This week controversial headlines have flashed across my newsfeed on more than one occasion announcing that a study at Melbourne University has found that children born via caesarean section perform worse than those born via vaginal birth (1). It was evident when flicking through the comments that this provoked a great deal of emotion from mothers, many of whom were quick to point out that their children born by caesarean section were doing well at school. In reading this, I could breathe a sigh of relief as I have been privileged enough to endure four “natural” births. But then again, I might not feel so wonderful tomorrow when a study is released drawing a correlation between larger families or younger mothers and lower cognitive outcomes. Then as a mother of a larger family who conceived my first three children under the age of 30, I might find myself feeling equally indignant.
Mothers who are attuned to news releases or find themselves searching for answers on Google will be accustomed to the often contradictory and confusing nature of the stated findings of research. If we are not careful and accept all that we hear as fact, we can be drawn into kneejerk reactions as we try to manoeuvre our lives to reduce risk and optimise the chances of good health, success, and happiness of our family. I used to be one of those parents. I would find myself chopping and changing ideas about diet, sleep routines, discipline, or school readiness from week to week depending on the latest thing I had read or on a friend’s persuasive arguments.
The caesarean study I referred to earlier offers a good example of why it is important to use discernment when listening to the results of studies, or the hearsay that often results from them. This is especially the case when study results are reported in the mainstream media. While I am not a medical professional here are a few things that might put mothers of caesarean section baby’s minds at ease, based on my reading of the actual study in question:
- In the study, the difference between the results for C-section children and other children is less than a tenth of one standard deviation. On some measures, the difference is much smaller than this. The article states that this equates at most to 35 school days, that is, it is like a child starting school a little over a month younger than their peers. It is also a similar difference between results typically found when studying the difference between boys and girls in early years of schooling. Although this is still considered significant in research, two of my own children, who were born under conditions similar to each other, achieved scores in their first NAPLAN test that were more divergent that this.
- There are many confounders that affect the results of a study such as this. Confounders are all the variables that the researcher is not able to rule out of the study. Some of these were taken into consideration in the formulas used to determine the results of this study, such as gestational age, weight, and socio-economic However, there were some were not excluded, such use of a ventilator or intensive care for the newborn after birth. The problem with this is that it is difficult to discern whether these interventions are necessary due to the caesarean or the complications (such as infant distress) that led to the caesarean.
- In the same study, to eliminate more obvious confounders, a separate set of data was provided comparing vaginal births with low-risk elective caesareans. This allows for a more direct comparison and these results indicate that, although marginal differences existed on some measures, there was little or no difference in problem solving ability for children aged 6-7 or in school readiness for children aged 4-5. This demonstrates that the differences may not be as significant as the blazing headlines lead us to believe.
- The main measures used in the study, NAPLAN and the Peabody Picture Vocabulary Test, have limitations in the application of the study. NAPLAN is not a measure of intelligence, it is a measure of reading and writing ability. The Peabody Picture Vocabulary Test, which can be a reasonable indicator of school readiness, is also not a direct measure of cognitive ability. Therefore, the measures are not actually measuring cognitive ability as the article implies. In my work, I have witnessed many students who achieve average or above average on a cognitive assessment, but have difficulties with literacy.
- This study tells us nothing about the children’s emotional intelligence, or even their physical health. It only measures children’s success based on a narrow number of variables. It is important to keep in mind many other studies indicate that it is a child’s emotional intelligence, rather than their cognitive intelligence, that has the greatest impact on their success in later life (2).
- This is one study, with only one similar study being reported. In this type of research this is not enough to draw significant conclusions. It is not uncommon in areas such as this to draw significantly different conclusions as others approach it with different methods and controls.
- The last point I will make is that this study cannot tell us how the choice to ignore medical advice to have a caesarean section may impact a children’s cognitive ability into the future. It is important to remember that caesareans are often suggested because it is deemed that a vaginal birth will significantly risk adverse results for the baby and/or their mother. Although doctor’s advice may at times be somewhat cautionary, there are cases where the outcomes for babies might be significantly worse if they are not delivered by caesarean section (3).
So how do we discern what information is worth paying attention to and what isn’t? Here are a few things I’ve learnt over my 12 years of mothering that have helped me to become more discerning and escape the trap of fear based parenting.
- Firstly, take research reported in the mainstream media with a grain of salt. Research is of value, but only when it is read and interpreted by those with the skills to do so and when it is considered in the light of other findings. When you can, try to trace the statements back to their sources to see how valid the quoted study really is and if there is other research to support their findings.
- Look for studies or research contradicting the findings. At least that will help you relax knowing that even the experts are not sure of the answers themselves.
- Examine the bias and motives of those who are stating the study findings. Are they trying to sell you something? Does it strongly support their life-style choices and world-view? Are they trying to provoke a reaction for the sake of a headline?
- Beware that the words you choose when “googling” will often lead to information confirming your preconceived beliefs. If you look up “does eating bacon cause cancer”, then you will likely stumble across plenty of articles to support an affirmative answer. I would suggest that if you feel compelled to “google” for answers to your questions, then at least look up the opposite questions, for example “why bacon doesn’t cause cancer”, so you can see more than one viewpoint.
- Go to a source for advice that is more reliable than the Internet (or even better, go to a few). I learnt this the hard way though my pregnancies. The more I “googled” the more anxiety I felt and the more I spoke to my doctor or mid-wives the calmer and more well-informed I felt. Doctors, mid-wives, and other experts weigh up a wide range of data and have a wealth of experience with patients in similar situations to you. This means that they are much more likely to be able to give you wise advice than the mums on your baby forum. But if you are in doubt regarding an expert opinion, then it never hurts to seek another expert opinion.
- Realise that many confounding factors affect outcomes, many of which we have little control over. IQ, like many other things that affect our children is highly influenced by genetics. Unfortunately, we can’t do much about genetics and we need to learn to live at peace with the children God has given us, along with their strengths and weaknesses.
- Be cautious of conspiracy theory lobbyists. These groups of people tend to produce theories that contradict the standard understanding promoted by government, medical or educational authorities. They can often focus on lesser known and less likely risks. In the process, they ignore the more obvious risks that are more substantiated by research. We need to be careful to weigh up both sides in common debates, trusting that in most cases, our authorities and experts have our best in mind. It is also important to recognise that life can never be completely without risk.
Fear-based parenting will lead to us to attempt to eliminate every possible risk and results in parents highly restricting children’s experiences and consumption to minimise the potential for harm. In the process, they often neglect to recognise the harm that anxiety driven, helicopter parenting can have on the psychological welfare of their children (4). There is a place for us using common sense in parenting by eliminating obvious and easily avoidable risks. But when we find ourselves forever dodging an ever-growing list of dangers then our life, and the life of our children, will be unnecessarily sapped of its joy. Worse still, we may make decisions that are to the detriment of our child’s health and wellbeing because we have become a victim of conspiracy theory.
I therefore encourage you to parent intentionally, but let go of the fear. Let the headlines designed to provoke fear pass by in your newsfeed without causing unnecessary anxiety. Research can be useful, but let’s leave it up to the experts to interpret it wisely and look to them as our source of advice rather than relying on the local newspaper reporter, or the faceless person on the baby forum’s interpretation. And rest easy Mums, it is unlikely that the caesarean section you had will have had a dramatic negative effect on your child. In fact it was probably the wisest decision you could have made. You can never eliminate all risks and avoid tragedy entirely. However, if you are meeting your child’s basic physical and emotional needs, and you are doing your best to protect them significant physical and psychological harm, then you are doing just fine.
Mother, MOPS Australia Region Leader, and Master of Education Candidate (Guidance and Counselling, Developmental).
- Polidano C, Zhu A, Bornstein JC. The relation between cesarean birth and child cognitive development. Scientific Reports. 2017;7(1):11483. doi: 10.1038/s41598-017-10831-y.
- O’Boyle EH, Humphrey RH, Pollack JM, Hawver TH, Story PA. The relation between emotional intelligence and job performance: A meta-analysis. Journal of Organizational Behavior. 2011;32(5):788-818. doi: 10.1002/job.714.
- Ouzounian JG. Risk factors for neonatal brachial plexus palsy. Seminars in Perinatology. 2014;38(4):219-21. doi: https://doi.org/10.1053/j.semperi.2014.04.008.
- Segrin C, Woszidlo A, Givertz M, Montgomery N. Parent and child traits associated with overparenting. Journal of Social and Clinical Psychology. 2013;32(6):569-95. doi: 10.1521/jscp.2013.32.6.569.