million more are prone to having the disease.
Khodakarami urged the Endocrinology and Metabolism Research Institute, affiliated to the Tehran University of Medical Sciences, to raise awareness on the issue so that women are enabled to make informed decisions.
Seeking Guidance
She advised pregnant women to seek the guidance of midwives for self-care and healthy lifestyles pre and post childbirth.
According to global data, about 9.5% of C-section babies develop asthma, compared with 7.9% for natural births. Obesity develops in 19.4% of children delivered by C-section, compared with 15.8% for natural births.
Jan Blustein and co-author Jianmeng Liu of the Institute of Reproductive and Child Health in Beijing write in The British Medical Journal that C-section rates are unnecessarily high in some countries in part because some surgical deliveries are elective, done only because women requested them, and because mothers who have one C-section are often encouraged to deliver this way again.
Why C-sections might lead to chronic health problems is not clearly established, but one prevailing theory is that women may pass “good” bacteria to babies during a natural delivery that protects against disease, Blustein says. Another possibility is that hormones released during labor might play a role in minimizing risk.
Before implementation of the 2014 Health Reform Plan in Iran, no effective action was taken to reduce cesarean births; however, since last year, promotion of natural childbirth is considered one of the health priorities.
As a first step towards reducing C-section, the Health Ministry has declared natural delivery free of cost in all state-run hospitals.
Secondly, the ministry announced that funding for hospitals with high rates of cesarean births would be reduced by 10%. The other measure was improving hospital birthing units to encourage women in natural childbirth.
The measures in the past year helped reduce C-sections across the country by 7% in state-run hospitals and 10% overall in both government and private hospitals.
