Water birthing and infectious risks: an Italian study

Warm water immersion during labour, including birth, used for relaxation and pain relief, has a long history in lay and clinical care, so the water births have become more and more popular in industrialized countries. In our study we investigated the effectiveness of the cleaning and disinfecting procedures used in the ‘‘Daisy’’ birth area (Careggi Hospital - Florence, Italy), where the water birth is practiced. Methods: From January 2016 to July 2017 we conducted a cross-sectional study: we collected swabs from the tap and from the water discharge system of the tubs used for water birthing and we collected water samples from the big pool used for pre-natal gymnastics. Samples were stored at 4 C until testing and all samples were analyzed within 1 h of arrival at the laboratory.The results were organized in a database and then exported for statistical analysis. Results: 142 samples were collected from the 4 tubs for the birth in water. There was a statistically significant difference (p = 0.01; OR = 0.28) in the presence of Staphylococcus spp. in the 2 examined years: in 2017 their presence was significantly lower (N = 5) then 2016 (N = 23). There was also a statistically significant difference (p = 0.03) in the presence of yeasts: in 2016 no one resulted positive, in 2017 six samples were positive, but with a low contamination. Water discharge system was at a higher risk of being contaminated by staphylococci (p = 0.01, OR = 3.08). 15 water samples were collected from the pool for pre-natal gymnastics: E. coli, Pseudomonas aeruginosa and Enterococci resulted negative in all the samples. Conclusions: A continuous monitoring is fundamental to avoid the onset of water-vehiculated infections for mothers and babies. Training programs are also important to improve the knowledge