Due to the death of an infant from Legionnaires' disease in January, midwives overseeing water births in Texas may see stricter infection control standards, according to a study published in Emerging Infectious Diseases.
No complications were originally reported when the Texas infant was born via water birth. Six days later, however, the infant was admitted to a local pediatric hospital after experiencing loose feces, cyanosis and respiratory failure.
Knowing the baby was exposed to a home water birth combined with symptoms of fulminant sepsis and respiratory failure led the hospital clinicians to suspect legionellosis, according to the report.
After 19 days in the hospital, the infant died of Legionnaires' disease.
The Texas Department of State Health Services investigated the incident and revealed a considerable gap in the standardization in, implementation of and compliance with infection control practices for midwives during home water births.
Following the investigation, the TDSHS drafted recommendations for the midwifery center associated with the reported fatal Legionella infection, the licensing board in Texas, TDSHS regulatory officials and professional midwifery organizations throughout the state, according to the report.
Recommendations included following the proper cleaning protocol for birthing tubs, not using recreational tubs that are unable to be properly disinfected, documenting birthing tub maintenance and documenting chemicals and quantities used for birthing tub disinfection.
Additionally, TDSHS recommended standardizing written water birth procedures for midwifery organization employees and clients to use, such as proper timing of tub filling to reduce proliferation of microorganisms and laboratory testing procedures to follow when birthing tubs are suspected of being contaminated with Legionella or other pathogens.
Regarding the case in January, culture isolation results from environmental swabs of the tub and well water used during the infant's water birth did not yield Legionella, but the swabs were taken after the delivery tub had been drained, disinfected and placed in storage.
Although the midwife present during the infant's birth was a certified professional, the jetted tub used for the birth is not approved for use as medical because it is difficult to disinfect, according to the report.
Additionally, the water treatment used inside the jetted tub included a non-Food and Drug Administration-approved additive and the midwifery center did not provide any written water birth procedures for the center's employees or clients to follow.