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The immunological effects of caesarean sections on newborns in Sao Paulo Brazil -

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Robyn Williams: And this is a baby driven Science Show where after New Zealand we go to Brazil via Boston and the AAAS where I've been touring the posters. Last week, two weeks ago, and now this week.

Now, the poster of come to is 'The immunological effects of Caesarean sections on newborns in São Paulo Brazil'. What is your name?

Isabella Gomes: My name is Isabella Gomes.

Robyn Williams: Isabella, did you go to Brazil yourself?

Isabella Gomes: Yes, I went to Brazil for four months in the year of 2015.

Robyn Williams: And have you any background in Brazil? Your name seems to be rather sympathetical?

Isabella Gomes: My dad is actually Indian, from Goa, which used to be a Portuguese colony, but I did learn Portuguese but I am in no way Brazilian or…

Robyn Williams: Ah, so you could speak the language, that's a huge advantage. And you have been at Princeton and now you are at Columbia.

Isabella Gomes: Yes, I was at Princeton for my undergraduate degree where I was a major in ecology and evolutionary biology and global health and health policy, and then I moved to Columbia to do public health journalism.

Robyn Williams: Now, Caesarean section, what did you find?

Isabella Gomes: So my study was basically analysing why the recommendation of 10% to 15% is so important, that's the WHO's national recommendation for Caesarean section rates for every single country. Brazil is at 60% and higher for the public sector, as well as 80% to 85% and higher in private hospitals.

Robyn Williams: Did you say 60% and 85%? That's gigantic!

Isabella Gomes: Yes, it is astounding. There are even places called boutique hospitals in Brazil that almost exclusively do Caesarean sections. So Brazil is literally called the Caesarean section capital of the world.

Robyn Williams: Do they have an excuse as to why they are doing it?

Isabella Gomes: So there is a lot of reasons that I found. For example, you can make more money per person if you are doing a Caesarean section, there's a lot of services that you can say there is a price for it. It is easier to schedule, which is why we see such an uptick in neonatal intensive care unit admissions within the neonatal intensive care units right before the holidays because of Caesarean sections. So there's a lot of incentives for doctors to push this as the procedure that is being done to have a labour.

But on the other aspect there is also other things such as disincentivising women to do a natural birth. So there's fear of obstetric violence if they go through the natural birth process. In some cases that I found, midwives are not allowed inside the hospital space. In other cases even the husbands were not invited into the birthing room. So basically a woman is having birth, she is in this incredibly vulnerable situation where she has no patient advocate. So in a lot of cases they prefer to do a Caesarean section.

Robyn Williams: And what about after effects of that procedure?

Isabella Gomes: So that's exactly what my thesis was looking at. So what I was studying was what are the immediate effects of Caesarean sections on newborns in Brazil. And a lot of studies have looked at the long-term effects, so they look at the development of asthma or obesity or diabetes and respiratory illnesses 10 years after birth. But what I was looking at was immediately what does the immunological profile of the newborn look like up to a week after birth. And we were looking at the blood tests, and we were able to get usable data from about 600 babies. And what we found was for certain blood test variables, like erythrocytes, leucocytes, neutrophils, platelets, platelet counts, they tended to be lower for babies who went through a Caesarean section than if they went through a natural birth. And this is also controlled for a number of variables, like gestational age, which is basically how long was the mum pregnant. So that sort of controls for preterm births.

Robyn Williams: But that's fairly drastic, the red blood cells as well is the white ones which give resistance to disease are way down lower.

Isabella Gomes: Yes, enough to make a difference immediately after birth, which would have a huge impact for children who are from low income or resource burdened communities, especially ones with high air pollution, like I just said. If you see development of asthma within this population, within 10 years you start to think, oh, why is that the case?

Robyn Williams: And what did the women say when you talked to them?

Isabella Gomes: So a lot of them would talk about the experience of what it was like to interact with a doctor. So a lot of them would say, oh, I would come into the hospital and I would say I wanted a natural birth, the doctor says it's okay, and that becomes my birth plan. And then at 37 weeks all of a sudden they say, I'm sorry, you've come up with a complication, we now have to do a Caesarean section. And as a woman myself I start to think would I switch doctors? No, I wouldn't because first of all they might say, well, we have to do a Caesarean section, do you want your child to be sick, do you want your child to die? This is bad. So there's first that factor, that maternal instinct.

And then the other aspect is I've developed this relationship with my doctor over the term of my pregnancy, I'm not going to switch doctors. So in terms of that, that's sort of what we were noticing. And then in another aspect, there's disbelief that because the process of Caesarean section is so mechanised, it seems so modern and civil and it has all of these other social aspects to it that seem so positive, while a natural birth, it seems very violent, and it seems extended over a long period, and there can be all of these complications, like the way the media portrays it.

So it's this huge cultural background that I don't think people have been paying a lot of attention to. When I first started this study, what I would often hear it is, oh, of course Brazilian women would want to do a Caesarean section, there's the vanity aspect, all they want is a scar below the bikini line. And you find that that's simply not…I mean, maybe it is the case for some people, but overall a lot of the women I talked to, it was what the system had glorified and made it seem safer. These are people who obviously care deeply about how their children's health is going to be and that what was really interesting to me throughout this research.

Robyn Williams: It's an extraordinary situation, it's almost scandalous…well, it is scandalous. How are you going to follow it up?

Isabella Gomes: Currently I am pursuing journalism in my graduate degree, so I'm hoping to find different aspects of this, understand how the insurance system is set up around Caesarean sections, as well as look at different regulations. So in 2015 they released these regulations that said that OBGYNs had to report the number of Caesarean sections they did recently, in the last few years, and what they found is for a lot of them doctors had literally not done a natural birth for a very long time, which is insane because now you start thinking do you even remember how to do a normal birth, do you remember how to facilitate that conversation with a mother, navigate that process, so that's how I'm hoping to look at it. But I also don't want to drop the public health research aspect of it, because, as we all know, data just really, really matters. And despite a lot of the conversation being about certain areas being still developing, there is an extraordinary amount of data behind this research, this specific topic. And I think this would be a great way to look at one of the populations with the biggest problem and see how we can facilitate a model that can be implemented on other countries' systems as well.

Robyn Williams: Congratulations, extraordinary work. Thank you.

Isabella Gomes: Thank you so much.

Robyn Williams: Isabella Gomes, Princeton and now Columbia University in New York, showing how you can combine solid science with investigative journalism, at the AAAS she was.