Association Between Cesarean Birth and Risk of Obesity(archpedi.jamanetwork.com)
archpedi.jamanetwork.com
Association Between Cesarean Birth and Risk of Obesity
http://archpedi.jamanetwork.com/article.aspx?articleid=2548440
42 comments
You could make this complaint about pretty much every academic study ever. Rarely is the underlying data, statistical models, etc. shared publicly.
Should they be (for repeatability and peer review)? Sure, I buy that argument. But it's not a valid reason to criticize this particular study.
And at least it's the source journal article, not a media post!
Should they be (for repeatability and peer review)? Sure, I buy that argument. But it's not a valid reason to criticize this particular study.
And at least it's the source journal article, not a media post!
I do make this argument for pretty much every quantitative study.
Code: totally agreed.
Data: tricky, because of privacy and HIPPA.
Data: tricky, because of privacy and HIPPA.
Why would a person who had had a "Cesarean Birth" choose to eat more? This raises more questions than it answers.
It's speculated that cesarian births do not get exposure the the mother's vaginal flora and their microbiome does not get properly seeded.
I wonder if manually exposing the child to the mother's flora would be of any benefit.
I wonder if manually exposing the child to the mother's flora would be of any benefit.
A pilot study on this was published pretty recently with some success in terms of passing the mother's microbiome on to the infant, though that's still a long way off from determining the benefits.
http://www.nature.com/nm/journal/v22/n3/full/nm.4039.html
http://www.nature.com/nm/journal/v22/n3/full/nm.4039.html
Thanks for sharing this. Our firstborn was an unscheduled c-section and my wife is now pregnant with our second child. We will likely schedule a c-section this time and I want to do whatever I can to help create a healthy gut microbiome at birth.
Before my son was born, we tried to persuade our OB to allow us to do this, or at least to look at the research herself. She wouldn't budge.
As an aside, my son was born 12 lb 1 oz, he now weighs 31 lbs at 5 months. The same weight as my 3 1/2 year old daughter.
As an aside, my son was born 12 lb 1 oz, he now weighs 31 lbs at 5 months. The same weight as my 3 1/2 year old daughter.
(31-12)3500/ (530) = 440 calories per day,
or 18 oz of baby formula per day.
That's approximately 100% efficiency converting dietary calories into body mass, or massive water retention.
You could cure starvation across the world if you good identify the source of that.
That's approximately 100% efficiency converting dietary calories into body mass, or massive water retention.
You could cure starvation across the world if you good identify the source of that.
How was it possible to forbid this procedure? Couldn't the mother (perhaps with some help from you?) just do it herself?
Given birth weight was already so high, I am skeptical flora has much to do with your son's case. How tall is he?
> Why would a person who had had a "Cesarean Birth" choose to eat more?
The described relation isn't between Cesarean Birth and choosing to eat more.
The described relation isn't between Cesarean Birth and choosing to eat more.
Definitely questionable, but maybe it's related to germs transferred during birth: http://well.blogs.nytimes.com/2016/02/01/post-cesarean-bacte...
Wild speculation: perhaps those that chose c-section are on average less able to tolerate pain, and therefore lacking in self control (to a degree) and therefore their progeny have a higher likelihood of overeating.
Disclaimer: There's a really bad stigma about c-sections and mothers who have them being "less" or "worse" because of it. I'm careful to point this out before we dive into a discussion on making accusations of "poor self-control". That said...
If you remove those c-sections that are medically necessary or recommended ("known indicators for cesarean delivery" is the language used in the abstract), then you're left with that population that truly "chose" to have a c-section. The association is stronger in this population.
I'd want to tie this back to those demographics. What kind of people truly choose a c-section? Is there something about that demographic that correlates to obesity for other reasons? Are obese women more likely to be counseled towards c-sections? Again, why? It's unclear if they normalized for this.
Incidentally, I think your speculation is probably wrong. You assume that c-sections are (or are regarded as) the lower-pain option. You can have a painless "natural" birth with an epidural, and post-birth recovery is going to be "painful"--in different ways--with either path. In other words, don't think people choose c-section for pain management in the first place, which invalidates the rest of your logic chain.
If you remove those c-sections that are medically necessary or recommended ("known indicators for cesarean delivery" is the language used in the abstract), then you're left with that population that truly "chose" to have a c-section. The association is stronger in this population.
I'd want to tie this back to those demographics. What kind of people truly choose a c-section? Is there something about that demographic that correlates to obesity for other reasons? Are obese women more likely to be counseled towards c-sections? Again, why? It's unclear if they normalized for this.
Incidentally, I think your speculation is probably wrong. You assume that c-sections are (or are regarded as) the lower-pain option. You can have a painless "natural" birth with an epidural, and post-birth recovery is going to be "painful"--in different ways--with either path. In other words, don't think people choose c-section for pain management in the first place, which invalidates the rest of your logic chain.
Interesting, and I think you may be right. I do think women choose c-sections because the are scared of natural birth for whatever reason.
It's probably true that there is some demographic component to this correlation, though I would assume the would control for that.
It's probably true that there is some demographic component to this correlation, though I would assume the would control for that.
I do think women choose c-sections because the are scared of natural birth for whatever reason.
I think that is pretty rare.
From what I have seen, women are much more likely to genuinely choose a C-section because they have a career and need to have the baby on a set schedule so they can get back to work. Having a baby the natural way is a fairly messy organic process that does not readily fit into the highly scheduled lives of modern two-career couples.
IIRC, only about 5 percent of babies show up on their actual due date. Most are either early or late. I have read plenty of articles where career women scheduled a C-section so they could schedule the birth and also schedule time off from work. Waiting for a baby to show up when they feel like it is rather inconvenient not only for you, but for your employer if you are anyone of any importance. It can amount to being willing to leave the entire department in a lurch when you suddenly drop everything. Babies can be anywhere from several weeks early to two weeks late, from what I gather. That leaves a window of potentially two to three months in which baby might decide "now's the time." In fact, my understanding is that a baby three weeks early isn't even classified as a preemie. So there is potentially a five week window for a "normal" birth.
I think that is pretty rare.
From what I have seen, women are much more likely to genuinely choose a C-section because they have a career and need to have the baby on a set schedule so they can get back to work. Having a baby the natural way is a fairly messy organic process that does not readily fit into the highly scheduled lives of modern two-career couples.
IIRC, only about 5 percent of babies show up on their actual due date. Most are either early or late. I have read plenty of articles where career women scheduled a C-section so they could schedule the birth and also schedule time off from work. Waiting for a baby to show up when they feel like it is rather inconvenient not only for you, but for your employer if you are anyone of any importance. It can amount to being willing to leave the entire department in a lurch when you suddenly drop everything. Babies can be anywhere from several weeks early to two weeks late, from what I gather. That leaves a window of potentially two to three months in which baby might decide "now's the time." In fact, my understanding is that a baby three weeks early isn't even classified as a preemie. So there is potentially a five week window for a "normal" birth.
Actually, having a c-section would be worse for "career" focused mothers.
Sure, you get to schedule your due date, but you are having a surgery. It takes longer to recover from a c-section then a natural birth. There is driving and lifting restrictions for weeks. FMLA leave is usually extended for those with c-sections by a few weeks.
And as for scheduling, you can define a maximum date, but the baby can still come early. Just because I'm schedule to have a c-section on September 1st, doesn't mean I can't go into labor in August 15th.
Sure, you get to schedule your due date, but you are having a surgery. It takes longer to recover from a c-section then a natural birth. There is driving and lifting restrictions for weeks. FMLA leave is usually extended for those with c-sections by a few weeks.
And as for scheduling, you can define a maximum date, but the baby can still come early. Just because I'm schedule to have a c-section on September 1st, doesn't mean I can't go into labor in August 15th.
In fact, my understanding is that a baby three weeks
early isn't even classified as a preemie.
Anecdote: he was 7lbs. 7oz. (right around average) and 3 weeks early. He likely would have been a monster at his due date, and may have been a c-section because he just would have been too big. Is that normalized in the study? Or are we flipping causation? Instead of "c-sections are correlated with obesity risk", is it "obesity risk is correlated with c-section"?
You are confusing induced labor with c-sections. Many natural births are scheduled and labor is medically induced...there are fewer babies born on weekends for this reason. Basically once you're within a week of the due date, doctor and mom have wide discretion to induce labor and begin the natural birth.
I don't think so:
We know that the risks of C-sections are greater than risks of vaginal birth, at least with your first pregnancy. So why are women opting for C-sections, even for their first birth? Some theorize that the combination of improved C-section safety, along with increased maternal age, has lead to women being able to control when and how they are going to give birth. This type of control is attractive to women who are balancing family and career -- they can perfectly plan maternity leave, right down to the date of the last conference call. Another popular theory is that some women, fearing the pain of vaginal delivery and wanting to avoid urinary incontinence, jump at the chance to give birth via C-section.
http://health.howstuffworks.com/pregnancy-and-parenting/preg...
I do know of cases where women are genuinely terrified of giving birth, as the GP suggests, and will opt for a C-section for that reason. But I think a more common reason is that women increasingly have careers.
I had both my children vaginally. I was a full-time wife and mom for many years. Two career couples have a much greater need to control the timing of things, including processes that, organically, cannot be relied upon to happen at a set time. The slack in my family was generally provided by the fact that I was a full-time wife and mom, so only my husband really needed to have a highly scheduled life. I was relatively free to be available as needed. Two career couples have no one in that position.
(Also:
According to the U.S. Centers for Disease Control, about 33 percent of American women who gave birth in 2011 had a cesarean delivery. (The c-section rate in the United States has risen nearly 60 percent since 1996.)
http://www.babycenter.com/0_c-sections-giving-birth-by-cesar...)
We know that the risks of C-sections are greater than risks of vaginal birth, at least with your first pregnancy. So why are women opting for C-sections, even for their first birth? Some theorize that the combination of improved C-section safety, along with increased maternal age, has lead to women being able to control when and how they are going to give birth. This type of control is attractive to women who are balancing family and career -- they can perfectly plan maternity leave, right down to the date of the last conference call. Another popular theory is that some women, fearing the pain of vaginal delivery and wanting to avoid urinary incontinence, jump at the chance to give birth via C-section.
http://health.howstuffworks.com/pregnancy-and-parenting/preg...
I do know of cases where women are genuinely terrified of giving birth, as the GP suggests, and will opt for a C-section for that reason. But I think a more common reason is that women increasingly have careers.
I had both my children vaginally. I was a full-time wife and mom for many years. Two career couples have a much greater need to control the timing of things, including processes that, organically, cannot be relied upon to happen at a set time. The slack in my family was generally provided by the fact that I was a full-time wife and mom, so only my husband really needed to have a highly scheduled life. I was relatively free to be available as needed. Two career couples have no one in that position.
(Also:
According to the U.S. Centers for Disease Control, about 33 percent of American women who gave birth in 2011 had a cesarean delivery. (The c-section rate in the United States has risen nearly 60 percent since 1996.)
http://www.babycenter.com/0_c-sections-giving-birth-by-cesar...)
This is totally wrong, women are afraid of c-sections and many c-sections start as natural births and go until the baby begins to falter. In fact, many women choose to have natural birth second child AFTER having a child via c-section even though natural birth after a c-section (VBAC) is very high risk for mom.
Women who are "afraid" of natural birth will get an epidural to help mitigate the pain, not a c-section.
Women who are "afraid" of natural birth will get an epidural to help mitigate the pain, not a c-section.
My only knowledge here is personal experience having talked to women swearing they will only ever have C-sections due to fear of natural birth.
If you read the article, the study was done in context of other studies showing that most of the gut bacteria comes from vaginal birth, e.g http://www.mdpi.com/2076-0817/3/3/769/htm
Correlation between healthy gut bacteria and lower obesity rate are not that surprising.
Correlation between healthy gut bacteria and lower obesity rate are not that surprising.
That's a tautology -- what does "healthy" mean?
I am speechless. Just in case anyone reads this and thinks having a C-section is painless: it's not. It's really not for the faint of heart, and it almost always happens after hours in labor anyway.
Before leaping to insulting conclusions about why women get C-sections, consider the most obvious explanation: this whole thing is just due to gestational diabetes -> higher risk of c-section AND gestational diabetes -> higher risk of obesity later in life for infant.[0]
[0] http://www.webmd.com/baby/gestational-diabetes-you#1
Before leaping to insulting conclusions about why women get C-sections, consider the most obvious explanation: this whole thing is just due to gestational diabetes -> higher risk of c-section AND gestational diabetes -> higher risk of obesity later in life for infant.[0]
[0] http://www.webmd.com/baby/gestational-diabetes-you#1
My only knowledge here is personal experience having talked to women swearing they will only ever have C-sections.
Couldn't it be the other way round? Children that tend to obesity are more likely to require a cesarean section? One common reason to use a cesarean is with unusually large babies, for instance.
Yes. The paper's abstract only notes an 'association', not a causal arrow. Readers simply infer the causal arrow.
Also, moms that are less healthy are more likely candidates for c-sections.
Yes. Obesity in the mother can increase birth weight. Increased birth weight can require a C-section. There is a strong link between obesity in parents and children regardless of delivery method.
Cesarean birth in the US is something mothers push for because they don't want the cosmetic consequences of a natural birth. I think technically they need a medical reason for it, but I'm guessing it's not too tough to qualify for it.
I have a guess here, in that children who don't travel down the birth canal aren't inoculated with certain bacteria from the mother that may be important in digestive and possible immune function. Just a guess assuming causation, but the mother's birth canal bacteria may play a role in child development.
I have a guess here, in that children who don't travel down the birth canal aren't inoculated with certain bacteria from the mother that may be important in digestive and possible immune function. Just a guess assuming causation, but the mother's birth canal bacteria may play a role in child development.
Doctors also push for it because they get paid more (according to Freakonomics).
A source:
http://www.wired.com/2005/05/realestate/
"consider these findings of a 1996 medical study: Obstetricians in areas with declining birthrates are much more likely to perform cesarean section deliveries than obstetricians in growing areas – suggesting that when business is tough, doctors may try to ring up more expensive procedures."
A source:
http://www.wired.com/2005/05/realestate/
"consider these findings of a 1996 medical study: Obstetricians in areas with declining birthrates are much more likely to perform cesarean section deliveries than obstetricians in growing areas – suggesting that when business is tough, doctors may try to ring up more expensive procedures."
They don't want they cosmetic consequences of a NATURAL birth?!?
Have you even seen someone who's had a C-section?
Two-piece outfits are usually not a part of their wardrobe afterward.
C-sections are terrible: scarring, risky, expensive, and having a far longer recovery period. Natural birth is no picnic, but compared to a C-section, it nearly is.
It's hard for me to believe anyone would prefer a C-section if it wasn't medically recommended.
Have you even seen someone who's had a C-section?
Two-piece outfits are usually not a part of their wardrobe afterward.
C-sections are terrible: scarring, risky, expensive, and having a far longer recovery period. Natural birth is no picnic, but compared to a C-section, it nearly is.
It's hard for me to believe anyone would prefer a C-section if it wasn't medically recommended.
This is so factually incorrect and full of opinion that I felt no choice but to downvote.
No, mothers don't just push it because they are concerned about cosmetics. What an overreaching and insulting generalization.
No, mothers don't just push it because they are concerned about cosmetics. What an overreaching and insulting generalization.
Do you have any evidence for this claim? You seem to be making generalisations without any evidence at all.
As a personal anecdote, I have several girl friends of childbearing age, who have stated a preference for C-sections for cosmetic reasons, as well as all the (rightly or wrongly) associated pain/complications with a natural birth. (e.g. tearing down there). So I wouldn't say it's completely unheard of.
In contrast, my wife went with a natural birth. She's a vetinary surgeon though, and has done plenty of deliveries of both types, so I assumed she made that decision with some thought. She said the recovery period is much longer, and it'd be silly to risk surgery if you could possibly avoid it.
As a personal anecdote, I have several girl friends of childbearing age, who have stated a preference for C-sections for cosmetic reasons, as well as all the (rightly or wrongly) associated pain/complications with a natural birth. (e.g. tearing down there). So I wouldn't say it's completely unheard of.
In contrast, my wife went with a natural birth. She's a vetinary surgeon though, and has done plenty of deliveries of both types, so I assumed she made that decision with some thought. She said the recovery period is much longer, and it'd be silly to risk surgery if you could possibly avoid it.
Somehow you are assuming all mothers, that's not a good assumption.
1) Cesarean birth is a risk factor for developing a less-than-optimal microbiome.
(http://jn.nutrition.org/content/138/9/1796S.full)
2) Prevalence of certain species in the microbiome is highly correlated with obesity. (http://go.nature.com/1sksCA6) "Our results indicate that the obese microbiome has an increased capacity to harvest energy from the diet."
2) Prevalence of certain species in the microbiome is highly correlated with obesity. (http://go.nature.com/1sksCA6) "Our results indicate that the obese microbiome has an increased capacity to harvest energy from the diet."
Those two facts seem to stand in opposition, unless "optimal" is used in a tautological sense.
I'd suggest a marker for quantitative research posted to HN along the lines of: runnable?