None of the comments address why birth has become so medicalized in the western world. Unless in the case of an emergency, 4-10% of births, why would you go through a risky surgery that makes it harder to breastfeed and bond with your baby and also forces you to stay immobile for weeks? 30-50% c-sections - why? It’s surgery! Expensive and risky. Vaginal unmedicated births in a calm, dim, supportive environment is the best way for mother and baby to begin their journey together - microbiome, immune system, nursing, speedy healing. Women get injured giving birth (tears etc) because of stress and a medical system that doesn’t believe women can birth on their own. Does anyone remember “The Business of Being Born?” I’m glad c-sections exist but they should be last resort. I have 5 friends with children who are on the spectrum, autistic, and ADHD / Tourette’s. All were born with c-sections after Pitocin. None were emergency procedures. Labor stalled because of being strapped to a bed or Pitocin made it too painful and epidural stalled progress. I wish we could invest in birth centers, midwives, and doulas so the doctors could do their work only in true emergencies. Having my daughter was the best thing I have ever experienced and I’m grateful it wasn’t violent, traumatic, or left me scarred. All women deserve peaceful and supportive births, emergency c-section or not. Our bodies can make and carry a baby - we can birth it! We are amazing.
I had four C-sections, the first two were medically necessary but after those two the doc advised against V-Bac. I think more research would be good, but I suspect it might be more complicated than blaming the association on the operation.
My daughter still was not coming out--labor not progressing--after 15 hours and Pitocin and all that--I asked if I could have a C-section and the doctor accused me of wanting to save money, because my insurance covered the surgery but not a vaginal birth! She was almost 9 pounds and he had already told me earlier I'd be OK "if I wasn't having a 9-pound baby." He examined me and told me she was 7.5 pounds, including a few days before she arrived. I get that he thought vaginal births were better for you and at the baby, and that may be true, but hurt my feelings with his attitude, and I wonder if it hurt my daughter's health besides. She finally had to be pulled out by forceps after 23 hours of labor. She has ADHD with autistic-like traits, and is obese. There also are genes for all of those in our family. And I have read that the baby's body is the one that sends the signal to initiate the birth. So it could be babies that don't have that working well are slower, and may result in C-sections.
2
I think that the message should be to move away from unnecessary c-sections, not to worry women who might need them. Anecdotal evidence: my first son was born via c-section after 30 hours of labor (my water broke early). If I hadn't had the surgery, he would either have been born healthy a day later or one or both of us might have died. He's now in his 20s without any of the conditions mentioned in this article. My second son was a VBAC on my insistence - this was the late 90s when the medical establishment allowed it. He has autism and a variety of other diagnoses.
Older women are much more likely to have a c section.
https://www.ncbi.nlm.nih.gov/m/pubmed/30677047/
Babies born to older parents are at higher risk for autism and other difficulties.
Likely, maternal age casually increases risk for both c section and chromosomal problems. Mystery solved?
3
I’m so impressed by the careful, thoughtful, and even-handed way in which this was reported. It is obvious the reporting and editing staff were aware of the many ways in which these findings could be misinterpreted, sensationalized, and provoke fear, and they mitigated these risks elegantly and responsibly through the wording of the article. Bravo.
1
The research is very limited and it has to look at the factors such as mother's health (Which could result in C-section).
I think "...the research is still very limited and difficult to carry out and constrained by the comparatively scanty research funding allocated to pregnant women and children..." and "...The first and most important thing to say is that these were observational studies, and that association is not the same as causation." needs to be included somewhere in the main description. If you have little to no evidence to base this on, and the only evidence you have is based on association, let's include that in the main description. Before every 'vaginal birth mom' we know waves this in our faces, saying "I knew it!!! C-Sections are the devil!!!!". Also, "...If your child was born by cesarean section, there’s nothing you can do to change that, and knowing about this association may make you worry..." YEAH. A fear mongering article will obviously cause further worry to mothers! Thanks for that! As if caring for a newborn, having and recovering from a C-Section don't cause enough worry for you!! Hope this adds needlessly to your already worried and stressed out mind!!!!
1
@K McAll I have a daughter with autism and knew pretty much from the beginning she was different, although she's now high-functioning and working on an animation for a client, which is what she does. (I had one child already.) But, my point is, you are busy enough taking care of a baby you don't have time to worry too much, and there is no point beforehand. Once the baby is born, just connect whenever you can, talk to them, maybe do a little extra than you would if you were not worried. If you get a diagnosis, of course then you take advantage of whatever services and knowledge you can find. But you love them the same, sometimes even more, because autistic people are often awesome. In addition to amazing cognitive abilities, they often have hearts of gold. My daughter never says a negative thing about anyone, never mind being mean. She might get angry at you, but never puts anyone down. These genes are prevalent throughout the gene pool, so some people also have some without a full-blown diagnosis. We would not have many of our scientific discoveries, and maybe even personal computers and all that without people with autism. (Rumors are that Bill Gates and Steve Jobs are/were on the spectrum, as are many famous people in all fields.) That's my two cents.
Dr. Klass overlooks the most likely cause of the rise in ASD and pediatric brain/learning disorders and the overuse of surgical birth: the overuse of Big Pharma’s drug Pitocin, whose role in the ‘active MANagement’ of childbirth is chronically under-investigated. That - and the rigid patriarchal OBGYN misdefinitions of women’s physiology, from their mythical ‘28-day’ menstrual cycle, to their conveniently re-defined ‘term of pregnancy’ (40 weeks, now 39 or 38 or whatever justifies the most interventions), to their ridiculous ‘Friedman labor curve’ of 1 centimeter of dilation per hour - or else more interventions. The raging-hormone testosterone problem driving the endless for-profit “Have It Our Way” regime of the US McBirth industry remains unchallenged; but it’s the reason that actual outcomes are ignored, and women’s choices and options are continually trumped, overridden and outlawed. The industry depends on enormous rates of inductions, Pitocin-and-epidural-driven labors, and resultant surgical births (call them what they are); the OBGYN corporate empire ignores actual outcomes like pediatric brain damage - despite decades of critical evidence outside their manmade misogynist firewall - and their current cult science of blaming women (race, BMI, socioeconomic status) for their poor outcomes (in a setting where ‘obstetric violence’ - forcing women to submit to their rituals - is now a defined legal problem). ‘Science’ indeed.
4
I had three C-sections: the first one due to a large baby estimated to be 10.15 at 37 weeks. My OB didn’t even give me the option to deliver naturally - said the baby could lose use of an arm if it “got stuck.” She was 11 pounds and breech (she flipped at 37.5 weeks!), born at 38 weeks, so definitely medically necessary. But for the next two - not nearly as big - it was during the time (early 2000s) when VBACs were a no-no, full-stop (read: malpractice risk). Anyway, all three - ages 20, 17 & 15 - were and are perfectly healthy. Lucky? I don’t know as maybe this is all anecdotal. I just wish I’d been given the chance for my kids to have had that natural and important entry into the world.
2
This is right up there with the NYT’s fear-mongering “The Chemicals in Your Mac and Cheese” article. Relative risk is NOT the number that matters. Laypeople don’t really get it, and fear is what gets the clicks. To quote our joke of a president, “Sad!”
6
My son has Asperger Syndrome and was born via c-section due to breech presentation and following an unsuccessful attempted version (turning the baby). I have often wondered if there is a correlation—breech due to autism? Autistic due to breech presentation or failed version? I also noticed amongst the parents and kids we met at various autism therapy groups and practitioners' offices that the majority seemed to have had some kind of fertility or pregnancy issue. I never thought it was a coincidence. Regardless, I will never regret my c-section, considering my grandmother died giving birth to my father, and my son is an absolute gem, autism and all.
13
I have a question for those more knowledgeable than me re: the gut microbiome hypothesis.
I tested positive for Group B Strep and received IV antibiotics throughout my entire (42 hour!!!) labor. Did those antibiotics kill off all the good bacteria that otherwise would have collected on my baby during delivery?
Really curious about the role of antibiotics as treatment for GBS and any whether there might be associations similar to those of CS.
2
This article piqued my interest as I have a 34 yr old daughter with Aspergers and ADHD. I had emergency C-section because her cord was wrapped around her neck. She went through a very asthmatic time when she was a child. And is extremely obese. WOW. Could this all be from the C?
2
@still looking for answers I have a daughter with Asperger's also. But my comment is I have heard that asthma can be due to C-sections because the baby's lungs don't get the same workout from coming through the birth canal. This has been found awhile ago. My daughter's cord was wrapped around her neck also but she came out super fast--2.5. hours total, and they took it off and gave her oxygen etc. and told me that she'd be fine. But I've read that might connect to autism. It will be nice when people do more research on all of this.
Interesting. My oldest son was born via emergency c-section and has been diagnosed with a developmental disorder. I elected to have a c-section with my second son and he was just diagnosed with ASD. Do I blame myself or the c-sections? No. I did what I thought was the right thing at the time—my first son’s delivery would not progress and he was flatlining. I chose to deliver my second son by c-section because I feared going through the same complications I did with my first. I remember my doctor saying to me “Don’t feel like you failed” and I laughed in his face. I have two incredibly smart, funny, successful, loving boys. I did NOT fail.
11
I suspect that Pitocin may be associated with a tendency toward autism, and I wonder what percentage of women who eventually get a c-section are first given Pitocin to "advance" the labor process. I know I was begging for a c-section after having my baby slam against my unready cervix for many hours (thanks to Pitocin), though I did deliver him vaginally. A friend who was also given Pitocin had a son who similarly leaned toward autistic behaviors, though neither of our sons are actually autistic. Birth is a natural process, and interfering by treating it as a medical procedure is bound to cause some problems.
9
I’m with you. I was in the same exact situation 3 1/2 years ago, before the Taylor study results. My husband was against chemo treatment but, again, said he would support me in whatever I decided to do. My doctor said if he were advising his wife, he would tell her to do whatever it took to reduce the risk of recurrence. I was on my way to my first chemo treatment when I turned around and cancelled the appointment. I spent 2 years second guessing my decision. But when you think about it statistically, the risks did not outweigh the benefits. Better to do things that you can control to reduce the risk of recurrence, lose weight, reduce alcohol consumption etc. It’s not an easy decision to make ever and thanks for writing about this.
2
(1) How about twins / multiple births that are generally delivered via c-section? Do we see more kids on the spectrum among these births? I read the article and did not see this as a covariate.
(2) Also, a direct quote from the study which seems to walk back their findings:
“Studies with both population and sibling analyses suggest that the observed associations are likely attributable to familial confounding because the significant findings from the population-level analyses were attenuated in sibling comparisons.”
4
@nazli Maybe you can explain that quote to those of us who don't understand it?
Hasn’t autism’s rise been linked most strongly to two things: better (therefore more frequent) diagnosis, and fathers’ older age? And don’t many older women giving birth have statistically more c-sections and also older male partners? Every other “cause” or correlation seems like wishful thinking.
9
@voltairesmistress I believe there are more factors being considered than that.
This is just an anecdote about c-sections in America. We knew my son would be around 10 pounds based on the ultrasound. My doctor told me she was not concerned because I had some of the best hips she’d ever seen. (Not that I can take credit, but I would like to give a shout out to my maternal great grandmother, who had 8 babies at home including 14 and 15 pound boys- thanks Bessie!)
Flash forward to labor- the ob-gyn on call walks in and immediately suggests they take me straight back for a c-section based on the size of my baby, without bothering to perform a physical exam! I said I wanted to at least try. Nine hours later the nurse summoned the doctor, and upon actually looking at me, she declared with surprise that I had a great pelvis. An hour later, my son was born.
The doctor clearly wanted to get it over with quickly so she could go home. The Super Bowl was on- I was having a contraction when Malcolm Butler made his goal line pick. But that is not an excuse to push for an unnecessary c-section. She should have taken 15 seconds to do a physical exam, every ob knew the second they looked at my pelvis from the inside. There is absolutely nothing wrong with having one if you need one, but if someone says that every c-section recommended is medically necessary, I’m here to tell you otherwise.
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@Courtney N THANK YOU Courtney!! Thank you for sharing this compelling and revealing anecdote.
1
Extremely skeptical that there is more than mere correlation here. Was this test controlled for the higher occurrence among specific age groups or other demographic groups? We already know that older parents are more likely to have children with ASD. And older parents are more likely to have issues with pregnancy, and probably thus more c-sections.
3
I suspect there is a link between the microbiome and autism based on my own life experience with Asperger's Syndrome and GI problems. I stopped eating gluten, dairy, and sugar, which not only put my IBS into remission, but caused a huge decrease in what I call my "aspie-ness". In the times I have gone back to eating a more standard american diet, my aspie-ness became stronger. A friend's notices a huge difference in her child, who is more severely autistic, when she put him on a similar food plan. Eliminating these foods changed our gut microbiome, which is where the link with kids and c-sections comes in, because they miss the opportunity to gain bacteria from the mom through vaginal delivery and have an altered microbiome. Rather than being scared that C-Sections could link to more Autism, we should take the opportunity to research how to restore our microbiomes and implement that.
Also, we need paid family leave for pregnant and postpartum mothers so that they don't have to elect having an induction or C-section so that they can fit having a baby in their work schedule. I have a 3 month old child and had her in an unmedicated natural birth, but because of my lack of paid leave and husband's lack of leave made doing so more difficult than it needed to be. I worked up until my due date and my husband worked while I was in early labor because we had to conserve the days we had. I can see why it would have been so much easier to schedule a birth date.
10
I agree. This is flawed.
Autism probably has two causes.
Environment - especially old chipped lead paint. It does not have to be ingested hand to mouth but breathed because it is airborne. Find out why there is a lead paint disclaimer with every NYC lease for apartments in buildings built before 1978. Ask DiBlasio about NYHA buildings as well.
And Heredity - it is family and predisposition. Stark at the Simons Foundation has a DNA test for it.
4
Thanks, NYT, for aiding in the hysteria that will now ensue. Will moms risk the lives of their babies by refusing C-sections when they are determined to be absolutely necessary because of this unsubstantiated link?
4
My boys were breech. C sections mandatory. Neither autistic. Stop the madness.
17
“Association doesn’t mean causation; we can’t say cesarean section is causing this.”
This contradicts the entire intention of the article.
4
Women In Mississippi have c sections so the doctors and hospitals can charge more.
4
@Deirdre Their insurance might not cover the birth but cover the surgery. So it can also be poverty. My husband was a graduate student when our first was born, and that was the kind of insurance we had. So my doctor did the opposite--he thought I was trying to have a C-section to save money when her labor stalled between 12 and 22 hours! She was pulled out by forceps eventually.
Breathtaking irresponsibility here. There are so many reasons a woman might have a a c-section, i.e. weight of baby, her anatomy, complications, etc. I'm not an OB GYN but it's clear that unless causation can be demonstrated, stories like this that imply that C-sections damage children are Alex Jones level clickbait.
12
Most likely, the reason for the autism is the reason that the C-section was needed in the first place.
4
My own observation is quite the opposite - many children are being exposed to undue Fetal distress during childbirth by normal delivery - studies have already shown the link between autism and hypoxia during childbirth. I think some stress is good but you can’t take a chance on prolonged or arrested labor.
I think this observational study is very unreliable.
Another observation is that the rate of Autism seems to be higher in developed countries - probably because parents are older in developed countries.
5
Articles like this cause more anxiety for new mothers. Many women have not elected to have c-sections, but they go on to mourn the birth that didn't go the way they wanted it to as if they somehow could have changed the course of things... And society views it that way, as well. I was asked several times when my son was a baby about why I decided to have a c-section. I never decided to have a c-section. Now we have something else to worry about.
7
This is a pretty weak study, and given that it's just one association and not causation--as the author of the article stresses repeatedly--I fail to see why the article was written and published in the first place, if not just to sow confusion and misinformation. Plenty of us have c-sections AFTER several hours of labor, not planning to do so but for emergency reasons, and we can elect to get our babies swabbed with our "flora" as soon as they are lifted out, as if they'd passed through. So a number of C-section infants have experienced labor and pushing contractions and have even received the mother's microbiome. Also, I'd like to know which countries were included in this study. Given that all hospital births in Mexico are scheduled c-sections, and have been for the past 50 years, does that country have higher autism-spectrum disorder rates? I, my spouse, and a number of my friends were delivered via Caesarian in the 1970s. None of us are on the spectrum or has ADHD. Has this correlation gone up in recent years for c-section babies, has it stayed the same over the past 50 years, and just how longitudinal is this study?
9
I just hate, hate, hate articles like this, or, more accurately, their headlines. - and yes, I read it, and understand they indicate this is correlation not causation, that there are a number of factors at play here, etc. etc.
But when it's you on the table having a c-section for any reason (breech, placenta privia, hypertension, preeclampsia) you shouldn't be lying there thinking "Oh great, I'm giving my baby autism."
Which I was, and, aside from the physical pain from the c-section, made my birth experience way more traumatic than it needed to be.
Not that it matters, but it appears my kid shows no signs of ASD, and to be clear, even if my child does, I will deal with it and embrace whatever the condition brings. But it isn't necessary to put more fear out there and barely established science.
9
Brazil has 55% of C-secction birth. I was born in Brazil with a C-section. I'm 65 now and all my family since my mother's generation (1930) were bring to this world with C-section. Even 2 months ago the newest member was delivered by C-section. Is 50% of Brazilian population autistic? I don't think so. I don't know the percentage of autistic children in Brazil, but it looks like the same percentage as over here in the US.
5
Reverse causality is a big risk here. On average children destined to develop autism might also need c sections more frequently. The existence of an “unmeasured confounder” ... a condition that causes both autism and need for c sections ... cannot be be controlled for in an observational study.
11
If we were able to provide equality of prenatal care to ALL mothers-to-be across the country and educate physicians/obstetricians, as well as expectant moms, on the risks associated with cesarean deliveries, we would be doing ALL of us as a country a big favor.
13
Rather than attacking the article for what it (doesn’t even) say, perhaps folks would do well to consider the fact that we really don’t know enough to say that there ISN’T causation. I totally get that association and causation are not interchangeable. But nor are they mutually exclusive. And the topic deserves further exploration.
There is interesting research being done in equine veterinary medicine which supports idea that the mechanical pressures of the birth canal seem to trigger (at least in horses) certain neurobiological changes that, when lacking, result in “dummy foal” syndrome...which shares important attributes with autism in humans.
Dr Madigan has found a way to largely reverse the autism-like condition in foals with a relatively simple approach of binding upon birth.
Rather than rejecting further scientific exploration because we’re too fragile to accept that there MAY be causation, why not explore it aggressively with an eye to figuring out (as Dr Madigan has) ways to overcome the potential negative effects of cesarean births...this in no way puts judgement on the necessity and righteousness of having a C-Section in many instances.
Google “Madigan Foal Squeeze” and read about it with an open mind.
20
@CattF We have limited time, money, and researchers. Their time and energy is better spent on things that actually have likelihood of being true, and a link between c-sections and autism is about as specious as a link between autism and vaccines.
5
@M
The fact is that nobody doing research on the causes of autism is taken seriously when they are investigating causes that people have control over.
Face it, people want it to be some external thing you you have no control over, like Down's syndrome.
In a similar way with vaccine schedules, the conversation on improving the vaccine schedule is totally overshadowed by people who cry "anti-vaxx!" and shut down a very important medical conversation about what the optimal vaccine schedule should be for people.
Sorry, but actual scientific truth doesn't bend to your feelings.
5
@M Any research on autism is useful because serious work in the area only started maybe 15 years ago, and meanwhile it's a situation that has increased, or at least come to increase notice, worldwide and affects people's lives. And actually many kids with autism have a family member with an auto-immune disease. So while one might scoff at the idea of vaccines causing autism, the ASD population may very well qualify to be recommended to not get vaccinated so early, so often or so heavily as most babies are now. But to do that you need to find ways to identify who is at risk. Or it could be the recommendation for all babies. That is not anti-vaccine, but it's an informed look at what's going on. Autism itself has been speculated to be a type of auto-immune response, and I get this from leading researchers in the field. Science should not stop because of one old fraudulent study, nor should broad conclusions be drawn.
I wonder if it's the C-section or the fact that it is planned and often in advance of a woman's set "due date". My 2nd delivery was induced. I was uncomfortable, huge, had had an 8lb baby the first time, and worried about how a labor beginning in the middle of the night would work with a 2 yr old and no nearby parents.
So, I was induced 1 day after my due date. It was still a long labor (1st was 24 hrs, this one was 12) due to again I have a posterior presentation delivery.
But this time, my baby was super sensitive to touch, had terrible colic, and was just a difficult baby. She also ended up being ADD (we didn't know then that all are actually ADHD).
I will go to my grave wondering if she just wasn't quite "done" in utero. So what If I'd been a week late? Would the results have been the same. Obviously, I'll never know but I will always suspect this was the reason. It might be the same for C-sections - not the surgery itself but that the baby wasn't quite ready to arrive.
18
Both mine were breech. Both scheduled c-sections. Both early before their appointed dates. Should I have told them to stay in utero after my water broke, badly? Life is what happens when you’re busy planning.
1
It's an interesting article. The topic merits further study, not hysteria, which makes the headline unfortunate.
There are a lot of risks with childbirth, and more knowledge helps us balance them appropriately.
I'm going with that instead of my own anecdotes, because even my anecdotal evidence is inconsistent.
9
Anyone who has taken and absorbed the lessons of a college-level statistics course realizes that this kind of article, while interesting, may cause readers unfamiliar with statistics to think this argument is casual.
I'm a proponent of the NY Times, but this kind of article fuels the type of misinformation that leads to people speaking out against the importance of vaccines and more.
I fully anticipate hearing about the casual nature of c-sections and kids being born with neurodevelopment issues over the near-term - when that has yet to be proved by one or more primary research studies (and not secondary research/observational studies). This is disappointing and possibly dangerous journalism, in my opinion.
21
And it speaks to the basic necessity of numeracy and the understanding of statistics in education. Really, statistics should not be an elective or a college course, but rather part of all math taught such that by the time students graduate they are able to read the paper and hear news about research with comprehension.
5
Even if folk lack the aptitude in or interest for mathematics- the theory should be taught, so they know how to read a graph and understand statistics even if they cannot or choose not to perform statistics.
3
@Garrett At least it starts the conversation, and people here anyway don't seem to be jumping to conclusions.
I've had 2 children both by c-section. Both are college graduates and have advanced degrees. This article is another scare tactic.
15
@Molly K.
And my husband and I are both products of mothers who had a daily martini and smoked a pack a day. I skipped 8th grade, and was in the top 5% of my h.s. graduating class; he graduated from Stuyvesant HS and went on to Wharton.
It doesn't change the fact that Fetal Alcohol Syndrome is a real thing.
53
My mother smoked during pregnancy as did my husband’s, and we both have asthma and autoimmune skin disorders.
8
Autoimmune disorders may be caused/fixed by diet. Read Plant Paradox. It fixed my husband’s vitiligo.
Has there ever been research into a connection between infant formula and autism? I had two c-sections, one emergent and one planned; neither of my sons developed autism (both are young adults now). I was fortunate to get the hang of breastfeeding, though it was incredibly challenging for the first six weeks with my first. Ultimately, I “exclusively” breast-fed (neither of my boys had formula), though both did have baby food introduced on a typical schedule (e.g., cereal at 4 months). Both are very average for weight, and no asthma nor diabetes. My first son walked at eight months, second son walked at 11 1/2 months. Oldest was in gifted programs and athletic, second one very athletic always, and currently a college athlete.
I hope I don’t seem to be using the article to brag, I hate when commenters use the space to blast their own horns. However, I chose to give details to offer encouragement to parents who have children by c-section. I think the pretext of the link between autism/ADD and c-section is absolute rubbish.
7
Dr. Klass , as a high school girl, I read your book Baby Doctor, and it inspired me to chase my dreams to medical school and beyond. As a practicing anesthesiologist, I’m appalled that you would write this article and give more visibility to one of the worst examples of implying causation from correlation that i have seen, on par with anti vaxxer propaganda. You have lost my respect.
21
As an epidemiologist, I can think of many confounders that may influence this “association,” but let’s remember that statistically significant and clinically significant are 2 entire different things. Clickbait headlines result in unnecessary fear mongering and medical mistrust.
25
Both my children were born by c-sectio about 35 years ago. I waited until I went into labor before the C-section was done. My son was losing oxygen and so an emergency surgery was done. My daughter was delivered by C-section because I had a prior Cesarean. Both children went to top universities and did not have any developmental problems. I believe waiting until labor started before doing the surgery helped avoid any problems re development.
1
Put simply the same factors that cause the need for a c-section may increase the likelihood of autism rather than the c-section causing the anomaly and that question has not, as the lead scientist says, has not been answered.
13
Exactly what I was thinking. That whatever went wrong with the labor or pregnancy that precipitated the c-section is more likely the cause of any neurological disorders.
6
@Julie I am deeply bothered by your language of "whatever went wrong" with the pregnancy or labor, as if having a breech baby--the reason for most c-sections in the US-- is something "wrong" or problematic. Did you know this? There are very few doctors in the US who will deliver a breech baby? This has been the way of things for at least 40 years, since I was delivered by c-section for the same reason (I'm not autistic or ADHD btw). Is there a correlation between breech babies and autism? I labored for 22h before we discovered my daughter was breech and sitting on the cord. The very necessary emergency caesarian saved both of our lives. Women's birth and labor stories are important and emotional narratives of their lives. The idea that something "went wrong" to cause an emergency c-section is absolutely offensive to mothers and to the birthing process itself.
2
@Mark Marks do you know what causes "the need for a c-section"? The number one reason for c-sections is the baby being breech. Midwives are not allowed to deliver breech babies and very few doctors are qualified to, or want to do this kind of delivery. I was breech and so was my daughter. We were both delivered by c-section (she in an emergency after a full day of labor; I was scheduled). Neither of us is on the spectrum or has ADHD. I want to suggest to you that "the need for a c-section" is not always a medically specific reason.
1
Trying to cause panic??
A 33% increase in risk of autism is not a 33% risk -but that's exactly how many people will (mis)understand the article. The overall risk is thought to be around 2.2%. A 33% increase would be about 2.9%.
Without including these facts in the article, the author is causing panic -even while warning against it.
25
Rather than the microbiome or the (absence!) of biomechanical forces during birth, I'd be looking at the narcosis. I'd start with a literature study on the relationship between having undergone general anesthesia during pregnancy/birth and the mentioned conditions.
6
The vast majority of women who have a c-section do so with a spinal or epidural analgesia, not general anesthesia.
15
@Frank This is also why this study seems too vague and/or bogus. No one uses general for c-sections any more, but they did 40 years ago. Are they studying c-section births from 40 years ago (my own generation) for these disorders, or are they only studying recent births? Is it the same correlation for c-sections from my generation, as for those today? The microbiome issue is also not clear, since you can elect to have your baby swabbed with flora from your birth canal if your plan is natural birth but you end up needing an emergency c-section. I think you might even be able to elect for swabbing with a scheduled c-section.
As the mother of an autistic child, I find the headline of this article reckless. The information therein, while interesting, does not lend itself to the alarmism the headline communicates. I’d expect a headline like this on fox, not the nyt.
44
I had to have c section, and my kid is a brainiac and healthy adult! Please don’t use scaremongering and making women feel inferior that they had a c section. Seriously a c section or both mother and baby would have died! So NYTimes you need to stop the clickbait.
27
@Oh My Did you read the article? To quote the last line, “Women shouldn’t be hesitant about cesarean sections when they are medically indicated,” and that was a point they made several times. Also from the last paragraph, “Association doesn’t mean causation; we can’t say cesarean section is causing this,” again a point they raised several times. But even if cesarean birth does cause the increase in autism and ADD, saying that there is a 33% or 17% percent increase in the risk is far from saying that children born through cesarean WILL have autism or ADD. An increase in the risk is very far from a certainty.
13
@Oh My I absolutely agree. This article should not have been published, with such limited and vague information in the study.
2
@Oh My and in the converse, my autistic son was delivered vaginally, so I agree, this could be troublesome
2
My ex had three c-sections and all of her kids, including one of mine, turned out just fine. Well, they're all kind of weird emo millennials, but fine despite that. :D
11
To those who felt this article shouldn’t have been published, I would say that it will possibly be a front page scare headline on tabloids.
The Times presumably tries to provide a clearer statement than the tabloids.
BUT, this is a “scary” topic and most folks are not familiar with the use of such exploratory studies to seek “signals” warranting (costly and difficult) controlled investigations.
So, the responses from many commenters is understandable.
3
Terrible headline, New York Times. As you note - the pregnancy itself could have complications and therefore be the cause of neurological issues. Why choose a headline like that to scare parents further and make those who did get c-sections feel guilty?
12
If we think about one of the most common reasons for cesarean sections - breech presentations - I think it makes a lot of sense to wonder whether a baby who has presented as breech already has potential atypical neurological tendencies. Certainly that's the argument of the Dutch neurobiologist Dick Swaab.
I would like to see the causes for the c-sections broken down much more in this study.
20
My daughter was born via planned c-section because of breech presentation. She failed to hit her milestones as an infant. We discovered when she was 8 months old that she has a rare chromosomal anomaly. She is now 4 and we have just received a provisional autism diagnosis. My husband was very concerned before she was born that her breech presentation meant something. We were assured it did not. I thank you for your comment because when I read these articles I still feel guilt about having a c-section even though I KNOW it was the right thing to do and that it is likely her neurological deficits that made the surgery necessary. And yet.
@Amber That's kind of scary--lots of babies present as breech and then flip around before delivery and before labor. But breech presentation is the reason for c-sections because doctors are not trained to deliver them, not because it is a problem for either baby or mother (other than an uncomfortable one that leads to back labor and possible cord risks). I and my daughter were both breech and c-sections. Off the charts intelligence, no spectrum disorders, socially well adjusted, etc. (Not to brag, but I'm very proud of how bright and precocious she is--bilingual and spelling in two languages at age 3). We were also both fed a mixture of BM and formula too, and we turned out just fine. Same with my husband, same with my best friend. Judging by the number of people and kids I know who were breech and c-section delivered alone, I'd say I see a strong correlation between breech/c-section and superior intellectual ability and charm!
@Jennifer
Jennifer, read: We Are Our Brains: From the Womb to Alzheimer’s, by Dick Swaab (published in the UK by Penguin). This is his hypothesis and I found it provoking when thinking about my own experience and that of our son. Clearly much more research needs to be done but the idea of atypical behaviours already present at the time of birth, behaviours in the baby that may work to make a vaginal delivery more challenging is worth exploring, I think.
About the clickbait accusations, if “Exploring a possible link between C-section and autism” is clickbait, I don’t know how the subeditor or author could have made it better. Maybe, “Um, it’s probably nothing, but you know, there is a vague correlation between method of delivering babies and, you know, stuff. But it’s irrelevant and boring”?
9
50 years ago my mother in law had two emergency c-sections in a three year span: one for my husband, who graduated top of his class at an Ivy League school and is now an esteemed professor of computer science, and another for his younger brother, who is now one of the leading hand surgeons in the world. My daughter and I would have died without a c-section intervention. I hope couples who need c-sections will not forgo necessary medical treatment after reading articles like this one (look what happened when it was suggested VACCINES caused autism...) While it’s true that the gut biome is different for babies who don’t pass through the birth canal, something as simple as a swab can transfer the mother’s healthy bacteria to her child. Yesterday the click bait article was something along the lines of “how to have a threesome.” Come on, NYT.
P.s. my c-section recovery was infinitely easier than that of my son’s natural birth, in which I suffered a 4th degree tear (basically a natural c-section). It took me months to be able to walk again comfortably; a few days after the c-section, I was good to go. Please, if you haven’t lived it, don’t judge.
20
Here we go. Can’t wait for Jenny McCarthy et al. to chime in on this one!
6
Correlation is not causation. We know that autism is a developmental disorder, which begins before birth.
14
I generally like this column, but this was a miss. This is an attention grabbing article, with little substance. It serves to add stress and consternation to parents and those expecting.
10
Maybe . But their heads are perfect upon arrival .
2
@GW: A neonate's skull is perfectly formed for its passage through the birth canal, and it behaves exactly as it should. Nature is amazing.
4
I see that most of the "what women should be doing" advice are coming from ... men(?)
paging Dr. Jen to this article.
8
“Association doesn’t mean causation; we can’t say cesarean section is causing this,”.... This should be in the first and not last paragraph. Frightening headlines are not what prospective mothers and mothers of young children need.
13
@Zoned, I think the first paragraph should state that the increase in incidence of autism went from 2.2% to 2.9%.
Saying an increase of 33% makes it sound like the risk is just that, when it's much closer to a 10th of that.
10
It was very clearly stated in the third and last paragraphs. The author made that quite clear throughout the article.
1
This is how we got the anti-vax epidemic: mainstream media fear-mongering using papers that show associations. By the time the definitive studies were done that demonstrated vaccines NEVER caused autism, the damage could not be undone.
You would think The New York Times would have learned from that debacle. Apparently not.
14
@Amy Tuteur, MD I am always glad to see your name! You're a voice of common sense amid the pseudoscientific natural-birth-and-mothering hysteria.
3
This is how we got the anti-vax epidemic: mainstream media fear-mongering using papers that show associations. By the time the definitive studies were done that demonstrated vaccines NEVER caused autism, the damage could not be undone.
You would think The New York Times would have learned from that debacle. Apparently not.
6
This was a meta analysis, meaning it combined 61 different studies. There is about zero possibility that the controlled variables were uniform across all of them.
Correlation is NOT the same as causation. There is about zero probability that the variables were uniformly controlled in 61 different studies. In essence, this tells us nothing.
15
@uwteacher I agree with you.
Anyone who has taken and absorbed the lessons of a college-level statistics course realizes that this kind of article, while interesting, may cause readers unfamiliar with statistics to think this argument is casual.
I'm a proponent of the NY Times, but this kind of article fuels the type of misinformation that leads to people speaking out against the importance of vaccines and beyond.
I fully anticipate hearing about the casual nature of c-sections and kids being born with neurodevelopment issues over the near-term when that has yet to be proved by one or more primary research studies (and not secondary research/observational studies). This is disappointing and possibly dangerous journalism, in my opinion.
3
The study discussed in this article looked at 20 million births in order to identify associations between C-sections and autism. The 33% correlation is just humongous.
The real question is, why in the world would we NOT conclude that an intervention as radical as a C-section could have important ,
probably adverse , consequences for the baby? Women must absolutely be made aware of the risks involved in this procedure.
There's absolutely no way all of these C-sections were medically necessary.
Now the task is to identify and alleviate the factors that are really driving this hurtful medical malpractice trend.
12
So many uncontrollable correlations: High functioning autistic parents, themselves, scheduling births between high functioning activities; anxious slightly autistic mother scheduling birth over natural birth; richer older parents more likely to have autistic children and also more likely to have c-sections.
5
@scoentella: I want to be sure I understand. Why can’t we control for these factors? Does it just make the study too large or expensive?
1
@Heliotrophic
This was a meta analysis, meaning it combined 61 different studies. There is about zero possibility that the controlled variables were uniform across all of them. It a relatively inexpensive way to do a study. It is also not really all that informative due to the lack of controlled variables.
6
@uwteacher: Thanks. So it's not that it's intrinsically impossible to control for these things, but just that it probably wasn't done here, it sounds like.
Contrary to what the alarmist headline implies, from reading the article, there appears to be NO evidence that cesareans cause autism. Rather, the more reasonable explanation is buried in the article: medical issues that lead to cesareans also have a higher risk of neuro-developmental problems.
For example, most emergency cesareans are performed when a fetal heart monitor indicates that the baby is in distress due to lack of oxygen. We know that hypoxia (oxygen deprivation) during birth can cause devastating brain damage to a baby, but perhaps even a short period of diminished oxygen could have subtle effects that manifest as autism.
Correlation/causation errors are rife in medical reporting. A few years ago, a study reported that underweight people have higher risk of death than overweight people, but this was later debunked on the ground that very sick people are more likely to be underweight than healthy people.
Another famous study several decades ago claimed that wearing bras causes breast cancer. In fact, women with larger breasts are both more likely to get breast cancer and less likely to go bra-less than small breasted women. Also, the type of women who adopt a bra-less lifestyle may also tend to be healthier in other ways, such as being vegetarian or eating more organic food.
13
Autism is also (and more closely) correlated with "old" sperm, and thus an indirect side-effect of Viagra. Research on this possible cause has not and likely will not get much research--for obvious reasons
13
Despite the article's highly speculative attempt to link the microbiome difference between vaginal and Caesarean delivery to autism, it is really hard to imagine a causal link there based on what we currently know about the causes of autism, just as there is no plausible mechanism to explain why vaccinations could cause autism. As far as I am aware there is no evidence for a connection between childhood microbiome and the development of autism spectrum disorders. If deficient microbiomes don't correlate to autism development generally, why would the impact of exposure to different microbes during different birth modalities? Sounds like the authors are planting the seed for the next anti vax style movement.
3
I mostly read the scientific article. Sloppy to use the word "association" in my opinion when (because of the nature of this type of metadata study) they have no information about factors that are correlated with increased chance of c-section e.g. maternal or paternal age at birth (which studies have also found to be correlated with increased risk of autism), maternal weight at birth, etc. Essentially the "association" seen could be the result of an underlying factor that was not even measured or examined in this study, not the mode of birth.
These studies are fast data grabs that examine few factors but get big headlines. Moral of this story: we don't know very much about csection consequences, except that for those women and babies that need them, they save lives!
5
But couldn't it be the opposite--babies that have proclivity to those illnesses before labor starts for some reason can't go through the normal birth process? (In some cases obviously it's different.)
4
I am an avid reader of this paper but I have noticed a tendency toward publishing alarmist articles--or alarmist headlines-- designed to draw in fearful parents, looking to blame themselves for their children's difficulties. It seems much too early to be drawing any kind of line between Cesareans and autism as clearly the researchers involved don't yet understand what their findings mean. It seems as if the more responsible article is about cesareans themselves and the cultural, medical, and personal decisions behind their still quite high rate.
16
@Susan If one wants to look at the "why" it is never too early to look at the patterns, associations, data points and begin making hypotheses and researching the maybes. That kind of inquiry is needed to move forward. Association have to be examined before proven. Getting attention to an issue is what the media does so I think we can expect headlines that draw attention - it's part of the job.
11
@redplanet
Yes, but nowadays all of that takes a back seat to people's feelings.
If people feel bad being told about the dangers of X, catering to their feelings is more important than dealing with that controllable danger.
7
@Susan, my daughter is on the autism spectrum (high-functioning) and has ADHD. And she was born by cesarean. This article certainly doesn’t make me blame myself. My C-section was medically necessary for 3 different reasons, including full placenta previa and prior uterine surgery. Had I not had a C-section, my daughter and I would likely have both died. Instead I have a beautiful, creative, and brilliant child who, yes, has social and emotional challenges, but who makes the world a better place. This research, while far from conclusive, seems to me useful in suggesting that more research into the link between gut fauna and autism is warranted. And perhaps such research could have the practical and beneficial outcome of finding a way to effectively introduce this beneficial fauna to cesarean-born newborns. Such research also strengthens the effort to reduce unnecessary cesareans, and helps to discredit the quack “science” behind truly harmful causal claims, like the bogus link with vaccines.
10
I work as a nurse with young nurses having quite a lot of babies. I am always amazed that practically everyone of them ends up having a C-section. Not one of them has ever been allowed to just go into labour and deliver naturally. They are all induced, for a large variety of reasons and end up with a C-section. I have no idea what the C-section rate is nowadays, but it seems very, very high.
17
@mollie
It's in the article. "In 2017, the overall rate was 32 percent"
2
@mollie
I also keep seeing young, healthy women I know have C sections. Many of them want to have a natural birth, but somehow they all end up in the OR. I wonder about it too.
7
Surprise surprise, another downside to the medical establishment's paternalism and fear of legal liability.
Mother Nature seems to know best here.
14
@Beckett: Perhaps you should ask someone more medically knowledgeable about how many mothers and babies used to die during delivery. No need to “throw the baby out with the bathwater” and go back to a world of preventable maternal-fetal deaths.
7
@Beckett, the number of women and babies whom Mother Nature used to kill has actually declined greatly through medical advances.
7
It is very likely that the direction of causality goes the other way than the headline states: Autism (first) is associated with Caesarian section (second), because Autism is also associated with large head circumference and different brain development. If this is true the association would be present for emergency Caesarians but maybe less for elective Caesarians, it would be good to check this in further research.
14
@Duncan
Agreed, given the variation in Caesarean rates around the country and internationally it should be possible to identify whether autism correlates more strongly with surgery in areas where there is less elective surgery.
1
The article noted that the increased occurrence of autism applied to both planned and emergency C sections.
2
While the percentage difference in autism after Caesarean vs. vaginal birth is discussed, the absolute numbers are nowhere given. The rate in subsequent autism might be 100% higher in one over the other, for example, but if the total number of cases of autism is tiny, the difference would still be tiny. Isn't it the case that regardless of method of delivery, vaginal or Caesarean, the percentage of cases of autism is low? This article doesn't say!
7
@Eliot: In case you missed it, there’s a link to the study at the top of the second paragraph.
3
Gosh, causation is certainly not correlation. I have two high functioning autistic kids and had natural births with both. Prenatal health excellent, nutrition, excellent. Perhaps what you are seeing with the uptick of autistic children, is the grouping together of folks who might be predisposed towards autism. At least when I meet engineers, both men and women, most of them seem suspiciously autistic and socially awkward. And they tend to gravitate towards each other, having found a common ground to converse about, and then they have babies....Cesareans, may be a red herring in this case....
10
@ Meena: I thought the “correlation is not causation” discussion in this article was pretty good. Didn’t you?
5
@Meena - Of all of the possible causes of autism, your idea makes the most sense to me.
1
Natural birth, breast feeding, and mom at home with baby are best.
4
Actually sociologists now know that the highest possible number of adult humans around the child is the best form of support and mirroring.
A village.
9
Yes. All of which I desperately wanted and tried to do. When I failed to produce enough milk and introduced formula (alongside breastfeeding), my son, age 4 weeks, FINALLY regained his birthweight. However, formula is like poison and so my son was taken into care.
As we know here in the UK, it is impossible to love a child and not produce enough milk and not successfully breastfeed. Perhaps we should also remove children born via c-section.
1
@Stevie Nope. Fed is best. And it's the mother's choice. Please don't perpetuate the myth/ideal that led to months of postpartum depression and obsession with feeding my baby only BM when I couldn't produce enough milk. Or the PPD from having to have an emergency c-section after planning a natural birth. My kid is fine and off-the-charts intelligent and well adjusted (and so am I, another c-section and formula-supplemented baby). I worry that articles like these will only serve to perpetuate more ppd and mom-guilt. Let's support each other instead of imposing impossible ideals.
2
Cesarean section births are more common in higher maternal ages. Autism is also more common for children of older mothers. Without controlling for maternal age, I think this meta-study is embarrassingly incomplete.
12
@Justin Koenig Any decent correlational study should automatically include control variables such as material age. The article does not say what controls were used. So, don't condemn the authors for their conclusions until you read the original article.
6
@Justin Koenig Recent research indicates that autism is also more common for children of older fathers. Maybe as another poster suggested, it is autism that comes first requiring a c-section for medical reasons relating to the autism. Obviously more research needs to be done. We should probably trust nature and only do c-sections when medically advised, not just to fit in with a doctor's or patient's schedule.
11
C-section as a by-product of the medico-legal environment? Legal=medical insurers defense counsel. A couple of good-the doctor insisted on it before his/her weekend lawsuits and it caused autism, etc-will end the legal and insurance company driven preference for “safer” c-sections preference
2
One must be very careful here to avoid "Post hoc ergo propter hoc" reasoning. The likelihood is that many of the C sections were done for fetal distress. Either the distress (such as anoxia) or (more likely) developmental neurological problems with the fetus caused the distress and contributed to neurological dysfunction in the child.
5
I agree that Cesarean section births should not be promoted for either the mother's or doctor's convenience. However, this article offers such a limited scope of the association between autism, ADD and cesarian section births it appalls me! Although the article admits that when necessary cesarean deliveries are important and life saving operations, the main thesis of the article would "induce" any woman who had one feel extreme worry and guilt. After 26 hours of labor my daughter-in-law was instructed that she had to have a cesarean for the health of the baby and because she was too exhausted to continue. She was devastated as she wanted a vaginal birth. Because of this and preeclampsia complications, she was told her second child should be a cesarian birth also. Her first born, my grandson, is super high functioning, but on the spectrum. Her second child, my granddaughter, is not. How about the possibility that one of the reasons her first born was not able to be born vaginally no matter how hard and long she pushed was because of some other factor in his DNA or make up, that was connected to his autism rather than assuming it was the cesarian? I think this narrow "observational study" proves that you can prove anything you want with a study - especially once you decide what the outcome of the study should be. And no baselines in the article! Shame on you Perri Kloss, M.D. You owe the women who had a cesarian an apology at the very least.
3
@ Elizabeth Sher: We must have read different articles. I read one in which Dr. Kloss thoroughly discussed what additional issues need to be studied and strongly encouraged medically necessary c-sections in situations like your daughter’s.
10
And who holds the power when there is a blip on the fetal monitor? The doc who says the c-section is "necessary" just in case or the mother who has been effectively threatened with her child's supposed imminent harm? C-sections are quick and easy. Labor and vaginal deliveries are usually slow and challlenging. I would advise women to get their care from certified nurse midwives if they are looking for competent and honest care.
12
Both of my children were delivered via c-section and both are identified as gifted learners by their school district, but since that's not a medical diagnosis I guess we can't analyze the % of gifted learners by delivery methods? I think it's absurd to connect birth delivery with autism.
And can we please move beyond telling women what's best for them and that there's one best way for them to do everything. Breast feeding over bottle, vaginal deliveries over c-section, MOM spending time with baby (as opposed to Dad? Grandparents?) Always organic, all the time. No plastics, how about cloth diapers over disposable? Come on! There are lots of fine ways to achieve many good outcomes. Stop the judging!
And for anyone negatively affected by the judgments: I bottle fed my kids, one strictly formula from birth. We're totally bonded, and he's bright, funny and healthy - fwiw.
11
This statement is what stood out for me:
“.....the research is ........ constrained by the comparatively scanty research funding allocated to pregnant women and children.”
This is a problem.
29
I checked out the limitations they listed, many studies they used did not include indicators for the mothers. This is big, they readily admit the possibility of many potential confounders. The other issue I have is the possibility here of publication bias for the studies they examined... those with significant relationships tend to get published more. I can't help but think some p-hacking is going on here. Irresponsible in my opinion, especially after the whole vaccine-autism fiasco. PhDs who want a headline with their name? I hope not.
3
How’s about the media stop acting like Autism is a death sentence for one day?
It would be great.
Some kids are autistic. So what? It does not mean they can’t live fulfilling lives. Disabled and neurologically diverse lives are just as valuable as the lives of everyone else.
12
I’m deeply grateful for my Asperger’s. My wife was attracted to the autistic traits in our courting (before we knew I was ASD). It makes me an uncompromising individual. It gives me a gifted mind that allows me to quickly find and process information. It gives me a well of feeling wherein music and art can reach deeper than in others, I can only assume.
The one drawback is the way my traits seemed to multiply under the stress of having my own kids. My tank runs on fumes a lot of the time so it requires a lot of support and understanding from my wife. Other drawbacks include a lower tolerance for smells, dust, disorganized noise....but all these things are navigable because I now know I’m ASD. So when I get triggered at Costco, I know there’s nothing wrong with dancing in a pair of headphones in the aisles. Seems to clear out the other humans.
7
@Austin W
The difference is that you're functioning, and lucky enough to have found people to love you and accept you.
Many people don't have that support system, and find it extremely difficult to get. Just ask any person with a health issue where it's not as easy to say it makes you a richer person.
Talk to women who have been dumped when they got breast cancer. Talk to men who have been dumped when they got testicular cancer.
4
I still disagree. Even more pronounced forms of autism are not comparable to cancer.
Information continues to grow about how to support ASD. Many of the struggles of raising someone on the spectrum result from ignorance of it. Treating ASD symptoms as bad and incoherent increases the difficulty. When people look at at ASD traits through the lens of “what is he or she trying to tell me?” the solutions become clearer.
I recommend the book “Uniquely Human” by Barry Prizant. It explores how people on the spectrum are basically like anyone else, and how following and valuing the apparently meaningless behavior of autistic children is actually a roadmap for improving conditions for neurotypical people.
1
Natural birth, breast feed, mommy stays home until baby in school. Works every time.
2
@Stevie: EVERY time? Do you mean that all of those women who died in childbirth or had stillbirths, or whose children died of various diseases in childhood were made up throughout history in some kind of long-running conspiracy? Wow.
9
@Stevie, how many times have you given birth vaginally, breast fed, and stayed home until your child or children went to school?
8
Works for WHAT?
Works to feed a family when there isn’t another breadwinner?
Works to feed a baby when there’s a cleft palate?
Works when there’s a placenta previa?
Works when there’s no paid parental leave? Works when a woman is the partner in the family with the education and training to earn a living?
Works to make every family the same?
Works for you?
4
And here we go again. Beating up on mothers who may have made choices to medically intervene when that was a necessity. It never gets old, does it?
8
@AMM
No one is beating up anybody. Part of the issue is when there was NO medical necessity and cesareans were done.
6
@AMM. What article are you referring to? Certainly not the one published in the NYTimes just now. There was not even a hint of "beating up". This kind of knee-jerk reaction shouldn't get in the way of good, honest research.
5
A C-section should be performed to save the life of the Mother or baby -- not to convenience the doctor or the Mother's schedule, as as happened in the past.
10
Older fathers. Men have important gaps, in the DNA sequencing, in their sperm chains, after the age of 35. The autism explosion is because everyone waits until they are geriatric (in pregnancy terms) to become pregnant.
Childbearing is for the young.
Society must adjust and accommodate and support young folk having children or expect the autism epidemic to continue apace.
8
There’s a wonderful history of autism written by Steve Silberman, called Neurotribes. In it he explains that there was never an epidemic, just a change in the DSM 3 to allow for the definition of autism to include people who were not mute.
But nobody seems to want to let go of this sense of epidemic. I’ve heard it’s from c sections, old sperm, old moms, having a cold in your first trimester, epidurals, vaccines, computer dating. But statistically there’s the same amount of autistic people as there ever were. They’ve mapped the human genome and still can’t find where the autism lies. Maybe we’ve always been here and we aren’t going anywhere. Maybe you could learn to love us as we are.
1
Me? I can certainly love you as you are!
Sending it now!
I have never met an unpleasant autistic person- those of my acquaintance are extraordinarily rewarding to converse with, this is particularly valuable now that many young folk are glued to their phones!
My quarrel is with the lack of support for childcare and child welfare and respect for mothers- not an easy job and yet we all owe our lives to some woman somewhere who gave up her bodily autonomy while we all grew a brain stem and four limbs! Go give the lady a hug! And a mother’s pension!
1
I don’t think this study was worth covering in the popular press. As the article points out, there is nothing here but an association; no causation has been proven. So, there is no real actionable information for the public here, just potential worry and guilt. Why not cover one of the many proven interventions (like reading to your kid) that improve outcomes for children instead?
21
@E: My guess is that it’s because scientific studies are interesting and some of us enjoy reading about them? Also, those who don’t definitely can find something else to read on the internet.
8
Another 'study' that may or not bear fruit. As a medical worker, what I have seen is that very few babies are breast fed. I do not see how this study would be com_lete without factoring this in their equation (sorry, my keyboard has lost the key for the letter between o and q)
7
@TenToes both my son and my brother were born vaginally and breast fed, and both are on the spectrum. My cousin was born via c-section and breast fed and is also on the spectrum. Our grandmother? Very likely the same. Family history matters.
16
@Multimodalmama you are absolutely right. The fact is that no one is yet certain about what causes autism. I did not mean to im_ly that breast feeding and/or c-section (or lack of )are contributors to autism. There is a wide range on the"s_ectrum. I won't go into all of the theories, but one I know is that is not the _arents fault. They have found some genetic markers, but that research is not yet enough develo_ed to finding a single gene or chromosone (s_). One thing I do know is that _eole on the s_ectrum. may be different than "neuronormative" but what I have seen is a vast range of children who are wonderful, talented, and an absolute gift.
2
@Multimodalmama you are absolutely right. The fact is that no one is yet certain about what causes autism. I did not mean to im_ly that breast feeding and/or c-section (or lack of )are contributors to autism. There is a wide range on the"s_ectrum. I won't go into all of the theories, but one I know is that is not the _arents fault. They have found some genetic markers, but that research is not yet enough develo_ed to finding a single gene or chromosone (s_). One thing I do know is that _eole in general do not understand autism ths_ectrum. may be different than "neuronormative" but what I You are also correct that there is indeed a familial connection, as you have seen in your family.have seen is a vast range of children who are wonderful, talented, and and gifted.
1
I don’t know if it’s c-sections, vaccines or something in our food or water, but something is very wrong, and getting wronger.
The number of children diagnosed with ASD has and is still growing at an alarming exponential rate.
In the 1950s it was estimated that 1 in 25,000 children was diagnosed with Autism.
In 1970s and 1980s, about one in 2,500 children was diagnosed with ASD.
In 2000, the US Centre for Disease Control (CDC) reported that the prevalence of ASD had reached 1 in 150 children.
In 2004 this figure had reached 1 in 125 children
In 2006 The figure was one in 110 children
In 2008 this figure reached 1 in 88, based on the CDC’s ADDM network of 14 monitoring areas across the US. These ranged from 1 in 208 in under-populated states to one in 47 in populated eastern states.
In March 2013, the US National Health Statistics Report indicated that 1 in 50 children across the US were diagnosed with ASD. In populated US cities this is already 1 in 27 children.
If one extrapolates the trend from these figures, we could easily be looking at a 5% incidence in Autism by 2020. That is one child in every 20 children across the US having a diagnosis of ASD by 2020.
8
@New World The change in stats that you cited could simply be due to an increase in diagnosis, due to better access to health care, more vigilance on parents' and physicians', to symptoms. This study just show a simple correlation and if you read their paper, which is open access, the authors themselves contend that there are unaccounted confounding variables to this study. For example, just due to the limitation of the data available, they have zero data for several factors, such as maternal age, reasons for proceeding to c-section, familial autism scores, etc. All of these factors are important for a complete and comprehensive study.
Most importantly, please do not attribute autism to vaccines. The last thing we need in trying to protect humanity and especially our younger generations is fear-mongering. Vaccines do not lead to autism; vaccines protect against numerous debilitating and potentially fatal conditions for the young and the old. If you want to attribute to these diagnostic differences in autism to microbiome, which is currently under heavy legitimate scientific investigation, fine, but please do not spread the anti-vaccination message in any sort of manner, cavalier or not.
31
@CW the increase in diagnosis hypothesis is absurd. I am the parent of a very high functioning adult with autism and within five minutes of meeting him you know he has autism. It's not something that would ever go un-diagnosed. There were not waves of people in the past with autism who just happened to "pass" as neurotypical.
My son is 24, when he was diagnosed with autism at 2 - everyone I met said "what's that?" It was a rare disorder that has proliferated in the last 25 years. And while I don't think vaccines are the cause, something is, something somewhere shifted in our environment or genetics to predispose subsequent generations to autism.
The first response to anyone even noticing the increase in autism is to panic about it leading to anti-vax sentiment. The surest way to silence anti-vax sentiments would be to find the actual causation factors behind autism - and that requires acknowledging the realities, including it's alarming increase. Downplaying a reality because of fear that people will make assumptions about vaccines will only reinforce the paranoia that leads to anti-vax ideology.
In reference to this article, anecdotally, I can report a natural birth - no c-section.
7
@Megan
It's actually not absurd at all. Plenty of people have different manifestations, and some have even been "cured" over time with therapy and diet changes and lifestyle changes.
Yes there are some cases where it's immediately evident. But plenty aren't that obvious.
6
The correlation might also be in the opposite direction. I have a son with severe autism. I did have a c-section. He had a head circumference that was above the 99th percentile. Correlations between enlarged head circumferences and autism have been found in the past. Also note: he was 10 lbs, 12 oz. at birth; I was 5' 2" and 125 lbs at the time. The c-section probably had no role in triggering his autism; his autism may have contributed to the need for the c-section.
35
Interesting. I have Asperger’s. My head is quite large and I was a big baby at 9.5 lbs.
3
I feel like some of the commenters have taken this article way too personally and subsequently missed the point of these kinds of studies: to get at possible factors that medicine can control or adjust for in the case of a situation such as a medically-needed caesarean. If the studies that are to follow from this can more definitively get at the role of the mother’s microbiome in her baby’s early development, there may be ways for doctors to mitigate the lack of natural birth to prevent certain developmental conditions, or even just make them less likely.
It’s not about what way you birthed your baby: it’s about all the ways to ensure they’re healthy. And yes, I understand that there are many healthy kids out there who happen to be on the spectrum...but I don’t know many prospective parents who would willingly roll the dice on having a developmentally-challenged child—knowing the condition could be severe, or not, but that’s not within your control—if they thought there could be a way to prevent it. We don’t go out of our way to eat poorly or do things that might affect our babies in utero for that very reason.
16
The word autism is so much in vogue right now, researchers are scambling to include it in their titles, to obtain more grant money.
Indeed there are many respected researchers with long careers in autism and other such conditions who are alarmed to see the recent trend of linking autism to ANYTHING.
I have a great chart showing the correlation between the rise of autism and the use of bio foods. Just to show how ridiculous these 'studies' can get. You can correlate just about anything.
My son is autistic. I know the stats well. There is a significant higher percentage of premature babies which grow up to develop the condition. Research is finding there is a genetic link but also clearly an environmental one. Having their small, fragile brains develop outside the womb seems to be a factor. I think a link to c sections would be significant only to reflect the reasons behind the c section, like a difficult pregnancy etc.
But we really must take all these meta studies with a grain of salt.
9
@Rose I'm sure your chart is nice, but you also miss a bigger point: autism has been with us longer than we have had a name for it. Some of my relatives were only properly diagnosed with Asperger Syndrome in their 20s. My grandmother was never identified as anything but "what is wrong with her?" when she was clearly on that spectrum, too. Having a name for something helps count the cases. Having an inflexible Taylorized society leads people to seek ways to help their kids. The two combine in a statistical phenomenon that may not reflect actual reality ... just like your "biofoods" table likely does.
4
Many C-sections are only performed after long and difficult labor. It should be studied whether extended laboring itself (in hopes of a natural birth) is causing the increased risk in ASD/ADHD.
30
@RCP But a great many natural births also include extended laboring, probably many more than those which result in a cesarean section. It may be worth studying long labors vs. short labors primarily in order to shape hospital policies around inducement, but it relatively rare that a cesarean is ordered solely based on long labor without any other indication. It is much more common for the intervention to be increased pitocin or vacuum/forceps.
2
My son received intravenous antibiotics for 48 hours after a vaginal birth (to treat anomalous fever at birth). He suffered food allergies in infancy and early childhood; still suffers moderate to severe eczema; and was diagnosed ADHD at age 11. I have always wondered if there is an association between these health issues and the depletion of microbes that might have resulted from the antibiotics at birth. This study of the possible connection between caesarean birth and health makes me wish that someone would do the same investigation of early antibiotic treatment.
22
NICU RN for 36 years, it's not the IV antibiotics, but very likely the reason for the premature or C-section birth - infection, fetal hypoxia, blood pressure, etc. That and maybe a genetic predisposition.
3
@Susanna
As a childbirth educator, author and researcher I can tell you that the need for antibiotics is more likely what caused his many problems. I call it Chicken or Egg Childbirth - what came first? In his textbook,
Volpe's Neurology of the Newborn, Dr. Volpe, writes that the preinatal strokes are on the rise. Although he is not an obstetrician ( or perhaps because he is not one) he suggests changes in obstetrics, such as vacuums and long second stage labor, In any event, maybe have your son get an MRI to ascertain what and where he was affected as a fetus/newborn,
2
I take issue with the line "Cesarean birth also means that babies are not exposed to the same mechanical forces and maternal stress hormones during labor." It should state that in some cases babies are not exposed to the same forces and stress hormones that happen during labor. Sometimes c-sections are used after a prolonged labor that does not lead to delivery. I was in labor for 44 hours before by daughter was born by c-section because she was sunny side up and refused to budge. Don't tell me she wasn't exposed to any "mechanical forces" or "maternal stress hormones" associated with labor!
26
@Lindsay Good point. And as you show in your comment this can be used in future when we have even larger numbers to help tease out which of the possible correlates of c section are most associated with developmental disorders. For example, if children born with c section after prolonged labor show less developmental problems, that could point toward the mechanical stress as important in the better outcomes after labor delivery.
11
@Lindsay
You are correct. Statistics show a definite difference between those born by elective ( no stress) C Section . On the other hand, being pummeled by contractions while facing up - instead of down - places pressure on the prefrontal cortex, etc. Babies were not meant to be banged on that part of their brains. Statistics show higher rates of brain injury in sunny side up babies. Fortunately, with help of a sonogram such babies can often be 'exercises' to turn long before labor begins. I speak from personal experience.
I am referring to the so called, "Marilus MANEUVERS" - .
3
As a retired developmental psychologist, any study reporting correlational data that invites a casual link sends my head automatically seeking alternate hypotheses. As far as I know, the only systematic factor associated with autism is heredity--though that leaves most unexplained. Since the real base rate has gone up a bit, some environmental change likely is involved. All the bad things--poverty, ignorance, obesity, health care, environmental quality, etc. tend to be correlated, so picking what is critical is tough. This study plausibly adds to our list of possible factors. Sorting out the biological differences of C-section vs. vaginal delivery from the maternal factors associated with C-sections will be a challenge.
9
@rawebb1
If you're actually a developmental psychologist you know that the vast majority of studies are reporting on correlations.
If people with your line of thinking were allowed to oversee the statistical integrity of any published study, 90% of journals and papers would cease to exist.
1
As another commentator noted, the article should state the baseline that the "33%" increase in risk of autism refers to. Some other clarifications should also be included. First, an association is not a risk, and you should not immediately shift into describing the association as a risk.
Second, you should describe what confounders (if any) the study accounted for. The obvious layman's response to this article is maybe some of the problems that lead to c-sections also contribute to autism, and causality runs in the opposite direction from what the article implies. Did the study consider that?
Finally, if you're going to talk about numbers and risk and the overuse of c-sections, you should also talk about the risk of not having c-sections where they're medically indicated, and the dangers of inducing an anti-c-section panic over autism fears. We are now experiencing a measles epidemic because of anti-vaccine panic. As someone whose baby would have died without a section, I would not want to see ill-informed discussion of this subject take over. I think it's irresponsible to describe this research without far more qualifiers than the article contains.
25
@John A. Quite. My understanding is that c-section deliveries are more common in older mothers, and that this is also a risk factor for autism. I wonder too about the socioeconomic factors at play - aren't autism diagnoses more common in affluent areas?
5
@Katrina I believe all of the things you have discussed are in fact correlated with Advanced Maternal Age (AMA). Autism risk increases with AMA and possibly Advanced Paternal Age. Affluent areas tend to have older mothers and fathers. This is partially why it is hard to get to root causes.
10
I had a natural birth but received penicillin intravenously for positive Group B strep and my son is autistic. I wonder about the microbiome connection. However, there is also family history of autism, although undiagnosed, many similar behaviors to members on both sides.
5
No, not the antibiotics given to you.
2
Cells dedicated to speech and empathy and their vascular support likely mature late in pregnancy or after birth and thus may be especially vulnerable to hypoxic extinction without immediate notice. Not yet differentiated or precursor cells may be especially delicate and consequential. Pelvic diameter limited brain growth before birth, which for human brains is just the beginning of a decades long maturation. Precious precursor cells of our most recent evolutionary functional features vulnerable during the switch over from maternal heart drive and respiration to the infant's must survive in every different delivery everywhere. Please.
3
@JVM: sudden pH buffer challenges to the newly self-supporting infant are also to think about considering that the scale of event time in the molecular and atomic realm is giga-second fast and that there may be shifts and swings of pH briefly outside the physiologic range that elude our gross notice but alter some number of some proteins.
@JVM: Another consideration when maternal connection ceases is that the infant's pH buffer systems and buffer reserves are weak and shallow. Low oxygenation should swing pH low, suddenly unsupported by maternal resources and then "pinked up" with pure oxygen, pH would suddenly swing high. The extremes or the shock of a sudden pH shift could challenge certain cells such as Langerhans and retinal cells. Are there data associating "pinking" with latter autism or diabetes, or obesity?
I had my baby at home after reading reports from the WHO on the questionable rise and benefits of c-sections and over-medicalized births (my son was born at almost 11lbs after some hard labor, totally healthy). No woman should feel less-than for having a c-section but the medical community should be more responsible when recommending surgery at birth. I read somewhere that most births now occur between 9am and 5pm. Hmmm.
12
@brandon: I gave birth to my eldest child on New Year's Eve at a small town hospital. You want to take a guess at how many other mothers were in labor that night? You'd be correct if you guessed none. It's not a myth that women are routinely induced or sectioned for the convenience of health care practitioners. On the plus side, I got a lot of personal attention that night!
13
@brandon You did the right thing. My own birth, in 1974, occurred a little AFTER 5 p.m. because the doctor spent the day at his office, then came to the hospital to "wake" my mother from twilight sleep and pull me out with forceps.
My oldest child was born by c-section caused by doctor errors. First, I was given an "epidural" during the final transition stage of labor because everyone missed the signs. As I was going through a continuous contraction for several minutes, the anesthesiologist missed the epidural space and caused me to be totally numb and paralyzed with the medicine. Progress halted entirely. Instead of letting up on the medicine or removing it to allow me to push productively, the doctor said I must submit to a c-section right away or else my baby would "ride the short bus."
How this article turns that threat on it head! C-section HEIGHTENED the risk of "riding the short bus!" I was left alone until the OB performed the surgery 1 hour later, just after LUNCH. I could have pushed that whole time!
Afterward, the OB said the problem was that I had a ridiculously narrow pelvis, and I couldn't give birth vaginally. She lied. I dismissed her and gave birth to three more children AT HOME.
Something is fishy with regard to c-section rates. So many are caused by arrogant doctors ruled by malpractice lawyers and indifferent hospital administrators.
11
It's hard to believe that nearly a third of delivering women NEED c-sections. Too many men in charge of our deliveries! Plus , somebody ought to do a study of the effects on the moms, infants, and families of the long and painful recovery time c-sections often demand, compared with a vaginal birth. Sometimes I wonder if the crazy obsession with women's bodies leads us to have less faith in our abilities to deliver babies without medical intervention.
22
@cgg: Be careful assuming that gender plays a large role in the rate of C-sections. The litigious culture surrounding medical care, most especially childbirth, leaves both female and male obstetricians understandably cautious when facing even minor signs of fetal distress. Doctors are fundamentally risk-averse, and so are laboring mothers.
13
@cgg
Many docs are not properly trained about how to help a Mom deliver vaginally. Their default is C section.
6
My son that is now 35 was a footling breach and was a c-section, he was also 3 weeks late weighing in at almost 11 pounds. The one main thing I have noticed with him as different from his 5 siblings is that he absolutely does not want to know about anything emotionally painful, ever. He did not squeeze through the birth canal and have that experience and I think this is why.
5
@stacey That's not a very scientific conclusion.
5
I do wonder, in addition to the passing along of important bacterial flora, if the compression of traveling through the birth canal has positive effects on the baby’s nervous system.
16
Please, for the love of God and sanity, please state the baseline before saying that something increases the risk by X%. A 33% increase (if causal at all) only increases the risk of autism by about 0.7-0.8%. That's much more honest and less scary.
Anyone who discusses percent increases on percentages without stating the baseline is committing journalistic malpractice.
255
@Stephen
Re: "only increases the risk of autism by about 0.7-0.8%"
So for 20 million deliveries, 0.7% represents 140,000 more babies that will be diagnosed with autism. That sounds like a lot to me still and something I'd be a little concerned about.
20
@Stephen
Thanks for stating this! I would hope by now that the NYT would state baselines. I guess stating relative versus absolute percentage changes are more attention grabbing? Why not both ? For example: a hypothetical 100% risk increase from a 0.1% to 0.2% risk?
13
@Tom Both Stephen and you are correct. For an individual Mom having a C-section a 0.7% risk increase is small and should allow her to stop worrying. For a country such as the USA a 0.7% increase means many babies diagnosed with autism and a huge health care cost increase and should be addressed by reducing unnecessary C-section. I agree with Stephen and wished journalists would learn how to present data appropriately.
25
Want to reduce c-sections? Don't gain 75#s especially if you're over weight already. Don't smoke, do drugs, be in shape, don't wait untill you're 40 to have kids. Go to prenatal classes and find out about your options so birth isn't a total shock when it starts. Some studies show people give more thought to what color their new car is going to be than whether to have another kid or not. Nature isn't PC, which is too bad, but life isn't fair. People forget that until the last century, pregnancy and child birth were the leading cause of death of young women. We've come a long way, but it's still a big deal and needs to be treated that way.
32
@Al
Actually, maybe its not the c-section that is increasing the rates of autism but the reason that the c-section had to be performed that is causing the increase - ie. gaining 75#s, smoking, doing drugs, being out of shape, waiting until you're 40 to have kids.
@Al Wow, just a bit judgy today? When my first born was a week "late" and measuring between 9-11 pounds, my doc asked if I thought about a c-section. I said I'd do whatever was recommended for baby's and my health. Baby was 9.2 lbs and it turned out the cord was wrapped around her neck several times. With my second born, I had the option to choose a c-section. I did and not for health reasons. When my son was born, they found pretty big cysts on my ovaries that they were able to remove at the same time. Whenever I think about how "quickly" I agreed to c-sections, I remind myself I don't know what negative outcomes may have resulted from not doing the c-sections and that everything turned out just fine for my kiddos. I was not obese, did not smoke; I was 27 and 30 at their births. Btw, I was also delivered by c-section, as the cord was wrapped around my own neck. My mother was none of your negative nonsense either.
4
@Al We do need men to tell us how to behave, still? As long as docs get more $$ for cesarean there will be more cesareans. As long as docs don't mind cutting up women's bodies there wiki be more cesarean s. 50 years ago they were deploring the high cesarean rates and still they continue . Money talks, patients pay.
5
Natural birth, breast feeding, and mother and child together all day during early years is best.
16
@Stevie
PFAs (chemicals found in non-stick pans, fire retardants and elsewhere) have been found in breast milk in 19 countries in Europe and N. America, at concentrations up to 10X the supposed 'safe' human exposure. These chemicals can affect development of nervous and reproductive systems and are associated with asthma and kidney disease. The thought of my baby ingesting a dose of PFAs directly from my body made me sick. He got formula.
12
@joymmoran
And where you think baby formula is made, if not in PFA-containing vessels?
You don't actually have to use non-stick pans or plastics. Cast iron cookware exists and is significantly cheaper than a Teflon pan you have to throw out every 3 years when the coating wears off.
8
@joymmoran What makes you think those chemicals aren't in formula? Cows often drink the same water humans do. Other production practices of cow milk are subject to several criticisms.
9
Is it true that if a pregnancy is cesarean then subsequent ones are most likely to be also. Have the researchers looked into this aspect of associations as well ?
9
@IN I don't know the answer to this, although I suspect it's true. I had a c-section 35 years ago and followed it with vaginal births for my subsequent kids. It was an easy decision - the c-section was so much harder.
3
@IN Not necessarily. It used to be that the type of incision increased the possibility of complications in subsequent deliveries, which is where once a c-section, always a c-section came from. OBs have learned how to do c-section incisions, so that it makes future vaginal births possible. However, not all OBs, not all hospitals, not all insurance policies allow VBAC (vaginal birth after c-section). Many hospitals have banned VBAC. Alot of the concern boils down to legal liability. C-section is also way more profitable for hospitals than vaginal birth. Many women who want to VBAC are denied or dissuaded from doing so before they get to the birthing room.
4
@IN
I'm not an OB but having a vaginal birth after a section is a big deal and has to be approached very carefully. Popular culture has made child birth a sitcom situation like colonoscopies but education and asking questions are your best friends. I can guarantee you there are worst things than a follow up section and the theoretical risk of autism.
1
I’m looking forward to a meta study on any differences between women who use an epidural and those willing or able to deliver vaginally without one.
Kudos to my wife for staying conscious and managing without one.
4
DD—I had epidurals with both births of my children. With my first child, I took the epidural after a very long labor, and frankly, I think it helped me avoid a Caesarian. With my second, I had the epidural as early as I could, which made the whole process so much easier. I was fully conscious both times. I did all the work in delivering both babies. With my second child, I could feel when the baby was ready to come and I needed to start pushing. I did the pushing-the baby didn't just fall out. I could feel the muscles and work them, but w/o the pain. In my view, both my children were born using natural childbirth. The goal of any birth is a healthy baby, and why one woman should get kudos for screaming through a birth or having one via surgery or an epidural disrespects all women.
122
@DD With the number of years those have been in use, I'd assume the studies have already been done and haven't found anything shocking. I gladly had an epidural with my daughter, but it stopped working for the last hour or so when the real pushing started. It was still nice to be able to get some rest for the 12 hours I spent waiting for my body to get to that point, without dealing with the pain of contractions that whole time.
5
I’ve had to full term vaginal births. Both of my labors were five hours, the first one doctor influenced and I was induced, the second one, same doc but I dictated the terms. For my first labor I had what was then called a saddle block that left me with absolutely no feeling below the waist, temporary paralysis. I did not like it at all because it made me feel disconnected from my body & my baby daughter (temporarily, of course). I took a totally different approach for my son, I used a birth method called Lamaze. It’s a focused breathing method that helps you relax the muscles in your body. I went to birthing classes to learn the method, these classes were not through a hospital by the way. This method allows you to have a pain free birth as well as knowing, by the type of breathing you are doing, where you are in the birth process. I continue to use this method when I have to have anything done that can be painful, works every time.
Regarding the increase in the number of cesareans, your article mentions only in passing the medical establishment’s concern about lawsuits. I suspect this is a big driver. In the 1980s, the rule of once-a-cesarean-always-a-cesarean began to be challenged. Now the old rule, I hear, is back in force. This is a shame, and will result in many unnecessary cesareans. Possible side effects on babies aside, reducing the cesarean rate would reduce complications and cost.
16
This is certainly worth investigating further. In our case my wife was advised to have a cesarean due to earlier surgery. I presume this was medically sound advise for 1983 and might still be. Our son is moderately autistic. We tested for Fragile X which was not present and have never had an explanation. No known family history, excellent pre-natal care, careful diet.
16
Way too many C-sections are the surely the result of financial pressures, but they are also the result of a widespread belief, perpetuated by movies and television — and sometimes medical professionals as well — that vaginal childbirth is a always a horrible, excruciating, and very dangerous undertaking. Midwives and doulas still get no respect, and are not allowed in some hospitals, despite evidence that their skills and advocacy reduce both c-sections and interventions like episiotomy. Homebirth is wrongly believed to be unsafe, again studies prove it's not; the country with the best outcomes for both mother and child is Holland where one third of births happen at home, with midwives. Women, and their partners, are bullied into believing that the womb is a perilous place where things are likely to go wrong, and that the only safe course of action is intervention and medicalization of childbirth.
64
This is so, so important and can never be stressed enough! Birth doesn’t HAVE to be horrible, painful, traumatic. I’m certainly not one of those hippy earth moms, but my second (unmedicated, midwife assisted, injury free) birth was a beautiful experience, and i honestly hesitate to call it painful. Physiological pain is a completely different thing than pain associated with injury. I needed an intervention with my first and THAT was traumatic. I’m glad I had the right kind of support this time around.
25
@Julia
All three of mine were incredibly painful, it sounds like you were very lucky.
2
Women in Holland are literally the largest women on earth. It is no surprise birth for them is easy. Short stature is in fact correlated with higher incidence of birth injury and need for c-section.
2
I think the link is that when a baby is in distress (not getting enough oxygenated blood due to hemorrhaging, blood pressure dropping, etc.), the event leads to a baby having neurological damage, not the quickest way to get the baby out - c-sections. Whatever CAUSES the emergency surgery is the cause of neurological damage, not the surgery itself. I used to work as a neonatal nurse practitioner, and we would catch the baby, pink them up and hand them back to their parents, proclaiming "just fine." When my youngest came out blue and not breathing (my blood pressure dropped suddenly and my doctor pulled him out with forceps), he was grabbed by my colleagues and resuscitated. He went on to have several neurological and developmental problems, which were mostly resolved with years of physical, speech and occupational therapy. I also think there must be some underlying genetic component, which given the right conditions (hypoxia), results in autism. My husband's brother's child was born by C-section due to severe hemorrhaging from a placenta previa, and he went on to have severe, non-verble autism.
77
@Terrie
You are so right about the multiple variables which apparently were not addressed. If a C-Section is done with one baby for medical reasons, involving the fetus, then subsequent C-Section could be done for the health and safety of the mother. The two C-Sections data should be separated and researched separately. Our son was a low-forceps delivery after two hours of Stage 2 labor when he could not move through the birth canal because his shoulder were too large and blocked his progress. There was a sudden drop in his heart rate and the doctor was right there and did the low forceps delivery. The baby's Apgar was 8, and he was turning blue at birth. However, his recovery was immediate, once born. If the medical response had been to proceed with an emergency C-Section, there would have been a delay in preparation, even only minutes, and who knows what consequence that delay might have had for the child. Those are the kinds of factors which must be considered in studies.
27
@Terrie
I think your comment is quite insightful. I wonder if any of the research has distinguished between planned C-sections and 'emergency' cesareans--the kind that happen after the mother's and/or baby's conditions have deteriorated. Seems as though the two present markedly different environments for the infant.
Also, just have to give a shout out to every mother who had a 'birth plan,' only to have the entire delivery go haywire through no fault of their own. Those are difficult, unpredictable hours no matter how hard we prepare. That said, research into the best way to prepare for birth, and how/when to medically intervene during delivery, seems vital.
46
@Groll
Thank you, and thank you, Jghr for your kind and insightful comments. My daughter is 32, and on the autism spectrum. After 22 hours of labor, and no progress in dilation, she was in distress, and was born by C-section. She presented face up. I believe the distress contributed to her autism. We were older parents, me 36 and my husband 46. Maybe that did it. I worked several summers in a plastic factory and an electroplating factory. Mane that was it. I was in a car crash before I knew I was pregnant. Had a neck X-Ray — told the tech that no, I couldn’t be pregnant. We’d quit hoping after 5 years. Baby was dosed with barbiturates for colic. There’s some weirdness in my family tree. I myself am a bit weird and may be on the spectrum. We stopped looking for causes after two solid weeks of grieving for what might have been. She’s here, and she brings great joy to us and those around her. She has asked if I wish she didn’t have autism. I tell her I’m sorry she has the challenges she has, but no, I’m glad she is who she is, and that everybody has challenges. I’m glad that research on causation continues, but I have to admit, articles like this cause some of the pain to return. I did everything right during pregnancy, except for the ignorant X-Ray, but here we are. Life is good. It’s not the life we expected, but.... that’s life! Thanks for the chance to express my feelings.
66
I understand the frustration in the comments here, but I still think there is something helpful to the article. From what I’ve read, there might also be a gut/bacterial correlation with autism, and I believe one of the advantages natural birth confers on the child is exposure to the bacteria in the mother’s vaginal canal, which then has a positive effect on the child’s gut later in life. Maybe as time goes on, we’ll be able to link these disparate studies together but I believe each study can contain clues even if it doesn’t be offer an explanation.
16
@L Deer and cows have "guts". People have digestive systems.
1
My grandson, "Nick" is autistic. His father and sister are definitely Asperger's Syndrome and so am I.
"Nick" was born via an emergency C-section when his mother was too fatigued to keep pushing and his oxygen levels had gotten too low.
People tend to want to have a single cause for problems but I suspect that genetics plays a more significant role than the type of birth. But I don't know if the lower oxygen levels that required the emergency C-section was a contributing cause of my grandson's autism or not. That should also be a topic for further research.
Yes, further studies are needed including more research into which genes seem to predispose a child toward autism. Articles in scientific journals have reported several genes that seem to be present in autistic children.
Earlier detection of autism and greater availability of affordable services for children on the autism spectrum are needed to help them overcome many of the deficits that come with being autistic.
"Nick" was diagnosed at 18 months and he's received many therapies that have helped him. He is mainstreamed in his public school but receives additional support from school staff. But it is unlikely that he will ever be able to be self-sufficient, a future burden that his parents and grandparents have to plan for.
29
"correlation is not causation", but the data is possibly a path to discovery, with interpretation...
12
Misses the point entirely. Cesarean rates are so high because it is a convenience for doctors and hospitals that make more money when pregnant mothers are in and out rapidly and on schedule. It is overdone to make greater profits.
50
Generalizing that C sections are more common because of profit is not something I have found to be true as a labor and delivery nurse. There are many factors involved in The C section rate of any hospital.
The population that a facility serves may be higher medical risk.
A particular provider may have an extremely busy practice that does not allow the type of monitoring that an individual patient requires and default to C section is more common. This can happen when a physician delivers babies at all hours and then must be in the office the during the day to see patients.
Liability and aversion to lawsuits contribute to high C section rates.
Availability of OR staff and anesthesia can contribute to higher rates. If a physician knows it can take up to 30 minutes for a section to be performed, he/she may be more inclined to call for surgery before a situation becomes emergent.
Induction of labor has increased C section rates. Induction of labor happens for medical reasons, but also has happened due to patient and doctor preference.
Sometimes patients request C sections for personal preference because of fear of labor, the birth process or schedule of the doctor or the mother.
Repeat C sections have increased the overall C section rate.
Bottom line, to blame the high C section rate on physicians and hospitals trying to make more money is an attempt to make a complicated issue more simplistic than it really is.
3
@Dave
Do you have any data proving this? Your statements are opinion only and do not take into account the myriad reasons C-sections are often necessary.
3
Amen, sister! A lot of "planned" c-sections are planned by a mother not wanting to go through labor, not the doctor wanting more money
The real crime here is the lack of funding for research about neonatal development.
Many people want to know what causes Autism. Many people want to know the safest methods during childbirth. However, without research there is no way to know these things.
37
The crime here is the differential rates of C-section by region and hospital. Sounds like some doctors and hospitals should lose their accreditation.
8
@Elise
Differing regions in the USA provide differing access to pre-natal care and health care in general. Why wouldn't that issue effect the rates of C-sections ultimately required at birth?
11
@DK
And different hospitals within a region can handle different populations causing them to have different rates. If one hospital handles the high risk pregnancies, they will have very different rates of things like cesareans compared to neighboring hospitals
13
I have to agree with the click-bait charge against the article. A headline with the words C-section and autism in it is going to get my attention. Our child was breach when my wife went into labor.
In the end, the headline and article present an unsubstantiated theory. The observational data indicates that it is a valid theory, but still it is just a theory. Theories are cheap, and there must be millions that never get written about. It seems though that a theory on these topics is worthy.
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This article is peak clickbait culture. Lead with an alarming headline, and then spend 1200 words walking it back and talking down alarmed readers. Lots of coulds and mights and perhaps here. It's like the author knows they're kicking up dust and is trying to prevent blowback at the same time.
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@Erin I suggest learning more about science and how to read an article about it. The title of the article is true to the findings of the study, and the article provides the proper cautions about inferring causation from correlation. I know you would like an observational study to be definitive about causation, but that's not how science works.
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@Rafael
I think it is a fair point. Look at where Exploring a link between vaccines and autism got us. We don't know the methodology behind what gave this bright red headline. Is it a case of p-hacking, maybe, we don't know what exactly they were doing with these data. Especially since I'm sure the authors knew this would get parents or future parents concerned and worked up. Definitely not how science or headlines should work in my opinion.
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@Daniel
Actually we do know the methodology. All you have to do is read the paper.
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Logically, since ADHD and autism are functions of brains being wired differently, it makes zero sense to think a caesarean birth caused these conditions. The brain had its wiring before the baby was born.
Now, they may correlate with caesareans, if the different brain wiring also was associated with health issues needing surgical intervention for birth.
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@Leslie Autism is not caused by the brain being wired differently. It's highly correlated to microbiome issues and different chemicals present in the blood.
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@Leslie, I agree. My entire family had some form of ADHD even if we weren't aware of it then. We all had natural births. Three of my grandchildren have ADHD. Only one was a Caesarean birth. I do think there is a hereditary component to it.
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@Katherine Cagle Anecdotes neither support nor refute patterns in large samples. What you think based on your family history has no relevance to what the actual relationship is.
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That JAMA article is like studying a single tree at the edge of a big forest. Health care professionals need to instead focus on the "Early Detection of Autism Spectrum Disorders & Other Developmental-Behavioral Conditions" and then, swiftly link at-risk and developmentally delayed children to the most effective community resources. https://drive.google.com/file/d/11MC6xP4ryAgDec31Vqet66ulHkY59Qk7/view?usp=sharing
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Actually, I think most of us would like to know whether there are steps we can take to reduce the risk. Early intervention and better services are great things, but they aren’t a substitute for researching causation.
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C-section babies are more symmetrical and prettier because they don't suffer the crush of the birth canal or hours of hard labor.
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@Mike Not all c-sections are planned. Sometimes babies do suffer hours of labor, and then are delivered via c-section.
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@Mike,
symmetrical and "pretty" (whatever that means) is a priority over long term health?
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I'm stunned by how irresponsible this article is. The research is so bad that it makes no sense whatsoever to publish it, other than to get clicks. My children were not born by C Section by the way so I have no agenda.
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@CMR you prefer to subject humans to randomized control trials? ok, i hope you don't get assigned to the unindicated c-section, or not have your cancerous pancreas removed. ignore the information nature offers you for free, just because it requires care to interpret. she linked to the paper, i can tell from all the specifics in your criticism that you carefully considered the research. meta analyses are extremely valuable because they show the balance of evidence whether results are robust across many study designs and sample sizes far larger than practical for any one study.
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Not mentioned is the profit motive for surgical deliveries. Although sometimes medically necessary the risk factors for both mother and child have been underplayed, not to mention the lengthier recovery time. All factors affect outcomes.
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@glorybe: I think it's less about the "making a profit" motive than the "avoiding a loss" motive. Lawsuits are breathtakingly expensive for hospitals and health care providers, and the increase in fetal monitoring can heighten anxiety over a bad outcomes, resulting in unnecessary intervention. Because the stakes of childbirth are so high, obstetricians are risk-averse and so are laboring mothers. Moreover, if a nervous father is in the room, he'll be all over everybody in shouting distance to do something the first time the fetal monitor indicates a decel. That's a lot of pressure for a health care team, even if they know better than to rush into surgery.
1
These C-Section scare mongering studies are getting ridiculous. I suspect C-Section kids are targeted for these studies because it is one of the few events you can successfully record during the pregnancy, as opposed to constantly monitoring the mother’s environmental exposures, eating habits, or just genetic chance. News flash, if a mother smoked pot a few times before she knew she was pregnant, she’ll probably lie about it.
The simple reality is we really can’t pinpoint what causes neurological disorders, although it probably has a large genetic component. Childbirth probably has little to no influence on the health of a baby, let alone a grown adult.
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As the article says, association is not causation. I feel publishing this story and using the headline you’ve selected could cause some unnecessary fear. Some women feel disappointed when they can’t have a natural birth and now this layers another level of worry.
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I am guessing that it’s not the csections themselves that increase the likelihood of autism, ADHD etc., but rather many factors that both increase the risk of csection AND neurodiversity.
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Rates of C section vary regionally, both in the USA and globally. Does the rate of autism correlate to the regional rate of C-section? If not, the hypothesis is incorrect.
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@Jennifer I can answer my own question, courtesy of CDC data. Many states with highest rate of C-sections have lowest rate of autism and vice versa.
https://www.cdc.gov/ncbddd/autism/data/index.html
https://www.cdc.gov/nchs/pressroom/sosmap/cesarean_births/cesareans.htm
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@Jennifer Or, autism is less screened for in the South, which could also mean that autism wasn't screened for where C-sections have been carried out least. Or less reported, or more reported regionally. All in all, this just means about nothing until they come up with a mechanism.
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@elmueador The data reported by the CDC controls for the variables you mention, otherwise the information would be meaningless.
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My son has autism. Completely natural, unmedicated birth.
I really don’t know what the point of these alarms is. Who is this supposed to help?
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Maybe doctors, hospitals, and malpractice attorneys, who have been complicit in the global overuse of c-section? Maybe parents, who are routinely told that c-sections save live but are rarely given a complete picture of the risks? More data = better decisions.
Scientific studies establish whether or not a hypothesis is true. They are not done to "help" advance any particular cause.
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Yeah can you please stop using the term “natural” birth? It’s antiquated and virtue signal-y. The NYT doesn’t use it. You can look up the article about why.
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Telling women how they should deliver their children is just so disheartening. Many women have elective c sections because they had an emergency c section previously and vbacs still have stigma and real risks. Give them all the stats so the decision is informed but then please leave women to make the best choices for their own bodies. Does this really still need to be said?
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@ET Evidently yes. And women should remember that.
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Both of my babies were about 7-10 days late, and both were on the larger side. C-sections were suggested by both of their doctors, but I opted to wait a bit with my healthy pregnancies. I was able to have successful vaginal deliveries with both of them within the 42-week deadline that my doctors gave me. Because I had no health issues, I intuitively wanted my children to “finish baking” and come when they were ready. I think this article would have been helpful for someone like me to help give me the strength to let nature take its course.
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The article takes great pains to repeatedly assert that the study in question in no way implies, asserts, or proves that it is the act of having a C section that somehow produces autism and ADHD and many of the comments above are worried that people will still think that’s what it means. And so here you have done it: congratulated yourself on avoiding autism and ADHD by choosing to not have the C section.
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@Aimée Morrison *for not having two unnecessary Caesareans that were both recommended by my doctors. Yes, I congratulate myself for not being a part of the nearly 33% Caesarian rate when my pregnancies were both healthy and normal. It took courage to say no to my doctors. I read volumes before making the decision. I also didn't get episiotomies because of the literature, and they've since been shown to be ineffective. I probably wouldn't be here today if it weren't for modern medicine, and I'm a big fan, but we all need to be educated and advocate for ourselves.
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We need to slow down and apply some logic! Just because someone somewhere had a c-section and the resulting baby was healthy into later life, does not contradict the findings of the study discussed in the article. Similarly, the article does not assert that there is one cause of autism or spectrum disorders; in fact, it only asserts an association thus far with c-section. But it does not indicate anywhere that c-section, if it is proven to be causational down the road, is the only reason spectrum disorders exist. Similarly, common sense tells us that even if a strong association is later found, not every baby born by c-section will be affected; certainly, we all know c-section babies, now adults, who are not affected. Please read carefully, and like the author states, do not prematurely assume or dismiss anything. I for one am glad this is being studied.
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@Present
Agreed - the issue that folks are having is that (1) this is an extremely sensitive topic given to wild misinterpretation (see anti-vaxxers), (2) there is a general problem right now with the intelligent consumption of science reporting (see climate change) and (3) it would have been great if the "first and most important thing to say" was actually the first thing said...
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My first child was delivered by an emergency C-section. This resulted in my following two children to be delivered by C- section. None of my children are autistic, obese or asthmatic. My eldest child is now in his forties so I've had time to assess their health for a while now. In light of my own experience I'm finding it hard to see a connection between C-sections and autism.
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@Helen Noble you are comparing your experience of sample size 3 (births) to a sample size of over 20 million deliveries. The study is simply stating an ASSOCIATION not a causation and will hopefully prompt more studies to research this association further.
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@Helen Noble Maybe try looking beyond your personal experience and consider that there are other people in the world, who may be having different experiences. And that there are yet other people, who study these experiences for a living, and have more information and expertise to work with than you do.
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Your study was underpowered.
3
I think we are reaching here. My cousin was born to a crunchy granola mom in 1960. Was a no medical intervention. No C-section birth. Both parents in their mid 20s. Mom received prenatal care. No smoking, drugs or alcohol all during her pregnancy. My cousin received no immunizations until he was 15.
He has Aspergers. (that is the term he chooses to use)
His whole life has been a nightmare of sensory overloads and social misunderstandings. He was finally diagnosed in his 50s. Had he been born much later, his Aspergers is "bad" enough to have qualified for an IEP or accommodations under the ADA for work.
I don't think there is a smoking gun for Autism. That if you do A, you'll cause Autism in your kid. My cousin had NONE of the risk factors, and yet here he is.
Instead of figuring out who and what to blame for "causing" Autism, how about society investing a bit time and energy for some understanding and accommodations towards the neuro diverse?
Easier to number crunch that a c-section may tip the scales towards Autsim, than figure out how to live with the neuro diverse to the benefit of everyone.
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Yes, but why must it be either or in this specific scenario?If there are steps that can be taken or potential information to be gained - shouldn’t we explore both the prevention while also supporting those navigating through it?
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Thanks for sharing. My youngest sister (9 siblings) has Aspergers though as a child the term did not exist for her (minimal brain dysfunction was the catch all I remember.) She was finally correctly diagnosed in her late 30s. Two of my four grandchildren are on the spectrum, level 1 and level 2, one belongs to our daughter and the other to our son. All were natural births, all vaccinated on the regular schedule. Go figure. I’d say there’s a genetic link (weak); there’s a strong predilection for left-handedness in the family too, and mitral valve prolapse, migraines, and nearsightedness. Not sure that any of that matters. What does matter is early intervention and ongoing support as needed.
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@Ford313 both can be done. Research and supporting those who developed autism.
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Maternal obesity is a risk factor for both autism and cesarean, I think. But I'm not a real doctor.
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It would be great to know if these c-sections studied were elective or emergency, pre-term or full-term. Some will use this as an excuse to prevent c-sections or increase the (already high) cost.
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@EsmeK If you look at the original study that is linked above, it included over 20 million deliveries with all of the above included and analyzed when possible. Both elective and emergency were associated with a higher odds ratio of ASD, ADHD, etc. With that sample size it's also likely there was a comprehensive range of gestational ages as well.
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@EsmeK
"The increased risk was present for both planned and unplanned cesarean deliveries."
8