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Water Birth Is Beautiful, When It Doesn’t Involve Legionnaire’s Disease

Two babies born via water birth contracted Legionnaire’s disease from heated birthing pools

According to a new report from the Centers for Disease Control and Prevention, two babies born via water birth in 2016, contracted Legionnaire’s disease, a life-threatening form of pneumonia, from heated birthing pools. While both babies survived, the CDC is now sounding the alarm, highlighting “numerous gaps in infection prevention” during water births.

Most major medical organizations in the U.S. have been decrying the practice since at least 2014, when a Texas baby born in a birthing pool died of Legionnaire’s.

“Until sufficient evidence is available, it is the recommendation of ACOG that birth occur on land, not in water,” according to a joint 2016 statement from the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. “Potential risks of in-water delivery include a higher risk of maternal and neonatal infections, difficulty in the regulation of the baby’s body temperature, increased chance of umbilical cord damage, respiratory distress resulting from the baby inhaling tub water, and potential for asphyxia and seizures.”

Water birth advocates defend their birthing tubs as soothing, relaxing spaces for mothers to de-stress during labor. They suggest that buoyancy promotes more efficient contractions and better blood circulation, and that water loosens the perineum and reduces the risk of vaginal tears during delivery. At the same time, however, there is perhaps no environment better suited for the Legionella bacteria that cause Legionnaire’s disease than poorly maintained hot tubs. Bacteria thrive in environments that are hot, but not too hot, and form thick, mossy biofilms that protect such dangerous microbes from disinfectants. Hot tub users need not even touch the biofilm to become infected—Legionella can ride into your body on airborne water droplets. In theory, proper hot tub maintenance prevents this. In practice, most people don’t follow the CDC’s hot tub guidelines.

Since water births occur in modified hot tubs, and since there are humans in charge of maintaining them, it’s almost surprising we don’t see more water birth complications. Although there are a handful in the literature: There was a 2014 case of Legionnaire’s in Texas, which tragically proved fatal for the newborn. Before that, there was a case in 2001 that claimed to be the first reported case of transmission of the disease via water birth—and, naturally, another report in 2003 that made the same claim.

After concluding that there’s no potential gain from water birth, and significant potential risks, AAP and ACOG both recommended against the practice. In response, the American College of Nurse Midwives and several other midwife organizations released statements endorsing the practice, based on a report of nearly 4,000 water births in the United States. Other studies have similarly shown that there is little or no increased risk to newborns delivered in heated tubs.

Legionella pneumophila bacterium. (Wikimedia Commons)

Because of these studies, there will probably continue to be a handful of future parents eager to hop into the birthing tub. If you’re one of them, consider perusing these guidelines before you take the plunge. And consider this: the ACNM and others argue that a handful of diseases and deaths does not denote a trend, and that water birth is statistically safe. They’re right — but only sort of. When there’s an observable, measurable advantage to a therapy, it’s worthwhile ignoring minor risks of the therapy in favor of its gains. But no robust scientific studies have shown any tangible medical benefit to delivering via water birth, which means it’s essentially a convenient, almost “recreational” option for soon-to-be moms. And if that option—with no known medical benefits—occasionally ends in Legionnaire’s disease, it’s probably not a great idea. Even if it only kills babies every now and then.