Vaginal or C-section: Does it matter?

Feb. 20, 2015

In the climax of William Shakespeare’s “Macbeth,” the title character is sword fighting and believes himself invincible because he was given a prophesy that said “no man born of woman shall harm thee.” Yet, that is how he was tricked, for his rival, Macduff, was “from his mother’s womb untimely ripped.” This and other historical references show that cesarean sections have been used for centuries, but today the high success rate has made them more common than ever.

The origin of the term Cesarean is popularly and probably falsely attributed to the birth of Julius Caesar. This is unlikely, since C-sections at this time almost always resulted in the death of the mother, and historical records mention Caesar’s mother later in his life. However, the origin may still be linked to Caesar as a law enacted during Caesar’s reign stated that a dead or dying pregnant woman was to be cut open and the child removed from her womb to save the child. Widespread use of this procedure began after anesthetics and antimicrobial therapies became available in the 20^th century.

In 1965, 4.5 percent of America’s babies were delivered via C-section. Today that figure has risen to almost one in three, and is on the rise worldwide as well. There are plenty of medical and nonmedical reasons for this shift from vaginal childbirth. Both come with side effects and consequences, some lasting longer than others. For example, C-sections have been linked to increased rates of diabetes and obesity, although we’re not sure why. In a recent study, birth by C-section lead to epigenetic changes in the child’s DNA.

Epigenetics are changes in our DNA that don’t result from changes in our genetic code. These changes can come from environmental factors, such as smoking, that alter the ability of a gene to be seen or expressed. What we didn’t understand until relatively recently is that epigenetic changes can be transmitted to offspring. So you are the product of your parents’ DNA and the environmental factors that affected your DNA in your lifetime and their lifetime before you were born. Then your DNA and epigenetic information is passed on to new generations. These changes accrue and could affect your children or grandchildren. So the descendants of a smoker may inherit more than their name, but epigenetic changes in DNA as well.

New research suggests certain epigenetic changes in a baby’s DNA called methylation are different depending on the type of birth. When DNA becomes methylated, it changes whether a gene is used to make a protein and this can then alter the properties of specific cells. In this study, researchers compared the DNA methylation patterns in stem cells of 25 vaginally delivered babies and 18 delivered by C-section. Distinct methylation changes were seen in more than 300 different regions of the genome between the two groups. Interestingly, many of these regions are associated with genes that control the immune system. We don’t know how these epigenetic changes affect the immune system and ability to fight disease, and don’t have sufficient information to link these differences to later health issues. But this remains an intriguing possibility and awaits more research.

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