Two weeks following submission, my letter in response to the obesity study was published, June 6, in the BMJ Archives of Disease in Childhood. Titled, "Findings do not inform maternal request caesarean risk", it reads:
As far as I can ascertain (having not yet accessed the full text), this study did not specifically examine maternal request caesareans, and in fact found that "after all factors were taken into account there was a stronger link with emergency caesarean than with pre-planned ones, although the numbers were small for this calculation."(1)
It is very concerning therefore that the authors appear to be presenting this study to the media as potential evidence to dissuade women from choosing a planned caesarean. For example, "A mother who chooses caesarean delivery on maternal request should be aware of [these] potential health risks... including childhood obesity."(1) And, "An association... would provide an important rationale to avoid non-medically indicated caesarean section".(2)
Hypothetical theories about the potential impact of gut bacteria remain unproven, and women choosing a caesarean are weighing up other perinatal risks such as stillbirth, asphxiation, shoulder dystocia and serious intrapartum injuries, as well as
maternal risks including pelvic organ prolapse, incontinence, psychological trauma and unpredictability of care.
Ideological opposition to maternal request caesarean is very unhelpful in the current debate. If the authors genuinely found a causal link with maternal request, fair enough, but if they only found a possible link with ALL caesareans, and especially emergency caesareans, then the study should not be used to criticise maternal request.
Otherwise, and despite NICE recommending last year that maternal request should be supported,(3) we have a situation where the Royal College of Midwives' education and research manager, Sue Macdonald, is quoted as saying, "This [study] highlights the need to avoid caesarean sections that are not medically needed."(1)
No, rather it highlights the problem with using irrelevant study findings to try and restrict what is an entirely legitimate birth choice for informed women planning a small family.
(1) "Babies born by caesarean 'more likely to be obese'," The Telegraph,May 24, 2012. http://www.telegraph.co.uk/health/healthnews/9284827/Babies-born-by- caesarean-more-likely-to-be-obese.html
(2) "Caesarean Section Delivery May Double Risk of Childhood Obesity: May Be Due to Different Gut Bacteria," Science Daily,May 23, 2012. http://www.sciencedaily.com/releases/2012/05/120523200749.htm
(3) NHS National institute for Clinical Excellence, "Caesarean Section:Full Guideline" November 2011
Letter was in response to: Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study, Huh et al