Each year in Canada, almost 105,000 babies are born by Caesarean section—a third of the total number of births—making it the most common inpatient surgery in Canada. Globally, C-sections now account for 1 in 5 of all childbirths.
This procedure, in which a baby is surgically removed from the abdomen, can save lives in cases where a natural delivery could be dangerous to the child and/or mother. Yet, as the World Health Organization notes, when performed for non-medical reasons, it can cause unnecessary harms such as bleeding, infection, slow recovery for the mother, and complications in future pregnancies; unnecessary C-sections also delay breastfeeding and skin-to-skin contact, which have both been shown to be important for a baby’s development.
The risks of C-sections are an understudied area, which, given their popularity, is surprising to psychology professor Scott Adler. A researcher focused on the early development of cognitive functioning, Adler was the first to show that the birth experience influences the initial state of brain function. His 2015 study, Differential Attentional Responding in Caesarean versus Vaginally Delivered Infants, published in the journal Attention Perception and Psychophysics, found that babies born by caesareans are slower than their vaginally delivered peers to focus their attention on an object of interest.
In 2016, Adler’s C-section research was supported by a three-year gift from philanthropists Graham and Mary Hallward and their Hallward Fund at the Toronto Foundation. Now, they have renewed their support of Adler’s research to help close the glaring knowledge gap on C-section birth. In January of 2020, they extended their funding for an additional three years to further explore the birth procedure’s impact on human development. Will babies born by caesarean be able to narrow the gap as they age? And will this delayed focus have long-term impacts?
“Given how readily available and common C-sections have become, we should know more about how it affects maternal health and child developmental outcomes,” Graham says. “If the impacts are unknown, it doesn’t allow for making the most informed choices.”
Adler’s original plan to study the attention spans and memories of caesarian-delivered infants was postponed by the pandemic, which also necessitated a change in approach. A portion of the Hallward’s gift was used to purchase a high-tech eye tracker that enables more efficient testing and precise results. Adler is also evaluating the results of data on 400 children ages 6 to 16 they collected before the pandemic; to date, the results show developmental differences in the youngest caesarean-delivered participants. This finding raises important questions about the potential long-term impacts of caesarean birth.
Adler’s team then undertook a behavioral and neuroimaging study with adults born by C-section, a study that found the same slowing in the focusing of visual attention as C-section infants along with distinct differences in brain connections. His research also shows different developmental timelines for attention deficits from infants to adults between those who were born by an emergency C-section relative to those born by a planned C-section, which suggest multiple avenues by which C-section delivery influences neurological development.
“This is research that is a bit below the radar, but it can lead to important insights about the connection between this birth pathway and risk factors in early neurological development,” Graham says.
