
Association Between Cesarean Birth and Risk of Obesity - Mz
http://archpedi.jamanetwork.com/article.aspx?articleid=2548440
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ginko
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.

~~~
midnitewarrior
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.

~~~
randomdrake
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.

~~~
victorhooi
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.

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xherberta
1) Cesarean birth is a risk factor for developing a less-than-optimal
microbiome.
([http://jn.nutrition.org/content/138/9/1796S.full](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](http://go.nature.com/1sksCA6)) "Our
results indicate that the obese microbiome has an increased capacity to
harvest energy from the diet."

~~~
gohrt
Those two facts seem to stand in opposition, unless "optimal" is used in a
tautological sense.

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RA_Fisher
It's so disappointing to see studies like these relied on when reported by
news outlets. To start, we don't have the data or statistical code used to
generate the results. Consider this a basic unit test. Of course we'd want to
further scrutinize the code and methodology, but we're not even there. :-(

I'd suggest a marker for quantitative research posted to HN along the lines
of: runnable?

~~~
basseq
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!

~~~
RA_Fisher
I do make this argument for pretty much every quantitative study.

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Splendor
What options currently exist to improve a person's microbiome?

~~~
Mz
Yogurt, probiotic supplements, dietary changes.

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AWildDHHAppears
Why would a person who had had a "Cesarean Birth" choose to eat more? This
raises more questions than it answers.

~~~
phormula
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.

~~~
firstworldman
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.

~~~
gohrt
(31-12) _3500 / (5_30) = 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.

------
seizethecheese
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.

~~~
basseq
_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.

~~~
seizethecheese
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.

~~~
Mz
_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.

~~~
mobilefriendly
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.

~~~
Mz
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...](http://health.howstuffworks.com/pregnancy-and-
parenting/pregnancy/labor-delivery/c-section4.htm)

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...](http://www.babycenter.com/0_c-sections-giving-birth-by-cesarean-
section_160.bc))

