LONDON, Ont. — A team of doctors says the case of a baby girl who went into multiple organ failure after being born underwater in a hot tub highlights the risks of such births.
The report published in the Canadian Medical Association Journal says the eight-day-old infant was admitted to a London, Ont., hospital with fever, poor feeding and fussiness.
She was moved to the intensive care unit that same day with multiple organ failure due to sepsis and spent five weeks on a ventilator.
The baby was started on antibiotics and began to improve, but on the 13th day of her hospital stay, she developed a rash on her limbs.
Factors like prefilling tub increase bacterial load: study
Tests found the baby was infected with legionella bacteria typically found in pools and hot springs because they thrive in temperatures between 20 C and 42 C.
Dr. Michelle Barton, the study's lead author from Western University in London, says the case shows that underwater births may be harmful or even fatal — especially when prefilled, heated pools are used.
"Factors such as prefilling the tank days ahead of delivery, inadequately disinfecting the birthing tank, using a contaminated water source, using jetted tubs and heating water all increase the bacterial load of the birthing water," reads the study.
The case — also authored by Brianna McKelvie, Aaron Campigotto and Tara Mullowney — says the girl was delivered underwater in a hot tub, which had been filled with water three days earlier and under the supervision of a midwife.
The doctors were unable to test the birthing water for the bacteria as the hot tub had already been emptied and disinfected.
The baby weighed about 7.7 pounds, was breast fed and was otherwise healthy.
The study says that "legionellosis is an uncommon diagnosis in the neonatal period."
However, it also says several reports of the infection in newborns have been linked to contaminated water systems at residences or hospitals or to the inhalation or aspiration of contaminated water in humidifiers, baths and birthing tanks.
"Neonatal legionellosis presents as a potentially fatal sepsis syndrome characterized by severe pneumonia progressing to acute respiratory distress syndrome, septic shock, multiorgan failure and death in more than half of cases."
The report suggests testing for legionella if a baby develops respiratory complications.
American obstetricians staying away from water births
A water birth involves an expectant mother being in a pool of warm water for at least a portion of labour. Supporters say it can be more relaxing for the mother and cause less distress to the infant as it is born into an environment similar to the womb.
Doctors in the United States and the United Kingdom recommend avoiding pools with jets or recirculating pumps for water births. The American College of Obstetricians and Gynecologists recommends expectant mothers say away from water births because there isn't enough data to determine the risks and benefits during labour and delivery, the doctors wrote.
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