A newborn girl in Canada developed a life-threatening infection after being delivered in a hot tub, according to a case report that some doctors say offers fresh evidence that women should not deliver babies in water.
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).
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."