Water birth and infection in babies (2024)

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  3. Water birth and infection in babies

Papers BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6953.511 (Published 20 August 1994) Cite this as: BMJ 1994;309:511

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  • Peer review
  1. J Rawal,
  2. A Shah,
  3. F Stirk,
  4. S Mehtar
  1. Departments of Paediatrics, Obstetrics and Gynaecology, and Microbiology, North Middlesex Hospital, London N18 1QX
  1. Correspondence to: Dr Shah.
  • Accepted 18 May 1994

Water births are becoming more popular among mothers and midwives because the buoyancy of water and the warmth of the water used in such births promotes “natural” labour while providing a non-invasive, safe, and effective form of pain management.1 Concern has been expressed, however, about contamination of the birthing tub system (the tub and its accessories) with bacteria that could cause infection in a baby. Virulent bacteria such as Pseudomonas aeruginosa and Klebsiella pneumoniae have been reported in water pumps and heating systems,2 filling hoses of the tub,3 and water in the tubs.4 Nevertheless, we do not know of any reports of a baby becoming infected owing to a water birth. We report on a newborn baby who developed pseudomonas sepsis after water birth.

Case report

A full term baby boy, weighing 3600 g, was born in the birthing tub of the labour ward of our hospital. His mother had no fever before the birth, and the membranes were ruptured for less than 12 hours. His condition at birth was good and Apgar scores were normal. At 11 hours of age he had two episodes of cyanosis. He was feeding poorly. On examination he was hypotonic and his peripheries were poorly perfused, with mottling of the skin. Probable septicaemia was diagnosed. Swabs from the ear and umbilicus and samples of urine, blood, and cerebrospinal fluid were taken for culture. He was given intravenous penicillin and gentamicin. Within 48 hours the swabs had grown P aeruginosa and gentamicin had been changed to ceftazidime. Within a further two days he had recovered. After being treated with antibiotics for seven days, he was discharged.

The cultures of urine, blood, and cerebrospinal fluid were sterile. The samples taken from the baby's incubator yielded no growth, but specimens taken from the birthing tub, filling hose, taps, exit hose, and disposable lining of the tub all grew P aeruginosa. The P aeruginosa that was isolated from the birthing tub system and from the umbilical swab was serotype 2 (Division of Hospital Infection, Colindale). Contamination of the birthing tub system had occurred despite meticulous washing with hot water and detegent and drying of the system after each birth.

Comment

Despite the increase in popularity in water births during the past decade reliable evidence is lacking about the benefits and hazards associated with such births. We have reported the case of a baby who became colonised with a virulent organism during water birth. The blood cultures were sterile, which argues against him being frankly septicaemic. Nevertheless, he behaved and looked like a septic baby and he responded convincingly to antibiotics.

This case highlights an important potential hazard of water birth. Although the results of the research on water birth being carried out by the National Perinatal Epidemiology Unit are still awaited, we endorse the need expressed by others that there should be regular microbiological surveillance of birthing tub systems with strict policies on infection control.3 5 Our policy now is to take samples for cultures from the birthing tub system after each water birth. We have shortened the filling and exit hoses, and these are heat disinfected after use.

References

  1. 1.
    1. Balakas J,
    2. Gorden Y

    . Water birth. London: Unwin Hayman, 1990.

  2. 2.
    1. Loomes SA,
    2. Finch R

    . Breeding ground for bacteria (letter). Nursing Times 1990;866:14-5.

  3. 3.
    1. Robb EJ,
    2. Spiby H,
    3. Norman P.

    Hygiene in birthing pools (letter). Nursing Times 1991;87(39):14.

  4. 4.
    1. George R

    . Bacteria in birthing tubs (letter). Nursing Times 1990;86(14):14.

  5. 5.
    1. Zimmermann R,
    2. Huch A,
    3. Huch R

    . Water birth. Is it safe? J Perinat Med 1993;21:5-11.

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Water birth and infection in babies (2024)

FAQs

Water birth and infection in babies? ›

The time that the baby spends underwater during a water birth is often a top concern for many care professionals. Since blood, other fluids and solids are a natural part of labor and delivery, babies could be exposed to bacteria if they open their eyes or mouth underwater. And that could possibly lead to infection.

Do water births increase risk of infection? ›

Overall rates of newborn infection do not differ between waterbirth and land birth (Bovbjerg et al. 2021). However, there have been reports of rare cases of newborn infection after waterbirth (Vanderlaan & Hall 2020).

What are the risks of water births to the baby? ›

Yes, water births are safe. It makes no difference in how healthy babies are, and they're no more likely to have difficulty breathing or to die. In fact, some research suggests your baby is less likely to need a transfer to hospital or stay in hospital or to be admitted to neonatal intensive care.

Why is water birth not recommended? ›

Pediatricians are most concerned with the potential risk of aspiration, hypothermia, and infection when babies are born in water.

Why do hospitals not allow water births? ›

The American College of Obstetricians and Gynecologists (ACOG) says that while water may provide some benefits in the first stage of labor, there isn't evidence yet to support benefits for the baby. So, while ACOG says it's okay to labor in water, they recommend “delivering on land.”

Why are babies so susceptible to infection? ›

Neonates exhibit less efficient immune responses to pathogens than adults because a specific regulatory mechanism prevents the induction of an appropriate response to fight many types of infections.

Why is a water birth better for the baby? ›

Shatken-Stern also notes that water births have been shown to decrease the risk of severe perineal tearing and the need for an episiotomy. An added benefit of water birth for the baby is the gentle transition it provides to life outside the womb.

How do babies survive water births? ›

When you are close to birthing your baby in the water you will need to keep aware of ensuring your bottom half remains submerged. Babies have lived in fluid for 9 months and therefore have not needed their oxygen from the air as we do, instead they receive this through their umbilical cord.

Are water births hygienic? ›

Are there any risks of infection? There is no statistical evidence that there is any more risk of an infection to both you and your baby with a water birth. Hospitals are meticulous when cleaning pools after every water birth and do regular checks to ensure that the pool is left hygienic after use.

Can a baby aspirate in a water birth? ›

Likewise, in a birthing pool, some babies with unrecognised hypoxia may gasp underwater. Indeed, the 1994 to 1996 survey cited two reports of water aspiration,2 and similar cases have been documented in the literature. Our case report emphasises the adverse effects of aspiration of water in birthing pools.

Are water birth babies calmer? ›

Babies born under water can be calmer following birth than babies born in air and may not cry or move vigorously. This is normal and no reason for worry. Your midwife will carefully observe you and your baby following birth, giving you any guidance and support needed.

Can babies aspirate during water birth? ›

Conceivably, uncompromised fetuses may be at risk of water aspiration and its resulting sequelae. Umbilical cord avulsion (cord “snapping” or cord rupture) has been observed as the newborn is lifted or maneuvered out of the water.

Who Cannot have a water birth? ›

It is not advisable for you to use the pool if: • If you have a medical condition or serious infection. monitoring). during your pregnancy we would recommend avoiding use of the birthing pool due to the increased likelihood of your baby being larger and possible complications during the birth.

What is the dive reflex in water birth? ›

The baby has what is called a “dive reflex”, which is an automatic response in newborns up to the age of six months and assists the baby with breastfeeding. The dive reflex happens when liquid hits the back of the throat causing the glottis to close so that liquid is swallowed rather than breathed in.

Does insurance cover a water birth? ›

There's usually no separate fee for laboring in a tub in a hospital, and your insurance will probably cover most of it (though you'll have to check your policy). The fees for a midwife for a home water birth or birth center water birth are usually included in whatever they charge for a normal birth.

Is it safe to have a water birth in the ocean? ›

"Giving birth in the ocean comes with its own set of risks including the temperature of the water, the unpredictability of tides and waves, and risk of infection due to harmful bacteria or pathogens in the water."

Can babies aspirate during a water birth? ›

Likewise, in a birthing pool, some babies with unrecognised hypoxia may gasp underwater. Indeed, the 1994 to 1996 survey cited two reports of water aspiration,2 and similar cases have been documented in the literature. Our case report emphasises the adverse effects of aspiration of water in birthing pools.

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