Public Health England (PHE) and NHS England have temporarily advised against the home use of birthing pools with built-in heaters and recirculation pumps, potentially filled up to 2 weeks in advance of the birth. This follows a single case of Legionnaires’ disease identified in a baby born in this specific type of birthing pool at home. The baby is currently receiving intensive care treatment in hospital.
Samples taken from the heated birthing pool used have confirmed the presence of legionella bacteria, which cause Legionnaires’ disease. Tests are ongoing to establish if it is the same strain which infected the baby. This is the first reported case of Legionnaires’ disease linked to a birthing pool in England, although there have been 2 cases reported internationally some years ago.
NHS England has today issued a Patient Safety Alert rapidly notifying the healthcare system – and specifically midwives – to the possible risks associated with the use of these heated birthing pools at home. The alert recommends that heated birthing pools, filled in advance of labour and where the temperature is maintained by use of a heater and pump, are not used for labour or birth. In the meantime, a full risk assessment into their use is being carried out.
The majority of birthing pools used at home are filled from domestic hot water systems at the time of labour – these birthing pools do not pose the same risk and are excluded from this alert. There are no concerns about these types of pools as long as pumps are used solely to empty the pool and not for recirculation of warm water.
Professor Nick Phin, PHE’s head of Legionnaires’ disease, said:
This is an extremely unusual situation, which we are taking very seriously. As a precaution, we advise that heated birthing pools, filled in advance of labour and where the temperature is then maintained by use of a heater and pump, are not used in the home setting, while we investigate further and until definitive advice on disinfection and safety is available.
We do not have concerns about purchased or hired pools that are filled from domestic hot water supplies at the onset of labour, provided that any pumps are used solely for pool emptying.
PHE and relevant local authorities are investigating the infection control measures required for this type of birthing pool and local authorities will be working with the small number of companies who supply these heated birthing pools for use at home.
Louise Silverton, director for midwifery at the Royal College of Midwives, said:
Women planning birth at home using a traditional pool that is filled when the woman is in labour or using a fixed pool in an NHS unit are not affected by this alert and should not be concerned. Birthing pools in hospitals are subject to stringent infection control procedures and monitoring. Home birthing pools filled during labour come with disposable liners and are only in place for a relatively short time period, reducing opportunity for bacterial growth.
Any women with concerns about using home birthing pools should contact their midwife or local maternity unit.
Legionnaires’ disease is extremely rare in childhood, with only 1 case in children aged 0 to 9 years reported in England between 1990 to 2011.The infection does not spread from person-to-person – people become infected with the bacteria through inhalation of contaminated water droplets.
Notes to Editors
- Key messages:
- the majority of birthing pools used at home are filled from domestic hot water systems at the time of labour
- there are no concerns about these types of pool as long as pumps are used solely to empty the pool and not for recirculation of warm water
- this new advice relates to the importance of women not labouring or giving birth in a heated birthing pool which has been filled prior to the onset of labour and where the temperature has been maintained by the use of a heater and pump
The heated pools from the supplier involved in this incident have been recalled. PHE is aware that around 10 companies in total supply these specific home birthing pools and each have somewhere between 2 and 14 which they loan out.
The pools are delivered around 2 weeks before the expected delivery date, filled from the domestic hot water supply, and the temperature maintained via a pump and heater until labour and delivery. Various disinfection regimes are recommended by the companies.
Legionella is a commonly occurring bacteria and can be found in around 10% to 20% of domestic hot water systems. Legionnaires’ disease is a severe pneumonia caused by the Legionella bacteria. There are 350 to 400 cases a year reported in England and Wales, mainly in older adults. More information about Legionnaires’ disease is available from the NHS Choices website.
- There are 2 international reports of legionella infection after birth in birthing pools, both from the late 1990s, in Italy and Japan:
- ‘Legionella pneumophila Pneumonia in a Newborn after Water Birth: A New Mode of Transmission’ (available from the CID website)
- ‘Neonatal Sudden Death Due to Legionella Pneumonia Associated with Water Birth in a Domestic Spa Bath’ (available from the NCBI website)
- Read the NHS England Patient Safety Alert
Image by Centers for Disease Control and Prevention (CDC)