Water births are growing in popularity around the world, but one mother’s experience has doctors cautioning against the practice entirely.

According to Reuters Health, in a case study, a Canadian mother had given birth in a hot tub to a full-term, healthy baby girl under the supervision of a midwife.

Eight days later, the baby fell ill and she was hospitalized with a high fever, poor feeding, and fussiness. The baby was moved to the intensive care unit when her organs started to fail and remained there for five weeks on a ventilator.

Doctors determined the baby had contracted sepsis due to Legionella bacterium entering her bloodstream from the hot tub.

The case study was reported in the Canadian Medical Association Journal.

According to the Centers for Disease Control and Prevention, Legionella bacteria is found in natural freshwater environments, such as lakes and streams.

The bacteria becomes harmful when it grows and spreads through man-made water systems, such as showers, faucets, hot tubs, decorative fountains, and hot water tanks and heaters. Legionella bacteria, which causes Legionnaire’s disease (a lung infection like pneumonia) and Pontiac fever (which includes fever and muscle aches) is spread through the inhalation of contaminated water droplets.

Although most people who come in contact with Legionella bacteria are not affected, those most at risk include people over the age of 50, current or former smokers, those with chronic lung conditions and/or weakened immune systems, the CDC says.

According to Reuters Health, because the Canadian mother had filled the hot tub three days prior to the birth of her baby, it possibly created an environment conducive for Legionella bacteria to breed:

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).

In an interview with Reuters Health, Dr. Michelle Barton of Western University in London, Ontario, explained although filling a tub with fresh water may reduce the risk of bacteria forming, “serious infections can still potentially occur in newborns whose immune systems are quite weak.”

Barton, lead author of the study, added that the incident highlights “a severe and potentially fatal adverse neonatal outcome of underwater birth, especially when prefilled heated pools are used.”

Canadian Medical Association Journal

As Reuters Health reports, doctors in the U.S. and the U.K. caution against water births in hot tubs or pool with jets because of the risk of contamination and warn against filling tubs in advance.

Dr. Joseph Wax, chairman of the American College of Obstetricians and Gynecologists committee on obstetrics practice and author of the guidelines told Reuters Health that because serious complications have occurred as a result of water deliveries, and that evidence of the benefits outweighing the risks is lacking, it is not recommended that women give birth in water.

Dr. Alastair Sutcliffe, a researcher at the Institute of Child Health at University College London agreed, explaining to Reuters Health:

“Warm water is an ideal environment for some bugs to grow. Babies are not dolphins — those are born underwater — humans are land mammals.”

Dr. Amos Grunebaum, a researcher at New York Weill Cornell Medicine, told Reuters Health that laboring in water before delivery has not been found to be harmful, but given the unknown number of complications resulting from water deliveries, the severity is enough to recommend against the practice.

According to the American Pregnancy Association underwater deliveries are popular because they can reduce stress on the mother and baby, allowing for a more relaxed birthing environment and experience. Risks associated with water births include water aspiration, in which the baby might gasp or inhale underwater. The association says, however, this occurrence would be rare as babies continue to rely on oxygen from the umbilical cord until they are exposed to air.

According to Reuters Health, the health of the baby in the case study improved once she was placed on antibiotics. Though Barton explained that had the baby not been tested for Legionella and given the appropriate course of treatment, she may have died.

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