Love’s Labours Lost: The Medicalization of Childbirth

CHMP senior fellow Meg Olmert is author of Made for Each Other: The Biology of the Human–Animal Bond.

The vast majority of our babies are born in hospitals and delivered by medical professionals. Childbirth has become a medical procedure that involves the regular use of synthetic oxytocin to induce labor contractions and analgesics to reduce the pain. Anesthesia is given to the 30% of mothers whose babies are delivered by C-section. Elective C-section—which is performed before the start of labor—is one of the most rapidly increasing surgical procedures. It’s only recently that wisdom and the long-term public health consequences of the medicalization of childbirth have been called into question.

In the mid-1990s researchers in Sweden began investigating the effects of C-section surgery on mothers. It was well known that mothers who had C-section surgery had difficulty breastfeeding. It was also well known that oxytocin, a brain hormone, is responsible for the release of breast milk and the instigation of labor contractions. Epidurals and anesthesia reduce levels of oxytocin in mothers, while surgical delivery eliminates the passage through the birth canal that powerfully triggers oxytocin production in the brain of baby and mother. By comparing blood samples the researchers found that women who delivered by C-section had weaker oxytocin pulses during breastfeeding than mothers who delivered vaginally. The vaginal-delivery mothers also produced more breast milk and reported feeling less anxious and more interested in interacting with those around them than the C-section mothers.

This tracks well with our new realization of oxytocin’s ability to promote maternal and social bonding, our capacity to cope with stress, and fight disease. We also now understand that these social and biological oxytocin advantages are passed from mother to infant during natural childbirth and through high quality, stable maternal care.

Another study comparing babies born by vaginal delivery and C-section showed that vaginally delivered babies were less reactive to pain. Just last month, a team of researchers showed, in rats, that oxytocin released during labor acts as a natural pain-killer. This analgesic effect may have long term consequences on perception of physical and perhaps psychic pain for the rest of our lives. Surgically bypassing the vaginal journey not only deprives the infant of the benefits of prenatal exposure to oxytocin; it prevents the baby from experiencing the massive sympathetic stress response that prepares the lungs for their first breath and activates the inflammatory defense system that will help it survive in the new world.

So, it’s not that surprising to learn that C-section is an established risk factor for later development of asthma and allergy, type 1 diabetes mellitus, childhood leukemia and testicular cancer. In 2009, another Swedish team investigated how C-sections might compromise the immune system of newborns. They analyzed the DNA of white blood cells extracted from umbilical cords of babies delivered by elective C-section and vaginal birth. The white blood cells of surgically delivered babies showed a significantly greater degree of “DNA methylation.” This means a methyl chemical group is added to a particular site of the genome, reducing access to the DNA and diminishing the chance that the gene will ever be activated. We now know that environmental influences—like how we are born or mothered—can exert this kind of dynamic effect on our DNA, resulting in long-term physiological, psychological, and behavioral consequences.

Future studies are needed to see if increased methylation of the DNA of white blood cells as a result of C-section is, in fact, silencing critical immune systems that are linked to the emergence of these common diseases. But even now, enough is known to give serious pause before a doctor recommends or a mother chooses elective Caesarean section.

CHMP senior fellow Meg Olmert is author

Reflection on the MacNeil PBS Autism Series and NYT Wakefield article

Guest Post by Michael Lerner, PhD, President, Commonweal, Co-Coordinator of Collaborative on Health and the Environment’s (CHE’s) Breast Cancer Working Group, Co-Coordinator of CHE’s Cancer Working Group, Co-Coordinator of CHE’s Integrative Health Working Group

The crash and burn of an autism guru. Andrew Wakefield has become one of the most reviled doctors of his generation, blamed directly and indirectly, depending on the accuser, for irresponsibly starting a panic with tragic repercussions: vaccination rates so low that childhood diseases once all but eradicated here have re-emerged, endangering young lives. New York Times [Registration Required]

This article in The Times and the Robert MacNeil autism series on PBS are both testimony to how the public and scientific dialogue on autism is changing.  Martha Herbert of Harvard was a leading voice in MacNeil’s documentary.  Herbert is a senior advisor to CHE-Autism, and one of the most distinguished proponents of the new paradigm of autism research and treatment.

When MacNeil on PBS gives such strong authoritative visibility to Herbert’s perspective, it is clear that the field has shifted in a significant way — and shifted in the specific direction that many CHE Partners have believed was warranted for many years.  So it is a good moment to reflect on what we are witnessing and lessons learned.

We are witnessing a decisive shift toward mainstream researchers recognizing a contributing role
of environmental factors interacting with genetic factors in ASD.  There is also, specifically, more mainstream recognition of the contribution of GI disorders to symptomatic distress in some ASD spectrum children — and the benefit of dietary change for some of these children. The debate continues over an essentially linguistic question of whether the dietary shifts that reduce symptomatic distress represent a treatment for the ASD disorder or simply a relief of GI distress unassociated with ASD. Those who argue the latter are on shaky ground because of the scientific evidence of strong gut-brain connections. Nonetheless, the linguistic conceit that this is “just” GI relief unconnected to the ASD disorder is a step forward since it allows mainstream clinicians to treat the gut disorder without needing to accept that for some children this may indeed affect the theoretically separate ASD disorder as well.  This reduces human suffering — the key purpose of the whole enterprise.

With this middle ground increasingly established, despite the linguistic variants of interpretation,  the remaining controversy shifts increasingly back to the vaccine debate, which has always been more hotly contested.  Part of that debate is whether vaccines contribute to the gut disorder.  Increasingly, we see some mainstream researchers agree that the role of vaccines in a subset of ASD children “deserves further study.”  This debate is, of course, so hot because of the concern of pediatricians and public health officials with declining vaccination rates and associated health dangers.  Again we see movement toward middle ground:  reformulation of vaccines, teasing apart which vaccines have a higher priority, teasing apart timing of vaccines, dis-aggregation of vaccines, and exploration of integrative approaches to enhancing resilience both to disease and to vaccines.

Guest Post by Michael Lerner, PhD, President, Commonweal, Co-Coordinator of Collaborative on Health and the Environment’s (CHE’s) Breast Cancer Working Group, Co-Coordinator of CHE’s Cancer Working Group, Co-Coordinator of CHE’s Integrative Health Working Group

The crash and burn of an autism guru. Andrew Wakefield has become one of the most reviled doctors of his generation, blamed directly and indirectly, depending on the accuser, for irresponsibly starting a panic with tragic repercussions: vaccination rates so low that childhood diseases once all but eradicated here have re-emerged, endangering young lives. New York Times [Registration Required]

This article in The Times and the Robert MacNeil autism series on PBS are both testimony to how the public and scientific dialogue on autism is changing.  Martha Herbert of Harvard was a leading voice in MacNeil’s documentary.  Herbert is a senior advisor to CHE-Autism, and one of the most distinguished proponents of the new paradigm of autism research and treatment.

When MacNeil on PBS gives such strong authoritative visibility to Herbert’s perspective, it is clear that the field has shifted in a significant way — and shifted in the specific direction that many CHE Partners have believed was warranted for many years.  So it is a good moment to reflect on what we are witnessing and lessons learned.

We are witnessing a decisive shift toward mainstream researchers recognizing a contributing role
of environmental factors interacting with genetic factors in ASD.  There is also, specifically, more mainstream recognition of the contribution of GI disorders to symptomatic distress in some ASD spectrum children — and the benefit of dietary change for some of these children. The debate continues over an essentially linguistic question of whether the dietary shifts that reduce symptomatic distress represent a treatment for the ASD disorder or simply a relief of GI distress unassociated with ASD. Those who argue the latter are on shaky ground because of the scientific evidence of strong gut-brain connections. Nonetheless, the linguistic conceit that this is “just” GI relief unconnected to the ASD disorder is a step forward since it allows mainstream clinicians to treat the gut disorder without needing to accept that for some children this may indeed affect the theoretically separate ASD disorder as well.  This reduces human suffering — the key purpose of the whole enterprise.

With this middle ground increasingly established, despite the linguistic variants of interpretation,  the remaining controversy shifts increasingly back to the vaccine debate, which has always been more hotly contested.  Part of that debate is whether vaccines contribute to the gut disorder.  Increasingly, we see some mainstream researchers agree that the role of vaccines in a subset of ASD children “deserves further study.”  This debate is, of course, so hot because of the concern of pediatricians and public health officials with declining vaccination rates and associated health dangers.  Again we see movement toward middle ground:  reformulation of vaccines, teasing apart which vaccines have a higher priority, teasing apart timing of vaccines, dis-aggregation of vaccines, and exploration of integrative approaches to enhancing resilience both to disease and to vaccines.