Long-term Immune Implications of Caesarean Birth: What the Research Says

A Caesarean section, or C-section, is a surgical way to deliver your baby. During the procedure, the doctor makes an incision in your lower belly and womb to bring your baby into the world. It’s a very common and safe method of delivery, especially when a vaginal birth might not be the best option for you or your baby.

A C-section is an operation that can carry risks for you and your baby. Indeed, Caesarean sections can be lifesaving for either you or your baby (or both of you) but can also lead to short and long-term consequences from both maternal and infantile perspectives.

Your healthcare provider might suggest a C-section if certain situations arise, like if your baby is bottom or feet first (breech position), if labour isn’t progressing as expected or if a condition like high blood pressure during pregnancy (preeclampsia) makes vaginal birth risky.

It’s natural to feel a little nervous about surgery, but please know that C-sections are performed every day with great care. Thanks to modern medical techniques, most mothers and babies recover well and go on to thrive. While it’s different from a vaginal delivery, a C-section is a safe and effective way to welcome your baby into the world when needed.

Research consistently highlights that when medically indicated, C-sections are lifesaving. Thanks to modern surgical techniques and excellent postnatal care, most mothers and their little ones recover smoothly and go on to thrive.

During a vaginal birth, your baby encounters beneficial bacteria like Lactobacillus and Bifidobacteria as they pass through the birth canal, your vagina. This process also naturally squeezes your baby’s chest, which helps to clear fluid from the lungs, preparing them to take their first breaths more effectively. This process supports your baby’s breathing and may reduce the risk of certain respiratory issues.

In a C-section delivery, your baby takes a different path into the world. Since they don’t pass through the birth canal, they miss the direct exposure to these helpful bacteria and the chest compression that aids lung function. Instead, their first contact is often with bacteria from the hospital environment, which may result in a different mix of bacteria in their gut. Additionally, C-section babies may sometimes retain a little more fluid in their lungs, which can occasionally require extra monitoring or care right after birth.

Even though the beginning of their journey is different, C-section babies can thrive just as well and catch up from the start. Practices like early skin-to-skin contact and gentle care from healthcare providers help their lungs, gut and immune system adjust beautifully to life outside the womb.

The immune system is like the body’s very own shield, working hard to protect against infections and keep you healthy. It’s made up of different parts, including white blood cells, tissues and organs like the thymus. There’s also an important group of cells in the gut, which helps defend the body and keep the digestive system healthy.

A large part of our immune cells, about 70 to 80%, are located in our intestine. The immune system and gut microbiome are completely intertwined³. The gut microbiome is a fascinating part of your baby’s body. It’s made up of trillions of tiny organisms that live in the digestive system. These helpful bacteria work together to digest food, produce important vitamins and even support the immune system by helping it recognise what’s harmful and what’s not.

When your baby is born, their immune system is still developing. It’s not fully developed yet, which is why the first six months are so important. During this time, your baby’s body gets a lot of support from the environment around them. Bacteria —tiny, helpful organisms—begin to interact with your baby’s body, teaching the immune system how to work properly.

Little by little, your baby’s immune system learns how to respond to the world around them, building a foundation for lifelong health. It’s amazing to think how nature has designed this journey, and with a little extra care, your baby’s immune system will grow and thrive.

When a baby is born vaginally, as they pass through the birth canal, their gut becomes colonized by beneficial bacteria such as bifidobacteria. This provides a good foundation for their gut microbiota and immune system. For babies born via C-section, research shows that their gut microbiome can look a bit different. They tend to have lower levels of beneficial bacteria. Instead, they may have higher levels of harmful bacteria for microbiota.

These differences aren’t permanent, but they can last for several months, especially during the early stages when the gut microbiome is just starting to develop. The good news is that there are ways to support your baby’s gut health; talk to your healthcare provider to learn more on how to catch up from the start.

Research indicates that babies born via Caesarean section often experience differences in their gut microbiome—the community of microorganisms in their digestive systems—compared to those born vaginally. C-section infants tend to lack strains of beneficial gut bacteria commonly found in healthy children and adults. Instead, their guts may harbour microorganisms that are more prevalent in hospital environments.

Some studies investigate that children born via C-section may have slightly higher risks of immune-related conditions, such as allergies, asthma, obesity and autoimmune diseases like type 1 diabetes¹².

It is true that the risks are there. But don’t worry: you can do something about it. Most C-section babies grow up healthy: genetics, environment, and parental care play significant roles in shaping overall health. No matter what your baby’s birth journey was, you can still give them the best.

If you're concerned about your baby's immune development, consider discussing practices that support a healthy microbiome with your healthcare provider. Every child is unique, and a loving, attentive environment contributes greatly to their well-being.

As researchers continue to explore how a baby’s mode of delivery influences their long-term health, some studies suggest that caesarean births might influence the development of certain immune-related conditions. This connection is primarily linked to differences in the baby’s early microbial exposure, which can affect how the immune system learns to respond to its environment.

●      Allergies and Asthma

Research shows that children born via C-section could be more likely to develop asthma by age five compared to those born vaginally¹⁷. Early microbial exposure is thought to play a role in teaching the immune system to tolerate harmless substances, like pollen or pet dander, which are often linked to allergies and asthma.

●      Autoimmune Diseases

Some studies find a slight increase in the risk of type 1 diabetes among C-section babies¹⁰. This condition occurs when the immune system mistakenly attacks the insulin-producing cells in the pancreas. Researchers believe that differences in early gut microbiome composition might influence the development of autoimmune diseases by affecting how the immune system distinguishes between harmful invaders and the body’s own tissue.

●      Inflammatory Bowel Disease (IBD)

Regarding conditions like Crohn's disease and ulcerative colitis, which are types of IBD, the connection with C-sections is not clear. Some research indicates a modest association between C-sections and an increased risk of IBD in children ^16,19. However, other studies have not found a significant link ^10,13,14. Overall, the evidence is mixed, and more research is needed to fully understand any potential connection.

It’s essential to remember that these risks are not definitive and definitely not 100% linked to caesarean delivery. Studies show trends, not guarantees, and many children born via C-section enjoy robust health and no immune-related challenges.

As a parent, you can take proactive steps to support your baby’s immune health. Contact your healthcare provider about the actions you can take to help your little one catch up from the start. Above all, your love and care create an environment where your baby can thrive, regardless of how they entered the world.

When it comes to C-sections, many misconceptions can create unnecessary worry for parents. Let’s address some of these myths with facts that provide clarity and reassurance.

Myth: All C-Section Babies Have Weaker Immune Systems

Fact: While research shows that C-section babies may have differences in their gut microbiome at birth, these differences are usually temporary. Most babies’ microbiomes begin to balance out within the first year, especially when parents focus on supportive practices.

You can take steps to nurture a healthy microbiome and support your newborn’s immune system development. Remember, your baby’s immune system is designed to adapt and grow strong over time! Reach out to your healthcare provider to know more.

Myth: Vaginal Birth Is the Only Healthy Option

Fact: Vaginal birth is the natural way to bring a baby into the world, but it’s not the only healthy option. For many families, a C-section is a lifesaving procedure that ensures the safety of both mother and baby. What truly matters is how you support your baby’s immune health after birth, regardless of how they were delivered.

Practices like breastfeeding, skin-to-skin contact and providing a nurturing environment all contribute to your baby’s long-term well-being. Every baby is unique, and with the right care and love, they can thrive no matter how they enter the world. Remember, your journey as a parent is about making the best choices for your family’s health and happiness.

Practical Tips to Take Care of Your C-Section Baby²⁰⁻²²

Supporting your baby’s immune system after a C-section delivery is easier than you may think. Simple, loving practices can help your little one thrive and grow strong.

●      Focus on skin-to-skin contact

Holding your baby close, especially during the first days and weeks, is a wonderful way to bond and support their health. Skin-to-skin contact allows you to share your beneficial microbes with your baby, helping to establish a healthy microbiome. This closeness also soothes your baby, regulates their temperature and strengthens the emotional connection between you.

●      Maintain regular check-ups

Routine visits to your paediatrician are essential for tracking your baby’s overall health and immune development. These check-ups provide an opportunity to monitor growth, ensure timely vaccinations and address any concerns you might have. Regular health care is a proactive way to keep your baby on the path to wellness.

By focusing on these simple but effective strategies, you can give your C-section baby the best possible start in life, nurturing their body and mind every step of the way.