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Do Pre-heated Birthing Pools Present a Legionella Risk?

Pregnant young woman on a hospital bed.jpegWhile it’s commonplace for pregnant women to give birth in the more conventional surrounds of their local hospital’s maternity wards, this isn’t always logistically possible. Indeed, we’ve all read stories about mother’s having their new-borns delivered anywhere and everywhere, from Disneyland, during a flight and while using a lift, in a limo, a library and a Post Office queue. Of course, these are extreme examples and if all goes according to (well-practised/rehearsed) plan, then you should be welcoming your new arrival into the world in a more clinical context. However with more expectant parents considering home births – and subsequently making the necessary preparations for these alternative means of delivery- we ask is it safe to do so? Or to be more precise; do pre-heated birthing pools present a legionella risk? Although the figure remains relatively unchanged in recent years, evidence suggests that the percentage of women giving birth at home (2.3% in 2015) will continue to steadily rise in the future, as an increasing number of soon-to-be parents jump on the bandwagon.

Therefore it’s imperative that we address one of the more often overlooked potential dangers of taking this option, to determine whether home birthing is something we should be avoiding or if it’s a perfectly safe and natural environment in which to welcome a baby into. But first of all we should raise awareness as to the underlying reason why parents might wish for home birthing over other traditional practices, to afford us a brief understanding as to the back story. According to experts on the subject of childbirth, the presence of water at this juncture has been found to offer an effective form of pain relief for mothers, many of whom habitually experience varying levels of discomfort at this crucial time. Meanwhile a sense of familiarity makes for a less stressful time, as instantly recognisable surrounding can help confidence during labour, making the pregnant women feel more in control and less inhibited. Add into this equation the privacy factor (when compared to giving birth in a hospital delivery room), and you can see why many expectant parents go down this route. But looking at the bigger picture, we need to establish if home birthing, courtesy of a pre-heated pool dedicated to this procedure, presents a realistic threat of legionella infection from the outset.

Pre-heated Birthing Pools, Which House Legionella Bacteria-friendly Temperate Conditions for Periods before Expectant Mothers Enter Labour, Can Give Rise to Legionnaire’s Disease

The key question here centres round the timing issue, and more specifically how long before the impending birth does a pool’s water content need to be heated in advance of infant arrivals? Heeding the advice offered by two leading and respected authorities on the subject of legionella, and Public Health England together with the National Health Service have recently gone to lengths to warn parents planning on home births that pools filled a certain period prior to the expected date of delivery are dangerous, and should be avoided to eradicate the risk posed by the water-borne bacteria. These official warnings come on the back of the 2014 case where a new born baby contracted Legionnaires disease in the aftermath of a home birth performed in a pre-heated pool, which immediately raised concerns and led to a uniformed stance being taken and highlighted. Because legionella becomes a threat to human health when the bacterium is allowed to take root and prosper in temperate, stored waters (typically between 20C and 45C), the danger can surface if and when the water temperature in a birthing pool has been maintained for a protracted passage of time in anticipation of the birth; and usually manifests by a heater and circulation pump. Such elements and ripe conditions can actively encourage the bacteria to form and grow, so people need to be alerted to such largely unseen risks.

Whilst what is clinically referred to as ‘fixed birthing pools’ found within NHS units are privy to routine and far-reaching infection control protocols and practices which wholly prevent legionella taking hold in either the water or the system itself, the same can’t be said when it comes to home birthing; whereby rigorous procedures – thanks to education on the subject – are often sadly lacking. Yet the issue can be avoided if expectant parents wishing to home birth facilitate traditional birthing pools which are only filled with water once the pregnant partner enters the first throes of labour; this, essentially is the rub. Given a clean bill of health by the relevant – and aforementioned – health-compliant bodies, these birthing pools are equipped with disposable liners, while at the same time the water is not kept warm by the facilitation of a heater which can, effectively, be responsible for the manifestation of legionella in the right scenario.

So to this end, and in answer to the titular question as to ‘Do Pre-heated Birthing Pools Present a Legionella Risk?’ then yes, they do, and as such should be avoided. To reiterate however, when dedicated birthing pools are used in controlled, clinical environs, then there’s absolutely no risk factor. From a domestic perspective, again legionella threat is negligible when the pool hasn’t been subjected to an advanced fill of subsequently heat-regulated water, in advance of the expected delivery date; and more especially by the ill-advised intervention of a heater and circulation pump. We hope this provides the clarity sought to make an informed judgement, should you be expectant parents weighing up the pros and cons of home birthing, perhaps having previously been worried by the legionella risk potentially involved. The overriding issue here focusing on the ‘pre-heating’ of the pool for an ‘extended period’, which is the big no-no.

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