The way a baby is born matters. A baby born naturally, via the birth canal, receives a healthy top-up of good bacteria from its mother while being delivered.

The 30% of babies born by Caesarean section in Ireland every year don’t have this probiotic advantage, according to new research from the APC Microbiome Institute in Cork.

This “interfacing food and medicine”’ institute, set up in 2003, includes UCC, Teagasc, the Cork Institute of Technology and Cork University Maternity Hospital (CUMH) scientists working together. In this case they were studying gut microbiota, and what effect these – or their absence – have on children between birth and two years of age.

Professor Anthony Ryan of UCC and CUMH, consultant neonatologist and one of the study leaders, points out that we all have bacteria in our gut and on our skin.“This collection of bugs – some good, some not so good – is called the microbiota,” he says.

“The greater number of good bacteria and the greater the diversity of good bacteria (the more types, the merrier), the less likely harmful bacteria will grow and take over our body systems. These healthy bacteria are called probiotics. Many people will have heard of bifidobacteria and lactobacilli. These are among the commonest types of health-promoting bacteria.

“During a normal birth, the baby gets covered all over – up and down into the digestive tract – with his or her mother’s bacteria. This is good for the baby. The ideal way to promote healthy bacteria in a newborn is for the baby to be born normally through the birth canal and then to be placed onto the mother’s breast within minutes of being born.

“That’s the gold standard for optimal microbiota development. Breast milk is a live tissue: that means it contains live bacteria, also called probiotics.”

In all, 30% of babies in Ireland are born by C-section, rather than vaginal birth. However, only 60% of babies are breastfed immediately after birth.

So what were the main findings of this research?

breastfeeding is key

There were 199 babies studied in Cork University Maternity Hospital, and findings showed that the bacteria babies got from a mother’s skin (when born by Caesarean section) were not as diverse as the bacteria that babies born via the birth canal receive.

“The really important finding for expecting mums and dads is that if your child is born by Caesarean section your baby can get close to the gold standard gut bacteria if you breastfeed for at least four weeks – but preferably for four months,” he says.

Premature babies were also part of the study. One in every 10 babies born in Ireland is born under 35 weeks’ gestation. “They are more likely to be born by C-section, and breastfeeding is often delayed because they are too sick to feed,” he adds. “They also may need courses of antibiotics, which ‘knock out’ the good bacteria (the probiotics) received from the mother.

“The crucial finding of our study is that even premature babies can have the gold standard microbiota of full-term, normally delivered, breast-fed babies at six months of age if the prems are given their mother’s breast milk at least until they come to their due date, the day they were expected to deliver if they were full-term.”

The study involved collecting over 1,000 stool samples from babies in Cork, Kerry and Limerick many times in the birth to two-year period.

finding a successful formula

Professor Catherine Stanton of Teagasc also led this research project, set up four years ago. “Babies born vaginally at full-term were found to have a relatively stable microbiota throughout the first 24 weeks of life, with good bacteria such as bifidobacteria predominating,” she says.

“These good bacteria help the baby thrive by assisting in the breakdown of complex sugars called human milk oligosaccharides (HMOs) in breast milk. Infants with more bifidobacteria are then thought to extract more nutrition from milk digestion.

“While it isn’t known what the long-term implications of an altered gut microbiota composition in the first weeks of life as a result of C-section and pre-term delivery are, this study shows that breast feeding these babies helps to move the microbiota composition level to that of full-term, vaginally-delivered babies.”

FORMULA BENEFIT IN THE FUTURE

This research may also lead to infant formula manufacturers being able to refine the baby food they make to match human breast milk more closely, she adds.

“If the baby is not breastfed, it is formula fed. There are opportunities [with this kind of research] for infant formula manufacturing companies to identify the effective components in breast milk – be they prebiotics or food microbiota – which could stimulate the introduction of prevalence of probiotics.

“These are introducing the good live bacteria into the infant gut: getting the right microbes in there as soon as possible after birth to get the baby’s immune system maturing in the appropriate way.

early life nutrition

“Infant formula companies are trying to underssxtand the benefits of breastmilk, the beneficial components of it, and making formula the best possible for early life nutrition.

“There are quite a number of infants formula fed in Ireland, and they deserve the best nutrition as well.”

This research is therefore good on two fronts, she believes. That’s to encourage all women to breastfeed – especially if they have a C-section, as this does make a difference – and also in the development of knowledge related to microbiota for use in infant formula.

“This research – focusing on results up to six months of age – clearly showed that for babies born through the vaginal canal there are microbes in there that feed the baby as it is passing through the birth canal.

“Therefore the other side of it is what microbiota could be given in formula or given to C-section babies that would stimulate the persistence and colonisation of the right microbes in the earliest period possible to give the best developmental outcomes long term.”

ANTIBIOTICS CAN WIPE OUT GOOD BACTERIA

Some babies have to get antibiotics when they are born – for instance, prematurely – or if they have an infection. “This can wipe out any early settlers of (good) microbes,” she adds. “We know from international research that there are long-term implications in the altered microbiome in the early period.

“That needs to be further studied and nutritional solutions found to address that. This would mean the use of the right probiotic microbes/prebiotics, call them what you like. Food for the microbes to stimulate the right microbiota are all important.

“There are studies ongoing internationally with neuroscientists and psychiatrists to look at the neurodevelopmental outcomes of antibiotic use in infancy. Are these children different in terms of their neuro development, their cognition, and development of their behaviour? That is all being looked at.”

NOTE: This microbiota research was funded by the Department of Agriculture, Food and Marine, the Health Research Board and Science Foundation Ireland and was published in the Journal Microbiome. Further results related to children from six months to two years will be published soon. For more information on this research see http://apc.ucc.ie and http://microbemagic.ucc.ie.

>> Oh, baby – motherhood is changing fast

CAESAREAN SECTION FIGURES show a four-FOLD INCREASE IN 30 YEARS

An ESRI, UCD and TCD study found that births by C-section had increased fourfold in the past 30 years. While this increase has reduced the number of deaths of mothers and babies Ireland’s C-section rate is average-to-high within the OECD where the Netherlands, for example, has rates almost 50% lower than Ireland. In 1984, the rate of C-sections in Ireland was 7%. By 1993 it was 13% and in 2014 it was up to 30%.

from births to breastfeeding – motherhood in ireland

breastfeeding support

For help with breastfeeding, see the Association for Improvements in the Maternity Services – Ireland (AIMS Ireland).

Or visit one of these helpful websites

evolving motherhood