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- [Voiceover] Of the millions of species that belong

to planet Earth, what is it that sets us apart

from all the others?

Is it our inquiring minds?

Our ability to explore.

To discover.

And to reason.

Ever since the dawn of civilization.

We have pursued the answer to one question.

Who are we?

We have looked to the stars.

We have searched our souls.

But the answers seldom satisfy for long.

Why are we so different?

We connect, communicate, invent,

and create.

We are able to cure,

to treat, to extend life,

even to create life.

We have built cities that touch the sky.

We have flown amongst the clouds.

- [Voiceover] That's one small step for man.

- [Voiceover] And traveled far beyond.

- [Voiceover] One giant leap for mankind.

- We challenge ourselves.

And while we are not perfect--

- [Voiceover] We shall fight on the beaches,

we shall fight on the landing grounds,

we shall never surrender.

- [Voiceover] I have a dream.

- [Voiceover] We endeavor to better ourselves--

- [Voiceover] That all men our created equal.

- [Voiceover] And now, we have surely arrived

at the golden age of technology,

but our journey still continues.

- [Voiceover] Hello from the children of planet Earth.

(men speaking foreign language)

Who are we?

We are amazing.

We are human beings,

and we have risen above all others to become

the dominant species on planet Earth.

Never before have we appeared to be stronger,

more powerful, and more in control.

Why is it then, that at this moment in time,

our species has never been sicker?

- We think we're at the pinnacle of our existence.

Look at the technology that human kind has available now.

And yet the reality is, we've never been sicker.

And it's going to get worse.

- We have been facing a rising epidemic of plagues.

From asthma to obesity, to allergic diseases.

This has been going on continuously over the last decades.

And there's no real sign that it's letting up.

- When you have asthma or inflammation within the lung,

you see cells that are not normally suppose to be there

invading that space,

so you cannot exchange the air quite as well.

And this an example of that invasion.

And this is inflammation within the lung sacks.

- [Voiceover] The World Health Organization has declared

non-communicable diseases have reached epidemic proportions.

Diseases such as asthma, diabetes, coeliac disease,

obesity, cardiovascular diseases, some cancers,

and mental disorders.

This diseases currently account for over 60%

of all deaths globally, and they are on the rise.

The World Health Organization estimates total deaths

from non-communicable diseases will increase by

a further 17% within the next decade.

The World Economic Forum and the Harvard School

of Public Health have predicted that the cost of treating

these diseases has the potential to bankrupt

global healthcare systems by the year 2030.

- So, the model that was compiled together by

the World Economic Forum and the Harvard School

of Public Health estimated that the cost of

non-communicable diseases between 2010 and 2030

would reach a staggering $47 trillion.

That is a huge sum.

To put this into context, the combined economic output

of most countries in the world in a given year

is less than $1 trillion.

And they're estimating a cost of $47 trillion.

It is a staggering sum indeed.

- By the year 2030, almost half of the net worth

of the world is going to go toward treating these diseases.

That's not sustainable.

We're bankrupting ourselves.

And the problem is that we're creating an invalid society.

We have people that are too sick to work.

We don't have enough caretakers for those people.

We're not going to have medical services to provide

for that number of people.

We simply can't afford it.

We're hitting the wall right now.

- We're increasingly seeing a world out there

with what is really a public health time bomb

waiting to go off.

And the research that we're doing suggests that

it's only going to get worse,

generation on generation.

So, tomorrow's generation really is on the edge

of the precipice.

- Unless we face it, there's no indication that it's

gonna get any better.

And I'm afraid that it will get worse.

And that means shorter lives.

And lives with more misery.

And more susceptibility to the big pandemics.

So, there's a lot of risk out there.

But we have the tools.

And if we had the way, we could fix it.

- [Voiceover] Four lifestyle risk factors have been

identified by the World Health Organization as driving

this epidemic:

smoking,

misuse of alcohol,

poor diet,

and lack of exercise.

But what if this isn't the complete picture?

What if there is an important piece of the jigsaw

that up until now, has been missed?

Scientists have recently embarked on a new journey

of discovery.

A journey that takes us through the lens of a microscope

to discover who we really are.

And how a species could get so sick so fast.

Let's rewind to the origins of life on Earth.

To 3.4 billion years ago.

All life on planet Earth evolved from bacteria.

Over billions and millions of years,

bacteria spread far and wide across the planet.

In the deepest oceans, in the heart of mountains,

in the atmosphere.

- Life appeared on Earth about 3.4 billion years ago.

And they were first.

This is a microbial planet.

Mostly bacteria.

And any other forms of life that came after

had to deal with bacteria.

Some bacteria involved into and with other life forms

to become more complex organisms

and complex ecosystems.

For life at its healthiest, exists as an ecosystem.

A diversity of species that coexist.

That live in harmony.

That live in balance.

But when the harmony is disturbed

and the balance is upset,

or when that diversity of species is reduced,

the ecosystem may become vulnerable to disease,

and could even die.

- If you removed half of the types of trees

in a very diverse forest, it doesn't stay the same

for the rest of the trees that are there.

There's extra space.

The dynamics of the interactions are completely changed.

Of the insects, the animals, may be changed

because of habitat, and the entire forest

takes on a totally different flavor.

And in some cases, a very unpredictable flavor.

This can happen in a local ecosystem.

It can happen at a planetary level,

but it can also happen at the micro level.

It can even happen within us.

Because we are a walking ecosystem.

The human body is host to trillions of microbes.

They outnumber our human cells by an astonishing ratio

of 10:1.

- So, it's estimated that we have about 10 trillion

human cells in our body,

and the current estimate is that we have about

a 100 trillion microbes living in our body.

And that's how it is everyday of our life.

- We're 90% microbial and only 10% mammalian.

The microbial part is said to be our microbiome.

- So, the microbiome are all the organisms

that live in the human body.

Bacteria, fungi, viruses, protozoa.

They're the organisms that live in and on us

that make us home.

- We estimate that they're approximately a thousand

species in the intestine.

Approximately 700 in the mouth.

Approximately 300 to 400 in the vagina.

Approximately 700 in the skin.

- You know, I used to be aware that I had

organisms on my skin and in my gut

and inside me,

but to now think about this me,

which is more microbe than human cells,

I don't know as if it connects me to universe a bit more.

- [Voiceover] This relationship between bacteria

and our human cells is one based on cooperation

and collaboration.

For thousands of years, this relationship has evolved.

We provide a home, a habitat for the bacteria.

In return, the bacteria in us and on us

help provide security.

Their important in helping us function as humans

should not be underestimated.

Bacteria help regulate our metabolism,

and they play an essential role in setting up

our immune system.

- We have grown up with our microbes

over many, many generations.

And in fact, we form what's called

a symbiotic super organism.

Because we do things for each other.

And those things are very important for the health

of the total organism.

- [Voiceover] Oue own ecosystem has thrived,

a diversity of species and balance.

But in the last century or so,

this ecosystem has become under threat.

- Just like a forest, you can't start cutting out

major sectors, major tree species, reduce the diversity,

and expect things to stay the same and

that forest to stay healthy.

It doesn't and we don't when we've lost the diversity

in our microbes.

- [Voiceover] The way we live our lives

has changed dramatically.

And scientists are now hypothesizing that this is having

an effect on our ecosystem.

The balance has become disturbed.

The scales are starting to tip.

The ecosystem has become sick.

- Let's say you have 10 diseases that

are rising at the same time.

Each one might have a separate cause.

Or perhaps there's one thing that's fueling

them all, that's causing all of them to rise.

And I think that one thing is a change

in our microbiome,

and what I've called missing microbes,

or the disappearing microbiota hypothesis.

That our ancient microbiome which protected

us against many diseases is degrading.

And with that degradation, these diseases are being fueled.

- When we compare our microbiomes

with those from peoples living isolated in jungles

of South America for example,

with no record of exposure to antibiotics before,

we estimate we have lost about a third of the diversity

of our microbes.

- It's pretty clear that our diversity is going down.

And that to an ecologist is dangerous.

Because the diversity protects us.

We have evidence that the organisms are disappearing.

So, the question is why?

And I would say part of it is modern life.

Nothing prepared our microbiome

for clean water, and smaller families,

and Caesarean sections,

and anti-bacterial substances everywhere,

and of course 70 years of antibiotics.

- [Voiceover] In 1928, Sir Alexander Fleming

made a world changing discovery.

Penicillin.

- Initially, a very small amount

of penicillin could be made.

In the case of penicillin, it's caused by a fungus,

or a mold.

And in the early 1940s,

while World War II was going on,

scientists were looking for a good source of penicillin,

a mold that really produced a lot.

And that mold where most of the penicillin,

even til today comes from,

came from one moldy cantaloupe in Illinois.

And that was the great strain that produced

huge amounts and we could harness that

to good for us.

- [Voiceover] That moldy melon, and the arrival

of mass produced antibiotics changed the face

of modern medicine.

- For those of us who've lived in recent decades,

historically, we've lived in a quite a privileged period

of human history, because we've had these

powerful medicines to fight these bacteria

that cause disease.

- Antibiotics underpin most medicine.

It's hard to do surgery without antibiotics.

It's hard to do transplantation, or chemotherapy.

We need antibiotics to help protect us against bacteria.

And in consequence, antibiotics are being used

more and more and more.

And certainly, here in the United States,

they're very much overused.

- [Voiceover] Widespread use of broad spectrum

antibiotics kill off good bacteria as well as disease

causing pathogens.

Combined this with the use of antibacterial products

that claim to kill 99.9% of all bacteria.

And it seems that over the past 70 years,

we have been waging war on our microbes.

This may be taking its toll on our microbial populations.

But where does our microbiome come from?

When are the seeds of our bacterial ecosystem sewn?

The critical time for seeding our microbiome

happens during childbirth.

Preparations for founding the baby's bacterial

ecosystem actually start inside the mother during pregnancy.

Scientists believe the baby grows up

in a near sterile environment in the womb.

Emerging research suggests that a small number

of bacterial communities may be present in the placenta.

And other recent research suggests that small colonies

of bacteria might also be present in the womb.

But the main seeding event occurs at birth.

In the weeks and days leading up to the birth,

key bacterial species gather in the mother's breasts

and her vagina, then during labor and birth.

A special cocktail of bacteria is transferred from

the mother to the baby in the birth canal.

(woman laughing) (water splashing)

- And as the baby starts going out through

the birth canal, the baby is acquiring the

mother's bacteria from the vagina,

the baby is covered with the bacteria.

The baby is coated, is swallowing the bacteria.

And that's the baby's first introduction

to the world of bacteria.

The world that we all live on.

That's the founding microbiome for that baby.

- [Voiceover] Rodney Dietert,

Professor of Immunotoxicology from Cornell University

believes that this microscopic process that happens

during childbirth is critical for future health.

His hypothesis is called the completed self.

- The completed self is the idea that we are intended

to be majority microbial from the very beginning of life.

At birth, we are supposed to be 90% microbial.

And that's the way it should be.

That's the way it is when we're healthy.

When the baby comes down the birth canal

during vaginal delivery, that is the major seeding event

and we know that the gut microbes in particular

are absolutely crucial in what happens

with immune system, and in the capacity to break down

different nutrients and different environmental chemicals.

That's where the action happens.

So, that is probably the single most important event

that's going to chart the course for whether

that baby becomes complete,

and whether that baby experiences a life

filled with health or one filled with disease.

- [Voiceover] The next stage for the microscopic transfer

of microbes happens during skin to skin with the mother.

Immediate skin to skin contact allows for the transfer

of skin bacteria from mother to baby.

And is important for other hormonal

and biological processes.

- When that baby comes out, the natural habitat

for that baby is the mother's body.

And that baby should go directly

skin to skin with the mother.

When that happens, oxytocin's released

and the cortisol starts to dampen down

that was released during labor.

The baby starts to smell and search for

the mother's breasts.

The skin is to skin is so amazing, that the mom

will warm up if the baby's cold.

That being on the mom's skin will regulate

the baby's blood sugar.

It regulates the baby's breathing.

It reduces crying.

It reduces stress.

It basically brings that baby into the world

in the gentlest way possible.

And helps it to adapt to being outside in the world.

- And it's an absolutely a critical time.

You know, the oxytocin levels are high.

It's the moment when the mother and the father

will see the eyes of the baby, and often this kind

of position, the baby recognizes the human face.

They will never have that moment again.

It's the first stage of falling in love.

And it actually sets a template for future life.

- [Voiceover] For the baby to have immediate

skin to skin with the mother, is the perfect

situation to establish breast feeding,

the next critical step in terms of the physiological

process of birth.

- When that baby then breastfeeds,

there's a whole other connection and cascade

of hormones that occurs.

The mother's releasing prolactin.

She's releasing oxytocin.

She's calming down.

She's relaxing.

She's falling in love with her baby.

Her baby's feeling the same for her.

- [Voiceover] Breast milk is a very complex substance,

exquisitely designed to provide everything needed

by the baby.

But importantly, breast milk also provides

everything needed by the baby's microbes

that have just been seeded in the baby's gut.

- In breast milk, you have several things

that the baby needs.

First of all, the mother provides certain immune

hormone-like substances that are really important.

Some of those are anti-inflammatory.

And that's going to be part of the challenge.

The baby needs those.

She provides antibodies as well.

And in addition, she provides some microbes

from her own breast tissue,

but she also provides sugars,

oligosaccharides they're called.

- [Voiceover] For many years, scientists were

really puzzled by one of the main components

of breast milk.

The sugars, the oligosaccharides were indigestible

by the baby.

So, why were they there?

- It's very, very complex.

But it especially contains indigestible carbohydrates,

indigestible substrates that the baby will

not be able to digest,

but the good bacteria will.

- [Voiceover] It's only recently that scientists

have discovered that the sugars were there

to feed the newly seeded bacteria in the baby's gut.

To feed, to nurture, and to help them grow in number.

- Breast milk is the best source for the baby's microbes.

And breast feeding beyond six months

were possible, even up to two years.

A lengthy duration of breast feeding

is really important because breast milk

contains the sugars that help the baby's microbes

to mature themselves.

They're exquisitely designed for those microbes,

and they're the best nutrient source.

And so that becomes extremely important.

To nurture a well seeded microbiome that's in the baby.

- [Voiceover] What happens if you interrupt this

complex process of feeding the newly seeded microbiome?

- If we break the natural rule of breastfeeding,

naturally, we may also be helping to compromise

the education of the immune system of the baby.

- [Voiceover] When a baby is born, it's immune system

is completely naive.

It doesn't what is safe, and what is dangerous.

So, the baby's developing immune system has to learn

which bacteria are the good ones that should be tolerated,

and which bacteria are harmful that should be attacked.

- It is a fascinating story already,

from what we're learning about the interaction between

the gut microbod in the infant as it develops.

And also the development of the infant immune system.

They're connected.

And so, as the gut microbod is developing

over the first year of life, so is that immune system.

And the way it is developing, it's learning

what is friend and what is foe.

You know, what is beneficial good bacteria,

and what is harmful.

- So, what we have here is an image of one of the types

of immune cells in our body called macrophage.

We study the mechanisms of exactly how

other cells in the body are told,

"Hey, we have an infection, come help us out."

- [Voiceover] The first bacteria to arrive

in the baby's gut kick starts this process.

They prime the baby's immune system.

Scientists believe that the immune system

has one chance to do this.

One chance for optimal future health.

- This is extremely important,

and if you upset this process, which is so crucial

in the early life, then we may have consequences later.

- We need our microbes in place,

at birth or shortly thereafter.

And the reason is, that that's when the immune training

needs to happen.

You may have an opportunity to correct the balance

in the microbes by taking probiotics later in life,

and that's great in a way,

but it doesn't answer the problem with the immune system.

There's one chance.

There's a narrow window.

If we miss the window, at that point, then the immune

system never matures correctly.

And that could lead to haphazard responses

and production to disease later in life.

- [Voiceover] If this complex seeding and feeding process

is interfered with, this could effect the development

of a child's bacterial ecosystem.

This could effect metabolic processes

and the immune system.

As a result, this could make our children

more susceptible to disease.

Scientists are hypothesizing this is what could be

happening born by Caesarean section.

Caesarean rates have sky rocketed

in the past few decades.

In the U.K., a quarter of all babies are now born

by Caesarean section.

In the U.S., it is around a third.

In China, it is about half.

And in some private hospitals in Brazil,

the Caesarean rate is over 90%.

- The rate of Caesarean section is going up

around the world.

Now, in many instances, that is a jolly good thing

because Caesarean section can be life saving.

And there are parts of the world where women

need Caesarean sections for their own health,

for the health of their babies, and they don't

have rapid access to them.

So, we've got a paradoxical situation,

where in some parts of the world,

women who need Caesarean sections can't get them.

And in other parts of the world,

women who don't need Caesarean sections

are having their deliveries in that way.

- My personal view of why the Caesarean section rate

has been rising steadily ever since high qualified,

is that we keep making Caesareans safer.

And because they're safer, that means the threshold

of risk in labor in which we would resort to a Caesarean

gets lower and lower, and lower.

And it's not just the professionals who perceive this.

The women themselves perceive Caesareans

as being relatively safe, which of course they are.

And hence, they're more likely to request

Caesarean section at a lower level of risk than they would

have done in 20 or 30 years ago.

- [Voiceover] Caesarean sections are sometimes essential,

and can be life-saving.

But there are some known short-term health risks

for the baby associated with being born in this way.

- Babies born by elective Caesarean section

who haven't been exposed to the normal process of labor,

do have more in the way of short-term health problems.

Perhaps the one that's most well known is

respiratory problems, and they can be quite unwell

with these respiratory problems,

they can need intensive care.

Obviously the majority just have mild degrees

of respiratory problems.

These babies also find it much more difficult

to establish feeding.

They're much more likely to have low blood sugar levels.

They tend to be sleepier, a bit more drowsy.

The short-term problems are well-recognized.

But where our research is asking new questions

is are there long-term implications from having been

born by Caesarean section as well?

- Until recently, the main emphasis with the Caesarean

has been to avoid the damage of difficult labor

to the mother, and to the baby,

cause the baby can get short of oxygen during

a difficult labor.

And it's been assumed that if you deliver

the baby in good condition by Caesarean,

that therefore the baby will do perfectly well

in the long term.

Unfortunately, it turns out that there is some aspects

of normal natural birth through the vagina

which are missing when you do a Caesarean section,

and it's turning out that that may lead to some problems

for the baby in the long term.

- [Voiceover] If a baby does not pass through the

birth canal, that baby will bypass the mother's bacteria,

encountering instead, bacteria potentially

from other sources.

Scientists are hypothesizing this could come with its

own set of problems.

- So, there's several issues with Caesarean delivery.

First of all, it bypasses the process where the baby's gut

would be seeded by the microbes from the mother's gut

and established at birth, through vaginal delivery.

In addition, the mother is likely to have been

administered drugs, or antibiotics that will effect

both her microbes, and the baby's microbes.

And finally, with Caesarean section occurring in hospitals,

the baby is going to get gut microbes from somewhere.

And unfortunately, they may be of the kind

that exist in hospitals, and are not necessarily healthy

for the baby, such as Clostridium for example.

- And we think, and this is still a hypothesis,

that that's part of the problem, that this generation

of kids have.

There immune system has been primed

by the wrong set of bacteria.

The seeding of the baby's micobiome could be critical

not just for the gut and the developing immune system,

but the latest research is also linking the seeding

of the baby's microbiome with the development

of other tissues, including the brain.

- The baby's microbes that are seeded by the mother

into the gut are important,

not just for the gut, but for most of our tissues.

And one example is, the brain.

Because we now know that depending upon the seeding,

that occurs, and the diversity of the microbes in the gut,

that affects the brain and the nervous tissue.

So, that a number of neural behavioral disorders

had been linked with the microbes being

not diverse enough.

That the seeding is inadequate.

And as a result, the byproducts that are produced

from normal nutrients by that baby affect the brain

in ways that produce behavioral alterations

that can be a problem.

- The fact that we can get these long term problems for the

baby doesn't mean that we should stop doing Caesareans.

They're clearly going to go on being necessary.

So, the challenge for us is to find ways of dealing

with this particular problem.

Just like we've improved the surgical technique.

We've improved the anesthesia.

We now need to improve how we deal with the baby.

So, that it overcomes this particular problem.

- If a mother must have a C-section, then there are things

that she can still do.

That can be really helpful for the baby.

So, it's very important to have immediate skin-skin contact

when that's possible.

Breast feeding of a significant duration,

six months or more, is really important.

Again, to nurture the microbes in the baby's gut.

In addition, there is an idea of using vaginal swabs,

and how that may be important in attempting to seed

what the baby would have gotten had the baby had

vaginal delivery.

- [Voiceover] Dr. Maria Gloria Dominguez Bello

is leading a pioneering study across multiple countries,

where babies born by Caesarean section are inoculated

with bacteria from their mother's birth canal.

- So, what we do is we take a gauze,

eight centimeters by eight centimeters,

we wet it with a sterile saline solution,

we fold it, and we make like a tampon with a slot of

surface exposed, we fold it as a fan,

and we incubate it in mom's vagina

during the last hour before the procedure,

before the C-section.

And the surgeon takes the gauze out just before

the procedure which lasts, it's really fast.

It lasts between 15 and 20 minutes.

So, the gauze is put into a sterile container

while the surgeon does the procedure,

and when the baby's born, the first thing the baby

will see immediately is that gauze.

We pass it through the mouth first,

then the face, and then the rest of the body.

So, we are currently doing the study.

It's a big study.

The full results will not be ready

before two or three years.

But we have decided to take the first babies

and publish a month of their progression,

of their bacterial communities.

And what we can tell so far, is that the baby's inoculated,

although they were born by C-section, they look more

similar to vaginal delivered babies than to C-section

delivered babies.

- Swabbing newborn babies could help introduce the mother's

bacteria to babies born by Casesarian,

but there doesn't appear to be a substitute

for the complex interplay of hormones and stresses of

natural child birth that could be

critical for future health.

- The single most important thing we can do for a

healthy baby across a life course, is to ensure

that microbial seeding occurs completely at birth

through vaginal delivery when possible,

the skin-skin contacts occurs, and that the microbes

are supported through breast feeding of

significant duration.

This should be on every birth plan.

Every health professional, every medical professional

attending to the pregnant woman, to the birth process,

through infancy should be aware of these things,

should be aware of the importance of the microbiome

and supporting a healthy microbiome

because that's what's going to influence the health

across a lifespan versus one filled with disease

for that child.

- [Voiceover] Science has shown that bacterial populations

in the gut are passed on from generation to generation

during vaginal birth.

So, a grandmother has similar bacterial species

in her gut as her daughter, and even her granddaughter,

if they all have vaginal births.

And so bacterial transfer can be viewed as a kind of

maternal heritage that is passed on from generation

to generation, from grandmother to mother to daughter.

But what happens if one generation gives birth by

Caesarean section?

This could be breaking the chain of maternal heritage.

Could we be producing a generation of children

who are missing vital bacteria?

And could that be passed down and down

for all future generations?

What is not known is what the consequences of this might be

for humanity.

There's other transgenerational processes

possibly happening during childbirth that could also

have ramifications for our species.

This is the emerging field of epigenetics in childbirth.

Epigenetics very, very simply are heritable changes

in gene expression that are independent of the

underlying DNA.

So, while your DNA is what you inherit from your

mom and your dad, there are parts of your gene

that switch on and switch off.

So, epigenetics is above the gene.

And epigenetics is simply saying that there are

changes made that silence parts of your genes

that can then be passed on into the next generation.

- And what we know happens at birth is that there

is a whole series of genes that you need to be switched on

in order to survive post birth.

And there are genes that you've had switched on

before birth that you need actually need to switch off.

You no longer them throughout life.

And birth appears to be the point that you

switch genes on or switch them off.

- A very, very long period of evolution has brought us

to the point that we are today.

It's highly plausible that normal labor, normal delivery

is in someway a programming event.

And by that, I mean that it turns on genes that affect

certain health trajectories.

- Anything from things occurring in the actual environment

of the mother giving birth to interventions that can occur

during the birth process like giving antibiotics,

inducing labor, providing the mother with pitocin,

C-section delivery,

forceps delivery, and things of that nature.

All of these interventions we believe may have an

implication or may cause changes in the epigenome

that can have later impacts on health outcomes.

- [Voiceover] The actual process of labor as well

as vaginal birth could be critical for long term health.

It could be that the stress of labor is actually

good for the baby.

It could help prime the immune system epigenetically

via a complex process involving hormones and also

have a long term effect on metabolism.

- [Voiceover] What evidence do you have?

- So, at the moment we don't have a lot of evidence

that there are epigenetic changes during pregnancy

and birth.

We got good epidemiological evidence showing that there

are links between ways babies are born and disorders

later in life.

But there are a couple of studies that have come out

showing that there are mutilations or changes seen

genetically with Caesarean section.

There are also studies showing that antibiotic use,

even antibiotic use during labor has been able

to show some evidence of mutilation.

So, we've got some evidence.

But because we've skipped this whole area,

nobody's been looking, and so we're now saying

turn the microscope on birth, it's a really important

part of a human being's life, and therefore probably

has much greater impact genetically than we ever thought.

- [Voiceover] Also have been few large scale university

research studies about the long term effects of

Caesarean sections, the same can be said

about another commonly used intervention.

The use of synthetic oxytocin to induce or speed up labor.

- I have spent the last 33 years trying to answer

the question you have asked me:

what are the long term consequences of pitocin

or syntocinon?

And I would say we still don't know.

The only way we could find out would be to do an experiment.

And I don't think anyone really

wants to be in that experiment.

But because the procedures that are used

to facilitate birth, the use of pitocin, syntocinon,

oxytocin, all the same thing,

has increased so much, we're now at the point,

where there's almost nobody left to study

that hasn't been exposed to it in some way or another.

- Animal studies are indicating that exposure to

synthetic oxytocin around the time of birth

can have detrimental outcomes.

But we can't study the same kind of mechanisms in humans.

So, while we have our correlational studies,

but we certainly need large population based studies

where we can look at associations between

birth exposures and long term outcomes.

- [Voiceover] With the potential transgenerational

effects of epigenetics, long term effects that can

be seen for up to and even beyond 100 years

in the future, we could be altering

genetic components of future generations

right now without even realizing.

- We're interfering and altering so many biological

processes during labor and child birth.

We don't have a clue as to what kind of long term

heritable, intergenerational changes can take place.

It's irresponsible to be biological manipulating

this emerging system in the baby.

This sensitive transitional system in the mother,

and not know the consequences.

- You know, people who work in epigenetics will tell you

you are what your grandmother ate.

This can go on to several generations.

So, we need to start the research now,

so that we haven't waited several generations

before we've got really good answers to things

that we can correct today.

- [Voiceover] Whatever the actual cause,

whether it is epigenetics, or alterations to the baby's

microbiome, a mixture of the two, or possibly

another reason altogether, it appears something is happening

with Caesarean section that is being linked to

increased risk of disease later in life.

- Epidemiologically the data is quite strong, it's linked

to Caesarean section long term outcomes.

Large population studies have shown that asthma

has increased, about a 20% increase risk of asthma.

If you're born by Caesarean section childhood,

compared to if you're born by vaginal delivery,

about a 20% increase in the risk of Type 1 diabetes.

Smaller increases in gastrointestinal problems,

so gout, related conditions, Crohn's disease,

coeliac disease.

All of those conditions cause a link to the immune system,

which is a common theme with them.

Obesity, we see a similar kind of increase in the risk

of obesity.

- [Voiceover] Scientists at Imperial College, London

have recently conducted a study into the link

between Casesarean section and increased risk of

obesity later in life.

- We've just completed and published a very large systematic

review and meta analysis.

In other words, we put together all of the published

world literature which examined the relationship

between obesity and overweight, and mode of delivery.

- So we took a data from over a 100,000 people,

from adults born from around the world,

born by the Caesarean section or vaginal delivery.

And we showed that if you were born by Caesarean

section, on average you had half a unit BMI greater

than if you were born by vaginal delivery.

Half a unit increase BMI in an individual means very little.

I could gain that and lost that in a week,

and wouldn't notice any difference in health impact.

But across the population, half a unit BMI increase

is a massive public health risk.

You see a very large increase in strokes,

in cardiovascular disease, early mortality, etcetera,

all through half a unit BMI increase.

- [Voiceover] As scientists are very keen to point out,

an association is not the same thing as cause.

- We don't know whether or not being born by

Caesarean section causes certain health problems,

causes you to be overweight or obese.

We know there's an association, and I have to emphasize

a phrase in science that is really, really important,

which is that association that does not mean as causation.

So, for example, you might find that the increased

risk in being overweight or obese, if you're born

by Caesarean section is actually because your mom

was overweight, and the risk isn't anything to do with

how you were born, but it's to do with the genes

that you inherited, or it might be due to the environment

in which you were brought up.

So, you can see that we have to be really careful

about whether or not actual mode of delivery

causes these problems.

But it's clearly a very, very important problem.

Because if it is causal, if Caesarean section

does cause health problems, rather than just being

associated with them, then we potentially

have a very big problem on our hands.

- Over the last 20 to 30 years, we've seen dramatic

increases in childhood asthma, Type 1 diabetes, celiac,

childhood obesity.

And we've also had increases in Caesarean delivery.

Does Caesarean cause these conditions?

No.

What Caesarean is to not allow the baby to be seeded

with the microbes.

The immune system doesn't mature and the

metabolism changes.

It's the immune dysfunction and the changes in metabolism

that we now know contribute

to those diseases and conditions.

- [Voiceover] The story of later life disease

associated with Caesarean section doesn't stop there.

- With Caesarean delivery, the problem is those children

are an elevated risk of asthma, Type 1 diabetes,

celiac disease, and obesity.

But that's just the tip of the iceberg.

One of the things that happens with Caesarean delivery,

increasing the risk of these childhood diseases

such as asthma, coeliac disease, and Type 1 diabetes

is that the other diseases where there's elevated risk

may occur later in life.

That the children are essentially programmed as a result

of these early environmental conditions for the appearance

of subsequent chronic diseases.

We know that non-communicable diseases are interlinked.

That if you have one, particularly as a child, your chances

of having another and maybe a third later in life

are very much increased.

So, for example, a child diagnosed with asthma,

it's not just asthma that we need to worry about,

because that child has a greater risk of being obese,

of having behavioral issues, and eventually

developing lung cancer than children who don't

have asthma.

The same thing happens for children with Type 1 diabetes

and very specific non-communicable diseases.

In that case, many of them are autoimmune diseases.

The same thing for children with coeliac disease,

which is increasing at prevalence.

So, that it's not just the first disease that's encountered

in childhood because of low microbial diversity,

but it's the progression of potentially multiple

chronic diseases or non-communicable diseases,

each one requiring a heavy medical intervention

and drug therapies.

- [Voiceover] This emerging science all seems to be

pointing in one clear direction.

That there is a link between Caesarean section

and increased risk of our children developing

not just one, but multiple non-communicable diseases.

If we continue on the same path, it is conceivable

that our actions could actually be accelerating us towards

the disaster scenario predicted by the

World Economic Forum and Harvard School of Public Health,

the bankruptcy of our global healthcare systems.

- You could also actually begin to think about

non-communicable diseases as a deeper threat

to national security.

If we don't find ways for managing these diseases better,

if we can't come up with cheap, or cost effective ways

to address them, we're going to be landed

with quite a big socioeconomic problem

that could be destabilizing in the worst case scenario.

And so I think that's why also we need to raise

more awareness around non-communicable diseases

and get more coordinated action on this.

- [Voiceover] Non-communicable disease is now

being recognized by world leaders as a serious global

health threat.

Action plans are being devised.

But what appears to be completely missing from their agenda

is the link between how we give birth and increased

risk of our children developing multiple

immune-related diseases later in life.

- Well, one thing is for sure.

Is that if you take information to very, very busy world

leaders that is not the subject that is actually being

debated, you stand very little or no chance of being heard.

So, it's crucial to take a subject that they're

all working on first, and then say in order

for you to achieve the goals that we have

all agreed to, you need to know this.

- [Voiceover] Are we too late?

- I don't think we're too late.

But we're definitely not too early either.

This is a really big challenge.

It's something we have to confront urgently.

We have to change our thinking.

We're gonna have to get our brightest minds on this.

We're gonna have to get coordinated at action

both within countries but also between countries.

And I think this is what we're all going to have to

pitch in together for the benefit of humanity.

Looking into the future, if antibiotics are no longer

effective because of antibiotic resistance, and if

we are unwittingly producing a generation

of children with compromised immune systems,

we could be sending our children out into

a world of disease with their shields down.

You can imagine the situation that if we continue

reducing our bacterial diversity, our children

could become more susceptible to infectious disease,

including pandemics.

- Well, the worst case scenario is in fact really terrible.

And that is that we know that the good microbes

of our body help protect us against the bad microbes.

And so the risk, is that of our microbes get too depleted,

then we will become quite susceptible to an invader,

a pathogen that arises somewhere, and that could

spread through our communities all over the world,

and cause a terrible plague or a pandemic.

Pandemics have occurred in the past,

and we're vulnerable to pandemics.

There are many more of us.

We live closer together.

Because of jet planes and other forms of travel,

we're no more than two days away from any village

in the world.

So, we have a very large interconnected community.

And that makes us more susceptible to pathogens.

And now, if our coastal defenses are weakening,

if we don't have the diversity, then we're more susceptible.

That's a scenario that I've called antibiotic winter,

which is very bleak, because it could really cause

untold numbers of death.

Now, if this happened tomorrow, it's too late.

There's not that much we could do about it.

But if it were going to happen 50 years from now,

then we could find ways to protect against it

and to restore our diversity.

And that's what we have to do.

- [Voiceover] Could we now be doing to ourselves

what we have already started doing to the planet?

Human kind's impact on our inner ecosystem seems

to be mirroring the influence we are exerting

on our global macro ecosystem.

We're disturbing the balance.

- Our westernized lifestyle and our technology,

which has given us so many good things,

have also collateral damage.

And we have to understand what is the impact

and try to correct before it's too late.

Both at the level of the planet, of our environment,

of our macro ecoystems, and of our own microbial

ecoystems that live with us.

- [Voiceover] Over a quarter of a century ago,

scientists warned mankind was causing damage

to our own planet.

The scientists faced fear resistance.

And the repercussions of inaction perhaps are now

being witnessed.

The same warnings are now being echoed with respect

to our own species.

Let's not make the same mistake again.

We can't afford to wait decades before action is taken.

Before wide scale studies are commissioned.

Before the global community wakes up

to what we may be doing to ourselves.

And it all starts with birth.

- [Voiceover] What's the worst case scenario

if we don't change?

- Well, the worse case scenario if we don't change

is that the humanity is heading for a huge health

crisis which will impact on us economically.

It will impact on our quality of life, but also most

significantly it's gonna impact on the next generation.

And it takes several generations to sometimes

sort out the problems we've created previously.

So, we absolutely have to act now.

If we're wrong, and if it was all smoke and mirrors,

then we've done no harm.

However, if we ignore it, we've potentially done huge harm.

So, that's why we actually have to act now.

- I think we're in the midst of the largest experiment

in human history.

And we're not running the controlled studies that

we need to know what the consequences are.

I think that's unethical.

I don't think it's acceptable.

I'm not saying we shouldn't use the procedures

and the medical advances that we have.

I'm saying we owe it to the children that we're producing,

to know everything we can about what the consequences

for that child of those procedures are.

(dramatic piano music)

- I think it's extremely urgent because the sooner

we can identify, and if there are truly risks

for negative health outcomes down the line,

we can make a significant impact on health

for all mankind.

For the first time ever, the obesity epidemic has reached

such proportions, that we're likely to see children

who have a shorter lifespan than their parents

or their grandparents.

If how we're born affects our chances of long term health,

can we do anything to reduce this obesity epidemic

even by a very small degree, we need to do something

about this now.

We need to seize this opportunity to actually turn

the course of human health.

The jigsaw is sort of being built isn't it?

This feels like another really important bit of the jigsaw.

It's pointing in a clear direction,

which is child birth is important for the future health

of our children, and we need to get it right.

- We have to alert the public about what's going on,

so that they understand what the stakes are.

And where this is coming from.

And we need to do more science to pinpoint

the problems and also develop the solutions.

If we're right, and I think we've only just begun to scratch

the surface on how right we may be,

then we have got potentially a huge issue coming up

to face us.

And a bit like climate change, even though we don't

have all of the answers as to what's going on, why,

and how severe that issue might be,

we're putting resources, we're putting politics,

we're putting policies behind it,

and we're changing things because it would be

so dreadful if we allowed this to escape

and become a bigger problem than it may.

- Scene, take one.

- It's a global problem.

It's not an American problem, it's not a European problem,

it's not a Japanese problem, it's not a Chinese problem.

It's a humanity problem.

It is (laughing).

- If we don't take the bigger perspective and fund

research that asks the smart questions,

the big questions, the developmental questions,

intergenerational questions, epigenetic questions,

how do we know that we're not altering the course

of humanity?

(dramatic orchestral music)