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There I was, with a camera in one hand and wiping the tears from my eyes with other. It was delivery day – I was going to be a dad. Like and eerie scene from a B-rated alien movie, out popped his little head from an amazingly small incision in my ‘then wife’s’ stomach. The flash from my camera filled the room – this was the happiest day of my life. Since that day over 11 years ago, my ‘then wife’ and I had another beautiful child, also through cesarean delivery. I had not given much thought to the fact that both my children entered this world through a small incision rather than the birth canal until last month, when the CDC’s National Center for Health Statistics released its update on US births. Since my first child was born, the rate of c-section deliveries appear to have been rising at a steady clip, jumping over 40 percent since 1996. In 2004, 29.1 percent of all children born in the US were delivered through c-section – that’s nearly 1.2 million incisions. The reasons for the increase are complicated, but have a lot to do with medical malpractice associated with vaginal deliveries, parental preference, health of the mother and or the unborn child, and just plain old convenience. In the days following the release of the CDC report, I scoured the media outlets that picked up the story to see if anyone mentioned an interesting and potentially alarming consequence of the rise c-sections. I was looking for the mention of words human biology, bacteria, and the new nine-letter curse word of 2005 – evolution. Nary a mention – not one. As a right of passage – a vaginal right of passage that is – the delivery of a fetus through the vaginal canal of the mother completes one of the most important cycles in the evolutionary history of humans. Our sudden adoption of c-sections as an increasingly preferred mode of child delivery, may be tinkering with some very important processes that took millions of years to develop. Let me explain. In what British ‘Darwinist’ Richard Dawkins calls an evolutionary stable strategy, humans have evolved a symbiotic relationship with a particular and complex set of bacteria in our intestinal system – a.k.a. the gut. The 500 or so species of bacteria, whose numbers are measured in the trillions, occupy every inch of our gut – with most of them living in an ecological niche they literally carved for themselves in our colon. As the evolutionary stable strategy suggests, the presence of these few hundred species, among all the tens of thousands of species of bacteria found in the air, water, and soil throughout the world, that theoretically have access to our “open” intestinal ecosystem (think mouth to anus), is not random. This means our established intestinal ecosystem is composed of a set of bacteria that can live in nutritional and physiological harmony with us – current members make it their evolutionary determined job to keep out new members – i.e., pathogens that seek to do us harm. The intestine of the unborn fetus in the mother’s womb is sterile – devoid of any bacteria. However, during vaginal delivery the newborn comes in contact with the bacteria-rich vaginal fluid and fecal matter of the mother. These bacteria quickly invade and populate the newborn child and serve as the first and last line of defense against invading pathogens that can make you child sick, or even worse, kill them. Saving of umbilical cords and the creepy ritual of eating the mother’s placenta aside, this cycle links the co-evolution of intestinal “microflora” of the mother to child, and may represent a more significant bond for those who understand it exist. This evolutionary bacterial right of passage has been and continues to be critical to the success of our species – and all mammals for that matter. A child born through c-section essentially skips this critical evolutionary process. Though a c-section baby does receive bacteria from the mother, it’s not the diverse and dense “base population” that it would have received from the vaginal fluids and fecal matter via a traditional birth. In either birthing method, the baby is subject to all the bacteria in the room – that even means the weird looking rubber-gloved fellow in the corner – who appears to be assisting the delivery staff in some way. But who can be sure. In the dozens of doctor visits my ‘then wife’ and I made during pregnancy, and through two births, never once did the doctor or any other person involved in “our care” tell us what I just told you. In many cases, c-sections are absolutely necessary and should be performed. But a 40 percent increase in just the last ten years? This is ridiculous. The debate in this country over evolution should not preclude health practitioners from understanding the basics of evolutionary biology. While we are culturally and socially modern, driving around in hybrid cars and arguing about stupid things, we are literally and biologically ancient hunter-gatherers. Ignoring our evolutionary past and its role in modern medicine and health, not just in birthing but for all ailments and diseases of modern civilization, is nothing short of medical malpractice.
Ignoring and tinkering with nature has
consequences, it always does.
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