Pregnant moms from poor areas, who shower, rather than bath or wash by hand, have a lower chance of going into labour early, new research indicates. It seems to be because showerers reduce their chances of fecal bacteria entering their vaginas during ablutions, which reduces their chances of aerobic vaginitis, and in turn reduces the risk of preterm labour.
A recent study conducted at the University of the Western Cape and funded by the National Research Foundation (NRF) examined more than 300 women who attended antenatal clinics in the Western Cape. We found a significant link between preterm delivery and the specific bacterial species that are commonly found in faeces and have been implicated in aerobic vaginitis.
These bacteria have been moved from the anus to the vagina during wiping after ablutions, thereby disrupting the balance of the normal microbiota of the vagina.
The most frequently found bacteria were Escherichia coli and Enterococcus faecalis, both of which are usually found in the gastro-intestinal tract, and Streptococcus agalactiae, commonly found in the vaginal-anal region.
All the subjects in this study came from poor or rural areas and often lack adequate sanitation and access to clean water.
Many of them have to walk long distances to get clean water, meaning that they are more likely to use this water for drinking than for washing.
The normal vaginal microbiota play an important role in maintaining vaginal health and preventing infections of the reproductive tract, but the composition of a woman’s vaginal microbiota can be affected by numerous factors, such as poor hygiene, age, diabetes, infections, menopause, sexual activity, pregnancy and the use of contraceptives or spermicides.
Pregnant women are more vulnerable to diseases and infections associated with poor hygiene and water contamination, so the importance of adequate hygiene practices cannot be over-emphasised. If the mother experiences vaginal infections during pregnancy, it can negatively affect the unborn foetus.
The presence of abnormality in the vaginal microbiota in early pregnancy is considered to be one of the most significant risk factors
for preterm delivery, as well as premature rupture of membranes and low birth weight, with serious consequences for the neonatal infections, namely septicemia, meningitis or pneumonia, all of which are associated with a high neonatal mortality. Neonatal sepsis is considered to be mostly caused by unhygienic practices and poor infection control, including lack of hand-washing, unclean surfaces and unhygienic cord-cutting in antenatal clinics or in some cases at home.
In our studied population, the majority of the mothers reported that they washed by hand while others reported bathing and only a few reported showering.
We did find that there was a connection between pregnancy outcomes and these different hygiene practices, with showering having the lowest association with preterm birth.
Researchers in previous studies have shown that among the neonatal deaths the majority are attributable to pneumonia, meningitis, septicemia, and diarrheal disease –diseases which are all linked to hygiene practices.
On the African continent, 230 women in every 100 000 who give birth to live babies will die, compared to 16 per 100 000 in developed countries. Hygiene plays an important role, but many poor women lack access to water and information about hygienic practices that could save their lives, as well as their babies’ lives.
As a result, maternal and neonates’ survival remains a significant challenge in many parts of Africa. Many lives – of mothers and children – could be saved by informing pregnant women of basic hygiene steps that they can take.
Eve Kaambo attends the University of the Western Cape.