Category: Building Regulations and Guidelines for Midwives

Buyers Guide to Water Birth Pools for Midwives, Hospitals, Maternity Units and Birth Centres

Posted on by K.D.Brainin

How to Choose a Hospital Water Birth Pool: Safety, Ergonomics, Hygiene and Long-Term Value

Choosing a water birth pool is not simply a question of size or price.

For hospitals and maternity units, the right pool must support mothers, protect midwives, meet infection control expectations and deliver reliable performance for decades.

Purchasing a water birth pool is an important decision for any hospital, birth centre or maternity unit.

A pool is not just a piece of equipment placed in a room.

It becomes part of the birth environment, part of the working space for midwives and part of a mother’s experience of labour and birth.

For that reason, value should mean more than initial purchase cost.

A well-designed hospital birth pool should deliver safety, comfort, hygiene, durability and ease of use every day, year after year.

Active Birth Pools have been developed over almost four decades to meet these needs.

Every curve, surface and feature is shaped around the practical realities of maternity care: how mothers move in labour, how midwives provide support, how rooms are cleaned, how emergencies are managed and how hospitals achieve long-term value from their investment.

Why Ergonomic Design Matters

Good ergonomic design is not decorative.

It is the art of making something work beautifully for the people who use it.

In a maternity setting, this means supporting two groups at once: the mother in labour and the midwives caring for her.

A birth pool must allow mothers to move freely, rest comfortably, enter and leave safely, and adopt natural upright positions.

At the same time, it must allow midwives to remain close, work in balanced postures and respond quickly without excessive bending, twisting or reaching.

Active Birth Pools are designed around these movements.

Their flowing, organic forms are not arbitrary.

The wide rounded rims, contoured profiles, integrated seating and recessed handgrips all serve a purpose.

They help mothers feel secure and supported, while giving midwives better access and reducing physical strain.

The result is a pool that feels intuitive to use.

Mothers can lean, kneel, sit, squat or rest as labour progresses.

Midwives can remain close without being forced into awkward or unsafe positions.

Protecting Midwives from Strain and Injury

Manual handling is a serious consideration in maternity care.

Supporting women in labour can place midwives under significant physical strain, especially when access is restricted or when they must work over hard, narrow or obstructed pool edges.

Active Birth Pools are designed to reduce these risks.

The extra-wide wraparound rim allows midwives to rest their forearms comfortably and maintain stable positions during prolonged care.

The pool’s contours allow closer access while reducing the need to bend, twist or overreach.

Unlike conventional designs with rim-mounted taps, fittings or protruding fixtures, Active Birth Pools keep the rim clear.

This gives midwives freedom to move around the pool and respond to the changing needs of labour and birth.

This is not only more comfortable.

It is safer, more efficient and more supportive of good clinical practice.

Helping Mothers Move Naturally in Labour

Water birth is closely associated with freedom of movement, relaxation and instinctive positioning.

Once immersed, the buoyancy of the water supports the mother’s weight, eases pressure and helps her relax more deeply.

A well-designed pool should enhance these benefits.

The interior must be spacious enough for movement, but supportive enough to feel safe.

It should encourage upright and forward-leaning positions, while allowing the mother to rest when needed.

Active Birth Pools are designed to create a calm, womb-like space where women can respond to their body’s cues.

The gently sculpted interior supports kneeling, squatting, leaning and resting.

his freedom of movement helps mothers find the positions that feel most comfortable and effective during labour.

Every detail exists to support the physiological process of labour while giving mothers a greater sense of safety, privacy and control.

Safe Entry: The “Sit and Swivel” Method

One of the most important, and often underestimated, aspects of water birth pool design is how the mother gets into the pool.

In strong labour, climbing up steps, stepping over a high rim and lowering into water can be difficult and risky.

It can also require unnecessary physical assistance from midwives.

Active Birth Pools solve this with a simple “sit and swivel” method.

The mother steps onto a single low step, sits on the extra-wide rim, swivels her legs into the pool and gently lowers herself into the water.

This allows her to maintain three points of contact and remain grounded throughout the movement.

The step unit lowers the effective height of the rim to around that of a standard bath, making access feel familiar and manageable.

It is also easy to move and does not obstruct access around the pool when not in use.

This simple approach reduces risk for mothers and helps protect midwives from the strain of physically assisting women into the pool.

Hygiene and Infection Control by Design

Water safety and hygiene are central to hospital birth pool selection.

Pools must be easy to clean, resistant to damage and designed to minimise the risk of bacteria accumulating in seams, joints or hidden crevices.

Active Birth Pools are made from Ficore®, a solid chemically fused composite resin developed exclusively for these pools.

Unlike acrylic or fibreglass laminates, Ficore® forms a seamless one-piece shell with a smooth, non-porous surface.

This construction helps eliminate joins, dirt traps and areas where biofilm could accumulate. The organic contours allow water to drain effectively and make cleaning quicker and more thorough.

Ficore® is also more slip resistant and less slippery than fibreglass or acrylic, while providing exceptional strength, durability and a refined finish suitable for demanding clinical environments.

The absence of unnecessary surface-mounted metalwork further supports infection control.

Recessed stainless steel handgrips are fully bonded into the structure rather than bolted or rim-mounted, helping to reduce cleaning and maintenance concerns.

Emergency Evacuation

Although emergency evacuation from a birth pool is rare, every maternity unit must have clear protocols in place.

Active Birth Pools are designed to make this process safer and simpler.

Extra-wide rims and integrated support seats help staff move the mother into a secure position before transfer.

Because the rim is clear of obstructing taps and fittings, access is less restricted.

The mother can be gently moved onto the internal seat, supported safely while additional staff and a trolley are brought into position, then transferred over the wide, softly contoured rim.

Active Birth Pools are also compatible with portable hoists.

Unobstructed access under and around the rim allows a hoist to be brought into position when required, offering an additional layer of safety and flexibility.

Why Ficore® Composite Makes the Difference

The material used to manufacture a hospital birth pool has a direct impact on strength, hygiene, comfort, durability and long-term value.

Ficore® composite allows Active Birth Pools to be manufactured as seamless, one-piece structures with exceptional structural integrity.

It enables refined curves, smooth radii and an organic form that would be difficult to achieve with conventional materials.

Ficore® also helps retain heat, resists hospital-grade cleaning chemicals and maintains its finish despite continuous use.

Because the pools are built to last for decades and require minimal maintenance, they offer strong lifecycle value for hospitals and birth centres.

For maternity units under pressure to deliver more with less, this matters.

A lower initial purchase price can quickly become expensive if a pool requires frequent repairs, replacement, specialist maintenance or presents ongoing cleaning challenges.

Active Birth Pools are available in three main sizes: the compact Princess, the mid-size Venus and the large Active Birth Pool.

The right choice depends on room size, intended use and the level of access required around the pool.

As a general principle, hospitals should choose the largest pool that comfortably fits the room, while leaving sufficient working space around it.

A minimum of around 80 cm is recommended at the sides, with 150–200 cm in front of the pool wherever possible.

Wall-mounted pools provide excellent access while saving space and reducing installation costs.

Freestanding 360° models allow movement all the way around the pool and use a specially designed Water Column to house plumbing and fittings away from the rim.

Options: Bespoke Water Column, Single Step Unit, Multi-Colour LED Lighting and Bluetooth Sound

For freestanding 360° pools, the bespoke Water Column provides a practical and hygienic solution for plumbing and fittings.

By removing taps and fixtures from the pool rim, it improves access, supports infection control and reduces manual handling risks.

The custom step unit supports the “sit and swivel” method of pool entry, giving mothers the height advantage they need while avoiding the risks associated with bulky multi-step units.

Optional multi-colour Chromotherapy LED lighting and Bluetooth sound can also help create a calm birth environment.

Soft ambient lighting improves visibility for midwives while helping mothers relax, and integrated sound allows music to become part of the atmosphere of the room.

Long-Term Value for Hospitals

A hospital water birth pool should be judged by its performance over time.

The best pools reduce risk, support safe practice, improve the experience of mothers and midwives, and remain reliable for decades.

They should be easy to clean, simple to maintain, comfortable to use and robust enough for demanding maternity environments.

Active Birth Pools combine ergonomic design, Ficore® composite material and bespoke manufacturing to deliver safety, hygiene, durability and long-term value.

They are designed not only to look beautiful, but to work beautifully in real clinical settings.

For hospitals, maternity units and healthcare planners, choosing the right water birth pool is a strategic decision.

It affects the quality of care, the working conditions of midwives, the experience of mothers and the long-term performance of the birth environment.

Compare whole-life value, not simply purchase price

The lowest initial quotation is not necessarily the lowest-cost option over the life of a maternity unit.

A hospital should consider expected service life, warranty, cleaning time, maintenance, repairability, reliability, energy and water use, replacement frequency, staff usability and the availability of technical support. [21,22]

Active Birth Pools states that Ficore® pools are engineered to last for decades and are guaranteed for life.

A long service life can reduce the financial and environmental cost associated with repeated replacement, while a durable and repairable surface can help maintain the pool’s performance and appearance.

A water birth pool should support the natural physiology of labour while meeting the practical demands of modern maternity care.

That requires more than a simple tub of water.

It requires thoughtful ergonomic design, advanced materials, safe access, effective infection control, emergency planning and long-term durability.

Active Birth Pools have been developed to bring these elements together in one integrated solution: safe for mothers, supportive for midwives, hygienic for hospitals and built to last.

Water Birth Pool Safety Risks: What Hospitals Should Avoid Before Buying

Posted on by K.D.Brainin

Purchasing a water birth pool is a significant responsibility.

The decision should never be based on appearance, price or catalogue features alone.

In a maternity unit, a birth pool becomes part of the clinical environment, the cleaning regime, the hot and cold water system, and the manual-handling strategy.

Every fitting, outlet, seal, drain, hose and access point can either reduce risk or introduce unnecessary complexity.

Some features look reassuring at first glance.

A rim-mounted tap may appear convenient. A swan-neck spout may look elegant. A door may seem to make access easier. A built-in heating or recirculating system may sound technically advanced.

But in a healthcare setting, the first question should always be: does this feature make the pool safer, easier to clean and easier to manage – or does it create another risk point?

This guide explains the design features hospitals, birth centres, architects, procurement teams and maternity staff should question before specifying a water birth pool.


Why design matters in a maternity setting

Healthcare guidance is clear that infection prevention should be designed into healthcare environments from the beginning. HBN 00-09 states that a building’s design can help infection prevention and control by providing an environment that is easy to clean and maintain. [1]

That principle applies directly to water birth pools. A pool with fewer joints, fewer ledges, fewer penetrations and fewer unnecessary fittings is usually easier to clean, inspect, dry and return safely to use. By contrast, complex fittings can create small spaces where moisture, organic matter and microorganisms can remain after cleaning.

NICE recommends that baths and birthing pools are kept clean using a protocol agreed with the local microbiology department or infection-control guidance, and in accordance with the manufacturer’s guidelines. [2] A good pool design should make that requirement practical in a busy maternity unit, not difficult to achieve.

This bath shows a variety of unsafe fittings and systems that are often found on water birth pools.
Note the overflow drain, recirculating water system, swan neck tap, integral shower, rim mounted plumbing and controls.

1. Rim-mounted taps, spouts and showers

Rim-mounted taps, spouts and showers should be treated with caution in a hospital water birth setting.

The issue is not only whether the fitting looks sealed. Bacteria and biofilm are microscopic. Small gaps around a base plate, tap hole, washer or fixing can retain moisture and residue. These areas can be awkward to reach during routine cleaning and inspection.

There is also a water-safety consideration. Water Regs UK notes that all bathroom water fittings need appropriate backflow protection rated to the highest downstream contamination risk, and that showers in healthcare premises can be treated as Fluid Category 5 risk. [3] In a water birth room, the estates team and water-safety group should therefore be closely involved in the specification of taps, showers, hoses, backflow protection and outlet positioning.

Safer principle: keep taps and spouts off the pool rim. Fill the pool from wall-mounted services, an IPS panel or a purpose-designed water column.

This keeps the pool simpler, leaves fewer holes and fittings in the shell, and allows water services to be managed as part of the hospital’s water system rather than as part of the pool itself.

2. Surface-mounted hand grips and internal metalwork

Handholds are important. Mothers need secure support when entering, leaving and changing position in the pool. The question is how that support is provided.

Surface-mounted hand grips, rails and metal plates can introduce fixing points, edges and narrow gaps.

If they sit inside the pool or on the rim, they may come into direct contact with pool water and can make cleaning more complicated.

They can also create protrusions that interfere with movement, comfort and midwife access.

In a clinical setting, cleanability matters as much as strength. A well-designed support feature should feel secure, be easy to wipe, avoid exposed fixings and avoid unnecessary ledges or dirt traps.

Active Birth Pools address this by using integrated, bonded hand grips designed to provide stable support while keeping the internal pool environment smooth, accessible and cleanable.

3. Swan-neck taps and retained water

Swan-neck taps may look attractive, but they are not ideal for a water birth environment.

Their shape can retain water after use, and retained water can contribute to microbial biofilm formation if outlets are not designed, flushed and maintained correctly.

HTM 04-01 gives healthcare premises guidance on the design, maintenance and operation of hot and cold water systems, including control and management of risks from Legionella, Pseudomonas aeruginosa and other waterborne pathogens. [4]

The lesson for birth-pool specification is simple: avoid decorative or domestic-style outlets where a lower-risk, healthcare-appropriate outlet would be easier to manage. Outlet choice should be made with the hospital’s estates, infection-control and water-safety teams.

4. Recirculating, jetted and pumped water systems

Recirculating systems, spa-style jets, pumped heating systems and whirlpool features have no place in a modern hospital water birth pool.

They add pipework, pumps, cavities, valves and hidden wet areas. Once microorganisms enter these systems, they can be difficult to remove. Recirculating or aerating systems can also generate aerosols when bubbles break or water is agitated, increasing the potential route of exposure.

NHS England issued a patient safety alert about heated birthing pools with built-in heaters and recirculation pumps filled in advance of labour. [5] Public Health England later reported that, after a recall of heated home birthing pools, 4 of 6 tested pools were positive for Legionella and 3 also tested positive for other potentially harmful organisms including Pseudomonas aeruginosa. [6]

This does not mean fixed hospital birthing pools are unsafe. The concern is specifically with unnecessary heating, storage, recirculation and hidden systems. The safer approach is to fill the pool for use, monitor water temperature during labour, empty the pool after use and clean it under local protocol and manufacturer guidance.

5. Integral plumbing and hidden services

Integral plumbing systems can look neat, but hidden pipework is rarely an advantage in a healthcare environment.

Flexible hoses, internal pipes, pumps, filters, valves, heaters and concealed spaces can be difficult to inspect, disinfect, maintain and monitor.

Stagnant water in dead legs or rarely used sections of pipework is a recognised water-safety concern. The HSE notes that hot and cold water systems can present a foreseeable risk of exposure to Legionella, and that understanding the water system and its parts – including dead legs, TMVs and outlets – is necessary for risk assessment. [7]

For hospitals, the safer design principle is separation. The birth pool should be a fixed, cleanable sanitary-ware product. The water services should be specified, installed, accessed and maintained by the hospital’s estates team as part of the wider water-safety plan.

6. Handheld showers and hose management

Handheld showers are a common source of confusion. They are useful for cleaning the pool after use, but they can create a risk if the hose or handset can enter the pool water during use.

Water Regs UK explains that shower installations must have appropriate backflow protection and that, in high-risk settings such as healthcare premises, showers may be classed as Fluid Category 5 risk. Hose handsets capable of reaching contaminated water sources require suitable Fluid Category 5 backflow-prevention arrangements unless the hose is permanently restrained or shortened to maintain an adequate gap. [3]

For water birth rooms, the safe approach is to prevent the shower hose or head from entering the pool during labour and birth, and to ensure the design is approved by estates and the water-safety group.

A removable cleaning hose may be acceptable where it is detached when the pool is in use and used only after the pool has been emptied for cleaning, subject to local approval.

7. Built-in filters and disinfection devices

Filters and disinfection devices should not be used to justify a poor basic design.

If a pool relies on filters to compensate for built-in plumbing, recirculation, hidden pipework or complex wet components, the underlying problem remains. Filters require maintenance, monitoring and replacement. They can reduce risk only when they are correctly specified and managed within a formal water-safety system.

The better design principle is to remove avoidable risk at source: no recirculation, no hidden wet systems, no unnecessary pipework inside the pool and no complex internal fittings that are difficult to access.

8. Overflow drains and hidden wet recesses

Overflow drains are another feature borrowed from baths and spa products that should be questioned in water birth pools.

An overflow adds hidden surfaces, internal channels and wet recesses.

These areas can be difficult to access during routine cleaning and can retain moisture between uses. If a feature cannot be reliably cleaned, inspected and dried, it should not be built into a healthcare birth pool unless there is a clear, justified reason.

The safer design principle is a simple, purpose-designed drainage system with components that can be removed, cleaned, disinfected, rinsed, dried and checked in accordance with local policy.

9. Doors, seals and access panels

A door in a water birth pool may appear helpful, but it introduces a major design compromise.

Doors require seals, hinges, locking mechanisms and joints. These features are exposed to warm water, organic matter and repeated cleaning chemicals. Any seal or hinge line can become a moisture trap.

In an emergency, a door may also complicate rather than simplify evacuation, because staff still need space, technique, equipment and coordinated manual handling.

Access should be solved through the pool’s height, internal shape, external step, handholds, midwife access and local emergency procedures – not by introducing a door and seal into the pool shell.

10. Domestic styling in a clinical environment

A maternity pool should not be specified as though it were a domestic bath, spa bath or wellness product.

In hospitals, design priorities are different. The pool must support infection prevention, water-safety governance, manual handling, cleaning, inspection, maintenance and repeated clinical use. A domestic-style feature may look reassuring in a brochure while creating avoidable work for maternity, cleaning and estates teams.

When assessing a pool, procurement teams should ask: Can every surface be reached? Can every component be inspected? Can the pool be cleaned quickly and consistently between births? Are water outlets separate and maintainable? Are there any hidden wet areas? Does each fitting justify its risk?

What safer birth-pool design looks like

A safer water birth pool is not over-engineered. It is simple, strong, cleanable and purpose-designed for maternity use.

Active Birth Pools are designed around this principle. They use smooth Ficore® surfaces, seamless one-piece construction, integrated hand grips, minimal fittings, purpose-designed drainage and water services kept separate from the pool rim. Freestanding installations can be supported by a dedicated water column so that taps, spout, shower and support rail remain separate from the pool itself.

This approach supports the same aim described in healthcare guidance: make the environment easier to clean, easier to maintain and easier to manage safely.

Buyer questions before specifying a water birth pool

Before purchasing a water birth pool, ask the supplier:

  1. Are there any taps, spouts, showers or controls mounted on the pool rim?
  2. Are any hand grips, rails or metal fittings bolted onto the internal surface?
  3. Does the pool include any recirculation, jets, pumps, heaters or hidden pipework?
  4. Can every wet surface be cleaned, disinfected, rinsed, dried and inspected?
  5. Are there any overflows, doors, seals or inaccessible cavities?
  6. Is the pool filled for use and emptied after use, rather than maintained warm in advance?
  7. Has the installation been reviewed by estates, infection-control and water-safety teams?
  8. Does the manufacturer provide clear cleaning and care guidance?

Conclusion: remove avoidable risk at source

No product can replace local clinical judgement, infection-control procedures, estates management or water-safety governance.

But good design can make those responsibilities easier to fulfil.

A hospital water birth pool should not be a spa product adapted for maternity use. It should be a fixed, purpose-designed sanitary-ware product that supports safe water use, effective cleaning, practical midwifery and maternal movement.

The safest features are often the ones that are not there: no rim-mounted taps, no jets, no recirculation, no hidden plumbing, no overflows, no doors and no unnecessary surface-mounted metalwork.

In maternity environments, simplicity is not basic. Simplicity is safer.

Evidence and source notes

[1] NHS England, Health Building Note 00-09: Infection control in the built environment. Summary states that building design can help infection prevention and control by providing an environment that is easy to clean and maintain, and that these features should be designed into a project from the beginning. https://www.england.nhs.uk/publication/infection-control-in-the-built-environment-hbn-00-09/

[2] NICE NG235, Intrapartum care recommendations. NICE recommends offering labour in water for pain relief, monitoring maternal and water temperature hourly, keeping water at or below 37.5°C, and keeping baths and birthing pools clean using agreed infection-control/microbiology protocols and manufacturer guidance. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations

[3] Water Regs UK, What backflow protection is required for a shower? Water fittings in bathrooms require backflow protection appropriate to the highest downstream fluid-category risk; showers in healthcare premises can be Fluid Category 5 risk, and hose handsets require suitable arrangements if they can reach contaminated water sources. https://www.waterregsuk.co.uk/topics/all-faqs/showers/

[4] NHS England, HTM 04-01: Safe water in healthcare premises. Guidance covers legal requirements, design applications, maintenance and operation of hot and cold water supply, storage and distribution systems in healthcare premises, including the control and management of Legionella, Pseudomonas aeruginosa and other waterborne pathogens. https://www.england.nhs.uk/publication/safe-water-in-healthcare-premises-htm-04-01/

[5] NHS England, Patient safety alert: Legionella and heated birthing pools filled in advance of labour in home settings. The alert advised against birthing pools with built-in heaters and recirculation pumps potentially filled in advance of birth. https://www.england.nhs.uk/publication/patient-safety-alert-legionella-and-heated-birthing-pools-filled-in-advance-of-labour-in-home-settings/

[6] Public Health England, Legionella contamination found in more heated birthing pools. PHE reported positive Legionella results in recalled heated birthing pools and reinforced advice against heated, recirculating home birthing pools filled in advance of labour. https://www.gov.uk/government/news/legionella-contamination-found-in-more-heated-birthing-pools

[7] HSE, Hot and cold water systems. HSE notes that hot and cold water systems can present foreseeable risk of exposure to Legionella, and highlights the importance of understanding system components including dead legs, TMVs and outlets. https://www.hse.gov.uk/legionnaires/hot-and-cold.htm

[8] Original Active Birth Pools source page used as the basis for the rewrite: Health and Safety risks you need to be aware of before buying a water birth pool. https://activebirthpools.com/health-and-safety-risks-you-need-to-be-aware-of-before-buying-a-water-birth-pool/

[9] Related Active Birth Pools page used to align house style and avoid duplication: Designed to Optimise Safety, Reduce Risk and Support Safer Birthing Environments. https://activebirthpools.com/birth-pool-safety-design/

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Water Safety and Legionella Control for Hospital Birth Pools

Posted on by K.D.Brainin

A practical guide for maternity teams, estates departments, infection-prevention specialists, Water Safety Groups, designers and contractors

Core message: A birth pool should be treated as part of the healthcare water system. Safe design removes avoidable stagnation, keeps services simple and accessible, supports fresh filling for each use, and makes complete drainage, cleaning and monitoring easier.

Water safety and Legionella control for hospital birth pools

Hospital birth pool water safety begins long before the pool is filled. It depends on the design of the hot- and cold-water system, the route and frequency of water use, the position of outlets, the ability to drain and dry the pool, and the procedures used by maternity, estates and infection-prevention teams.

Legionella and other waterborne microorganisms can multiply where water is allowed to stagnate, where temperatures support growth, or where deposits and biofilm provide protection. In a maternity setting, the objective is not to treat the pool as an isolated product, but to integrate it into the hospital’s wider Water Safety Plan and system of control.

Active Birth Pools are purpose-designed hospital sanitary ware. They are intended to be filled with fresh mains water for each labour, emptied after use, cleaned and disinfected in accordance with local protocols and the manufacturer’s guidance. They are not recirculating spa pools and should not be operated as continuously heated or prefilled systems.

Why Legionella control matters in maternity environments

Legionella bacteria occur naturally in water and may grow in engineered systems when conditions are favourable. The Health and Safety Executive identifies temperature, stagnation, scale, sediment and biofilm as important risk factors. Control therefore depends on design, operation, maintenance, monitoring and clear responsibility. [1][2]

Birth pools deserve particular attention because warm water is used close to a mother and newborn. Published investigations have linked neonatal legionellosis with prefilled, heated and recirculating birthing tubs. These rare but serious cases reinforce a fundamental distinction: a hospital birth pool should be freshly filled for the individual mother and should not behave like a warm-water storage or spa system. [5][6]

The lesson is not that water birth itself creates Legionella. The risk arises when the water system, fittings or operating method allow microorganisms to grow and then expose the mother or baby.

Bring the birth pool into the hospital Water Safety Plan

NHS guidance in HTM 04-01 applies to the design, installation, commissioning, operation and maintenance of hot- and cold-water systems in healthcare premises. It is written for healthcare management, Water Safety Groups, design engineers, estates managers, operations managers, contractors and supply-chain businesses. [3]

The birth pool and its associated pipework, valves, outlets, hoses and drainage should therefore be considered by the Water Safety Group from the earliest design stage. Responsibility should not be divided between the maternity room designer, plumber, equipment supplier and clinical team without a single coordinated assessment.

The project should identify who owns the risk assessment, who approves the design, who commissions the system, who manages flushing and temperature monitoring, and who authorises the pool for clinical use.

Design out stagnation and unnecessary complexity

The safest water system is generally the simplest one that meets the clinical need. Long pipe runs, blind ends, oversized distribution pipework, seldom-used branches and redundant fittings can create areas of low flow or stagnation. HSE guidance emphasises designing, maintaining and operating water services to prevent or adequately control Legionella growth. [2]

Birth-pool services should be routed as directly as practicable, with accessible isolation, commissioning and maintenance points. Any arrangement that may hold warm water between uses should be challenged during design review.

The pool itself should have a free-flowing outlet and should drain completely. Surfaces and fittings that trap residual water make drying more difficult and can undermine an otherwise sound cleaning procedure.

Use fresh water for every labour

A hospital birth pool should be filled shortly before use with fresh water from the approved healthcare water system. It should not be filled in advance and held warm while waiting for a mother, and water should not be stored or recirculated between users.

Fresh filling reduces the opportunity for organisms to multiply in the pool water. It also makes the start of each use clear and auditable: the pool has been cleaned, rinsed as required, freshly filled and checked before the mother enters.

The filling time should be fast enough for clinical practicality without encouraging the unit to keep the pool prefilled. Appropriate flow rates and correctly sized services are therefore part of infection prevention as well as convenience.

Control water temperature without creating avoidable risk

HSE guidance notes that Legionella can grow in water systems between approximately 20°C and 45°C, particularly where stagnation is present. Temperature control in the building system is therefore a central control measure. [4]

Healthcare hot-water systems are normally managed at temperatures that limit bacterial growth, with safe delivery temperatures achieved at the point of use by an appropriate thermostatic arrangement. The specific design must follow HTM 04-01, local Water Safety Plan requirements and the project engineer’s assessment. [3]

The temperature used for labour is a separate clinical requirement. NICE recommends monitoring the woman’s temperature and the water temperature hourly, and states that the pool water should not be above 37.5°C. [7] Mixing for maternal comfort should occur at filling and use, not by maintaining a reservoir of lukewarm water within the system.

Position taps, spouts and hoses carefully

Outlets are critical parts of the water system. Their design and position affect flushing, cleaning, splash, aerosol generation, access and the possibility of contamination from hands or the pool environment.

Fittings should be selected for healthcare use and positioned so that they can be inspected, cleaned, maintained and replaced. They should not create hidden cavities or inaccessible water traps around the pool rim.

Flexible hoses require particularly careful governance. A hose that is left containing water, stored wet, allowed to touch the pool water or used for more than one purpose can become a contamination route. Where a hose is required, the Water Safety Group should approve its specification, storage, flushing, cleaning, replacement interval and connection arrangement. The design should also protect the mains supply from backflow in accordance with water regulations and local engineering requirements.

Manage little-used outlets and periods of low activity

Birthing rooms may have irregular patterns of use. A pool that is clinically important may still remain unused for days or weeks. The associated outlets must therefore be included in the hospital’s programme for little-used water services.

Local procedures should define flushing frequency, the volume or duration of flushing, responsibility, safe disposal to drain and record keeping. Flushing should be carried out in a way that avoids unnecessary aerosol and does not expose patients or staff to hot water.

After closure, refurbishment, commissioning work or an extended period of non-use, the pool services should be assessed and returned to use under the Water Safety Plan rather than simply opened and filled.

Drain, clean and dry after every use

Once the mother has left the pool, water should be discharged promptly through the designated drainage system. The pool should then be cleaned and disinfected using the local protocol agreed with infection prevention or microbiology and in accordance with the manufacturer’s guidance. NICE expressly requires this approach for birthing pools. [7]

Cleaning and disinfection are separate steps. Organic material and visible soil must be removed so that the disinfectant can act on the surface. Staff must use the correct product, concentration and contact time and must follow any rinsing requirement.

The design should allow all internal surfaces, the outlet and accessible fittings to be reached. After the procedure, residual water should not remain trapped in the pool or its accessories. A clean, dry pool provides a clear starting point for the next use.

Commissioning and handover are essential

A well-designed installation can still be compromised if debris, flux, construction contamination or stagnant commissioning water is left in the system. The birth-pool installation should be commissioned as part of the healthcare water system, not treated as a final decorative fitting.

Handover information should include as-installed drawings, valve and outlet identification, flushing points, cleaning instructions, product data, commissioning results, risk controls, maintenance requirements and the agreed operating procedure.

Maternity staff should understand what they are expected to check. Estates and infection-prevention teams should know which components require planned inspection, servicing, sampling or replacement.

Monitoring, records and response to concerns

An effective control scheme is supported by records. These may include flushing logs, temperature checks, servicing, cleaning records, microbiological sampling where indicated, corrective work and Water Safety Group review.

Routine Legionella sampling is not a substitute for good control. HSE guidance explains that testing should be based on the risk assessment and control scheme and carried out by competent people using appropriate methods. [8]

If results, temperatures, flow conditions or clinical observations suggest a problem, the pool should be managed under the organisation’s Water Safety Plan. This may include taking the outlet out of use, investigation, remediation, verification and formal approval before return to service.

Active Birth Pools: design principles that support water safety

Active Birth Pools are designed as fixed hospital sanitary ware with smooth, seamless internal surfaces and straightforward filling and drainage. The pools use fresh water for each labour and do not depend on pumps, jets, filters or recirculation systems.

Separating the water controls from the principal working rim can improve access for cleaning and maintenance. The Water Column option provides a dedicated location for services on freestanding installations, while wall-mounted arrangements can be integrated with an appropriate clinical-services panel.

The final safety of any installation depends on correct specification, installation, commissioning and operation within the hospital’s Water Safety Plan. Product design supports that system; it does not replace it.

Design principle: Do not manage waterborne risk by relying on cleaning alone. Begin with a simple, free-flowing system that avoids stored warm water, unnecessary pipework, inaccessible fittings and residual water.

A practical specification checklist

  • Include the birth pool and its services in the healthcare Water Safety Plan and Legionella risk assessment.
  • Obtain Water Safety Group input before the layout and water-service design are fixed.
  • Use a direct, appropriately sized hot- and cold-water supply with no avoidable dead legs or redundant branches.
  • Provide suitable temperature control in accordance with HTM 04-01 and the local engineering strategy.
  • Specify healthcare-appropriate outlets that can be accessed for inspection, cleaning, maintenance and replacement.
  • Assess any flexible hose as a water-safety component and define its storage, flushing, cleaning and replacement arrangements.
  • Provide backflow protection appropriate to the installation and local water regulations.
  • Ensure the pool fills quickly enough to avoid operational pressure to prefill it.
  • Use fresh water for each labour; do not store, continuously heat or recirculate pool water.
  • Ensure the pool and outlet drain completely and can be cleaned and dried without inaccessible water traps.
  • Include little-used outlets in the flushing and monitoring programme.
  • Commission, document and approve the installation before clinical use.
  • Give maternity staff clear operating, cleaning and escalation procedures.
  • Keep records and review performance through the Water Safety Group.

Frequently asked questions

Can Legionella grow in a birth pool?

Legionella can multiply in water systems where temperatures, stagnation, scale, sediment or biofilm support growth. A freshly filled, promptly emptied and properly maintained hospital pool presents a very different operating condition from a prefilled or recirculating heated tub. The full installation still requires risk assessment and control.

Are birth pools covered by HTM 04-01?

The pool’s hot- and cold-water services form part of the healthcare water system. Their design, installation, commissioning, operation and maintenance should be managed in line with HTM 04-01, HSE guidance and the organisation’s Water Safety Plan.

Does the pool need Legionella testing after every use?

No general rule requires testing after every use. Sampling should be determined by the risk assessment, control scheme and Water Safety Group. Monitoring temperatures, flow, flushing and maintenance remains essential.

What is the safest type of birth pool for a hospital?

A purpose-designed fixed pool with smooth, accessible surfaces, complete drainage and no pumps, jets, filters or recirculating water avoids many of the complexities associated with spa-style systems. The surrounding water-services design is equally important.

Who should approve the installation?

Approval should involve the hospital’s Water Safety Group together with maternity, estates, infection prevention, the Authorising Engineer or other competent water-safety adviser where applicable, designers, installers and the pool supplier.

How should a birth pool be cleaned?

Follow a local protocol agreed with infection prevention or microbiology and the manufacturer’s guidance. Remove visible contamination first, use the approved disinfectant at the correct concentration and contact time, rinse when required, drain completely and leave the pool clean and dry.

Are Active Birth Pools medical devices?

No. Active Birth Pools are purpose-designed hospital sanitary ware. They should be specified as part of the maternity room and its water, drainage, cleaning and maintenance systems.

Plan a safer hospital water birth installation

Active Birth Pools can provide dimensions, technical drawings, installation guidance and project support for maternity teams, architects, estates departments, Water Safety Groups and contractors. Early coordination helps ensure that the pool, outlets, Water Column or services panel, drainage and room layout form one coherent system.

References and source notes

  1. Health and Safety Executive. Legionnaires’ disease: The control of legionella bacteria in water systems. Approved Code of Practice and guidance, L8, fourth edition. https://www.hse.gov.uk/pubns/books/l8.htm
  2. Health and Safety Executive. Legionnaires’ disease: Technical guidance, HSG274, second edition, March 2024; including Part 2 on hot- and cold-water systems. https://www.hse.gov.uk/pubns/books/hsg274.htm
  3. NHS England. Health Technical Memorandum 04-01: Safe water in healthcare premises, Parts A, B and C. Publication page updated 27 August 2024. https://www.england.nhs.uk/publication/safe-water-in-healthcare-premises-htm-04-01/
  4. Health and Safety Executive. Hot and cold water systems; and guidance on preventing or controlling Legionella risk. Updated 2024. https://www.hse.gov.uk/legionnaires/hot-and-cold.htm
  5. Collins SL, et al. Fatal Legionellosis after Water Birth, Texas, USA, 2014. Emerging Infectious Diseases. 2015;21(1). https://wwwnc.cdc.gov/eid/article/21/1/14-0846_article
  6. Public Health England. Neonatal Legionnaires’ disease associated with a water birth in a domestic spa pool, England, 2014. Health Protection Report and related investigation, cited in the published case literature.
  7. National Institute for Health and Care Excellence. Intrapartum care, NICE guideline NG235, recommendations 1.6.10–1.6.12. Updated 2025. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
  8. Health and Safety Executive. Testing and monitoring your water system for Legionella. Updated 30 September 2024. https://www.hse.gov.uk/legionnaires/testing-monitoring-water-system.htm
  9. Active Birth Pools. Product, cleaning, care and installation guidance. https://activebirthpools.com/

Editorial note: This page provides general design and governance information. It should not replace a site-specific Legionella risk assessment, the hospital Water Safety Plan, HTM 04-01, HSE guidance, local infection-prevention procedures or professional engineering advice.

Why Midwife Comfort and Safety Starts with Better Birth Pool Design

Posted on by K.D.Brainin

A birth pool is a workplace

A water birth pool is not simply a vessel for warm water.

In a maternity unit it becomes part of the midwife’s working environment.

Midwives use the pool repeatedly.

They observe, communicate, monitor, reassure, assist with entry and exit, support examinations where clinically appropriate, manage water temperature, help maintain a safe space around the pool and respond quickly when circumstances change.

That ongoing use is the reason midwife comfort, safety and wellbeing should be treated as a primary design requirement.

If the pool forces poor posture, every use can add to physical strain.

If the pool supports good working access, it helps midwives stay close, balanced and available throughout labour and birth.

This is the principle behind Active Birth Pools: the pool must support the people who use it every day.

Download Midwife Comfort and Safety Assessment

Why ergonomic design matters to midwives

The Chartered Institute of Ergonomics & Human Factors explains that user-centred product design starts by identifying the key users early in the design process and researching their needs before the finished product is developed.

In Case Study 18, Improving Birthing Pool Design, the Institute records that earlier barrel-shaped pools had not been designed for any of the users.

Midwives were unable to monitor and examine mothers in the pool without putting strain on their back and neck. [1]

The same case study identifies the midwife as a key user who needs a comfortable working position, knee room beside the pool and the ability to reach the mother for examinations and monitoring. [1]

This is exactly where birth pool design becomes an occupational-health issue.

The design either helps the midwife work close to the pool in a natural posture, or it creates an obstacle that the midwife has to work around.

The problem with vertical-sided pools

A pool with a solid vertical surround places a physical barrier between the midwife and the person in the water.

The midwife may have to stand with feet wide apart, lean forwards over a narrow rim, twist from the waist or support weight through the arms and shoulders for prolonged periods.

These positions are uncomfortable in the moment and can become more significant when repeated across shifts, weeks and years. The issue is not only one difficult birth.

It is cumulative exposure to avoidable strain.

The Health and Safety Executive identifies manual-handling risks to midwives and auxiliary staff who assist births in pools.

These risks can arise from routine tasks, the position of the mother in the pool, and the position of the midwife while carrying out tasks at the pool or supporting entry and exit. [2]

The concave shape: giving the midwife knee room

The key ergonomic difference in Active Birth Pools is the concave outer profile.

Instead of forcing the midwife to work around a vertical wall, the recessed shape allows the midwife to sit closer to the pool with her legs naturally positioned beneath the rim, as if sitting at a desk.

This design principle is directly supported by Case Study 18, which identifies a concave side as a feature that provides knee room for the sitting midwife. [1]

Knee room matters because it changes the whole working posture.

The midwife can sit closer, remain more upright, rest the arms, see clearly, communicate calmly and reach the person in the pool with less bending and stretching.

Reducing bending, reaching and twisting

HSE guidance on manual handling in birthing pools is clear: pool design should allow the midwife to get as close as possible and minimise bending and reaching over. [2]

This is one of the most important tests of a hospital birth pool.

Can the midwife get close enough to work comfortably? Can she support the person in the water without excessive forward reach? Can she move around the pool without obstructions? Can she change position easily during a long labour?

Active Birth Pools are designed to answer yes to these questions.

The concave outer form, wide rounded rim and unobstructed working edge are intended to reduce the awkward postures that can occur when staff have to lean over a fixed barrier.

HSE guidance on musculoskeletal disorders highlights the need to manage work-related risks such as manual handling, back pain and upper limb disorders. [3]

In the birth-pool context, design should therefore help reduce avoidable physical loading wherever possible.

The extra-wide rounded rim

The extra-wide rounded rim is another midwife-centred design feature.

A narrow rim concentrates pressure into a small area of the forearm.

A wider rounded rim allows the midwife to rest the forearms more comfortably while staying close to the pool.

This can make a considerable difference during prolonged observation, reassurance and hands-on support.

The rim should also remain clear of taps and fittings.

Midwives need freedom to move around the pool and choose the most appropriate position.

A clear working edge supports better access, better posture and better responsiveness.

Supporting entry and exit protects midwives too

Although the primary focus of this article is midwives, entry and exit must be considered because they directly affect the midwife’s role and physical workload.

HSE identifies risks when midwives actively support entry or exit into the pool, or when the mother uses the midwife as support while entering or exiting. [2]

For this reason, pool design should reduce unnecessary lifting, pulling and steadying by staff.

A secure sit-and-swivel approach over a wide, supportive rim gives the person entering the pool a more controlled method of access. It also helps the midwife guide rather than physically carry or hold body weight.

NICE recommends supporting women and pregnant people with mobility issues to access water during labour and birth through an individualised needs assessment and reasonable adjustments. [4] From the midwife’s perspective, this reinforces the need for pool design, room layout and local procedures to work together.

Emergency evacuation: designed in, not improvised

Emergency evacuation is another area where design directly affects the midwife’s work.

HSE advises that emergency procedures should identify what situations could arise, whether the mother can participate, how to get her out of the pool, how many staff or helpers are required and how to call for additional help.

HSE also lists equipment that may be needed, such as an evacuation net, flotation aids, slide sheet, height-adjustable bed or trolley, hoist and slings. [2]

The pool should support these procedures rather than make them harder.

Access around the pool, the working height, the rim, internal supports and the ability to move the person towards a safe exit point all affect how calmly and efficiently staff can respond.

Good design cannot replace training, staffing or local policy. But it can make the trained response easier to carry out.

Midwife comfort is a safety issue

Midwife comfort is sometimes treated as a soft benefit. It is not.

A midwife who can work close to the pool in a stable, supported position is better placed to remain attentive, calm and physically available.

Good posture supports good practice. It helps midwives observe, listen, monitor, reassure and assist without unnecessary strain.

For midwives who use birth pools on an ongoing basis, the difference between an obstructive design and an ergonomic design is not theoretical.

It is felt in the back, neck, shoulders, arms and wrists at the end of a shift.

The pool should never make the midwife’s work harder than it needs to be. It should support safe, skilled, compassionate care.

Designed for the people who use it every day

Active Birth Pools were developed from a user-centred ergonomic approach, including the work described in CIEHF Case Study 18 and the involvement of a health-service ergonomist working with midwives at Nottingham City Hospital. [1]

That approach remains central to the design today.

Every curve, rim, recess and support feature has a purpose. The concave side gives knee room. The wide rounded rim supports the arms. The clear working edge allows movement around the pool.

The internal supports and access features help reduce avoidable strain during entry, exit and assistance. The overall form helps midwives get closer, reach less and work more comfortably.

A water birth pool should be beautiful, durable and easy to clean. But above all, it should work safely for the people who use it every day.

For midwives, better birth pool design means better access, less strain and a safer working position.

That is why midwife comfort and safety starts with better birth pool design.

Download Midwife Comfort and Safety Assessment

References

[1] Chartered Institute of Ergonomics & Human Factors. Case Study 18: Improving birthing pool design. Produced and published by CIEHF. https://activebirthpools.com/wp-content/uploads/2023/01/Improving-birthing-pool-design.pdf

[2] Health and Safety Executive. Moving and handling in health and social care: Manual handling in birthing pools. Updated 12 January 2026. https://www.hse.gov.uk/healthservices/moving-handling/birthing-pools.htm

[3] Health and Safety Executive. Musculoskeletal disorders at work. Updated 16 March 2023. https://www.hse.gov.uk/msd/index.htm

[4] National Institute for Health and Care Excellence. Intrapartum care, NICE guideline NG235: recommendations on labouring in water, water temperature, cleaning and access for people with mobility issues. Published 29 September 2023; last updated 9 June 2026. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations

Sit and Swivel – the Safe Way to Enter a Water Birth Pool

Posted on by K.D.Brainin

All women no matter what their shape or size will find it exceptionally easy to get into our water birth pools. Mothers don’t even think about it – they move instinctively and naturally lower themselves into the water.

Why safe access begins with the design of the pool itself

Entering a water birth pool should feel simple, instinctive and secure – never like an obstacle course. For a mother in strong labour, who may be tired or less steady on her feet, the safest access method is one that reduces climbing, preserves balance and minimises the need for physical assistance.[1-4]

The Active Birth Pools solution

A compact 15 cm single step and an extra-wide, rounded rim allow the mother to step up, sit down, swivel her legs into the pool and lower herself gently into the water. The movement is grounded, controlled and familiar, with three points of contact maintained through the transfer.[1,2]

A simple movement – designed into the pool

The simple act of entering a birth pool is one of the most misunderstood aspects of water birth practice. It should never create anxiety, require awkward manoeuvres or expose the mother or midwife to avoidable risk.[1,2]

Active Birth Pools were developed with manual handling, ergonomics and safe access in mind. The design was considered with safety and manual handling expertise so that women of different shapes, sizes and fitness levels can enter with ease and with minimal need for assistance.[1,2]

Mothers do not need to climb over the pool. They sit, swivel and lower themselves into the water in one natural, fluid sequence.

How the sit-and-swivel method works

1. Step onto the compact single step. The 15 cm height advantage lowers the effective rim height of a typical 75 cm Active Birth Pool to approximately 60 cm – comparable with an ordinary bath.

2. Turn and sit securely on the broad rim. The extra-wide, rounded rim provides a comfortable, supportive surface rather than a narrow edge.

3. Swivel the legs into the water. The mother remains seated and grounded while moving her legs over the rim.

4. Lower gently into the pool. The movement can be paused and controlled, including if a contraction occurs during entry.[1,2]

Because the mother can maintain three points of contact, the transfer is more stable and less dependent on precise balance than climbing a multi-step unit, standing at height, stepping over a rim and descending into water.[2]

Why the single step makes such a difference

The single step is not intended to create a staircase. Its purpose is simply to reduce the effective height of the pool rim before the mother sits down. Used together with the wide rim, it supports a grounded transition into the water without requiring the mother to climb.[1,2]

• The average Active Birth Pool height is approximately 75 cm – similar to a desk or dining table.
• The 15 cm single step reduces the effective entry height to approximately 60 cm – similar to an ordinary bath.
• The compact step does not dominate the poolside or prevent the midwife from moving freely around the pool.
• Its small footprint helps preserve a clear working area and reduces obstruction and trip risk.[1,2]

Protecting mothers and safeguarding midwives

HSE guidance identifies manual handling risks where staff actively support a mother’s entry or exit, or where the mother uses the midwife as a support. HSE also advises that hazardous manual handling should be avoided where reasonably practicable and that unavoidable risks should be assessed and reduced.[3-6]

The sit-and-swivel method addresses the issue at source. By replacing a climb-and-step-over sequence with a seated transfer, it reduces the likelihood that a midwife will need to steady, lift, catch or become a handhold for a mother who is tired, contracting or unsteady.[2,3]

This matters because an unexpected loss of balance can place a sudden and unpredictable load through a midwife’s back, shoulder or arm. Good pool design should minimise that foreseeable people-handling risk rather than relying on staff strength or reaction.[2,3,6]

Why multi-step entry systems deserve careful scrutiny

There is a widespread assumption that a large step unit with handrails must be the safest way to enter and leave a birth pool. In practice, such systems are often required because the pool has a narrow rim or a high, straight-sided profile that cannot support a seated transfer.[1,2,7-9]

A multi-step system may look reassuring, but the whole movement sequence should be considered. A mother may need to climb, turn or reposition, step over the rim and descend into water – potentially finding a submerged floor, seat or plinth while her balance, concentration and coordination are affected by strong labour.[2]

The movement pathway: a practical comparison

Consideration

Sit and swivel

Multi-step entry

Climbing

No multi-step climb

Climbing required

Position while crossing rim

Seated and grounded

May be standing or elevated

Three points of contact

Maintained naturally

Variable through the sequence

Need for physical support

Reduced

Potentially increased

Poolside obstruction

Minimal

Larger footprint

Trip risk when not in use

Low

May be greater

Cleaning, movement and storage

Lower burden

Additional handling and storage task

Emergency access around pool

Clearer perimeter

Potential obstruction

Source: Active Birth Pools Manual Handling Assessment; HSE guidance.[2-6]

Wet-room conditions change the risk

A birth room containing a pool is a wet clinical environment. Even with careful housekeeping, the mother may have wet feet and water may be present around the access point. Strong labour can also alter movement: a mother may pause suddenly, close her eyes, grip, squat, lean or become temporarily unable to follow a sequence of instructions.[2,10]

An access method should therefore allow her to stop safely. With sit-and-swivel entry, she can pause while seated on the rim. The risk is different if a contraction begins while she is part-way up a step unit or standing as she negotiates the pool edge.[2]

Clear space around the pool matters

A bulky step unit does not disappear after entry. If left beside the pool, it occupies working space in the area where midwives, partners and equipment need to move. If moved away, it creates another lifting, cleaning, drying and storage task.[2,7]

The compact Active Birth Pools step provides the required height advantage without obstructing the midwife’s free movement. This helps keep the poolside clearer for observation, support and emergency access.[1,2]

A warning about multi-step systems

The original Active Birth Pools article records the judgement of consulted health and safety specialists in strong terms: “The thought of wet-room conditions with mothers in strong labour climbing up a multi-step unit, stepping over a rim and down onto a submerged plinth is abhorrent.”

It also notes their concern that, when not in use, bulky step units take up space, obstruct movement around the pool and may present a trip hazard.[1,2]

The design principle is straightforward

A handrail may provide a point to hold, but it does not remove the hazards created by climbing, changing direction, stepping over a rim and descending into water. Active Birth Pools solve the access problem at design level: the broad rim is an integral, load-bearing support surface, not an accessory added to compensate for a narrow edge.[2,7-9]

The safest access strategy is not the one with the most equipment. It is the one that removes the unnecessary movement.

Questions for maternity teams and procurement leads

• Can the mother sit safely and comfortably on the pool rim?
• Is the rim wide and rounded enough to support sit-and-swivel entry?
• Does the pool design eliminate the need for climbing?
• Will the access equipment obstruct staff movement around the pool?
• Where will the step unit be placed or stored when it is not in use?
• Does the system add a trip, cleaning or manual handling burden?
• Can midwives work close to the mother without leaning, twisting or reaching?
• Is emergency access around the pool kept clear?[2-6]

Conclusion

Entering a water birth pool should be easy enough that the mother barely needs to think about it. Active Birth Pools’ extra-wide rim and compact single step support an instinctive sequence: step, sit, swivel and lower. The mother remains grounded; the midwife is less likely to become a physical support point; and the space around the pool remains clearer.[1-3]

For mothers in strong labour, for midwives working in a wet clinical environment and for hospitals seeking to reduce manual handling and trip risks, safe access should be designed into the pool from the outset.[2-6]

Supporting document

Manual Handling Assessment: Safe Entry and Exit for Hospital Water Birth Pools

Open the assessment

References

1. Active Birth Pools. Sit and Swivel – the Natural Way to Enter a Water Birth Pool. Accessed 14 June 2026.

2. Active Birth Pools. Manual Handling Assessment: Safe Entry and Exit for Hospital Water Birth Pools. 2026.

3. Health and Safety Executive. Manual handling in birthing pools. Updated 12 January 2026.

4. Health and Safety Executive. Moving and handling in health and social care. Updated 12 January 2026.

5. Health and Safety Executive. Manual handling at work: overview. Updated 25 March 2024.

6. Health and Safety Executive. Manual handling at work: reduce the risk of injury. Updated 1 April 2025.

7. Croyde Medical. Croyde Universal Birth Pool Steps. Accessed 14 June 2026.

8. Febromed. CombiPool. Accessed 14 June 2026.

9. Seagull Medica. Birthing tubs. Accessed 14 June 2026.

10. Milton Keynes University Hospital NHS Foundation Trust. Guideline for the Use of Water During Labour and Birth. 2022.

 

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Emergency Evacuation from a Water Birth Pool: A Practical Guide for Midwives

Posted on by K.D.Brainin

The evacuation a collapsed woman is potentially hazardous and poses risk of injury to mother and midwife.

If the need for an emergency evacuation arises the midwife should:

  1. summon help
  2. stabilise the mother
  3. turn the taps on to raise the water to rim level.

The buoyancy of the water reduces the relative weight of the mother by approximately 33% making it easier to move her and effect safe evacuation.

Midwives should float/move the mother onto a seat or support and hold her safely until help arrives.

Basics:

  1. The mother should be screened to ensure that she meets the inclusion criteria prior to entering the birth pool.
  2. Continuous risk assessment is essential to reduce the incidence of emergencies in the pool.
  3. At the first sign of a contraindication the mother should be asked to get out of the water and assisted from the pool for monitoring and care.
  4. If the mother is unable to leave the pool under her own power or has collapsed an emergency evacuation will need to be conducted.
  5. A trolley should be available
  6. for the mother to be moved onto.
  7. Care must be taken that proper lifting techniques are employed to avert strain & injury.

Example 1: Emergency evacuation utilising the labour support seat

DSC_5440

The mother has been moved onto and held on the labour support seat

DSC_5449

The midwives guide the mother onto rim by sliding her up the side of the pool

Once on the rim she can be easily transferred onto a trolley

DSC_5456

Example 2) Emergency evacuation utilising the safety seat

DSC_5469

The mother is moved into position under the safety seat

DSC_5471

The midwives glide her up the side of the pool

DSC_5473

Onto the safety seat,

and then onto the rim for transfer onto the trolley

DSC_5483

Active Birth Pools are portable hoist compatible

Manual Handling advisors may insist that women are evacuated from the birth pool with a hoist and that this facility is provided for.

Active Birth Pools are designed to accommodate a portable hoist should the need arise.

Clinical Guidelines – Royal Cornwall Hospital

Clinical Guidelines – Royal Worcester Hospital

Guideline for the Management of Women Requesting Immersion in Water  – Norfolk and Norwich University Hospitals

Operational Policy and Clinical Guidelines – Abbey Birth Centre

Birthspace: An evidence-based guide to birth environment design – Queensland Centre for Mothers and Babies

Use of water for labour and birth – Hywel DDA Local health Board

Guidelines for use of pool during labour and delivery – East Cheshire NHS Trust

Guiding principles for midwifery care during normal labour – Barking, Havering and Redbridge NHS Trust

Waterbirth care during labour for low risk women – Sandwell and West Birmingham Hospitals

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2016 – Launch of the Water Birth Safety Initiative

Posted on by K.D.Brainin

Hospitals in the United Kingdom began allowing women to use specially designed pools of water for labour and birth during the 1980’s.

The wide-spread popularity and acceptance of water birth pools as a standard part of the maternity care package necessitated the development of guidelines & regulations to define standards and ensure they’re met.

The United Kingdom Department of Health has published a panoply of water safety directives that apply to water birth pools.

Policies and recommendations set forth in the Water Birth Safety Initiative are based upon these publications.

The Water Birth Safety Initiative (WBSI) calls for development of international standards modelled on the UK’s so that women the world over can benefit from the use of water for labour and birth safeguarded from risk.

The WBSI calls for the implementation of stricter protocols and sets forth recommendations for equipment standards.

The guidelines set forth in the WBSI are intended to serve as a framework of standards for birth pool suppliers, hospitals and midwives to work with to establish  safe codes of practice.

Guidelines for Water Birth Pools Installed in Hospital

Water is more prone to bacteria growth after it leaves the public water distribution system and enters a building’s plumbing.

There it finds warmer temperatures, stagnation, and smaller pipes, valves and fittings.

Biofilm that forms on valves and fittings and pipe walls not only feeds bacteria but also protects them from the hot water and chlorine that typically would kill free-floating organisms.

Large systems with complex piping networks — like those found in hospitals, hotels and large apartment buildings — are especially prone to bacteria growth.15

Water Birth Pools that are installed in hospitals have the benefit of being maintained by staff to ensure that protocols are established, met and maintained.

Consideration and due diligence with regard to the prospective purchase of water birth pools and the assessment of pools already in use needs to be taken to ensure that the associated plumbing and electrical systems meet relevant safety standards.

The United Kingdom’s Department of Health and National Health Service has an exemplary safety record achieved by establishing rigorous sets of guidelines and regulations for the design, installation, use and maintenance (cleaning/disinfection) of water birth pools.

In the UK water birth pools are classed as a Category Fluid 5 water risk which represents a serious health hazard due to the concentration of pathogenic organisms, radioactive or very toxic substances, e.g. containing faecal material or other human waste; butchery or other animal waste or pathogens.

Water Birth Pools must be installed in compliance with water regulations as set forth in The Water Supply (Water Fittings) Regulations 1999.11

The 7 sins of water safety

To ensure high standards are met it is strongly advised that you do not use a water birth pool that has any of these features:

  1. Overflow drains
  2. Internal water inlets
  3. Hand-held showers
  4. Systems with flexible hoses or extended pipes
  5. Integral or secondary plumbing systems
  6. Any type of recirculating or pumped water systems such as whirlpool, jacuzzi, spa, bubbling, filtering etc
  7. Heating systems

1) 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 installed on water birth pools as they constitute a constant infection control risk much more significant than the possible risk of damage due to water overflowing.11,12

Some digital taps on the market can be set for filling time thus obviating the risk of the pool overflowing.

2) Internal water inlets

Internal water inlets act in place of taps to fill the pool.

They are installed on the inside of the pool just above the water line and connected with pipework to a thermostatic valve.

If the water level rises there is a high risk of back flow enabling bacteria to enter the system creating a risk of cross infection.7

3) Handheld showers

Handheld showers present a significant infection control risk due to the fact that they can fall in the pool and 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. 13

Handheld showers present a Fluid Category 5 risk to the mains water supply.

It must not be possible to submerge the showerhead in the water due to risk of cross infection.

In order to comply with category 5 water regulations covering back siphonage, a class AUK3 air gap would be required, which generally prevents the use of handsets, unless there is a separate break tank installed in the hospital plumbing system.

4) Systems with flexible hoses or extended pipes

Systems that employ flexible piping, have branch pipes or hold stagnant water present a potential hazard and must not be used with water birth pools.

It is impossible to clean, disinfect or monitor these systems.

They have been proven to be a source of Legionella and Pseudomonas. 14

Weekly flushing recommendations recommended by the department of health cannot be executed with such systems, and the effectiveness of this cannot be monitored due to the inacessibility of the closed system.

5) Integral or secondary plumbing systems

Integral, secondary or proprietary plumbing systems are fitted to some water birth pools.

As these systems can employ flexible and non-flexible piping, overflow drains, handheld showers and are often pumped or recirculating they present a significant infection control risk and should be banned from use.

Regulations stipulate that water birth pools are filled from thermostatically controlled wall mounted mixer taps plumbed directly into the hospitals water supply with the minimum of pipework.

Not only do secondary or integral plumbing systems present unacceptable risks, they are impossible to clean, disinfect or monitor and therefore present an extremely high and unacceptable infection control risk.

They must not be present on pools used for labour and birth. 10

6) Recirculating or pumped water systems

Recirculating or pumped water systems such as whirlpool, jacuzzi, spa, bubbling, filtering etc. have the perfect environmental conditions to be a potential source for the growth of microorganisms, including legionella bacteria and must not be installed on water birth pools.

Water systems that are able produce aerosols represent the highest levels of risk.

Aerosols can be generated very easily when the water surface is broken -for example, by falling water droplets, splashing, or by bubbles breaking at the surface.

Once introduced to artificial water systems, Legionella can thrive in warm water (30 – 35 °C) and has been shown to be present on flexible seals and metal surfaces within plumbing systems used in domestic potable water supplies.

Inadequately maintained spa pools (birth pools with pumped or recirculating systems) provide ideal conditions to support the growth of legionellae and other microorganisms, which may then become aerosolised and subsequently inhaled.15


7) Heating systems

Heating systems for water birth pools are not necessary and present unacceptable infection control risks.7

There are two types of heating systems in use:

1. Recirculating system with a heat exchanger

Water is pumped out of the pool and through a heat exchanger and then flows back into the pool.

These systems present one of the highest infection control risks and should not be installed on a water birth pool under any circumstances. (covered by points 4, 5 and 6 above).

2. Electric heating systems

Similar to under floor heating found in homes do not present an infection control risk.

But, they do present an unacceptable health and safety risk and should therefore not be installed in water birth pools.

These systems consist of a network of cables embedded in the fabric of the birth pool that are attached to the power supply through a thermostat.

The heat is transmitted from the cables through the floor of the pool and then transferred to the water.

The inherent problem with these systems is that the water is relied on to take the heat away from the material.

If a woman remains motionless the heat becomes concentrated and a “hotspot” develops which can result in the woman being burned.

Recommendations

Plumbing for filling and emptying water birth pools should be simple, straight forward and kept to the minimum.

A set of taps (see below) mounted on the wall 15cm above the rim and a drainage system similar to that of a normal bath is all that is required.

Rim mounted taps present two areas of risk:

1. Women may hit their head on taps that are mounted on the rim of the pool causing injury.

In the throes of labour a woman is not as cognisant of her surroundings as she normally is.

She needs to be protected from the potential harm that could result from hitting her head or other part of her body on the spout.

2. Risk to the taps and pool caused by the labouring woman grabbing onto the spout for support could easily cause damage to the fitting or fabric of the pool.

Filling the birth pool

Water Birth Pools should be filled directly from the hospitals main water supply through a ¾ Thermostatic Mixing Valve (TMV).

To comply with UK National Health Service regulations the valve must have TMV3 approval for use in Healthcare and Commercial situations and certify that it conforms to the performance requirements of the Department of Health.16

To kill legionella and other bacteria, water in hospitals systems is heated to 60 – 80 °C.

Water temperature entering the birth pool should be limited by the TMV to 44 °C to prevent scalding.

The added benefit of using a TMV connected directly to the hospitals main water supply is that it can be set to automatically flush itself of stagnant water twice a day and be thermally disinfected periodically.

dsc_2965

The use of a TMV ensures a safe water supply.

Digital thermostatic mixing valves with enhanced thermal performance that incorporate these features are ideal:

1) Programmable control to accurately mix and maintain the temperature of the water flowing into the birth pool and limit the temperature of the water to 44 °C to prevent scalding.17

2) Programmable fill duration to fill the pool to the desired depth and then turn off.

This is important as water birth pools are not allowed to have overflow drains installed and this feature will prevent the pool from overflowing when unattended.

3) Programmable duty flushing to ensure that water does not stagnate within the tap and associated pipe work, effectively controlling the multiplication of legionella & other bacteria in infrequently used outlets.

Flushing duration is in line with HSE L8 recommendations.18

4) Programmable high-temperature thermal disinfection to destroy the proteins in viruses and bacteria and render them as dead or inert.

Thermal disinfection works by achieving a moist heat which is set at a specific temperature for a set amount of time.

Viruses and bacteria are very sensitive to heat and they will die if exposed to higher temperatures. 19

Emptying the Pool

Water from a birth pool needs to be treated as Fluid category 5 waste representing a serious health hazard due to the concentration of pathogenic organisms derived from fecal material or other human waste and emptied directly into the hospital’s waste water system.20

The pipework needs to have a trap or U bend fit as close to the waste/drain as possible.

The drainage fitting or waste should seal neatly into the drain.

The drainage fitting should be cleaned and flushed through with disinfectant and then dried as part of the cleaning protocol.

The waste should be kept closed when the pool is not in use.

There should be NO flexible pipe used in the drainage pipework.21

The waste should be remotely operated (i.e. pop up waste with rim mounted control) and of the best quality, preferably high-grade brass, to resist the corrosive action of chlorides and other disinfectants.

DSC_2915

End notes

The Water Birth Safety Initiative was conceived by Keith Brainin to motivate and enable birth pool suppliers and health care professionals to raise standards and implement protocols to make water birth safe.

References

[1] Healio – Infectious Disease News. (2014, December 26). Legionellosis death after water birth sparks call for stricter infection control protocols. http://www.healio.com/infectious-disease/practice management/news/online/%7Bfe352169-755d-4d21-9bb2-abb8ae209f89%7D/legionellosis-death-after-water-birth-sparks-call-for-stricter-infection-control-protocols

[2] Inquisitr. (2015, January 16). Oregon Water Birth Leaves Baby Disabled, Lawsuit Wants Labor Options Banned. http://www.inquisitr.com/1761136/oregon-water-birth-leaves-baby-disabled-lawsuits-wants-labor-options-banned/

[3] GOV.UK. Alert after Legionnaires’ disease case in baby, 2014. https://www.gov.uk/government/news/alert-after-legionnaires-disease-case-in-baby

[4] The Guardian. Legionnaires’ disease in baby is linked to heated birthing pool, June 17, 2014.http://www.theguardian.com/society/2014/jun/17/legionnaires-disease-heated-birthing-pool-baby-public-health

[5] Guidance from the  Water Regulations Advisory Scheme (WRAS) https://www.wras.co.uk/consumers/advice_for_consumers/what_are_the_water_regulations_/

[6] M.W. LeChevallier, 2003 World Health Organization (WHO). Conditions favouring coliform and HPC bacterial growth in drinking- water and on water contact surfaces. Heterotrophic Plate Counts and Drinking-water Safety. Edited by J. Bartram, J. Cotruvo, M. Exner, C. Fricker, A. Glasmacher. Published by IWA Publishing, London, UK. ISBN: 1 84339 025 6.

[7] www.gov.uk. Public Health England advice on home birthing pools, 2014.  https://www.gov.uk/government/news/public-health-england-advice-on-home-birthing-pools

[8] Health and Safety Executive. (2013). Legionnaires’ disease: Technical guidance [3.4], 2013. http://www.hse.gov.uk/pubns/priced/hsg274part3.pdf

[9] United Lincolnshire Hospitals NHS Trust UK. Cleaning, Disinfection and Sterilization Guidelines for Re-Usable Medical Devices 2010.
http://www.activebirthpools.com/wp-content/uploads/2014/05/Lincolnshire-CLEANING-DISINFECTION-AND-STERILIZATION-GUIDELINES-FOR-RE-USABLE-MEDICAL-DEVICES.pdf

[10] http://www.eurosurveillance.org. Case of legionnaires’ disease in a neonate following an home birth in a heated birthing pool. England, June 2014 http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20857

[11] Water Regulations Advisory Scheme (WRAS). Fluid Categories. https://www.wras.co.uk/consumers/resources/glossary/fluid_categories/

[12] WHBN 00-10 Welsh Health Building Note. Part C: Sanitary assemblies2014, http://www.wales.nhs.uk/sites3/documents/254/WHBN%2000-10%20Part%20C.pdf

[13] Department of Health, Children, young people and maternity services. Health Building Note 09-02: Maternity care facilities, 2009.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147876/HBN_09-02_Final.pdf

[14] Freije, Matthew R. Some waterborne bacteria are tough, 2010. http://www.watertechonline.com/articles/some-waterborne-bacteria-are-tough

[15] Woolnough, Kevin. Legionella Expert Calls for Greater Vigilance, 2014. http://www.eurofins.co.uk/news-archive/legionella-expert-calls-for-greater-vigilance.aspx

[16] BEAMA. TMV Standards and regulations, 2013. http://www.beama.org.uk/en/product-areas/heating-hot-water–air-movement/thermostatic-mixing-valves/tmva-faqs-on-thermostatic-mixing-valves/tmv-standards-and-regulations.cfm

[17] Health and Safety Executive. Managing the risks from hot water and surfaces in health and social care, 2012. http://www.hse.gov.uk/pubns/hsis6.pdf

[18] Health and Safety Executive. Legionnaires’ disease The control of legionella bacteria in water systems, 2013. http://www.hse.gov.uk/pubns/priced/l8.pdf

[19] Health and Safety Executive. Managing legionella in hot and cold water systems. http://www.hse.gov.uk/healthservices/legionella.htm

[20] SMS Environmental – the water experts. Fluid Categories. http://www.sms-environmental.co.uk/fluid_categories.html.

[21] Nottingham University Hospitals NHS Trust. Legionella Management and Control Procedures, 2014.

Bibliography

  • Ashford and St. Peter’s Hospitals, Women’s Health and Paediatrics Division (Abbey Birth Centre). Operational Policy and Clinical Guide, 2014.
  • BASINGSTOKE AND NORTH HAMPSHIRE NHS FOUNDATION TRUST . CLEANING, DISINFECTION AND STERILISATION POLICY. Prod. Helen Campbell. BASINGSTOKE AND NORTH HAMPSHIRE, BASINGSTOKE AND NORTH HAMPSHIRE, 2010.
  • BEAMA. TMV Standards and regulations. 2013. http://www.beama.org.uk/en/product-areas/heating-hot-water–air-movement/thermostatic-mixing-valves/tmva-faqs-on-thermostatic-mixing-valves/tmv-standards-and-regulations.cfm (accessed 2014 йил 24-09).
  • Buckinghamshire Healthcare NHS Trust. Water birth and use of water in labour guideline. Prod. Miss G Tasker and Audrey Warren. 2013.
  •  Dekker, Rebecca. “Evidence on the Safety of Water Birth.” http://evidencebasedbirth.com/. 2014. http://evidencebasedbirth.com/waterbirth/ (accessed 2014 10-09).
  • Department for Environment, Food and Rural Affairs. Water Supply (Water Fittings) Regulations 1999 Guidance Document relating to Schedule 1: Fluid Categories and Schedule 2: Requirements For Water Fittings. 1999. http://archive.defra.gov.uk/environment/quality/water/industry/wsregs99/documents/waterregs99-guidance.pdf.
  • Department of Health. Children, young people and maternity services Health Building Note 09-02: Maternity care facilities. 2009.

—. “Health Building Note 00-09: Infection control in the built environment.” www.gov.uk. 2002. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/170705/HBN_00-09_infection_control.pdf (accessed 2014 6-12).

—. “Health Technical Memorandum 64: Sanitary assemblies.”  2006. http://www.wales.nhs.uk/sites3/documents/254/HTM%2064%203rded2006.pdf (accessed 2014 10).

—. “Water systems Health Technical Memorandum 04-01: Addendum” .2013. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/140105/Health_Technical_Memorandum_04-01_Addendum.pdf (accessed 01 2014-10).

 —. “Water systems Health Technical Memorandum 04-01: The control of Legionella , hygiene, “safe” hot water, cold water and drinking water systems”. 2006.

  • DH, Estates & facilities. Water systems Health Technical Memorandum 04-01: Addendum . Department of Health, Department of Health.
  • Elizabeth R Cluett, Ethel Burns. Immersion in water in labour and birth. 2009.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000111.pub3/abstract (accessed 2013 13-05).
  • Elyse Fritschel, Kay Sanyal, Heidi Threadgill, and Diana Cervantes. Emerging Infectious Diseases.CDC. Centers for Disease Control and Prevention. CDC. 2014. http://wwwnc.cdc.gov/eid/article/21/1/14-0846_article (accessed 2015 5-January).
  • Freije, Matthew R. Some waterborne bacteria are tough . 2010. http://www.watertechonline.com/articles/some-waterborne-bacteria-are-tough (accessed 2015 20-01).
  • GOV.UK. Alert after Legionnaires’ disease case in baby. 2014. https://www.gov.uk/government/news/alert-after-legionnaires-disease-case-in-baby (accessed 2014 3-12).
  • GOV.UK. Public Health England advice on home birthing pools. 2014. https://www.gov.uk/government/news/public-health-england-advice-on-home-birthing-pools (accessed 2014 03-August).
  • Healio – Infectious Disease News. Legionellosis death after water birth sparks call for stricter infection control protocols. 2014. http://www.healio.com/infectious-disease/practice-management/news/online/%7Bfe352169-755d-4d21-9bb2-abb8ae209f89%7D/legionellosis-death-after-water-birth-sparks-call-for-stricter-infection-control-protocols (accessed 2015 07-01).
  • Health and Safety Executive. Legionnaires’ disease The control of legionella bacteria in water systems. 2013. (accessed 2014 07-07).

—. “Legionnaires’ disease: Technical guidance.”  2013. http://www.hse.gov.uk/pubns/priced/hsg274part3.pdf (accessed 2014 20-10).

—. Managing legionella in hot and cold water systems. http://www.hse.gov.uk/healthservices/legionella.htm (accessed 2015 07-01).

—. “Managing the risks from hot water and surfaces in health and social care.”  2012. http://www.hse.gov.uk/pubns/hsis6.pdf (accessed 2014 20-11).

  •  Health Facilities Scotland. Consultation draft of SHTM 04-01 Water Safety for Healthcare Premises Part G: Operational Procedures and exemplar Written Scheme 2013. Health Facilities Scotland.
  •  Inquisitr. Oregon Water Birth Leaves Baby Disabled, Lawsuit Wants Labor Options Banned. 2015.http://www.inquisitr.com/1761136/oregon-water-birth-leaves-baby-disabled-lawsuits-wants-labor-options-banned/ (accessed 2015 16-01).
  •  Laura Franzin, Carlo Scolfaro, Daniela Cabodi, Mariangela Valera, and Pier Angelo Tovo. Legionella pneumophila Pneumonia in a Newborn after Water Birth: A New Mode of Transmission. Oxford Journals, November 2001: 104.
  • Legionella Control. Birthing Pool Death Linked To Legionnaires disease. https://legionellacontrol.com/blog/166-birthing-pool-death-linked-to-legionnaires-disease (accessed 2014 27-11).
  •  Legislation.gov.uk. The Water Supply (Water Fittings) Regulations 1999.The National Archives. 1999. http://www.legislation.gov.uk/uksi/1999/1148/contents/made (accessed 2015 05-01).
  •  M.W. LeChevallier, World Health Organisation. Conditions favouring coliform and HPC bacterial growth in drinkingwater and on water contact surfaces . 2003.
  •  N Phin, T Cresswell, F Parry-Ford on behalf of the Incident Control Team. CASE OF LEGIONNAIRES’ DISEASE IN A NEONATE FOLLOWING A HOME BIRTH IN A HEATED BIRTHING POOL, ENGLAND, JUNE 2014.http://www.eurosurveillance.org. 2014. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20857 (accessed 2015 10-01).
  •  Nottingham University Hospitals. LEGIONELLA MANAGEMENT AND CONTROL PROCEDURES. May 8, 2014.
  • Rosanna A. Zanetti-Daellenbach, Sibil Tschudin, Xiao Yan Zhong, Wolfgang Holzgreve, Olav Lapaire, Irene Ho ̈sli. Maternal and neonatal infections and obstetrical outcome in water birth . Prod. Women’s University Hospital Basel. Spitalstrasse, Basel: European Journal of Obstetrics & Gynecology and Reproductive Biology , 2006 28-August.
  • SMS Environmental – the water experts. Fluid Categories. http://www.sms-environmental.co.uk/fluid_categories.html.
  • Takuhito Nagai, Hisanori Sobajima, and Mitsuji Iwasa. A fatal newborn case of Legionella pneumophila pneumonia occurring after water birth in a bathtub with an all day circulating system, June 1999 – Nagoya City.http://idsc.nih.go.jp/. 2000. http://idsc.nih.go.jp/iasr/21/247/de2474.html (accessed 2014 17-06).
  • Takuhito Nagai, Hisanori Sobajima, Mitsuji Iwasa, Toyonori Tsuzuki, Fumiaki Kura, Junko Amemura-Maekawa, and Haruo Watanabe. Neonatal Sudden Death Due to Legionella Pneumonia Associated with Water Birth in a Domestic Spa Bath. 2002.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC154682/ (accessed 2014 3-12).
  • The Guardian. Legionnaires’ disease in baby is linked to heated birthing pool . 2014. http://www.theguardian.com/society/2014/jun/17/legionnaires-disease-heated-birthing-pool-baby-public-health (accessed 2014 18-June).
  • U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC) Atlanta, GA 30333. Guidelines for Environmental Infection Control in Health-Care Facilities . 2003.
  • UNITED LINCOLNSHIRE HOSPITALS NHS TRUST. CLEANING, DISINFECTION AND STERILIZATION GUIDELINES FOR RE-USABLE MEDICAL DEVICES. Lincolnshire, 2010 January.
  • Water Regulations Advisory Scheme. Fluid Categories . https://www.wras.co.uk/consumers/resources/glossary/fluid_categories/ (accessed 2014 3-12).
  • which.co.uk. Having a water birth and using birth pools. http://www.which.co.uk/birth-choice/articles/using-water-in-labour.
  • Woolnough, Kevin. Legionella Expert Calls for Greater Vigilance. http://www.eurofins.co.uk/news-archive/legionella-expert-calls-for-greater-vigilance.aspx (accessed 2015 17-01).

Please feel free to distribute and share this document crediting  © K. D. Brainin (Active Birth Pools) 2015

Active Birth Pools: Cleaning and Care

Posted on by K.D.Brainin

When it comes to water birth pools, hygiene and water safety are paramount.

Active Birth Pools are designed to meet the highest standards for water safety, hygiene and infection control.

This begins with Ficore®, the exceptionally durable material used to manufacture our pools.

Ficore® is five times harder than conventional materials and is unaffected by disinfection with 10,000 ppm hypochlorite when used correctly.

The seamless, one-piece construction and absence of surface-mounted metalwork remove the joints, gaps and fixings where micro-organisms can collect and propagate.

Active Birth Pools Cleaning and Disinfection Guidelines

This is a two-step procedure – first cleaning of the pool and surround, then disinfection of the pool and surround.

  1. Prior to emptying the pool remove debris and larger particles from the water with a sieve to prevent it from blocking or obstructing the outlet.
  1. Use the standard infection control precautions (plastic apron, disposable gloves and eye protection) when cleaning the pool. Ensure the area is well ventilated.
  1. Cleaning – use a non-abrasive detergeant with non-abrasive sponge or cloth to thoroughly clean the pool. Ensure the tap is cleaned first, so as not to transfer micro-organisms from the “dirty” pool area to the cleaner tap region. Rinse well with warm water.
  1. Disinfecting – use an approved hypochlorite disinfectant listed in the table below following the directions on the packet for mixing the solution to the correct concentration for disinfecting the birth pool and surround.
  1. Apply the solution to the tap and spout prior to disinfecting the pool.
  1. There are 3 methods for disinfecting the pool that are commonly used in hospitals:

1) Fill the pool with cold water and add the requisite amount of disinfectant – leave for ten minutes.

The advantage of this method is that it is 100% effective but wasteful of water, time consuming and uses a large amount of disinfectant

2) Make up 2-3 litres of solution and pour it around the inside of the rim. Then use a new disposable mop or cloth to spread the disinfectant over the surface of the pool. Leave for ten minutes.

The advantage of this method is that it is economic in terms of time and cost but relies upon the person carrying out the task to ensure that 100% of the pools surface is disinfected.

3) Fill a spray bottle with disinfectant and thoroughly spray the surface of the pool and surround. Then use a new disposable mop or cloth to spread the disinfectant over the surface of the pool. Leave for ten minutes.

The advantage of this method is that it is economic in terms of time and cost but relies upon the person carrying out the task to ensure that 100% of the pools surface is disinfected

  1. Open the drain outlet and empty the pool of the disinfectant.
  1. Using cold water, rinse the tap then the pool to remove all traces of the disinfectant, to prevent any residue being left on the pool surface.
  2. Dry the entire surface of the pool using a new cloth or disposable mop head.
  3. Keep the drain outlet closed when not in use.

Damage resulting from exposure to higher water temperatures, or steam cleaning or will not be covered by our guarantee.

If you are duty flushing the taps with hot water/steam add 10cm of cold water to the pool first.

Do not use hydrogen chloride (bleach) or hydrogen peroxide as they are highly corrosive and will cause the metal fittings to rust and may damage the surface of the pool.

If you want to use another product please contact us for approval as damage resulting from unapproved products will not be covered by our guarantee.

Warning: Copper/Silver Orca Disinfection Systems

Hospitals worldwide are starting to use Copper/Silver orca disinfection systems in an effort to combat bacterial issues and improve water safety. We have discovered that there is great potential for staining with the Copper/Silver orca disinfection system

Copper-silver ionization systems introduce trace amounts of copper into the pool water. In some cases, exposure to elevated copper levels can lead to staining of the sanitary ware and other surfaces, such as walls, floors, or fixtures.

This study goes into great detail – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384302/

Please note that staining caused by these systems is NOT covered by our guarantee.

If your hospital is using one of these water treatment systems we suggest that you contact the department responsible for water safety as regular monitoring and appropriate copper levels are essential to mitigate the risk of staining.

Hospital Water Birth Pools

Posted on by K.D.Brainin

Create a calm, clinically appropriate water birth environment with hospital-grade birth pools designed around mothers, midwives and the realities of modern maternity care.

Why hospitals choose Active Birth Pools

For nearly four decades, Active Birth Pools have helped maternity services provide water birth facilities that are safer, stronger and more practical to use.

Our pools are hand-built to order in England from Ficore® composite and designed specifically for professional maternity settings. Every curve, rim, seat, handhold and access point has a purpose: to support mothers, protect midwives and help hospitals maintain a clean, efficient birth environment.

Built around five priorities

Safety – Designed to reduce avoidable risks, support secure movement and allow midwives to remain close, observant and ready to assist.

Hygiene –  Designed to reduce avoidable risks, support secure movement and allow midwives to remain close, observant and ready to assist

Midwife comfort and support – Ergonomic rims, practical working height and clear access help midwives provide care without unnecessary bending, reaching or strain.

 Maternal comfort –  Generous depth, supportive contours and intuitive handholds help mothers relax, move freely and find comfortable positions during labour and birth.

Long-term value – Durable construction, proven performance and a lifetime guarantee make Active Birth Pools a practical investment for maternity services.

Designed for mothers

A birth pool should help a mother feel secure, supported and free to move.

Active Birth Pools provide space, depth and internal support for upright, forward-leaning, kneeling, sitting and resting positions. Mothers can use the rim, internal handholds and contoured surfaces instinctively, without needing complicated instructions or additional equipment.

The result is a pool that supports physiological labour, maternal confidence and dignity.

Designed for midwives

A hospital birth pool is also a workplace.

Midwives need safe access, clear sightlines and a comfortable working position. Poorly designed pools can force midwives to bend, kneel, reach or twist for long periods. Active Birth Pools are designed to support better posture, closer access and more effective hands-on care.

The aim is simple: better comfort for midwives, better support for mothers and a safer working environment for the whole maternity team.

Designed for hospitals

Hospitals need water birth facilities that are safe to specify, straightforward to clean and reliable over many years of service.

Active Birth Pools are designed for the practical demands of maternity units, including infection prevention, manual-handling awareness, emergency access, room layout, plumbing integration and long-term lifecycle value.

Whether you are planning a new maternity unit, refurbishing an existing birth room or replacing an older pool, we can provide product guidance, technical information and specification support.

Hospital-grade construction

Active Birth Pools are hand-built from Ficore® composite, a specialist material chosen for strength, warmth, durability and hygiene.

Unlike standard baths or domestic-style tubs, our pools are designed for repeated clinical use in demanding maternity environments. The material, form and finish work together to create a pool that feels calm and inviting while meeting the practical needs of hospitals and birth centres.

Evidence-aware water birth facilities

Water immersion is widely recognised as an important option in maternity care. Current guidance and research support the availability of water during labour and birth for appropriate women and birthing people, with local clinical assessment, infection-control procedures and safety protocols in place.

The pool itself matters. A well-designed hospital water birth pool can help maternity teams offer water birth with greater confidence by supporting access, hygiene, comfort, observation and emergency response.

What makes Active Birth Pools different?

  • Specialist water birth pool design since 1987
  • Thousands of pools installed worldwide
  • Hand-built in England
  • Ficore® composite construction
  • Lifetime guarantee
  • Award-winning ergonomic design
  • Comfortable for mothers
  • Safer working conditions for midwives
  • Practical specification support for hospitals, architects and project teams

Plan your hospital water birth facility

Choosing a birth pool is a clinical, practical and financial decision. The right pool should support safe care, clean efficiently, protect staff, fit the room properly and deliver reliable performance for decades.

Request specifications and pricing

Download the buyers’ guide

References and source notes

These references support the landing page claims and should be used to ground external-facing content. Claims in final published copy should remain proportionate and should not promise specific clinical outcomes.

  1. Active Birth Pools homepage. Used for company positioning including hospital-grade focus, long specialist experience, award-winning design, Ficore® composite, hygiene, durability and lifetime value. https://activebirthpools.com/
  2. Active Birth Pools Venus / 360 product information. Used for product positioning around 360° access, Water Column plumbing design and unobstructed rim access. https://activebirthpools.com/products/venus-birth-pools/
  3. NICE NG235: Intrapartum care recommendations. Supports careful wording around access to water during labour and birth, individualised assessment and reasonable adjustments. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
  4. Royal College of Midwives news summary on Oxford Brookes water birth research. Supports cautious evidence-aware copy around benefits associated with water birth, including reduced interventions and increased satisfaction. https://rcm.org.uk/news/2022/07/water-births-provide-clear-benefits-and-a-positive-birth-experience-to-mother-and-baby/

 

Some water borne bacteria are tough

Posted on by K.D.Brainin

Originally published by  Matthew R. Freije in 2013

Water is more prone to bacteria growth after it leaves the public water distribution system and enters a building’s plumbing. There it finds warmer temperatures, stagnation, and smaller pipes, valves and fittings.

Biofilm that forms on valves and fittings and pipe walls not only feeds bacteria but also protects them from the hot water and chlorine that typically would kill free-floating organisms.

Large systems with complex piping networks — like those found in hospitals, hotels and large apartment buildings — are especially prone to bacteria growth, but home plumbing systems are not exempt.

In fact, Legionella bacteria have been found in many home plumbing systems, some of which have been implicated in cases of Legionnaires’ disease.

Closer look at waterborne bacteria

Not all types of bacteria are unhealthy; some actually protect humans from illness. Only the disease-causing (pathogenic) bacteria are a concern, and these include Pseudomonas aeruginosa, Helicobacter pylori, Legionella, E. coli and Mycobacteria avium.

Many pathogens that can be transmitted from water also can be transmitted from food or surfaces or passed from person to person. For Legionella, however, water is nearly always the source.

Transplant patients, smokers, the elderly, persons with underlying disease such as cancer or diabetes, or patients undergoing chemotherapy treatment are many times more likely than a young nonsmoker in generally good health to become infected by waterborne bacteria and to die from that infection.

Modes of transmission

Drinking water is only one of the ways in which harmful bacteria can enter a person’s body.

Some bacteria can be inhaled in small droplets while showering, brushing teeth or washing the face.

Even while washing hands, a person could unknowingly inhale small water droplets that become airborne directly from the faucet or after water splashes against the sink.

Water droplets can enter the lungs and cause infection also by aspiration: contaminated water in the mouth, perhaps while swallowing, gets past the choking reflexes and enters the lungs instead of the esophagus and stomach.

Aspiration is more likely to occur in smokers, because their damaged respiratory tracts fail to keep substances out of the lungs.

Water-related illness associated with skin contact is less common in generally healthy people.

However, Pseudomonas aeruginosa has caused skin rashes in people using swimming pools or whirlpool spas that have not been properly treated to kill bacteria.

All four modes of transmission — ingestion, inhalation, aspiration and skin contact — have one crucial fact in common: The source of the problem is in the water.

If the water is not contaminated, illness will not occur.

Reducing risk

Bear in mind that the following comments pertain only to home plumbing systems. Some methods that are effective in home plumbing systems will not work well in hospitals, hotels or other large buildings.

Chemical disinfection

The disinfectant in a public water supply cannot be relied upon to control pathogens in a home plumbing system.

The free chlorine concentration varies significantly from city to city and even within a given distribution system, depending in part on the distance from the treatment plant to a home.

The water entering some homes may have 1.0 part per million (ppm) free chlorine while others will have 0.2 ppm or less.

Moreover, hot water at faucets and showers is unlikely to have any disinfectant, as chlorine concentrations are likely to dissipate in the water heater.

Although two studies conducted by the Centers for Control of Disease and Prevention (CDC) indicated that city water systems treated with monochloramine are less conducive to Legionella growth than are systems treated with chlorine, more data is needed to draw conclusions, particularly since Legionella have been found in several buildings supplied with monochloramine-treated water.

Point-of-entry (POE) treatment systems are used in some hospitals and hotels to inject chlorine dioxide or copper-silver ions into the plumbing system, or perhaps only into the hot water system.

However, this is not the most desirable or effective option for pathogen control in homes. A single treatment with chlorine or chlorine dioxide may be beneficial for newly constructed systems or systems that have been stagnant for a long period of time.

Following Water Quality Association (WQA) guidelines, the home plumbing system should also be disinfected in conjunction with the installation of a POE filtration system.

Hot water temperatures

The types of bacteria typically found in plumbing systems grow well in warm-water environments but will not multiply above a certain temperature.

For example, in the absence of biofilm, Legionella will not multiply at temperatures above 122 F (50 C) and will die within about 32 minutes at 140 F (60 C). Pseudomonas aeruginosa will not multiply above 108 F (42 C). Mycobacteria will multiply up to about 124 F (51 C).

Keeping water at 140 F (60 C) in large-building plumbing systems will not always control bacteria because of dead areas and other complexities in a large piping network, but studies have shown that high temperatures are effective in controlling Legionella bacteria in single-family residences.

In 95 Chicago-area homes studied by P.M. Arnow’s group*, Legionella were found in water samples collected from plumbing systems at temperatures under 140 F (60 C), but not in a single sample from systems above 140 F (60 C).

Setting the water heater to deliver 140 F (60 C) water to all taps will help to control waterborne pathogens but should not be done if the house is occupied by children or others who may open a hot water faucet unaware of the risk of scalding.

Skin damage will occur in adult males within 15-30 seconds at 130 F (54 C) and within 3-5 seconds at 140 F (60 C). Children and the elderly will scald even more quickly, and they will scald at lower temperatures.

Ultraviolet treatment. Properly sized ultraviolet (UV) disinfection units installed at the point of entry may be effective in controlling bacteria in home plumbing systems.

Whole-building UV has been unsuccessful in solving Legionella problems in large buildings because in those systems a residual disinfectant is required to prevent recontamination from biofilm. However, UV has been effective in controlling Legionella on a single floor of a hospital. Turbid water must be filtered for UV to be effective.

Filters and RO. Typical sediment or carbon filters will not block bacterial pathogens, and dirty ones actually make a good habitat for them. However, hollow-fiber membranes and other devices with a pore size of 0.2 micron or smaller will block bacteria.

At this time, submicron point-of-use (POU) filters are used in some hospitals but not generally in homes. However, several new sub-micron POU and POE filtration products are likely to be introduced, including products for home systems.

Whole-house hollow-fiber membrane systems, already available, provide filtration to 0.02 micron nominal and a flow rate of approximately 11 gallons per minute (gpm). These systems must be backwashed at least once daily.

Reverse osmosis (RO) systems certainly remove bacteria but need to be properly maintained to prevent bacteria growth in tanks and on membranes.

For pathogen control, filters should be evaluated based on: flow rate reduction; independent studies validating their ability to block bacteria; filter life; distance from the point of use (since bacteria could be released from biofilm downstream of the filter); and cost.

Many options are available for pathogen control in home plumbing systems, only a few of which have been discussed in this article.

Remember, it is critical to control waterborne pathogens in homes occupied by the elderly or immuno-compromised.

* “Prevalence and significance of Legionella pneumophila contamination of residential hot-tap water systems,” Journal of Infectious Diseases 152 (1985); 145-151

Matthew R. Freije is president of Solana Beach, CA-based HC Info.

He is a consultant, author and course instructor specializing in waterborne pathogens. Freije earned a B.S. degree in mechanical engineering from Purdue University; a water treatment plant operations specialist certificate from California State University, Sacramento; and is a Certified Water Specialist (WQA). His book Legionellae Control in Health Care Facilities: A Guide for Minimizing Risk has sold in more than 30 countries. Portions of this article were taken from Freije’s new book on home water treatment, due to be released this year.

Water Safety Management for Water Birth Pools in Hospitals

Posted on by K.D.Brainin

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

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

Below a list of guidelines to help you create a safe water birth facility.

 

Ventilation for the birthing environment

Posted on by K.D.Brainin

Engineering experts Phil Nedin and Dr. Anna Coppel from Arup’s advanced Technology and Research team look at the science of ventilating a birthing room.

Water Birth Pools expel a high volume of moisture that must be considered when designing the ventilation system for a water birth room.

Ventilation for birthing pool facilities

 

How to restore your old birth pool to pristine condition

Posted on by K.D.Brainin

We’ve been supplying water birth pools to hospitals since 1989.

Many of the pools we supplied in the 90’s are still in active service!

Below Venus Pool at the Royal Berkshire Hospital 1992 – still in use today

hospital birth pools client list

We occasionally receive reports that the pools are not looking as clean and bright as they originally were.

Not to worry.

There is a product called tide mark cleaner that was developed for spas and swimming pools.

You can either use it to remove stains or brighten up the appearance of the pool when necessary.

It will restore your pool to pristine condition.

Here’s a link:

http://www.amazon.co.uk/Waterline-Cleaning-removes-lines-cleaner/dp/B006DFD7VK

For information about cleaning and disinfection procedures please click here.

 

 

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Setting up a water birth facility

Posted on by K.D.Brainin

Hospitals in the United Kingdom have been evolving clinical guidelines for the use of water for labour and birth for over 3o years.

The protocols for operational policy that they’ve developed are widely regarded as the benchmark standard internationally.

Below a collection of guidelines and publications to help you create a water birth facility.

Clinical Guidelines – Royal Cornwall Hospital

Clinical Guidelines – Royal Worcester Hospital

Guideline for the Management of Women Requesting Immersion in Water  – Norfolk and Norwich University Hospitals

Operational Policy and Clinical Guidelines – Abbey Birth Centre

Birthspace: An evidence-based guide to birth environment design – Queensland Centre for Mothers and Babies

Use of water for labour and birth – Hywel DDA Local health Board

Guidelines for use of pool during labour and delivery – East Cheshire NHS Trust

Guiding principles for midwifery care during normal labour – Barking, Havering and Redbridge NHS Trust

Waterbirth care during labour for low risk women – Sandwell and West Birmingham Hospitals

Waterbirth Guidelines – Midwifery Led Unit, Wirral Hospital

Choosing a Water Birth – East and North Hertfordshire

Birthing pool use of labour and delivery – Wansbeck General Hospital

Water birth and use of water in labour guideline – Buckinghamshire Healthcare

Water for labour and birth guideline – Northern health and Social Care Trust

Immersion in water during labour and birth – NHS Forth Valley

Intrapartum care midwifery led unit – Wirral Women & Children’s Hospital

Guidelines for water birth within the hospital and at home – Dartford & Gravesham NHS

Disinfection and Sterilisation policy (infection control) – Basingstoke and North Hampshire NHS FT

Legionella – blowing bugs out the water

Posted on by K.D.Brainin

In recent years, Legionella has made it back into the news, with several reported outbreaks in hospitals across the UK.

As recently as June this year, Brighton and Sussex University Hospitals NHS Foundation Trust was fined £50,000 for failing to control the growth of Legionella in its water systems.

With the spotlight firmly back on the need for bug-free water systems, manufacturers are bringing to market a range of solutions.

Facilities and estates managers should avoid water temperatures and conditions that favour Legionella growth, ensure water cannot stagnate anywhere in the system, remove any redundant pipework that may exist in the network, and stop using any materials that encourage the development of Legionella.

Good offence is the best defence when it comes to water systems.

Options that should be considered include thermal disinfection – maintaining constant high temperatures as well as shock disinfection; chemical disinfection – the presence of an additive like chlorine; good system design to avoid stagnation of water; regular maintenance to remove any sediment from the system; and the use of materials that inhibit the formation of biofilm for the bacteria to feed off.

Guidance on the subject can be found in the latest versions of the Health and Safety Executive’s ACOP L8 and its appended HSG 274 parts 1, 2 and 3, among others.

Legionnaires disease is caused by a bacterium that exists in water and remains inert at temperatures below 25°C.

It proliferates in water circuits at temperatures fluctuating between 25°C and 45°C, meaning hot and cold water systems, air conditioning circuits, and cooling towers are most at risk.

Facilities and estates managers should avoid water temperatures and conditions that favour Legionella growth, ensure water cannot stagnate anywhere in the system, remove any redundant pipework that may exist in the network, and stop using any materials that encourage the development of Legionella.

Active Birth Pools are fabricated in one solid piece of Ficore composite without seams or seals and are impervious to bacteria.

An Active Birth Pool manufactured in Ficore meets or exceeds all relevant regulations and will withstand the rigours of heavy hospital use and disinfection with caustic chemicals.

Ficore is a composite of eight different elements chemically fused during manufacturing and then heat cured at high temperature to create a material that is light in weight but ‘heavy’ in performance.

1. The surface of Ficore is isophthalic neo-pentyl-glycol that is:

a) 50% harder (stronger) than acrylic and fiberglass – materials other birth pools are made from.

b) Able to withstand both continuous heat or hot water of 80 degrees Celsius/176 Fahrenheit, and thermal shock of alternating hot and cold water.

c) Extremely smooth, tactile and warm to the touch.

d) Resistant to most chemicals including acid or alkaline solutions (e.g. lime scale remover) which neither acrylic nor vitreous enamel can withstand.

e) Less slippery than acrylic or fibreglass. Mothers experience better traction and are safeguarded from injury resulting from slipping or falling.

2. Due to Ficore’s high insulation factor Active Birth Pools maintain water temperature 6 x longer than acrylic baths and 12 x longer than vitreous enameled baths.

3. Ficore has an extremely high degree of structural integrity.  It is none flexing, and will not buckle, bow, or change shape under pressure.

4. It will not chip as will vitreous enamel.

5. It is fully repairable.

6. While fibreglass or acrylic birth pools carry only a 1 – 2 year guarantee, we guarantee Active Birth Pools manufactured in Ficore for 20 years.

7.  Ficore is:

  • Approved by Lloyd’s Register of Shipping
  • Approved by Wine Laboratories Limited for long term storage  of high alcohol content wines and spirits
  • Approved by The Water Research Council and the Water Bylaws Advisory Service for the longterm storage of potable water.

Active Birth Pools are not equipped with features such as overflow drains, jets/jacuzzi’s, integral plumbing and heating systems which are in contravention of Health & Safety regulations.

 

United Kingdom Department of Health: Safe water in healthcare premises

Posted on by K.D.Brainin

Guidance on design, installation, commissioning, testing, monitoring and operation of water supply systems in healthcare premises.

This Health Technical Memorandum (HTM 04-01) has now been revised into 3 parts, A, B and C.

It gives advice and guidance on the legal requirements, design applications, maintenance and operation of hot and cold water supply, storage and distribution systems in all types of healthcare premises to:

  • healthcare management
  • Water Safety Groups
  • design engineers
  • estate managers
  • operations managers
  • contractors
  • the supply chain

It also provides advice and guidance on the control and management of the risk posed by Legionella, Pseudomonas aeruginosa and other water borne pathogens within a healthcare setting.

Part A: covers the design, installation and commissioning

Part B:  covers operational management

Part C:  focuses on specific additional measures that should be taken to control and minimise the risk of Pseudomonas aeruginosa in augmented care units

It should be read in conjunction with the HSE’s Approved Code of Practice (L8) and HSG274 Part 2.

It is equally applicable to both new and existing sites.

Part A: design, installation and commissioning

Part B: operational management

Part C: Pseudomonas aeruginosa – advice for augmented care units

Supplement: performance specification D 08 – thermostatic mixing valves

 

The use of water for labour and birth – Colchester University Hospital

Posted on by K.D.Brainin

Feeling relaxed, secure and in control and being able to move about freely can make
it more likely for you to have a quicker and more natural birth.

For some women using a birthing pool can offer all of these benefits.

Today more and more women are considering using water for pain relief in labour.

A midwife can support you in using a birthing pool at home or in our midwife-led units
at Colchester General Hospital and Clacton and Harwich hospitals in the community.

Using a birthing pool is likely to increase the chances of a normal vaginal delivery
and therefore we would like to offer this option to as many women as possible.

We have compiled this leaflet to give you and your partner relevant information about
labouring and giving birth in water.

Please talk to your midwife during the antenatal period who will be able to answer any questions you may have.

Please click here to read the full document

 

The use of water in labour and birth – NZ College of Midwives

Posted on by K.D.Brainin

The New Zealand College of Midwives (Inc) supports immersion of women in warm water during labour as a method of pain management.

There is no evidence that remaining in water for the birth of the baby leads to adverse outcomes for the mother or baby where the labour has been within normal parameters.

Definition:

Water birth means where a baby is born fully submerged into water.

Rationale:

• Evidence supports immersion in warm water as an effective form of pain relief that reduces the use of narcotics.

• There is no evidence to suggest that immersion in water during labour or birth in water leads to any detrimental effects for either the mother or her baby.

• Evidence that immersion in water during labour reduces the length of active labour is inconclusive.

• Evidence that birth in water reduces perineal trauma or blood loss is inconclusive.

Guidelines:

Midwives offering water immersion for labour and for birth are responsible for ensuring the information given to women is accurate and up to date.

The following guidelines are recommended:

• There are no adverse factors noted in foetal or maternal wellbeing during labour.

• Baseline assessments of both maternal and baby wellbeing should be done prior to entering the bath/pool and assessments continued throughout the time in water as for any normal labour.

• Vaginal examinations can be performed with the woman in water.

• Pethidine should not be given to women labouring in water.

• The water temperature should be kept as cool as the woman finds comfortable during the first stage of labour (around 35oC) and increased to no more than 37oC for the baby’s birth.

• If maternal temperature rises more than 1oC above the baseline temperature then the water should be cooled or the woman encouraged to leave the bath/pool. Women need to be aware of this in advance.

• Water temperature should be recorded as the woman enters the bath/pool and regularly during the time she remains in the pool.

• Careful documentation should be kept of maternal and water temperatures, FHR and the approximate surface area of the woman’s body submerged.

• The cord should not be clamped and cut until after the birth of the baby’s body.

• The baby should be brought to the surface immediately, with the head facing down to assist the drainage of water from the baby’s mouth and nose.

• The baby’s body can remain in the water to maintain warmth, unless the baby’s condition dictates otherwise. (Note: babies born in water may take slightly longer to establish respirations than those born into air. Maintain close observation of colour, heart rate and respirations.)

• Third stage should be managed physiologically as for any other low risk birth. If oxytocin is required or third stage is prolonged the woman is assisted to leave the bath/pool.

• Midwives must ensure that baths and pipes are thoroughly cleaned after use.

References:

Title: Labour and delivery in the birthing pool
Author: Forde, C, Creighton, S, Batty, A, Howden, J, Summers-Ma, S, and Ridgeway, G

Title: Warm tub bathing during labour: maternal and neonatal effects
Authors: Ohlsson, G, Buchave, P, Leandersson, U, Nordstrom, L, Rydhstrom, H, and Sjolin, I
Source: Acta Obstetricia et Gynecologica Scandinavica, Vol 80, pp 311 – 314, 2001

Title: Immersion in water in the first stage of labour: a randomised controlled trial
Authors: Eckert, K, Turnbull, D, and MacLennan, A
Source: Birth, Volume 28, No 2, pp 84–93, June 2001

Title: Immersion in water during first stage of labour
Author: Homer, C
Source: Letter to the editor, Birth, Vol. 29, No 1, March, 2002

Title: Waterbirths: a comparative study. A prospective study on more than 2000 waterbirths Authors: Geissbuhler, V and Eberhard, J
Source: Foetal Diagnosis Therapy, Vol. 15, pp. 291 – 300, 2000
Title: Immersion in water in pregnancy, labour and birth Author: Nikodem, VC
Source: Cochrane Database Systematic Review, 2000

Title: Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey
Authors: Gilbert, R and Tookey, P
Source: British Medical Journal, 319 (7208), pp. 483 – 487, 1999

Title: Birth under water – to breathe or not to breath
Author: Johnson, P
Source: British Journal of Obstetrics and Gynaecology, 103, 202-208, 1996

Title: Labour and birth in water: temperature of pool is important
Authors: Deans, AC and Steer, PJ
Source: British Medical Journal. 311:390-391, 1995

Title: Waterbirth – An attitude to care
Author: Garland, D
Source: Books for Midwives, 1995. Chesire

Title: Foetal hypothermia risk from warm water immersion
Author: Charles, C
Source: British Journal of Midwifery

The purpose of New Zealand College of Midwives Consensus Statements is to provide women, midwives and the maternity services with the profession’s position on any given situation.

The guidelines are designed to educate and support best practice.

All position statements are regularly reviewed and updated in line with evidence-based practice.

Watford General Hospital: Cleaning & disinfecting water birth pool and surrounding area

Posted on by K.D.Brainin

Watford General Hospital

Before use

The pool needs to be cleaned every 24 hours, as per instructions below. On completion The Pool Cleaning Record is signed by the member of staff performing the procedure.

Prior to each use and every 24 hours (to coincide with the daily pool cleaning), the pool taps need to be run for 2 minutes, as per water flushing guidelines.

After Use

1. Use the standard infection control precautions (plastic apron, disposable gloves and eye protection) when cleaning the pool. Ensure the area is well ventilated.

2. Remove any debris from the pool, using the sieve, before emptying the pool (to prevent debris blocking the pool outlet). Please ensure the thermometer has been removed from the pool prior to empyting the pool, in order not to block the pool outlet.

3. Use a non-abrasive detergeant to clean the pool of any further debris and blood; ensure the tap is cleaned first, so as not to transfer micro-organisms from the “dirty” pool area to the cleaner tap region. Please see guidance on cleaning sinks/basins and taps below. Rinse well with warm water.

4. Ensure the pool tap outlet is turned to “closed” prior to cleaning the pool tap and pool area with the chlorclean solution (2 tablets in 2 litres of cold water).

5. Clean the pool tap first prior to cleaning the pool with the chlorclean solution, as above.

6. When cleaning the pool itself, pour the chlorclean solution around the side of the pool. Using a clean disposable mop head/cloth, clean the surfaces of the pool and leave the solution in the pool for 10 minutes. Discard this mop head.

7. Open the tap outlet and empty the pool of the chlorclean solution.

8. Using cold water, rinse the tap then the pool to remove all traces of the chlorclean solution, to prevent any residue being left on the pool surface.

9. Dry the entire surface of the pool using a clean cloth or fresh disposable mop head. the pool is dried ensure the mop bucket asigned for cleaning the pool is cleaned and dried throroughly. Store it with the mop handle in room 8. Ensure all disposable mop heads used are disposed of in a yellow clinical waste bag.

11. Ensure the outside of the pool, window ledges, sink and its tap are cleaned with a chlorclean solution.

12. To clean the equipment (sieve, pool thermometer, mirror) used: wash and rinse these in warm water. Then soak for a minimum of 30 minutes in a chlorclean solution (2 chlorclean tablets in 2 litres of cold water), to cover equipment. After this, rinse and dry the equipment before placing these on a clean inco sheet on the top of the delivery box.

13. Finally, after the pool room has been restocked of equipment, towels, draw sheets etc, the floor is mopped using a chlorclean solution and a separate mop/bucket supplied by Medirest.

Guidance on cleaning of sinks/basins and taps in West Hertfordshire Hospitals NHS Trust
(to minimise risk of Pseudomonas aeruginosa)

Step 1 – cleaning the surrounding area

All basins, sinks and surrounding areas should e free from clutter and debris:

• Put on disposable gloves and apron
• Using a new disposable cloth and detergeant damp-clean the paper towel holder, then the soap dispenser, paying particular attention to theunderside of the soap dispensing unit, finishing with the nozzle.
• Then clean the underside of the sink/basin working from the higher level downwards.
• Carefully dispose of the cloth into the appropriate waste bag.
• Dry all surfaces with disposable cloth/towel as above.

Step 2 – Cleaning the wash-hand basin

• Using a new disposable cloth and sanitiser clean tap(s) first – start at the tap outlet end (do not put the cloth into the tap outlet), finish at the base and then clean tap handles.
• Then clean around the inside of the sink/basin from top rim of bowl, then overflow and waste outlet (do not put cloth into the overflow or waste outlet)
• Rinse as above
• Carefully dispose of cloth in appropriate waste bag.
• Dry all surfaces with disposable cloth/towel as above
• Dispose of gloves and apron in appropriate waste bag and decontaminate hands between the cleaning of each sink.