Hired home-birthing pools across the country have been recalled and hire companies put under scrutiny after a baby born using one of the heated pools developed legionnaires' disease.
The NHS and Public Health England (PHE) have banned certain types of home-birthing pools until further notice, after the child – who remains in hospital with severe pneumonia – became unwell.
Heated pools from the supplier have been recalled, with at least six other companies – hiring out 60-70 pools – being questioned by PHE on their safety precautions. PHE said it was "unclear" whether or not the companies had carried out legionella risk assessments.
PHE said the advice was a "temporary" measure, and referred to the home use of birthing pools with built-in heaters and recirculation pumps, which can be filled up to two weeks in advance of the birth. NHS England issued a patient safety alert on 17 June to alert midwives to the possible risks associated with the use of this type of heated birthing pools at home.
This is the first reported case of legionnaires' disease linked to a birthing pool in England, although there have been two cases reported internationally in the late 1990s. Legionnaires' disease, caused when the legionella bacteria is inhaled from contaminated water droplets, is extremely rare in childhood, with only one case in children up to the age of nine reported in England between 1990 and 2011.
The PHE advised that the majority of birthing pools used at home are filled from domestic hot-water systems at the time of labour, which carry less risk as long as pumps do not recirculate warm water. The recalled pumps were delivered two weeks before labour and, once filled from the tap, were kept warm by a pump and heater until labour and delivery.
Prof Nick Phin, PHE's head of legionnaires' disease, said: "Further investigation into this incident has confirmed that the type of legionella bacteria found in the birthing pool is the same strain which caused the baby to become ill with legionnaires' disease. As part of the investigation, PHE has been working with local authorities to investigate the provision of these pools by a number of companies, including the advice given by the companies on pool filling and on controlling risks from exposure to legionella."
The decision to ban the birthing pools was based on the difficulty of preventing the growth of legionella in recirculated warm water over days or weeks in homes, he added. "For this reason, PHE has confirmed its earlier precautionary advice and is recommending that this type of pre-filled, heated birthing pool is no longer used at all at home."
Louise Silverton, director for midwifery at the Royal College of Midwives, said that women should not be concerned if they were planning a birth at home using a traditional pool filled when they were in labour or using a fixed pool in an NHS unit. "Birthing pools in hospitals are subject to stringent infection-control procedures and monitoring," she said. "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."
