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ACEs Risk Factor #2: Difficult Birth

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Unnatural Birth by C-section

There are two main reasons a Cesarean section (C-section) would be performed:

  • Due to medical factors
  • Due to social factors

C-section originally served as a surgical solution for complications with difficult labor, such as:

  • Dystocia
  • Intrauterine distress
  • Fetal position

Natural childbirth allows for a timely connection between mother and child through skin to skin contact, which is important in establishing coordination and psychological development Chen (2019).

The effects of C-section on the psychological health of the child has a negative impact on senses of smell, touch, and visual ability. This in turn affects the ability to use sensory information from different parts of the body and respond appropriately Chen (2019). C-section increases the risk of ADHD, Autism Spectrum Disorder, and Schizophrenia in children.

Prolonged Labor

A 2-hour rule of the second [or active] stage of labor to prevent maternal and neonatal morbidity/mortality was first introduced in the mid-1800s Laughon (2014). Forceps were first used to shorten the birth and no stillbirths were reported in published observations Hamilton (1853).

ACE Risk Factor #2 - Difficult Birth

Increased risk of maternal morbidity, hemorrhage, fever, and infection are caused by prolonged labor. The adverse effects to the child are an increased risk of Apgar score [newborn birth test], neonatal intensive care unit (NICU) admission, birth depression, minor trauma, seizures, sepsis, asphyxia [suffocation], Hypoxic-ischemic encephalopathy (HIE), cerebral palsy Laughon (2014).

Nuchal (Cord Around Neck)

A nuchal cord is a common (12-37%) occurrence that increases with advancing gestation and occurs when the umbilical cord becomes wrapped around the fetal neck 360 degrees Peesay (2012). When the cord becomes wrapped too tight or compressed it can cause obstructed blood flow, anemia, respiratory distress, hypoxia, unconsciousness, loss of muscle tone, and stillbirth.

Breech Birth

The occurrences of breech presentation, when the baby is positioned bottom first, decreases with gestational age Hickok (1992). The incidence for childhood handicap, such as seizures, birth trauma, following breech presentation was high for babies born vaginally and by C-section Cluver (2012).

Brain Hemorrhage

Significant developmental disability can be the result of a preterm birth and studies have identified intraventricular hemorrhaging (IVH) [bleeding inside or around the ventricles in the brain] as a major cause of adverse outcomes for very low birth weight preterm infants McCrea (2008). IVH occurs in 20-25% of very low birth weight preterm newborns, of those 10-15% of <1500g [3.3 pounds] birth weight suffer the more severe grades of hemorrhaging, and over three-quarters of these develop mental retardation and/or cerebral palsy.

There are two common types of generalized (affects the entire brain) seizures and they both cause temporary loss of consciousness:

  • Generalized seizures (grand mal seizures)
  • Absence seizures (petit mal seizures)

When a person experiences absence seizures, they stop moving or speaking, stare straight ahead blankly and lose consciousness for 30 seconds or less. Though hardly noticeable, a person can have 50-100 absence seizures per day, undetected. Once the seizure ends, the person resumes normal activities, without realizing what happened. A child with repeated absence seizure episodes is said to have childhood absence epilepsy, a brain disorder that causes recurrent seizures if not treated and starts between the ages of 4 and 15 years.

The disorder interferes with the child's ability to pay attention, have conversations, and participate in class, if the teacher is not familiar with the condition, she may claim they appear to be daydreaming Harvard (2018).

Three things the doctor review when figuring out a diagnosis are:

  • Any history of brain trauma
  • Serious head injury
  • Infections involving the brain, such as encephalitis or meningitis


Absence Seizures (Petit Mal Seizures). (2018, December). Health.Harvard. Retrieved May 6, 2020, from

Chen, H., & Tan, D. (2019). Cesarean Section or Natural Childbirth? Cesarean Birth May Damage Your Health. Frontiers in psychology, 10, 351.

Cluver, C., Hofmeyr, G. J., Gyte, G. M., & Sinclair, M. (2012). Interventions for helping to turn term breech babies to head first presentation when using external cephalic version. The Cochrane database of systematic reviews, 1, CD000184.

Hamilton G. (1853). On the Mortality Arising from the Use of the Forceps in Tedious Labours. The British and foreign medico-chirurgical review, 11(22), 511–518.

Hickok, D. E., Gordon, D.C., Milberg, J.A., Williams, M.A., & Daling, J. R. The frequency of breech presentation by gestational age at birth: a large population-based study. American Journal of Obstetrics and Gynecology. 166(3), 851–852.

Laughon, S. K., Berghella, V., Reddy, U. M., Sundaram, R., Lu, Z., & Hoffman, M. K. (2014). Neonatal and maternal outcomes with prolonged second stage of labor. Obstetrics and gynecology, 124(1), 57–67.

Peesay M. (2012). Cord around the neck syndrome. BMC Pregnancy and Childbirth, 12(Suppl 1), A6.

<#1 Risk Factor - Difficult Pregnancy                    #3 Risk Factor - Early Hospitalization>


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