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 The baby girl was delivered full-term and was healthy at birth. But
she was hospitalized at eight days old with high fever, poor feeding
and fussiness, and then was moved to the intensive care unit (ICU)
because her organs were failing, researchers report in the medical
journal CMAJ.
She was diagnosed with sepsis, a life-threatening immune response to
an infection with Legionella bacterium that entered her bloodstream.
This bacterium thrives in warm water, and the hot tub, which was
filled days before her birth, may have created an ideal environment
for an infection.
This baby’s experience “serves to highlight a severe and potentially
fatal adverse neonatal outcome of underwater birth, especially when
prefilled heated pools are used," said lead author Dr. Michelle
Barton of Western University in London, Ontario.
“Although freshly filling a hot tub may reduce the risk, serious
infections can still potentially occur in newborns whose immune
systems are quite weak,” Barton said by email.
The baby had been born underwater in a hot tub at home, supervised
by a midwife. The hot tub had been filled three days before birth, a
practice that can lead to increased concentrations of bacteria such
as Legionella in the water as it thrives in temperatures from 20 to
42 degrees Celsius (68 to 107.6 degrees Fahrenheit).
After multiple tests, she was started on antibiotics to treat
infection and began to improve. She spent five weeks on a ventilator
in the ICU before she left the hospital.
The baby might have died, however, if she hadn’t been tested for
Legionella and given an antibiotic regimen tailored to this
diagnosis, Barton said.
Doctors in the U.S. and the UK advise against water birth in hot
tubs or pools with jets because of an increased risk of
contamination, and they also caution against filling the tubs in
advance, researchers note.
For mothers, laboring in water may help ease pain, lower the need
for anesthesia and potentially speed up the early, or first, stage
of labor before the cervix is fully dilated and the baby is ready to
emerge, according to the American College of Obstetricians and
Gynecologists (ACOG).
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Because rare but serious complications have been documented with
water births, and because evidence of benefits that might outweigh
these risks is lacking, women should avoid delivering babies in
water, said Dr. Joseph Wax, chairman of ACOG’s committee on
obstetrics practice and an author of the guidelines.
“It is recommended that delivery occur on land and not in water,”
Wax, a researcher at Tufts University School of Medicine in Boston,
said by email.
Heated tubs are especially dangerous, noted Dr. Alastair Sutcliffe,
a researcher at the Institute of Child Health at University College
London who wasn’t involved in the case report.
“Warm water is an ideal environment for some bugs to grow,”
Sutcliffe said by email. “Babies are not dolphins – those are born
underwater – humans are land mammals.”
Laboring in water prior to delivery hasn’t been found to be harmful,
said Dr. Amos Grunebaum, a researcher at New York Weill Cornell
Medicine who wasn’t involved in the case report.
“The actual amount of newborn complications after underwater births
are unknown because there are no population studies on this,”
Grunebaum said by email. “But complications can be serious enough to
recommend against an underwater birth.”
SOURCE: http://bit.ly/2l8roQ4 CMAJ, online October 23, 2017.
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