Everything You Know About Breastfeeding Is Wrong, Continued Again

Following the two previous posts, this one is about to go deeper into two sub-topics, the first being birth by surgery, and the second being the suspected reason why that seems to contribute to childhood obesity.

Overweight mothers are very likely to have large babies. The baby’s size is a strong determining factor in the medical decision to deliver by cesarean section. Also, C-section mothers are statistically less likely than vaginal birth mothers to breastfeed their babies, or if they do, they tend not to continue with it for as long. In addition, obese women, in general, are “less likely to start breastfeeding […] and less likely to breastfeed for at least 6 months,” according to the American Journal for Managed Care. These four related facts create a complicated and often self-perpetuating group of circumstances that conspire to add to the overall prevalence of childhood obesity.

Birth by surgery

For The Atlantic, economist Emily Oster and physician W. Spencer McClelland wrote,

Evidence and expert consensus are consistent on the message that C-sections, on average, come with greater risks than vaginal births: more blood loss, more chance of infection or blood clots, more complications in future pregnancies, a higher risk of death. Even if serious complications don’t occur, C-section recovery tends to be longer and harder.

[H]ospitals’ C-section rates vary from 7 percent to 70 percent. Differences in patient complexity cannot account for that spread.

Whatever challenges may be present with vaginal birth, a C-section intensifies them. In the U.S., almost one-third of births (over 30%) are surgical. Many people feel that this happens for the convenience of physicians, who would prefer not to come out in the middle of the night for deliveries. Yet despite life being made easier for them, the financial rewards are greater, so this is a very controversial subject. If C-sections were limited to medical necessity, the World Health Organization feels that the rate would be more like 10% or 15%.

For these post-op mothers, whether they are obese or normal weight, feeding the newborn becomes even more complicated, which is why such guides as “10 Tips for Breastfeeding After a C-Section” exist. Its author, nurse and lactation counselor Shantel Harlin, mentions that whether a C-section is planned or decided on after labor has already begun, the baby’s nutrition is affected. Apparently, women who deliver by predetermined C-section frequently have no intention to breastfeed anyway, or if they start, they only keep it up for about three months.

The role of the microbiome

All this increasingly points to a connection between breastfeeding and the trillions of tiny organisms that live inside us and evidently control large portions of our lives. It is strongly suspected that C-sections cause obesity in infants because these microbes are not given the chance to play their appointed role in preventing it.

The theory is not universally accepted, but the last post in this series will quote some of the many experts who have adopted this way of thinking. Childhood Obesity News has briefly touched on the subject before, citing…

[…] studies that have observed increased obesity rates in children delivered by caesarean section. During a vaginal delivery, the baby is supposed to pick up microbiota on the way out, collecting a starter kit of bugs as the basis for its own colony. When a child is surgically removed, the opportunity to acquire those valuable bacteria is denied. What if it’s true that C-section kids get fat because of an inadequate microbiome? A lot of assumptions would have to be questioned.

Your responses and feedback are welcome!

Source: “Understanding Why Women With Obesity Don’t Breastfeed,” AJMC.com, 01/12/19
Source: “Why the C-Section Rate Is So High,” TheAtlantic.com, 10/17/19
Source: “10 Tips for Breastfeeding After a C-Section,” KindredBravely.com, 08/11/20
Image by Marc van der Chijs/CC BY-ND 2.0

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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