We need to stop playing blame game over having autistic children

WHY WAS this research published? — I thought as I read the new study by UCC academics finding a link between C section and autism. It doesn’t prove anything.

While the research team found that babies born by Caesarian have are 23% more likely to develop autism they also point out that they don’t know whether autism is caused by C section or whether babies with autism are just more likely to be born by C section.

Among the reasons hypothesised for the association is the fact that babies born by C section have different microbiotic life in their guts than babies born naturally and that this may affect brain development. Or it could simply be that babies born by C Section are often born at 37 to 39 weeks, instead of at 40 weeks plus.

But isn’t it a whole lot more likely that ASD babies will have more issues in the first place and will end up coming out by C Section? The analyses of the genetic development of ASD infants – including those coming from the international Genome Project, which has a base in Trinity College, Dublin – shows autism to be so “heritable” that if you have a diagnosis in your family you have a 50% chance of having autistic “traits”. When one identical twin has ASD his sibling has it in about 70% of cases.

But not always to the same extent. There is a margin of error with autism and genetics where “environment” may play a part. But most studies I have seen suggest this may happen early in the gestation.

Some issues identified in the research which the UCC team presented cast doubt on the idea that there is any “causal link” between C Section and eventual ASD diagnosis. The first one is that the “link” was established for first-time C Sections, not subsequent ones – which are the C Sections often carried out, not because of an issue with the baby, but because the mother has had a C Section before. Also, the babies born by “elective” C Section showed a “nonsignificant” increased rate of ASD.

I am also suspicious about the influence of maternal age on the findings. The research which was reviewed for the UCC study was meant to control for maternal age but we can’t be confident that the control was effective over time and across cultures in the 5,000-plus articles studied.

We know that older mothers have more ASD babies and they also have more C Sections. The Journal of the American Academy of child and adolescent psychiatry found the risk of having a baby who develops autism to be 50% higher in a mother of 35 and over than in a mother in her mid to late-20s.

And look at the C Section rates. In first time mothers the international rate of C Section at 25 and under is 13.1% and it increases incrementally until it reaches 28.2% for mothers over 34.

The average age of a mother having her first child in Ireland is 31, which means huge numbers of us are increasing our chances, not just of having a C Section, but of having children with ASD by the time we complete our families, and our risks of Down syndrome and other chromosomal disorders.

But when did you last hear a scare story about maternal age? It’s not politically correct to encourage women to have their babies early. It doesn’t suit their career trajectory and that doesn’t suit our economy.

By contrast, the UCC story is one we want to hear. An association between C Section and autism is similar to the other narratives about autism which have had huge international appeal in the past.

C Section is an unnatural intervention in a natural process the rate of which is growing at an alarming rate. This makes it the perfect “enemy” on which to pin autism, the rate of which is also meant to be growing at an alarming rate. The UCC study says the rate of increase “suggests factors other than improved detection and diagnosis is responsible” but this is highly debatable.

It is impossible to measure the historical rate of a new diagnosis accurately. The rate of ASD as opposed to classic autism before the early 1990s was officially zero so any growth from that base looks exponential. For comparison consider the rate of diagnosis of Alzheimers, another new diagnosis, which has officially doubled since the 1980s, though experts don’t reckon the rate has increased at all.

The historian Elaine Showalter has shown how societies can construct epidemics of psychological illnesses when there are writers who want to present their research and vulnerable people who want a reason for what is wrong with them. There are plenty of vulnerable people looking for someone or something to blame for their child’s autism.

The UCC study says “the potential cause” for ASD and ADHD “urgently requires further investigation”. But what if there is no cause we can easily control? Is the real epidemic the fact that we as a society have lost the ability to deal with a cruel twist of fate to the degree that we look for “cause” where there is none? Regular readers of this column will not be expecting me to defend the increasing rate of C Section. There are so many risks to mother and baby from C Section — the main one being that it subjects a woman on the cusp of the biggest physical and psychological challenges of her life to major surgery — that we don’t need another one. There should only be medically indicated C Sections and we should not have the “emergencies” cooked up by hospitals with their interventions, including induction, which is also associated in this research with an increased rate of ASD.

But neither should we have a situation in which a woman needs a C Section to save her life or that of her baby and starts pleading with hospital staff not to have one so her child will not be autistic. Members of the UCC research team have been out saying the potential risk is “small” but would you take a “small” risk that your child will have a chronic disability for the rest of his life? Nor should the parents of ASD children born by C Section have to suffer the guilt and agony caused by this research which has proved, let us remember, absolutely no “causal link” between C Section and autism.

As the mother of an ASD child born when I was over 35 but “naturally” at 38 weeks, I am getting very tired and very angry as my child is repeatedly pictured as the damaged victim of some enemy we don’t like: pesticides, tuna fish, the Government, fluoride, vaccinations and now C Section.

For me, he is not damaged and he is not a victim. He is the way he was meant to be. I have got over it but I’m still waiting for the rest of society to do the same.

Join Prof Louise Kenny, Prof John Higgins, Prof Richard Greene, Prof Eugene Dempsey and a host of experts and patient speakers for a public forum and discussion on the risks and benefits of Caesarean sections on Thursday, November 13, at 8pm at the Cork University Hospital, Main Auditorium.