Alessandra Gail C. Narciso | BS MT – 1

When I was searching for an article in ScienceDirect on anything respiratory-system-related, I was looking for something generic. But as this article’s title popped up on my screen, I couldn’t help but let my cursor hover over it. I have never thought of the possibility that a Caesarian birth could lead to many respiratory complications.

How could a Caesarian birth render an infant vulnerable to respiratory diseases? How can the absence of the labor process affect the baby’s ability to adapt to breathing outside the womb? I couldn’t wrap my head around it.

Yeganegi et al. (2024) discovered that choosing a C-section for childbirth could affect the child both short-term and long-term. In the immediate postpartum period, the gut microbiota establishment is disrupted. Instead of normal exposure to the vaginal microbiota, the infant is exposed to the mother’s skin and the surrounding environment.

The vaginal microbiome usually allows the infant to gain beneficial bacteria like lactobacillus for early immune development and gut health. However, in this case, if the baby is exposed to the bacteria on the mother’s skin and hospital environment, the child will not have the same beneficial bacterial colonization. Instead, the infant’s gut will be populated with microbes that are less effective in promoting the proper immune response and digestion. The vaginal microbiome is purposefully filled with bacteria that support the baby’s immune system development.

This leads to long-term effects of developing asthma and respiratory infections.

C-section births are primarily associated with Neonatal respiratory distress syndrome (NRDS). These are caused by insufficient production of pulmonary surfactant, a vital substance essential for surface tension reduction in the lungs. Without this, the alveoli in the lungs would not be able to expand properly and facilitate gas exchange. As we know, this is the most crucial part of breathing.

Should this abnormality persist, it may lead to Respiratory Distress Syndrome (RDS). This is characterized by inadequate inflation of the lungs. Infants take in rapid and shallow breaths and often experience a bluish change in the skin or cyanosis.

RDS may also arrive from problems in clearing pulmonary fluid in the baby. During vaginal childbirth, the squeezing or contraction experienced helps facilitate lung fluid clearance. An event not present in C-section deliveries.

This absence delays the initiation of the newborn’s breathing. Normal childbirth signals the production of important hormones like catecholamines and glucocorticoids that prepare the baby’s lungs for its eventual independent function after birth. The aforementioned hormones are crucial for surfactant production.

Additionally, a channel in the alveolar surface epithelial cells called the amiloride-sensitive sodium channel, or the epithelial sodium channel (ENaC), is a key player in fluid clearance. They facilitate the absorption of sodium and water across the epithelial surface. However, in C-section births, this mechanism is not as effective since these channels are less activated due to no vaginal contraction during delivery. Therefore, more fluid is accumulated than drained. This further adds to the delay in establishing normal breathing in the infant.

I had figured that I’d be used to the interconnectedness of the body, given that I’m already months into this curriculum, but I seem to be surprised every time. It was very fascinating to see how the different systems of the body coordinate to preserve life, even as early as the infant stage, we can see how active this interplay is.

This article clearly demonstrated just how crucial the early developmental stages of infancy are for respiratory system function. The stage where you have no control over and possess the least mental and physical capacity sets the stage for your body’s long-term health.

As I continue to explore these connections, it becomes even more apparent how a seemingly simple choice of delivery method can reverberate throughout the child’s life. It’s incredible to think how the body’s systems collaborate to support life, but also how those systems need to function properly from the very beginning to ensure the child’s health and well-being. This truly highlights the importance of birth processes and their lasting effects.

Yeganegi, M., Hajizadeh, N., Bahrami, R., Azizi, S., Mirjalili, S. R., Marzbanrad, Z., Saeida-Ardekani, M., Lookzadeh, M. H., Alijanpour, K., Aghasipour, M., Golshan-Tafti, M., Noorishadkam, M., & Neamatzadeh, H. (2024). Caesarean section and respiratory system disorders in newborns. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 23. https://doi.org/10.1016/j.eurox.2024.100336