Water births are becoming popular not just with the home birth community, but also in birthing centers. That being said, with several recent cases in Arizona of Legionnaires’ disease in newborns after water births in home tubs, the safety of water births is being questioned.
What is Legionnaires’ Disease? Legionnaires’ disease is a bacterial form of pneumonia that is spread through contaminated water. Symptoms include fever, chills, cough and headaches. The bacteria is naturally found in fresh water and can contaminate water tanks, hot tubs, cooling towers, and air conditioners. You can contract it by breathing in the mist that contains the bacteria or aspirating it. You cannot get it from someone else and most people who are exposed do not get the disease. However, individuals with poor or immature immune systems, such as newborns, are particularly susceptible.
So, what do we know about these two cases in Arizona last year and how did these babies contract Legionnaires’ disease? In both cases, the infants were delivered at home in a tub where the water had been pre-filled with tap water at a temperature where the bacteria can thrive (77 to 113 degrees F). Temperatures need to be higher than 140 degrees Fahrenheit to kill these bacteria. While these incidences are rare, waterborne infections can be serious and fatal especially for a newborn whose immune system is still developing.
So what do the experts recommend: The American College Of Obstetricians and Gynecologists (ACOG) has found using tubs in the first stage of labor may be associated with shorter labor and decreased use of epidurals (results were not consistent in a 2009 Cochrane systemic review). However, when it comes time to pushing and actual delivery of the baby, there is concern for increased risks of drowning, infection (cases of Legionella and Pseudomonas bacterial infections have been reported) and umbilical cord avulsion. While further studies may provide more definitive recommendations in the future, ACOG advises that although the early part of labor may be spent in water, birth of babies should occur "on land."
If you do plan on having a birth immersed in water, ACOG encourages you to use a disposable birthing tub rather than a hot tub. The Arizona Department of Health developed guidelines and resources on how to have a safer water birth and reduce the risk of infection to your baby after those two cases of newborns that had contracted legionella pneumonia. If you plan on being at a birthing center, make sure to ask what their sanitizing protocols are and what their policy is on cleaning tubs.
Dr. Pam
What is Legionnaires’ Disease? Legionnaires’ disease is a bacterial form of pneumonia that is spread through contaminated water. Symptoms include fever, chills, cough and headaches. The bacteria is naturally found in fresh water and can contaminate water tanks, hot tubs, cooling towers, and air conditioners. You can contract it by breathing in the mist that contains the bacteria or aspirating it. You cannot get it from someone else and most people who are exposed do not get the disease. However, individuals with poor or immature immune systems, such as newborns, are particularly susceptible.
So, what do we know about these two cases in Arizona last year and how did these babies contract Legionnaires’ disease? In both cases, the infants were delivered at home in a tub where the water had been pre-filled with tap water at a temperature where the bacteria can thrive (77 to 113 degrees F). Temperatures need to be higher than 140 degrees Fahrenheit to kill these bacteria. While these incidences are rare, waterborne infections can be serious and fatal especially for a newborn whose immune system is still developing.
So what do the experts recommend: The American College Of Obstetricians and Gynecologists (ACOG) has found using tubs in the first stage of labor may be associated with shorter labor and decreased use of epidurals (results were not consistent in a 2009 Cochrane systemic review). However, when it comes time to pushing and actual delivery of the baby, there is concern for increased risks of drowning, infection (cases of Legionella and Pseudomonas bacterial infections have been reported) and umbilical cord avulsion. While further studies may provide more definitive recommendations in the future, ACOG advises that although the early part of labor may be spent in water, birth of babies should occur "on land."
If you do plan on having a birth immersed in water, ACOG encourages you to use a disposable birthing tub rather than a hot tub. The Arizona Department of Health developed guidelines and resources on how to have a safer water birth and reduce the risk of infection to your baby after those two cases of newborns that had contracted legionella pneumonia. If you plan on being at a birthing center, make sure to ask what their sanitizing protocols are and what their policy is on cleaning tubs.
Dr. Pam
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