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Water birth and infection in babies

Departments of Paediatrics, Obstetrics and Gynaecology, and Microbiology, North Middlesex Hospital, London N18 1QX Correspondence to: Dr Shah.

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.

1. Balakas J, Gorden Y. Water birth. London: Unwin Hayman, 1990.
2. Loomes SA, Finch R. Breeding ground for bacteria (letter). Nursing Times 1990;86(6):14-5.
3. Robb EJ, Spiby H, Norman P. Hygiene in birthing pools (letter). Nursing Times 1991;87(39):14.
4. George R. Bacteria in birthing tubs (letter). Nursing Times 1990;86(14):14.
5. Zimmermann R, Huch A, Huch R. Water birth. Is it safe? J Perinat Med 1993;21:5-11.

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