PHE advises temporary suspension of heated home birthing pools filled in advance of labour in home settings.

Please be clear this alert is NOT for baths and birthing pools filled from domestic or hospital hot water systems then pumped out when cold/dirty or then going through normal plumbing. This IS for heater filter units which re-circulate warm water. This is not about these circulatory systems being innately dangerous either – just that the sanitzation and effectiveness of all units now have to be checked to ensure safety before being hired out or used. There is a potential for contamination if the unit is not fully disinfected, or the unit is not working properly or the users do not follow the strict instructions. Investigation is under way. So if you have one, lend one, or hire one, then contact your local Health and Safety Dept at your local authority to get advice on ensuring this awful situation does not happen to you, a loved one, or a customer.

 Every good wish

Ruth@Aquabirths

 https://www.gov.uk/government/news/alert-after-legionnaires-disease-case-in-baby

Press Release Text:

Public Health England (PHE) and NHS England have temporarily advised against the home use of birthing pools with built-in heaters and recirculation pumps, potentially filled up to 2 weeks in advance of the birth. This follows a single case of Legionnaires’ disease identified in a baby born in this specific type of birthing pool at home. The baby is currently receiving intensive care treatment in hospital.

Samples taken from the heated birthing pool used have confirmed the presence of legionella bacteria, which cause Legionnaires’ disease. Tests are ongoing to establish if it is the same strain which infected the baby. This is the first reported case of Legionnaires’ disease linked to a birthing pool in England, although there have been 2 cases reported internationally some years ago.

NHS England has today issued a Patient Safety Alert rapidly notifying the healthcare system – and specifically midwives – to the possible risks associated with the use of these heated birthing pools at home. The alert recommends that heated birthing pools, filled in advance of labour and where the temperature is maintained by use of a heater and pump, are not used for labour or birth. In the meantime, a full risk assessment into their use is being carried out.

The majority of birthing pools used at home are filled from domestic hot water systems at the time of labour – these birthing pools do not pose the same risk and are excluded from this alert. There are no concerns about these types of pools as long as pumps are used solely to empty the pool and not for recirculation of warm water.

Professor Nick Phin, PHE’s head of Legionnaires’ disease, said:

This is an extremely unusual situation, which we are taking very seriously. As a precaution, we advise that heated birthing pools, filled in advance of labour and where the temperature is then maintained by use of a heater and pump, are not used in the home setting, while we investigate further and until definitive advice on disinfection and safety is available.

We do not have concerns about purchased or hired pools that are filled from domestic hot water supplies at the onset of labour, provided that any pumps are used solely for pool emptying.

PHE and relevant local authorities are investigating the infection control measures required for this type of birthing pool and local authorities will be working with the small number of companies who supply these heated birthing pools for use at home.

Louise Silverton, director for midwifery at the Royal College of Midwives, said:

Women planning birth at home using a traditional pool that is filled when the woman is in labour or using a fixed pool in an NHS unit are not affected by this alert and should not be concerned. Birthing pools in hospitals are subject to stringent infection control procedures and monitoring. 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.

Legionnaires’ disease is extremely rare in childhood, with only 1 case in children aged 0 to 9 years reported in England between 1990 to 2011.The infection does not spread from person-to-person – people become infected with the bacteria through inhalation of contaminated water droplets.

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Dilation Dilemmas: Conner’s Birth Storyhttps://bornstroppy.files.wordpress.com/2013/02/alana-and-family.jpg?w=287

Here is a lovely birth story, a home water birth where the mother laboured instinctively, but, as Senior Midwife Christian Howarth reflects afterwards, one wonders how helpful it is to tell a woman how far she is dilated.  Does she need to know  when her real question is ‘how much further?’

See what you think:

My husband Chris and I had decided from quite early on in my second pregnancy that we wanted to have the baby at home. My first pregnancy, labour and birth had been fine and so was my second. At our 20 week scan we found out that our eldest son Dylan (now 3), would have a baby brother who we decided to call Conor.

I had started having BraAlana birthpoolxton Hicks a few weeks before labour started and a few false alarms! We couldn’t believe how different this was from the first time. We had arranged to hire a birth pool which we got while the Olympics were on and Dylan and I would have an evening soak in the birth pool whilst watching the highlights of the day! As I had a lot of lower back ache towards the end of the pregnancy, the birth pool was a godsend and good fun for Dylan too! We also felt it was very important for him to understand that his baby brother would be born at home in the birth pool.

I decided to go for a pregnancy massage a few days before my due date. As I was paying for the massage, I had quite a strong pain but thought nothing of it as I had been having such powerful Braxton Hicks. When I got home from having the treatment, the contractions started. It was 3pm on the Friday afternoon of the Bank Holiday weekend. I decided that I would see how regularly the contractions were coming.  They didn’t stop and so I decided to call Chris to tell him to get home. He wasn’t answering his phone so I called my mum (who had finished work that lunchtime and started two weeks of annual leave) and asked her to come. Mum was always going to come and pick our dog Sasha up and take her up to her house but at that point we didn’t realise that she would be in charge of filling the birth pool up in Chris’ absence! Because of the false alarms I had been having, I received a text from Chris explaining he was in the middle of carrying out some training for one of his clients and what was the matter! He soon set back home when he realised that the baby was coming though!

I then called my in-laws who were looking after Dylan and explained that they might want to keep Dylan at their house for the night and rang BRI to explain that I was in labour and wanting them to inform the midwives on call that I was in labour.

I had been attending pregnancy yoga and relaxation classes and so was just breathing through the contractions whilst burning jasmine and clary sage in my oil burner and staying upright. I found swaying my hips really helped and I loved the TENS machine! I knew the contractions were getting closer together and lasting for longer so I rang BRI to ask them to let the midwives know I wanted them to come out. This was about 530pm. They told me to take some paracetomol for the lower back ache which I did.

The midwives arrived about 630pm and took time to read my birth plan while they had a cup of tea. We were chatting and I was still wandering round and pausing to have contractions and resting on Chris for a good hour or so. I then felt that the contractions were getting more intense and I asked the midwife to examine me to see how dilated I was. When I was told that I was 4cms dilated I felt quite concerned and was wondering how else I could speed things up apart from keeping mobile and using the yoga positions. The midwife suggested that she carry out a bit of a stretch which was very uncomfortable as I was lying down. As soon as I was able I got straight up and restarted rocking my hips.

The midwife had definitely worked her magic as then the contractions really stepped up and I felt that I wanted to get in the birth pool. I felt pressure on my bladder which was different from my labour with Dylan and I felt like I was starting to make noises like I was getting ready to push. I kept thinking how stupid this was though as I’d only 10 or 15 minutes earlier been told I was 4 cms. This was now about 750pm.

When I got in the pool, I felt much more comfortable and was kneeling over the edge of the pool holding Chris’ hands. The sensation to push was getting more tempting and I made a joke to the midwives about how this was crazy when I was only part way towards the 10cm! They were very hands off and after a couple more contractions I realised thatAlana and family the noises, the pressure and the urge to push were getting more extreme…..I then saw both midwives putting their plastic aprons on and knew that Conor would soon be born.

After a couple more contractions and bearing down I said that I thought I could feel his head crowning. The position I was in made it very awkward for the midwives to see and they asked me if I could move to a slightly better position but I couldn’t! Instead they asked me to reach down. I did so and could feel his hair wafting about in the water. A couple more pushes and he was out. I guided him to the surface of the water, his big blue eyes looking up at me through the water blinking! It was 835pm and I’d gone from 4cms to giving birth in less than an hour!

When Conor came to the surface, we realised that his cord was round his neck but the midwife soon unhooked it with her fingers. She asked me to give him a bit of a rub to get him to make some noise which I did. He did cry but not as loudly as Dylan had so the midwives cut the cord and then rubbed him with a towel which did the trick.

By 1030pm, the midwives had left us to it and we were sat with a glass of champagne in our lounge, our new baby boy snuggled in our arms.

Christian Howarth Senior midwifery tutor at Huddersfield University reflects:

Well I can’t really comment on the story because I wasn’t there!

Cervical dilatation is an interesting thing isn’t it?  Women seem to have been told for years that their cervix has to dilate to 10cms, magic number before the baby can come out.  It’s not surprising then that they would ask for a midwife to check dilatation.  How sad that she thought  she needed to speed things up when she found out that her cervix was four cms dilated.  That’s brilliant, that’s halfway there!

You have to look at the whole picture though. Dilatation itself isn’t a particularly good guide – it’s part of the information that may be needed.  A midwife would also have to consider how well engaged the baby’s head was, how the head was descending, how strong the contractions were, how long they were lasting, how the woman was breathing, what noises she was making …  I think I’d do all that before I thought about examining the woman.  What else can you see – any external signs of full dilatation? A show, bulging vulva, the ‘thin blue line’?  Do I really need to carry out an invasive examination? Is the woman labouring or in transition?  Is she about to give birth? Listen to the woman!

There’s always the worry that an examination will lead to further intervention.  Is it necessary to speed things up?  It seemed that this woman was in established labour, so why carry out a stretch and sweep? Again, I wasn’t there, so I can’t really comment on that.  It is not uncommon for a cervix to dilate very quickly in a second or third labour! Particularly if it’s well applied to the head (or bum). I know this, but I am always hearing stories about it!  Women feel disheartened by finding out they are ‘only’ 4cms dilated, and perhaps ask for pethidine or other analgesia – only to give birth half an hour later, doped up, and likely not to remember those first precious moments.

Hope these comments are useful.

The Dangers of Uninterpreted Birth Footage

Dear all,

 

It has always been my main critique of programmes such as One Born Every Minute that they give footage without comment, analysis or context thus rendering the information it provides at best un-useful and at worst downright misleading.  For instance watching a shoulder dystosia without some discussion about its rarity, on the fact that it’s occurrence is more likely in the semi recumbent position, and the various methods of dealing with the situation, renders the footage both distressing and misleading to watchers.

 

I remember years ago a theologian, I respect immensely contended that the Bible should not be read in public without appropriate interpretation to the listeners.  He gave the example of John 21 where after the crucifixion the disciples lock themselves in an upper room ‘for fear of the Jews’.  This passage without appropriate context and interpretation had been the justification for anti semitism and violence against Jewish people over many centuries.  However contextualised, you would realise for instance, that the disciples were Jews and Jesus was a Jew – so how could they lock the door for fear of ‘the Jews’ when this was their identity also?  This phrase is actually believed to come from the context of the writer of the Gospel some decades later, a context where Gentile Christians were being persecuted by the Jewish population in that area.   So the phrase ‘for fear of the Jews’ which has caused so much strife and suffering has little to do with the Gospel story itself and much to do with the context in which the story was written down.  “This,” said my friend Dave Bowen, “Is why the Bible should always be read with appropriate interpretation.”

 

I have come to think this same rule should apply to the sharing of birth stories and especially of the televising of birth.  Editing and comment is everything in these situations: We need to have the analysis and information to really interpret what is happening in its appropriate context.  This would mean discussion from different perspectives, disagreement and comment about the practice presented, enabling viewers and readers to get a real flavour of the variety of opinions and practices that  women can receive in their birth and the opportunities for choice there are.  It would also mean of course that practitioners would have to submit their practice to the discussion and comment of their peers in a public arena – it could be a brave practitioner and a very tactful editor who could accomplish that feat.  And yet without it women are being misled and misinformed by the ‘camera that never lies’.

 

With this in mind I came to this latest birth story to cross my desk.  As I read it, questions were raised in my mind and I thought, this is a lovely birth story but there are some real questions about the practice of the carers and the way policies are implemented and practice explained.  I felt that this birth story should not be published without some pointers and questions for further discussion. 

 

For instance:

  • Where does the 24 hour deadline for induction after waters breaking come from?  Where is the risk/benefit analysis of this policy?
  • Fantastic way to spend your early labour: on the allotment and walking the dog! Not worrying about progress or lack of it.
  • Could the midwife have avoided that devastating moment for the mother by giving her positive information that would encourage her efforts rather than dishearten? How could she have encouraged a woman making slow progress with her birth?  Is giving the information ‘1cm dilated’ as unhelpful as uninterpreted  birth footage? What about effacement? What about not giving a number but simply saying progress is being made but there is a way to go yet? What would a caring midwife say to a woman in this situation?
  • The most glaring question in this story is: if the TENS was not working and the pains were so strong – why did the mother wait so long to get in the pool? – particularly when it clearly gave so much relief?  Was she waiting for permission from the midwife? Why did she need it?

 

With these questions I hand you over to the Mother’s tale:

The arrival of Albert Oliver, 7th March 2012.

My waters broke when I woke up at 8.30am on Tuesday 6th March.  After getting in the shower I decided that they really had gone, and that I wasn’t just suffering from late pregnancy incontinence!  I rang my husband, Tony, who was already at work, and he headed home to be with me.  I also rang the delivery suite who rang the community midwife on call.  San came round at about 9.30am and confirmed my waters had gone.  She told me that I needed to ring them again when my contractions were 5 mins apart, and that should labour not begin within the next 24 hours, I was booked in for induction at 8.30am the next morning.

I spent the day with Tony and another friend, Carol.  Carol had arranged to visit that day anyway and help me rotovate my allotment. Poor Tony got roped in too.  I kept moving (light allotmenting jobs) throughout the day.  At 4pm Carol left, taking our dog with her.  Another friend called in, and we went for a walk, and had an evening meal at about 6ish.

Throughout the day I had been having contractions, and at about 7ish these became stronger and more regular.  I’d put my TENS machine on early in the day, as soon as I started feeling mild contractions. A bit after 8pm I rang the delivery suite again, as we were recording my contractions as coming every 2 to 5 mins.

Cat arrived at about 8.30pm, and after observing me, we decided that I would have an internal examination to see where we were up to.  I was really very nervous about this, as I hadn’t had any internal prodding so far in my pregnancy.  It was absolutely fine however, nowhere near as intrusive as I thought it would be.  However, the examination revealed I was only 1cm dilated at this point, and Cat commented that my contractions weren’t either consistent or long enough for me to be in established labour.

I was understandably devastated at this news (as it REALLY hurt by this point!).  Cat left, saying that I needed to call her when my contractions were every 2 minutes and lasting a full 60 seconds.   The next 2 and a half hours were not fun, and I caved in at 11.30pm and asked Tony to ring delivery suite.  Cat arrived by midnight and examined me again.  At this point I was 9cm dilated, and was incredibly relieved to hear it (as it REALLY REALLY hurt and the TENS machine by this point just didn’t seem to be cutting the mustard).

I finally got into the pool at about 12.30. We’d filled it around 6pm, so Tony needed to boil some kettles to get it back to temperature.  It felt amazing as soon as I got in, and made a massive difference to my pain management (the gas and air was making me too sick so I didn’t bother with it).  The second midwife dealt with further kettles after I got in the pool, as I didn’t want to let go of Tony’s hand.

Albert arrived at 1.39am, so I was only in the pool an hour or so.  I picked him up (with help from the midwife) and cuddled him in the pool, but had to get out to deliver the placenta (as I was bleeding).  Albert was wrapped up and given to his dad to hold, so Tony had loads of time with him immediately while the midwives dealt with my third stage.

I would recommend a pool birth to anyone, whether at home or in hospital, it made a huge difference to my labour experience – as soon as I got in the pool, the pain seemed manageable, and Albert seemed to arrive quite quickly.  We now have a perfect, happy little boy!”

A happy ending to a good birth story.  But as practitioners and as stroppy mothers and midwives, that cannot be enough – we have to ask the questions too.