Whether a child is delivered naturally or by C-section may affect the mother’s response to a baby’s cry. (Ruth Fremson/The New York Times)When my own daughter was born by Caesarean section delivery, I was surprised how uninvolved I was in the process. My body was numb, and my view of the surgery was blocked by a sheet. When I finally heard a baby cry, it took a minute for me to realize that the sound belonged to my own baby.
That’s why I was particularly interested to read of new research showing that the method of delivery seems to influence how a mother’s brain responds to the cries of her own baby. The brains of women who have natural childbirth appear to be more responsive to the cries of their own babies, compared to the brains of women who have C-section births.
The finding is based on brain imaging scans conducted two to four weeks after delivery among just 12 women, half of whom had vaginal births and half of whom gave birth by C-section. The study, published in The Journal of Child Psychology and Psychiatry, found that the cry of a woman’s own baby triggered significant responses in several parts of the brain related to sensory processing, empathy, arousal, motivation, reward and habit-regulation. The effect was greatest in the brains of women who had delivered vaginally compared to those women who delivered their babies by C-section.
The conclusions that can be drawn from the study are limited because it involved so few women. However, it does support the theory that C-section birth may result in slight delays in attachment, putting those women at slightly higher risk for postpartum depression.
Lead author Dr. James Swain of Yale University’s child study center said in a press release that the mode of delivery has been associated with decreased maternal behaviors in animals and a trend for increased postpartum depression in humans. It’s estimated that about 30 percent of births in the United States are delivered by C-section, the study says.
“Our results support the theory that variations in delivery conditions, such as with cesarean section, which alters the neurohormonal experiences of childbirth, might decrease the responsiveness of the human maternal brain in the early postpartum,” Dr. Swain said. “This work could lead to early detection of families at risk for postpartum depression and attachment problems and form a model for testing interventions.”
It’s important to note that the study measured only short-term differences in brain patterns following childbirth. There’s no evidence that delivery method has any long-term implications on a woman’s ability to parent or bond with her child or recognize her baby’s cry.
Within a few hours of my own C-section, I quickly figured out the pain medication the doctor was giving me was interfering with my ability to be alert and focused on my baby. Once I quit the pain drugs, I was surprised and delighted at how distinctive and unique the cry of my own baby sounded to me.
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Wow. So many problems, so little time. I can’t believe this study got published - 12 women? Really? You can SAY conclusions that can be drawn based on such a small sample size are limited all you want, but when you proceeed to go right ahead draw a bunch of great, big, fat conclusions, you’re disclaimer is, shall we say, disingenuous.
Congrats all around to the folks successfully taking advantage of the public’s and, apparently, the medical community’s appalling scientific illiteracy.
Let the guilting and competitive mothering begin! Because what we REALLY needed was more fodder for that fire.
FROM TPP — The story notes that the conclusions that can be drawn are limited but I don’t think the fact that it’s a small study makes it useless. It’s simply not financially possible or practical to do brain imaging studies on thousands. This is the data we have. And if it leads to extra support for C-section mothers to help prevent or identify early post-partum problems — where is the harm in that? For my personal set of circumstances, C-section was the right delivery option, but I do wish someone had warned me about the disconnected feeling I had afterward. There was a brief moment of self doubt when I didn’t experience the initial euphoria of birth that I had heard so much about. I would have been relieved had someone told me not to worry, that it was a chemical thing and that joy and bonding would quickly kick in, as they did.
— burntnortonThank you for highlighting an important and little-known consequence of surgical birth. Going through labor and vaginal birth gives women an incredible surge of natural oxytocin, the “love hormone”. The artifical version of oxytocin (Pitocin) which is drastically over-used to induce and augment labor, does effect the brain in the same way to trigger an emotional response to the baby. It is the lack of that hormone that puts c/s mothers (and those with induced births) at a disadvantage in bonding. Obviously, many c/s mothers do overcome this disadvantage and bond perfectly with their babies, and many c/s mothers manage to avoid the PPD associated with the stress of surgical birth, but that doesn’t change the fact that the challenge exists. Just another set of reasons (on top of increased breathing difficulties for baby, and increased chance of infection and internal scarring for mom) why cesearean birth should be used MUCH more selectively than it is today. There are hospitals here in NJ with 50% c-section rates!! Why? Its absolutely criminal that there is not more public outcry about what’s happening in maternity rooms today. Rent The Business of Being Born from Netflix, it is a real eye-opener and covers this topic beautifully.
— MThat doesn’t surprise me: from an evolutionary perspective, it makes perfect sense that the act of birth would prime the mother for attachement.
I was taken aback, though, to see the percentage of births by Caesarian section. 30%? Am I right to suspect crass overuse here?
— Josh HillThank you so much for this post! I believe that, regardless of your choices, it is essential to have adequate expectations. I have heard many women being disappointed by natural birth because they had expected it to be a wonderful experience which never materialized. Conversely, C-sections can feel less real.
Yes, it is a small study, but we can draw some initial conclusions to help new mothers overcome some of the potential problems observed.
(in grad school, whenever we don’t have anything substantive to say we attack the methodology; yes, methodology is important, but in most cases involving humans it is not possible to design good experiments)
— AGNThank you for this. My daughter was also born via C-section, after long, non-progressive labor coupled with an infection. When I heard her cry, I was hemorrhaging and losing consciousness, but remember wondering if that cry was from my baby or not, and also trying to make myself be happy. It would be interesting to know if those were planned C-sections or if the mothers had labored for some time.
— C momI also recommend Birth Without Violence by Frederick Leboyer. His book attempts to take the birthing process from the perspective of the unborn child and take the trauma out of it. He emphasizes repeatedly how unnatural childbirth is in the U.S. The noise, the lights, the temperature, all are quite clinical and unnatural to the way mammals nest, give birth and bond with their young.
— Susan SullivanThis is ridiculous! So what is the objective of this study, to somehow prove that mothers who give birth “naturally” are better mothers than if they gave birth surgically. My doctors probably saved my sons life by delivering him by c-section when they did. I would say that this was one of the best parenting decisions I have ever made. When he was born, I was so responsive to his cries, I hardly ever put him down for the first six months of his life! I would imagine I was hearing him cry when I was not with him. Just another opportunity for mothers to judge other mothers
— DeborahOnly 12 women? How does the study show that these findings don’t differ from those got purely by chance? Even if including large numbers of women in such brain studies is not feasible, it’s unconvincing to present conclusions drawn from such tiny numbers.
Plus, if the differences last only for a short while, what’s the point of the study?
Extrapolating from these findings, we might be tempted to infer that adoptive mothers of newborns don’t respond to their babies’ cries at all, which is clearly untrue.
FROM TPP –The differences detected reached the point of statistical significance, which means it is unlikely the differences were due to chance.
— SDear Poster #1,
I don’t think that this is about “Let(ing) the guilting and competitive mothering begin!”, but rather another thing to consider in light of the increase in selective C-sections.
Yes, the sample size is small. however, the results were consistent which is a good indicator of success.
I’m not surprised by this; i could have posited that natural birth leads to a more immediate response. After all, the surge of adrenalin after delivering is pretty incredible. Both mother and infant are jazzed and the infant is hard wired to find mom and start the breastfeeding/bonding/take care of me process. Without that process, according to evolutionary biology, the baby can’t survive.
— PamMy experience was totally not in accordance with this study. I had an horrendous labour of 24 hours as the baby was transverse and it was Christmas and the doctor didn’t arrive until a day after my waters broke. I had an emergency operation by epidural and when the doctor lifted my son up i bonded immediately, and 25 years later I still feel that same feeling of love I felt in those first moments. I was frozen from the neck down but my husband held him. When we got home I would awaken before he cried to be fed as I was so in tune. If I hadn’t had the caesarean section both my son and myself would be dead.
— Gail GrinterFROM TPP — But your experience actually supports the point. You experienced labor, which induces all these hormonal, brain changes. So even though you ultimately delivered by c-section, you still experienced labor. Scary story though, and good to know everyone was okay.
I cannot believe that only 30% of births in the US are by c-section. I thought the number was much, much higher.
— vhFROM TPP — Well it varies by region, state, hospital and doctor..And yes, in some places it is much higher.
Burntnorton, it has long been thought that c-sections can delay bonding between mother and child. That part isn’t new. This study simply provides additional evidence that known phenomenon is physiological. Yes, it’s small, but the results are statistically significant for the sample size.
Personally, I applaud this research. Post-partum depression is reaching epidemic proprotions in this country, and there is mounting evidence that our disruption of the natural physiological process of birth may be largely to blame.
— KaeRegarding “initial euphoria” after delivery, if thank god that’s over is euphoria, I guess I was euphoric. Otherwise I was simply exhausted. I delivered one child by each method, and all I can say is they’ve got to be kidding.
— KarenI delivered two babies vaginally, and still remember being well out of the delivery room and in a recovery room, hearing a baby cry, and thinking, “Whose kid is that crying? Mine? Oh yeah, I’m supposed to sit up and DO something.” The connection to comfort/nurse/burp/re-diaper my baby took some actual thinking. Please, regardless of delivery method, some statisfical variance for the absolute fog of new motherhood! And still a few years into the game, I’m slow to offer sympathy. “Oh, you bumped your head? No blood? No, you don’t get a band-aid!”
FROM TPP — Ha! So interesting to hear this perspective…And yes, FOG is right…..I’m still in it!.
— DeniseJust dusted off my statistics books from my doctoral training in psychological research. Let’s see… With a sample size of 12, a study is… absolutely useless.
— ScottI expect journalists to fail to understand this, but how on earth did this pass muster in a peer-reviewed journal?
Off the top of my head, here are several alternative hypotheses that can not be ruled out because of the failure to get a large enough sample to allow random distribution render them improbable: hearing ability of mothers, size of babies, premature births?, gender of babies, type of drugs used, difficulty of birth, first-time parent?, hospital setting, ethic backgrounds, age of mother, physicians, time of year, geography, machinery used to do brain scans, etc.
FROM TPP — One thought — the fact that it appeared in a peer reviewed journal and was conducted by respected researchers at Yale is probably a better barometer of it’s scientific interest than a dusty statistics textbook.
I had the exact opposite experience! When my first son was born (vaginally, after 24 hours of labor and three hours of pushing), I only felt relief that the ordeal was over. Shellshocked, I felt little or nothing when I held my baby. This was the start of a six-month bout of near-paralyzing PPD.
My second son was breach, so I had a planned C-section. Although I was petrified by the idea of “having an operation” (my first) and it was supremely bizarre to feel the doctor rummaging around in my uterus like an overstuffed suitcase, I was much more “involved” in the birth and felt an immediate bond with my new son. And no PPD, thank God.
I guess you can never tell, but it’s good for all women to know that many different outcomes and emotions are “normal.”
— CarolynAn interesting article, and not one that I disagree with, but please, please spell Cesarean correctly. Despite myth, birth via surgery has nothing to do with Caesar.
— RobinI cannot help but wonder if whether or not the mothers breastfed over those weeks had anything to do with the results…Was this factor considered?
FROM TPP — I had the same question but I don’t have the answer for you. Will let you know if I find out.
— JMore fodder for the natural childbirth nazis - A completely meaningless study, but it will be used against anyone who dares to have a c-section. I’ve had two and don’t remember any bonding and/post partum depression issues. But that is probably because I wasn’t perceptive enough.
— AngelaMTPP- My objection was not that it didn’t reach statistical significance. My point was that a sample size this small does not allow us to rule out competing hypotheses. This is true no matter what the journal or university involved. Please be more receptive to valid statistical arguments- your readership deserves to understand the flaws of a study that is the center of a top story on NYTimes.com.
FROM TPP — You are correct that other issues may be influencing the data. And I’m certainly open to the issue — I highlighted it myself in the story, noting that because of the small sample size what we can learn from the research is limited. But that doesn’t mean it’s useless. Of course, this is just one piece of the puzzle, and it isn’t entirely clear what it means. But this data combined with other data from animal and human studies helps explain why C-section moms may be at higher risk for post-partum mental health issues. Thanks for taking the time to comment and respond again.
— ScottThat is not just a small sample–it’s a microscopic sample! It’s not like there aren’t TONS of women giving birth out there to have studied! This is pretty much statistically insignificant. I’m not saying that there couldn’t be some kind of intense bonding or imprinting that occurs at the painful moment of natural childbirth, but, this study doesn’t prove it. Perhaps the depression or lack of bonding could be linked to the drugs related to the C section, or the depression related to the painful surgery after effects?
— ClassifiedBasically, it’s interesting food for thought, but taken with more than one grain of salt. I am a journalist, and I would have qualified the study a lot more, even if folks from Yale thought it noteworthy. I mean, the leading academics for centuries thought the Earth was flat, too :)
— ClassifiedI’m not really sure of the significance of this study since for many women who have c-sections, it’s not really their choice to make. So I guess bottom line for me in response to this study is so?
— mkSimply because a study has an “n” of 12 in and of itself does not render the findings useless, but one must simply be cautious about interpreting and applying the findings. For example, small-n research is often used to generate hypotheses for future studies. Scienfically-trained and thoughtful individuals should discuss the findings but give them less weight than findings from, for example, a larger sample study, or a study that controlled for potential confunds (which this study might have done), or a study where conditions were randomly assigned, etc.
And while the media takes and runs with these type of findings, it’s certainly not the fault of the researchers.
By the way, both cesarean and caesarean are considered correct spellings. However, the former is usually preferred in the U.S. and the latter preferred in other English-speaking countries. The definite etymology of the word has not been determined.
— John Riceanother thing that seems confused by some posters, including myself perhaps, is the difference between post-vaginal-delivery “bonding” with the baby and “responding” to the baby’s cry. it took some time for me to “bond” in the many (subjective) clichéd senses of the word (i’d often find myself loving my child while simultaneously wondering half-unconsciously when this “visitor” was going to go home and let me sleep)–but even during these times i could hear through any din and across rooms (when my husband held our child) her nigh subsonic cry. of course, i haven’t any scientific evidence for this.
— eb