Is there a link between mode of birth and gut microbiota? As ‘Dr Pal’ sparks a row, here’s what research says

A clip from YouTuber BeerBiceps' show features Dr Palaniappan Manickam talking about gut microbiota in babies.

BySumit Jha

Published Dec 12, 2023 | 9:00 AMUpdatedDec 12, 2023 | 9:00 AM

The gut microbiota in newborns plays a crucial role in shaping the infant's immune system. (Creative Commons)

Have you seen the clip featuring Dr Palaniappan Manickam, popular as “Dr Pal” on social media, which has been attracting comment — both positive and negative — of late?

In the video, he asserts that babies delivered via C-section have reduced gut microbiota compared to babies born vaginally, potentially leading to obesity in their later years.

However, medical professionals and research studies contradict the claims made by the renowned doctor, presenting conflicting evidence and challenging the suggested link between C-section births and future obesity.

Dr Pal is a practising physician based in Sacramento, California, renowned for his med-com (medical comedy) content shared across various social media platforms.

The video clip

The clip in question was from YouTuber Ranveer Allahbadia’s “BeerBiceps” show where Dr Pal said, “You take two deliveries, one baby is born through normal vaginal delivery. When the baby is born through vaginal delivery, it swallows the normal vaginal bacteria, so that all the good bacteria gets the first place. It’s unbelievable.”

He added, “If you go to a Caesarean section, they have only the skin microbes of the mom, when you are taking them out, and environmental bacteria, more than the normal vaginal bacteria. There are multiple studies showing that if you look at the kids who are born through C-section and follow them over the time, the likelihood of obesity slightly increases.”

Since its circulation on social media, this video has created a furore over the division of C-section and vaginal delivery babies based on the gut microbiota.

In reality, the clip has been taken out of context.

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The original context

In the full video, Dr Pal said, “You take two deliveries, one baby is born through normal vaginal delivery and another baby is born through C-section. We did research to find out which baby has good bacteria. So when they are born, there is so much real estate because there is the small intestine — like 22 feet long, and large intestine — 5 feet long. There is so much real estate, fresh, there are no microbes, nothing.”

He added that when the baby is born via vaginal delivery, it swallows the normal vaginal bacteria that goes into the stomach that creates a triggering cascade response so that all the good bacteria get the first place.

“The same thing when you go to a Caesarean section, when you take that baby’s stool specimen and look at that microbiota, they have only the skin microbes of the mom when you are taking them out, and some microbes from who is taking the baby out, like the people who are handling the baby — the gynaecologist, the caregivers, and environmental bacteria, more than the normal vaginal bacteria,” he said.

He stressed on the fact that he is not saying that C-section is bad. “Please don’t take it as an example over here, but what I am trying to say is that it starts right from birth. Then there multiple studies showing that if you look at the people whose kids who are born via C-section and you follow them over a period of time, the likelihood of obesity is slightly increased for those delivered via C-section, and this is a very controversial finding,” he said.

He said that some studies have refuted it, some studies have supported it, “but the bottom line is that their (babies born via C-section) microbiota, their bacteria is definitely slightly different compared to that of someone born vaginally. This can change by implementing good gut health techniques like dietary exposure to dirt.

Later, after the clip went viral, Dr Pal clarified, “This clip without the full context is controversial. C-section is not bad. I am not against it. Patients should absolutely proceed with a C-section if recommended by their OBGYN. The gut bacteria can be balanced properly even after a C-section. The studies are not conclusive — it is just a trend. Please watch the full episode for the context.”

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Gut microbiota in newborns

The gut microbiota in a newborn plays a crucial role in shaping the child’s immune system, aiding in the digestion of nutrients, and contributing to overall health.

The establishment of a diverse and balanced microbiota early in life is associated with positive outcomes for the developing immune system, helping to defend against infections and diseases.

Additionally, a healthy gut microbiota is linked to proper nutrient absorption and metabolism. Factors such as mode of delivery, breastfeeding, and environmental influences can impact the composition of the gut microbiota, highlighting the significance of early life microbial colonisation for a child’s well-being and long-term health.

Gut microbiota assembly and immune system development are intimately linked in early life. For example, microbial colonisation is associated with the maturing of natural killer and dendritic cells in the first three months of life.

Studies that support Dr Pal’s claims

A few studies back up the claims made by Dr Pal regarding gut microbiota and C-section deliveries.

A 2022 study stated that C-section and antibiotics can break transmission chains from a mother to her newborn, preventing transmission of maternal-derived pioneer gut bacteria at birth.

Instead, C-section generally leads to transmission of opportunistic pathogens such as Enterococcus and Klebsiella species, not from the mother, but from environmental sources, including the hospital.

Another study suggests that identifying the canonical C-section microbial signature in newborns delivered by post-labour C-section suggests that the major factor driving the association between birth mode and child microbiota is not entering the birth canal, but rather exiting through it.

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The contradictions

Hepatologist Dr Cyriac Abby Philips, best known as @TheLiverDoc of X, disagreeing with Dr Pal, said that older studies mention that babies born via vaginal delivery have a different bacterial profile than those born via C-section. The microbiomes of C-section babies look a lot different from those of babies born vaginally.

“But the impact of this on the future health of babies remains unclear — meaning there is no significant impact on babies’ health in this context. But new studies have shown that whether one is born naturally or via Caesarean section, babies receive essential microbes from their mothers. So, don’t worry about the type of delivery,” said Dr Philips.

He cited a study that said, “While Caesarean-born babies do receive less of their mother’s gut microbiome during birth, they make up for this by drinking their mother’s microbes via breastmilk.”

The study found that about 80 percent of C-section-born babies had hospital-acquired bacteria in their guts when they were born, compared to 50 percent of vaginally-born babies. But by the time the babies were weaned at the age of around 6 to 9 months, these differences had largely disappeared. And all the babies were healthy, so the researchers couldn’t tell if there were any health implications.

Additionally, new research suggests that exposure to vaginal microbiome during birth may not influence babies’ gut microbiome as has long been assumed.

A new study conducted by a team of Canadian scientists has revealed that the composition of the mother’s vaginal bacteria has no significant influence on the bacteria composition found in infant stool during early life.

“It does not appear that exposure to maternal vaginal microbiota at the time of vaginal birth establishes the infant stool microbiome,” said Dr Deborah Money, Professor of Obstetrics, University of British Columbia in the study.

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Link between C-section deliveries and obesity

Dr Philips stated that there is absolutely no link between C-section deliveries and obesity later on in life. This has been debunked by well-designed studies recently. “And there is no proof that the changes associated with gut bacteria due to C-section vs vaginal delivery promotes obesity in kids in the future,” he said.

He cited a study‘s findings that contradict several smaller studies that did find an association between C-section deliveries and offspring obesity, but did not consider the numerous maternal and prenatal factors.

Another study found no evidence of an association between elective or non-elective C-section and young adulthood obesity in young male conscripts when accounting for maternal and prenatal factors.

Delivery by C-section does not increase the chance of a baby ending up overweight or obese as a young adult, researchers have found, contrary to previous research.

“A woman wants a C-section vs normal vaginal delivery? It is her choice. And then there are medical reasons to opt for C-section too. C-section is all fine,” said Dr Philips.