By Dr Rose Kamenwa, Consultant Paediatric Gastroenterologist at Aga Khan University Hospital
Delivery by caesarian section seems to be the new trend and fashionable delivery method as most first and second time mothers prefer it as a less painful option compared to natural birth. However, C-section births raise the risk for allergies to infants because the delivery process eliminates the friendly protective bacteria from getting into contact with the baby during birth. This is a factor which should be taken into consideration because protective bacteria contained in the birth canal play a key role in stimulating appropriate immune responses and suppressing unfriendly bacteria in the baby.
The global prevalence of allergic diseases is skyrocketing, affecting between 30 to 40 percent the world’s population. The prevalence of cesarean section deliveries mirror a similar trend with mounting evidence suggesting that cesarean section birth may be a risk factor for childhood allergic diseases. Allergic conditions include food allergies, anaphylaxis, asthma, eczema and other skin diseases, allergic rhinitis, allergic conjunctivitis and reactions to drugs and insects.
Often, these burdensome conditions start early in life with the highest incidence in children below two years of life. Allergic diseases usually overlap and have the potential to be severe, or fatal. Cesarean section babies have different microorganisms in the digestive tract, which have been identified to prolong immaturity of the immune system and thereby increase the risk for the development of allergic diseases. Beneficial gut flora, or microorganisms are acquired from the maternal vaginal tract and thus are more likely to be transferred to the baby during vaginal births than during Caesarean sections.
The relationship between allergic diseases and mode of delivery has been actively investigated as the proportion of cesarean sections has increased. Researchers in Norway reported that children delivered by C-section have a 52 percent increased risk of asthma compared with those of vaginal delivery’s 19 percent risk.
The World Health Organization (WHO) recommends cesarean delivery as an indicated choice of delivery in less than 15 percent of births. However, many countries have a much higher prevalence, due to less strict medical indication for the procedure. WHO further states that “There is no justification for any region to have caesarean section rates higher than 10-15 per cent”, since increased rates of C-section do not give additional health benefits but may increase maternal risks, have complications for both mother and infant as well as future pregnancies and put more strain on the available health resources.
However, many expectant mothers are now opting and requesting for elective C-section delivery even without medical reason. In Kenya, the increase in elective cesarean births mirrors a trend in the West, and is happening despite warnings from medical experts who say it should remain a last resort. Until recently, caesarean section rates were at a maximum of 25 per cent in public referral hospitals, but these rates have increased by more than 100 per cent and now stand at 50-60 per cent and are even higher in some private facilities. In 2018, official records showed that C-section accounted for 58.2 per cent of National Hospital Insurance Fund’s maternity costs as a third of the women covered by the fund opted for C-section delivery.
Doctors who have undergone extensive training to understand allergies particularly their association with gastrointestinal problems, can create awareness of risk factors for allergic diseases and helping mothers differentiate symptoms of allergic diseases from those of other conditions. Most distraught mothers visit the children’s unit with babies suffering from various digestive system problems including colic, vomiting, constipation, diarrhea, poor weight gain, food refusal and food intolerance in the infant. All these problems can emanate from food allergies whose diagnosis involves detailed history-taking followed by individualized food allergy tests. We currently have no cure for food allergies, eczema, or asthma and our evolving understanding of the factors involved in the development of these conditions may help in prevention strategies.
While C-section remains a life-saving procedure for the mother and the baby where the reason is clear, every mother contemplating to undergo the procedure should be fully aware of the risks. It is therefore important to educate women in their reproductive ages together with their families about the link between C-section and allergies, and the importance of avoiding unnecessary cesarean section.