title: [Water birthing: retrospective review of 2625 water births. Contamination of birth pool water and risk of microbial cross-infection].
abstract: The aim of this study was to document the practice of 2625 water births at Vipiteno over the period 1997-2009 and compare outcome and safety with normal vaginal delivery. The microbial load of the birth pool water was analyzed, and neonatal infection rates after water birth and after land delivery were compared. Methods. The variables analyzed in the 1152 primiparae were: length of labor; incidence of episiotomies and tears; arterial cord blood pH and base excess values; percentage of pH<7.10 and base excess values >/=12 mmol/L. In all 2625 water births, the variables were: analgesic requirements; shoulder dystocia/ neonatal complications; and deliveries after a previous caesarean section. Bacterial cultures of water samples obtained from the bath after filling (sample A) and after delivery (sample B) were analyzed in 300 cases. The pediatricians recorded signs of suspected neonatal infection after water birth and after conventional vaginal delivery.
  
  
  RESULTS
  There was a marked reduction in labor duration in the primiparae who birthed in water; the episiotomy rate was 0.46%. Owing to the pain relieving effect of the warm birth pool water, pain relievers (opiates) were required in only 12.9% of water births. Arterial cord blood pH and base excess values were comparable in both groups. Shoulder dystocia/neonatal complications were managed in 4 water births; 105 women with a previous caesarean section had a water birth. In sample A, the isolated micro-organisms were Legionella spp. and Pseudomonas aeruginosa; in sample B, there was elevated colonization of birth pool water by total coliform bacilli and Escherichia coli. Despite microbial contamination of birth pool water during delivery, antibiotic prophylaxis, as indicated by clinical and laboratory suspicion of infection, was administered to only 0.98% of babies after water birth versus 1.64% of those after land delivery.
  
  
  CONCLUSIONS
  Results suggest clear medical advantages of water birthing: significantly shorter labor duration among the primiparae; a net reduction in episiotomy rates; and a marked drop in requests for pain relievers. During expulsion of the fetus at delivery, fecal matter is released into the birth pool water, contaminating it with micro-organisms. Despite this, water birthing was found to be safe for the neonate and did not carry a higher risk of neonatal infection when compared with conventional vaginal delivery.
authors.affiliation: Reparto di Ginecologia e Ostetricia, Ospedale di Vipiteno, Bolzano, Italy. albin.thoeni@as-bressanone.it
authors.forename: A
authors.initials: A
authors.lastname: Thöni
authors.forename: K
authors.initials: K
authors.lastname: Mussner
authors.forename: F
authors.initials: F
authors.lastname: Ploner
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014871:Water Microbiology