Active Birth Pools: Water Safety, Hygiene and Infection Control

K.D.Brainin Founder & Director
Blog: 02.01.2023

When it comes to the creation and care of water birth facilities nothing is more important then Health and Safety.

Micro-organisms breed freely in warm moist environments and must be prevented from propagating.

The potential for water birth pools to be both a habitat and a delivery medium for harmful bacteria such as Pseudomonas and Legionella is well known.

We completely understand this and engineered our water birth pools to optimise safety, negate risk and deliver safer birthing environments.

Seamless one-piece construction in Ficore combined with the minimum of fittings result in water birth pools of unparalleled hygiene and water safety.

Active Birth Pools are fabricated from proprietary material with unique qualities called Ficore®  composite.

Ficore has much higher degree of strength, durability and resistance to bacteria when compared to fibreglass or acrylic.

Seamless, one-piece construction in Ficore® improves hygiene by denying bacteria the environment to grow.

The ultra-hard surface makes our water birth pools easier to clean and more resistant to bacteria.

With Health Department Regulations as a guideline we have utilised intelligent design and a range of innovations to negate risk and maximise water safety.

In addition to the advantages that Ficore give our pools from a material perspective we need to look at the advantages it provides from an engineering and manufacturing perspective.

Ficore’s unique properties allow us to design our pools with flowing, organic forms that improve hygiene by facilitating more effective cleaning.

The super smooth finish and flowing contours optimise drainage and eliminate “dirt traps”.

Active Birth Pools: Fittings and Fittings

Hand grips

Our stainless steel hand grips, supplied by renown brassware manufacturer Samuel Heath are bonded directly into the pool

They are not surface mounted like on other birthing pools.

The bar is solidly sealed into the fabric of the pool with Ficore.

There are no gaps – there is no movement.

This make it impossible for moisture penetrate and for bacteria to breed


Drainage System

Our drainage is purpose designed and manufactured to the highest standards.

It has been a subject of interest of numerous investigations by infection control specialists, all of them who came back to use to give their approval.

The waste sits in a recess and is double sealed in with silicone for a water tight, bacteria resistant seal.

The stainless steel fittings are made from solid brass and won’t be damaged from use of of chlorides and other disinfectants.

The plug can be taken out and soaked in hypochlorite in between births.

The rim mounted control wheel can be easily removed for cleaning.

Multi-Colour LED Underwater Lighting

The internal light fitting fits flush to the sidewall, has a stainless steel bezel and is sealed in with silicone.

Due to the fact that the fittings are water tights and vertically mounted water cannot penetrate or build up.

The control switch on the rim is is also water tight and fully sealed.

Taps and Showers

We do not supply taps but recommend 3/4″ thermostatic bath or bath/shower mixers like the Rada T3.

Taps are never mounted on the rim but on the wall or water column as shown above.

Spouts should be 25cm above the rim to prevent contact from pool water and to protect the mother from hitting her head.

Handheld showers are very useful for cleaning the pool but must be detachable so they can be removed while the pool is in use.

The Water Column

Freestanding water birth pools are becoming increasingly popular.

These installations typically present significant water safety and hygiene risks as rim mounted plumbing and fixtures provides the perfect breeding ground for micro-organisms to thrive.

For wall mounted installations the thermostatic taps, spout, handheld shower and grab rail are fixed to an IPS Panel in accordance with health department regulations.

For freestanding birthing pools a solution needed to be found.

To solve this problem we developed the Water Column – a bespoke design concept that separates the plumbing from the pool to optimise hygiene and water safety and provide crucial support for mothers and midwives.

It’s highly utilitarian, sleek ergonomic design complements the look and usability of our pools .

Unsafe Fittings and Features Commonly Found on Water Birth Pools

Because they are mounted on the pool, close to the water the potential for pool mounted fixtures and fittings to become contaminated with bacteria and cross infect is greatly increased.

This whirlpool bath clearly shows a large number of unsafe fittings and systems as applied to water birth pools.
Note the overflow drain, recirculating water system, Swan neck tap, integral shower, rim mounted plumbing and controls

There are other manufacturers who produce water birth pools that are safe but, many water birth pools are equipped with features that at first might seem safe or even an advantage, but in reality present risks or breach regulations.

These water birth pools (mainly produced in Europe) are over engineered and equipped with a profusion of fittings and features that put mothers and midwives at risk.

Please note: the images of fittings and features shown in this section are for illustrative purposes and do not show actual birthing pools.

Rim Mounted Taps and Spouts

Rim mounted taps, spouts and showers are one the biggest Health and Safety risks

These fittings present a serious infection control risk as the space between the surface of the pool and the fitting is a suitable breeding ground for bacteria.

Remember – bacteria are microscopic – even though the fitting may appear flush to the surface of the pool there is space for micro-organisms to establish themselves.

The risk that bacteria will propagate in the moisture between the plate and the rim is unacceptable.

There is also a risk that rim mounted taps could be contaminated with water from the pool and flow back into the tap.

There is the potential for back contamination of the tap, with bacterial colonisation into the system in contravention of water fitting regulations

Taps and spouts for water birth pools should be wall mounted 25cm above the pool and fitted with backflow protection.

There is also a significant risk that mothers could seriously hurt themselves by hitting their heads on these taps.

Swan Neck Taps

Swan neck taps are often seen mounted on the rims of water birth pools. Though attractive this type of tap presents a significant infection control risk.

Swan neck taps retain larger volumes of water which then stagnates and HFN 30 and HPSC recommends that swan-neck taps should not be used.

This is because they do not empty after use and could be prone to microbial biofouling with microorganisms including Legionella and P. aeruginosa the latter of which was associated with a swan neck tap during the neonatal outbreak in Northern Ireland  (HPSC, 2015).

Surface Mounted Hand Grips (internal and rim mounted)

Surface mounted handgrips are a serious infection control and manual handling risk.

Some water birth pools feature surface mounted hand grips similar to the ones shown above.

The is great potential for bacteria to become established between the fitting and the pool which makes these fittings an unacceptable infection control risk.

The risk of cross-infection is dramatically increased with surface mounted metalwork that is inside the pool as they come into direct contact with the water while the mother is using the pool.

From a manual handling perspective these handgrips are dangerous as they form an obstruction that mothers can hurt themselves on and they interfere with movement around the pool.

Overflow drains

Overflow drains harbour bacteria and can serve as a conduit for cross infection.

Regulations are very clear on this point.

Overflow drains should not be fitted to water birth pools as they constitute a constant infection control risk.

Re-circulating water systems

Re-circulating or pumped systems with jets such as whirlpools and  jacuzzi present the perfect conditions for the growth of micro-organisms.

Water systems like these present the highest levels of risk as they produce aerosols.

Aerosols are generated when the water surface is broken – for example, by falling water droplets, splashing, or by bubbles breaking at the surface.

Once introduced to these systems, Legionella and Pseudomonas thrive and can become aerosolised and then inhaled.

Integral Plumbing Systems

Plumbing systems like these utilise flexible and non-flexible piping, overflow drains, handheld showers, pumps, hoses, heaters, surface mounted fittings and filters.

These systems are impossible to clean, disinfect or monitor and therefore present an extremely high Infection Control Risk.

Stagnant water within the system is an ideal breeding ground for bacteria.

UK regulations state that water birth pools should be filled with wall mounted, thermostatically controlled mixer taps plumbed directly into the hospitals water supply.

Hand held showers

Handheld showers present a significant infection control risk.

If the shower head falls in the pool it may be contaminated with bacteria that could breed and be passed on next time the shower is used.

Department of Health regulations clearly stipulate that handheld showers and bath/shower mixers are not installed for use with water birth pools as they present a Fluid Category 5 risk to the mains water supply.

N.B. There are systems available that enable you to detach the hose and shower head from the tap. These are permissible as long as the shower fittings are detached when the pool is in use and only employed afterwards for cleaning.

Pumped heating systems

Heating systems for water birth pools are not necessary and present unacceptable infection control risks.

Water is pumped through a heat exchanger and then back into the pool creating the ideal environment for bacteria to breed.

These systems present one of the highest infection control risks and should not be utilised.

Bacteria filters and disinfection systems

Some water birth pools are equipped with these devices in an attempt to mitigate the risk of infection and bacteria infestation that are inherent in built-in plumbing systems.

Bacteria filters and disinfection systems can not be relied upon and will not guarantee adequate hygiene standards.

Doors

There is no reason for a water birth pool to have a door and many reasons why they should not.

Doors are mistakenly used for two reasons:

  1. To facilitate emergency evacuations
  2. To help mothers get in and out of the pool

Doors present an extremely high risk of infection and should be banned from use in water birth pools for this reason alone.

The door seal (typically foam or rubberised material) is the perfect breeding ground for bacteria.

From manual handling perspective doors are not practical or fit for purpose. They actually complicate emergency evacuations and put mothers and midwives at risk.

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