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No link found between caesarean birth and food allergies

<p>While babies born through caesareans may lack some gut bacteria that would otherwise be gained through vaginal births, recent research has consistently shown that there is little evidence for caesarean births being responsible for asthma and allergies. A recent study by the Murdoch Children’s Research Institute (MCRI) in Melbourne, confirmed no link between caesarean births and food allergies during the first year of life.</p> <p>This research, published in the Journal of Allergy and Clinical Immunology: In Practice, looked at 2,045 infants who underwent skin prick testing and an oral food challenge to test for allergy status. In this group, of the 30% that were born by caesarean, 12.7 % had a food allergy, compared to 13.2% born vaginally, meaning there was no statistically significant difference between birthing methods.</p> <p>“We found no meaningful differences in food allergy for infants born by caesarean delivery compared to those born by vaginal delivery,” says Rachel Peters, who led the study. “Additionally, there was no difference in likelihood of food allergy if the caesarean was performed before or after the onset of labour, or whether it was an emergency or elective caesarean.”</p> <p>A potential link between caesarean births and allergies had long been suspected because of the difference in early microbial exposure compared to vaginal delivery.</p> <p>“The infant immune system undergoes rapid development during the neonatal period,” says Peters. “The mode of delivery may interfere with the normal development of the immune system. Babies born by caesarean have less exposure to the bacteria from the mother’s gut and vagina, which influences the composition of the baby’s microbiome and immune system development. However, this doesn’t appear to play a major role in the development of food allergy.”</p> <p>These findings will assist caregivers to better evaluate risks and benefits of caesarean birth, and provide reassurance to parents that such interventions do not lead to an increased risk of food allergy in their babies.</p> <p>One in 10 infants, and one in 20 children over the age of five years in Australia, have a food allergy, one of the highest rates in the world. This research provides further good news to parents and children: 30% of peanut allergies and 90% of egg allergies naturally resolved by six years of age. These infants should be targeted for early intervention trials, such as oral immunotherapy.</p> <p>“Prioritising research of these and future interventions for infants less likely to naturally outgrow their allergy would yield the most benefit for healthcare resources and research funding,” says Peters.</p> <p><em><strong>This article originally appeared on <a href="https://cosmosmagazine.com/health/caesarean-no-food-allergy-link/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Qamariya Nasrullah.</strong></em></p> <p><em>Image: Shutterstock</em></p>

Caring

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Vaginal birth after caesarean increases the risk of serious perineal tear by 20%, our large-scale review shows

<p>Pregnant women who previously birthed by caesarean section are presented with a choice: whether to try for a vaginal birth, or book in for a repeat caesar.</p> <p>Those mulling over a vaginal birth are counselled at length about the risk of a rare but nasty outcome – the uterus rupturing while labour is in full flight.</p> <p>But new research looking at 130,000 births over five years has uncovered an increased risk of another outcome women deserve information about: extensive tearing around the vaginal region during birth.</p> <p>Our new study, <a href="https://pubmed.ncbi.nlm.nih.gov/34913246/">published</a> in the British Journal of Obstetrics and Gynaecology, hones in on the risk of vaginal trauma for those who birth vaginally after a prior caesarean. This kind of birth trauma relates to significant injury to a woman’s perineum, the important region between the vagina and anus. The perineum anchors many pelvic floor muscles that help control the bladder and bowels.</p> <p>We defined serious birth injury as a tear in the perineum that <a href="https://www.thewomens.org.au/images/uploads/fact-sheets/Perineal-tears-third-and-fourth-degree.pdf">extends</a> into the anal sphincter – the delicate ring of muscle that helps us control our bowels. Damage to this muscle is called a third-degree perineal tear.</p> <h2>What we studied</h2> <p>The study looked at 130,000 births in Victoria and compared the risk of a third-degree perinatal tear among first-time mums with those who birth vaginally after a prior caesarean (sometimes referred to as a <a href="https://www.acog.org/womens-health/faqs/vaginal-birth-after-cesarean-delivery">VBAC</a>). In our study, vaginal birth included women birthed without any medical assistance, and births by forceps or the ventouse (vacuum birth). Anything but birth by caesarean.</p> <p>The results were clear: a vaginal birth after a previous caesarean increases the chance of significant vaginal trauma (third-degree tear) by 21% (albeit from a low baseline rate).</p> <p>A potential reason for this increased risk might include a mismatch between a uterus that has birthed before and a perineum that has not. If this is the case, the labour progresses quickly, which does not allow enough time for the perineum to stretch naturally. However, the real reason for this risk is unknown and further research is needed.</p> <h2>Lifelong impacts</h2> <p>Once a vaginal birth injury occurs, the tears are immediately repaired by obstetricians. Many women heal fully – but some who sustain a third-degree tear during birth develop distressing issues that never disappear, despite expert care, including from specialist physiotherapists.</p> <p>Symptoms can include an ongoing dragging sensation in the pelvic floor, or true prolapse of the vaginal walls. Sometimes, coughing or sneezing can cause urine leakage. And for some, jogging becomes too hard due to leaking of urine and pelvic discomfort. Others might suffer from reduced faecal control and even the odd episode of faecal soiling. Sex can be painful.</p> <p><a href="https://images.theconversation.com/files/442177/original/file-20220124-13-zzb927.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/442177/original/file-20220124-13-zzb927.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" alt="woman with caesar scar holds baby" /></a> <span class="caption">Women who had a caesarean birth the first time around are at greater risk of serious birth injury from a subsequent vaginal birth.</span> <span class="attribution"><a href="https://image.shutterstock.com/image-photo/closeup-woman-belly-scar-cesarean-600w-1883782888.jpg" class="source">Shutterstock</a></span></p> <h2>This doesn’t mean women shouldn’t consider VBAC</h2> <p>This increased risk of injury does not make it unsafe for women who have had a caesarean before to try for a vaginal birth. But our results should be incorporated into counselling of these women about their choices.</p> <p>Since the risk of vaginal birth injury including the anal sphincter sits at <a href="https://www.safetyandquality.gov.au/sites/default/files/2021-04/perineal_tears_ccs_v3.pdf">around 5-7%</a> in Victoria for first-time mothers, the increase of 21% raises the overall likelihood to around 6–8.5%. It’s a modest rise that will bother some, but not others.</p> <p>Still, women deserve to be given this information so they can judge for themselves whether it worries them enough to ask for a repeat caesarean, or try for a vaginal birth.</p> <p><a href="https://images.theconversation.com/files/442432/original/file-20220125-23-f3cuam.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=1000&amp;fit=clip"><img src="https://images.theconversation.com/files/442432/original/file-20220125-23-f3cuam.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" alt="pregnant woman in waiting room" /></a> <span class="caption">Birth counselling should fully explain the risks.</span> <span class="attribution"><a href="https://www.shutterstock.com/image-photo/pregnant-woman-courses-expectant-mothers-1185645562" class="source">Shutterstock</a></span></p> <p>Counselling is not just about cautioning women of the risks. As midwives and obstetricians, we talk with these women about what will happen when they go into labour, when to come into hospital, and what their chance (and definition) of “successful” vaginal birth might be.</p> <p>We also mention the most enticing advantage for those whose destiny is an uncomplicated vaginal birth – they sidestep another caesar. Often, this means a <a href="https://pubmed.ncbi.nlm.nih.gov/17181678/">shorter recovery time</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/23186385/">improved likelihood of breastfeeding</a>.</p> <p>After these discussions, some women will feel the very small risk of serious vaginal trauma (or <a href="https://doi.org/10.1371/journal.pmed.1001184">uterine rupture</a>) is one well worth taking and opt to try for a vaginal birth. Others will opt for the certainty of a repeat caesarean.</p> <p>Women deserve full support in their birth choices. And they deserve to be fully informed about possible risks. It’s time we broaden our discussions with women planning a vaginal birth after caesarean section to include the increased risk of vaginal birth trauma.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/173249/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><span><a href="https://theconversation.com/profiles/anthea-lindquist-1296574">Anthea Lindquist</a>, Obstetrician and Perinatal Epidemiologist, <em><a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em> and <a href="https://theconversation.com/profiles/stephen-tong-1310350">Stephen Tong</a>, Professor of Obstetrics and Gynaecology, <em><a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></span></p> <p>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/vaginal-birth-after-caesarean-increases-the-risk-of-serious-perineal-tear-by-20-our-large-scale-review-shows-173249">original article</a>.</p> <p><em>Image: Shutterstock</em></p>

Family & Pets

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The issue no one talks about that affects up to 50% of post-menopausal women

<p>As we age, it’s only natural for our mind and body to go through changes – some welcome, some not so welcome. While we can all appreciate the wisdom and lust for life that comes with growing older, there’s one thing in particular that all women would agree we could all do without.</p> <p>Vaginal atrophy is a condition that affects <a href="http://onlinelibrary.wiley.com/doi/10.1111/jsm.12190/full" target="_blank"><strong><span style="text-decoration: underline;">up to 50 per cent</span></strong></a> of all post-menopausal women, but sadly, it’s an issue that is constantly brushed under the rug. Even worse? Only 25 per cent seek treatment.</p> <p>So, what exactly is it and how can it be treated? According to Wellington-based gynaecologist, <a href="http://www.dranjubasu.co.nz" target="_blank"><strong><span style="text-decoration: underline;">Dr Anju Basu</span></strong></a>, vaginal atrophy is “a very common problem of menopause that results in symptoms of vaginal dryness, painful intercourse, vaginal burning, itching, abnormal discharge and urinary symptoms such as incontinence. Society tends to forget older women and doesn't give thought to their quality of life, assuming women over 50 don’t want to have sex! That’s not true, and I’m hoping to change that.”</p> <p>Previously, treatment has consisted of vaginal moisturisers or topical hormone creams to improve these symptoms. The effectiveness of these treatments, however, depends on the patient’s willingness to stick to them as they also only improve symptoms for as long as they are used. Thankfully, there is a new non-hormonal and effective therapy available to women suffering from vaginal atrophy.</p> <p>MonaLisa Touch is a pain-free, non-surgical procedure introduced in 2008, which consists of three five-minute laser treatments to help stimulate collagen production, improve hydration by restoring cells, and improve elasticity and blood supply of the vaginal wall. MonaLisa Touch relieves symptoms for 12 to 18 months, and annual booster treatments ensure long-lasting results.</p> <p>It’s an effective treatment for women who do not want to use hormonal creams, or are not suitable candidates for hormonal treatment (for example, women with breast cancer).</p> <p style="text-align: center;"> <iframe width="500" height="281" src="https://www.youtube.com/embed/yP5wpoiieuU?feature=oembed" frameborder="0" allowfullscreen=""></iframe></p> <p>Dr Basu is one of only four professionals in New Zealand who can perform the treatment, and the only one in the Greater Wellington region. One of her patients, Carol*, sings the praises of the MonaLisa Touch treatment after it gave her a new lease on life.</p> <p>“For many years, I suffered severe discomfort caused by vaginal dryness,” Carol explains. “Both my daily and social lives were badly affected. In short, I had no quality of life. With no treatment, my condition worsened to the extent that I could not walk feely or sit on a chair comfortably. I had become house-bound.</p> <p>“My general practitioner referred me to Dr Basu in Wellington,” she adds. “She treated me using the new MonaLisa Touch laser therapy. Following a course of three months’ treatment there has been an improvement to my vaginal dryness and my quality of life is now finally improving.”</p> <p>If you would like to learn more about vaginal atrophy or this exciting new treatment, <a href="http://www.monalisatouch.com" target="_blank"><strong><span style="text-decoration: underline;">click here</span></strong></a>, or email <span style="text-decoration: underline;"><strong><a href="mailto:Donna.May@southerncrosshospitals.co.nz">Donna.May@southerncrosshospitals.co.nz</a></strong></span>.</p> <p>*Name has been changed.</p> <p>THIS IS SPONSORED CONTENT BROUGHT TO YOU IN CONJUNCTION WITH <a href="http://www.dranjubasu.co.nz" target="_blank"><strong><span style="text-decoration: underline;">DR ANJU BASU</span></strong></a>.</p>

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