Birthing Pools & Legionnaires’ Disease: Awareness & Risk
In this article our healthcare water safety specialists look at the use of birthing pools and consider if they create a risk from Legionnaires’ disease.
The article looks at how birthing pools are typically used both in hospitals and at home, what factors can increase legionella risks, and what steps can be taken to keep people safe when using such pools.
A version of this story dealing with the risks from Legionnaires’ disease when using birthing pools first appeared in Legionella Control International’s newsletter. To get it in your inbox, sign up for free here.
Legionnaires’ disease and birthing pools
Legionella is a type of bacterium that can cause a number of diseases including the potentially serious pneumonia-like Legionnaires’ disease.
Legionella bacteria thrive in warm water environments. These can be both natural and manmade. If the water temperature sits anywhere between 20 – 45 degrees Celsius, the bacteria can multiply if it has nutrients to feed on. This could happen over time even if the water introduced to start with is perfectly clean.
Legionella bacteria thrives between 20 – 45 degrees Celsius
There are cases where hot and cold water systems such as those found in buildings, water storage tanks, cooling towers, and water features generating spray and mist have become contaminated with legionella bacteria. Under certain circumstances this can lead to an outbreak of Legionnaires’ disease if people nearby inhale contaminated mist. Once inside the body the bacteria then find their way into the lungs, where they can cause Legionnaires’ disease or other less serious conditions such as Pontiac fever.
Are heated birthing pools a legionella risk?
So, where do heated birthing pools feature on the risk scale for legionella? As with any other water system, there is a risk of legionella colonising such a pool. However, for this to occur, specific circumstances would need to be met that are not normally present when a heated birthing pool is used correctly.
Using birthing pools safely
There are two scenarios whereby a pregnant woman would typically use a birthing pool. This would either occur at home or in hospital. The latter is a fixed birthing pool rather than only being for temporary use, as a home pool would be.
A home pool is much like a temporary swimming pool, with sturdy sides once inflated that are comfortable to lean against while giving birth. They range in size, with some large enough to allow the woman’s partner to get in with her.
In the UK, NHS healthcare sites must follow strict water safety measures relating to any source of water. This includes fixed birthing pools, which means regular cleaning, testing and infection control measures are used. In this case, there should be no issue with legionella as the risks will be carefully managed. Those responsible for water safety in healthcare environments will include birthing pools in their site water safety risk assessment, identifying any potential issues and putting steps in place to mitigate those issues to keep people safe from harm.
Home birthing pools
In the case of a birthing pool used in the home, the pool would be set-up in the home prior to the birth. You can either rent or buy one. Once the woman goes into labour, a disposable liner is put into the pool and it is then filled with warm water. After the birth, the water is drained-off and the pool is dismantled, so there is no risk of legionella bacteria getting the time or temperature range it would need to multiply and cause health issues. Since fresh water is used to fill the pool, there should also be no nutrients there to feed any bacteria. This means the main risk factors of water stagnation, temperature and a food source should not be present.
Which birthing pools pose a Legionnaires’ risk?
So far, it seems that all birthing pools ought to be safe. However, a report from Public Health England (PHE) revealed that a newborn baby contracted Legionnaires’ disease following a water birth in 2014. In this case, the home birth took place after the pool had been filled with hot water and then kept warm for two weeks. This contrasts with the usual way of using a home pool, by filling it with warm water only when the woman goes into labour and ready to use it. The method used that led to the baby becoming ill was not – and is not – recommended.
Birthing pool risks and what to avoid
So, a pre-filled birthing pool where a heater and pump are used to keep the water warm is the situation to avoid. You can still use a pump and heater if you fill the pool when the woman is in labour and ready to use it. If a home birthing pool is used in the recommended manner, there should be no risks from Legionnaires’ disease. The idea is clearly to make sure you are not trying to get ahead of yourself and fill the pool with water long before it is needed – just in case.
The PHE report stated that Legionnaires’ disease only very rarely occurs in babies or children. It’s one reason why this case stands out. Women using birthing pools, whether at home or in hospital, should have no need to worry unless they are getting them ready way ahead of time.
More about Legionnaires’ disease
Legionnaires’ disease is a serious form of pneumonia caused by inhaling legionella bacteria into the lungs. It causes shortness of breath, a fever, coughing, and other symptoms often associated with flu. Many people who are diagnosed with the disease require hospital treatment to recover. This may involve oxygen treatment and antibiotics, usually given intravenously for between one and three weeks.
It is reassuring to know that the birthing pool case of Legionnaires’ disease mentioned in the Public Health England report was an isolated one. It is also clear how the baby was inadvertently exposed to a situation where legionella bacteria were present. That means that such situations can be avoided in future.
Healthcare water safety specialists
Our healthcare water safety specialists support those responsible for the control of waterborne pathogens including legionella in hospitals and other healthcare environments, helping them to protect people and so meet their health and safety obligations in this specialist area.
We are experienced in the role of Authorising Engineer (Water) and deliver professional water safety risk assessments for legionella, pseudomonas and other waterborne pathogens. We also offer water quality testing, independent compliance auditing, City & Guilds training and other risk management services that help keep staff and others safe.
If you would like to speak with one of our healthcare specialists about managing your water safety risks call us today on 0330 223 36 86 or contact us here …