Infection Control and Midwifery: A Survey of Water Birth Practices

BACKGROUND: Following the investigation and subsequent first documented fatality of a neonate from Legionellosis associated with water birth in the United States, Texas Department of State Health Services (DSHS) epidemiologists investigated  potential gaps and variability in midwife infection control education and procedures in water birth.  Limited data exists regarding general midwife practices and no current literature exists regarding the prevalence of water birth in the United States outside of a birthing center setting. The following study aims to describe education, experience and training relevant to infection control practices for water birth, quantify water birth utilization and describe infection prevention measures implemented for water birth in various setting not limited to birthing centers by direct entry midwives.

METHODS:   Licensed, certified professional midwives with addresses in Texas (N=226) were invited to participate in the study.  Paper surveys were mailed to invited participants with an additional URL to the same survey content as an alternative electronic option.  No personal identifying information was requested.  Data was managed and analyzed using SPSS version 22.0 (SPSS Inc., Chicago, IL).  

RESULTS:   Of 70 surveys obtained, nearly one quarter of surveyed midwives had no academic training beyond a high school diploma (24%), and fewer reported a nursing background (19%).  Midwife experience varied with 36% practicing midwifery for more than 15 years.  The majority of respondents reported performing midwifery practice in a patient home setting (56%). The median number of infants delivered per year was 35.  Of respondents who currently practice water birth (n=65) the average number of infants delivered via water birth was 17 annually.  The majority of these respondents reported they did not receive training in infection control practices including infection prevention during water birth (66%). Few reported conveying possible risks of waterborne infections during water birth to patients (32%). Few water birth practicing midwives reported use of sanitizers or disinfectants during tub use (17%), and fewer maintain cleaning records of tubs and associated hoses/thermometers (14%).  Twenty-one percent of midwives used tubs with heating elements/circulating water.  89% of midwives allow family members to enter the birthing tub during various phases of labor and delivery.

CONCLUSIONS: As both midwifery and water birth increase in the United States, public health officials need to be aware of the prevalence of water birth and the practices which may influence acquisition of infections during water birth.  Additional responses will allow for a valid reflection of direct entry midwives in Texas.