Infection Risk Management for Waterbirth in Hospitals and Birth Centers

Infection control is a vital part of ensuring the safety of attendants, mothers and babies during waterbirth. In this blog post, we will discuss the infection prevention requirements for birth pools in hospitals and birth centers. We will also look at some of the design features of permanent birth pools that can impact on infection control.  We will not address portable birth pools.

There are two main elements to consider for infection control: the water used and the vessel that holds this water, i.e. the birth pool. The water used will not be sterile but it does need to be free of legionella and other contaminants such as feces. Management of legionella is beyond the scope of this post but we should note that cases of legionella infection during waterbirth have led to the banning of recirculating water heating systems for waterbirth in the United Kingdom and guidance from the US CDC advising against their use. We assume that the water used meets standards for human consumption – local research and measures are required if not.

Decontamination of birth pools needs to be appropriate for their intended use.  In the absence of lesions on the skin of the mother and attendants, the pool and water may be in contact with mucus membranes but not penetrate skin and the pool will become contaminated with blood/body fluids during use. The appropriate decontamination approach is cleaning and disinfection. Cleaning is the removal of physical matter from the surface of the item using detergents and usually cloths or mops. This must be followed by disinfection by either heat treatment or chemical action. For birth pools only chemical action is appropriate and the most common agent is a hydrochloride, although use of chlorous oxide agents is becoming more widespread.

Most birth pools are larger than baths and present a challenge for comprehensive cleaning of the inside surface. Having talked to hospitals about this challenge, we recommend the use of a mop (single use head or laundered) for cleaning inside the pool.

Birth pool design features that impact infection control include plug/drain, overflow, doors, lights and handles. Any feature that includes a join with the pool surface material creates a site for contaminants and these can be difficult to decontaminate effectively. Our approach is to minimize the number and size of such joins and this is one reason why we do not have doors or internal handles or lights on our FP3 pool. Plugs with a chain are not easily decontaminated and therefore we supply single use plugs. Overflows are not required in some countries because infection control overrides other building regulations. The US is an exception: usually, an overflow is a requirement for building code sign off. If you can avoid having one then do so.

This is an overview of infection control and we have more to say about the subject in future posts. Let us know your experience and approach.