Freestanding water birth pools are becoming increasingly popular.
These installations typically present significant water safety and hygiene risks as rim mounted plumbing and fixtures provides the perfect breeding ground for micro-organisms to thrive.
For wall mounted installations the thermostatic taps, spout, handheld shower and grab rail are fixed to an IPS Panel in accordance with health department regulations.
For freestanding birthing pools a solution needed to be found.
To solve this problem we developed the Water Column – a bespoke design concept that separates the plumbing from the pool to optimise hygiene and water safety and provide crucial support for mothers and midwives.
It’s highly utilitarian, sleek ergonomic design complements the look and usability of our pools to create the ideal facility for water birth.
The wide rim, step unit and grab rail make it safe for mothers to get in and out of the pools.
The column is the perfect height for midwives to rest and lean on while attending the births.
Mothers have a choice of hand holds for support in upright and standing positions.
Adding colour to the column and step adds another dimension to the ambiance of the room.
The Water Column is available in the full range of British Standard or RAL colours.
The demountable handheld shower is essential for cleaning the pool after the birth.
It should be removed while the pool is being used to maintain optimum hygiene standards and to not contravene relevant water safety regulations.
The Water Column has a large access panel at the back that opens up to give plumbers plenty of room to install the thermostatic mixing valve, pipework and associated fittings.
We supply the Water Column only, and not the plumbing or fittings pictured in the images above.
Shown is the Rada T3 Bath/Shower Tap with Rada Spout and Grohe Demountable Handheld shower.
Active Birth Pools are Rated No.1 for water safety and infection control standards.
This is because the material we use (Ficore) is 5 x harder than other materials and is immune to the effects of disinfection with 10,000ppm hypo-chlorite.
Seamless one-piece construction and the absence of surface mounted metal work deny micro-organisms the environment they need to 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.
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.
Use the standard infection control precautions (plastic apron, disposable gloves and eye protection) when cleaning the pool. Ensure the area is well ventilated.
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.
Disinfecting – use chlorclean or similar hypochlorite disinfectant following the directions on the packet for mixing the solution to the correct concentration for disinfecting the birth pool and surround.Do not use bleach as it is highly corrosive and could cause damage to the fittings.
Apply the solution to the tap and spout prior to disinfecting the pool.
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
Open the drain outlet and empty the pool of the disinfectant.
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.
Dry the entire surface of the pool using a new cloth or disposable mop head.
Keep the drain outlet closed when not in use.
Please note: If you want to use a product that is not chloride based please contact us for approval.
Damage resulting from higher water temperatures, steam cleaning or use of products not approved by Active Birth Pools 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.
Protocols from hospitals using Active Birth Pools.
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:
Internal water inlets
Systems with flexible hoses or extended pipes
Integral or secondary plumbing systems
Any type of recirculating or pumped water systems such as whirlpool, jacuzzi, spa, bubbling, filtering etc
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.
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.
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.
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.
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 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/
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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.
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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).
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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).
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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).
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Many water birth pools on the market are equipped with features that at first might seem safe or even an advantage, but in reality present risks.
(We’re not showing images of other birth pools to illustrate the points below as this could be contentious.)
Re-circulating water systems
Re-circulating or pumped systems with jets such as whirlpools and jacuzzi present the perfect conditions for the growth of micro-organisms.
Water systems like these present the highest levels of risk as they produce aerosols.
Aerosols are generated when the water surface is broken – for example, by falling water droplets, splashing, or by bubbles breaking at the surface.
Once introduced to these systems, Legionella and Pseudomonas thrive and can become aerosolised and then inhaled.
Integral Plumbing Systems
Plumbing systems like these utilise flexible and non-flexible piping, overflow drains, handheld showers, pumps, hoses, heaters, surface mounted fittings and filters.
These systems are impossible to clean, disinfect or monitor and therefore present an extremely high Infection Control Risk.
Stagnant water within the system is an ideal breeding ground for bacteria.
UK regulations state that water birth pools fitted with thermostatically controlled mixer taps plumbed directly into the hospitals water supply.
Hand held showers
Handheld showers present a significant infection control risk.
If the shower head falls in the pool it may be contaminated with bacteria that could breed and be passed on next time the shower is used.
Department of Health regulations clearly stipulate that handheld showers and bath/shower mixers are not installed for use with water birth pools as they present a Fluid Category 5 risk to the mains water supply.
N.B. There are systems available that enable you to detach the hose and shower head from the tap. These are permissible as long as the shower fittings are detached when the pool is in use and only employed afterwards for cleaning.
Pumped heating systems
Heating systems for water birth pools are not necessary and present unacceptable infection control risks.
Water is pumped through a heat exchanger and then back into the pool creating the ideal environment for bacteria to breed.
These systems present one of the highest infection control risks and should not be utilised.
Bacteria filters and disinfection systems
Some water birth pools are equipped with these devices in an attempt to mitigate the risk of infection and bacteria infestation that are inherent in built-in plumbing systems.
Bacteria filters and disinfection systems can not be relied upon and will not guarantee adequate hygiene standards.
2019: Venus Water Birth Pool, Peterhead Hospital
Overflow drains harbour bacteria and can serve as a conduit for cross infection.
Regulations are very clear on this point.
Overflow drains should not be fitted to water birth pools as they constitute a constant infection control risk.
Surface mounted metalwork
Metalwork such as grab rails, taps and handles are an obstacle that comes between mother and midwife.
These fittings ALL present a serious infection control risk as the space between the surface of the pool and the fitting are perfect for bacteria.
Remember – bacteria are microscopic – even though the fitting may appear flush to the surface of the pool there is space for bacteria!
The Active Birth pools approach:
Thanks to the amazing properties of Ficore composite (the material we make our pools from) we’re able to bind the hand rails directly into the fabric of our pools.
Our lighting and drainage fittings are of the highest quality and have been inspected and passed by infection control specialists world-wide.
Double step units
In breech of Manual Handling protocols.
Mothers must not climb up and step over the sides of the pool to enter the water.
When not in use these step units present an obstacle and trip hazard.
There is no reason for a water birth pool to have a door and many reasons why they should not.
Doors are mistakenly used for two reasons:
To facilitate emergency evacuations
To help mothers get in and out of the pool
Doors present an extremely high risk of infection and should be banned from use in water birth pools for this reason alone.
The door seal (typically foam or rubberised material) is the perfect breeding ground for bacteria.
From manual handling perspective doors are not practical or fit for purpose. They actually complicate emergency evacuations and put mothers and midwives at risk.
The Active Birth Pools approach:
Click here to find out how our birth pools give midwives safe, practical options for handling emergency evacuations.
Click here to find out how safe and simple it is for mothers to get into an Active Birth Pool.
Height adjustable pools
Manufacturers of these pools say that height adjustment makes midwives more comfortable and less likely to strain or injure themselves.
They are completely wrong!
Given the choice of standing or sitting comfortably in a stationary position for an extended period of time we all choose to be seated.
It’s that simple.
If you look at photos of midwives standing by elevated birth pools you’ll see that they are often uncomfortable.
If you look at photos of midwives sittingby the pools you’ll notice how the solid, vertical sidewall prevents them from getting their legs under the pool.
They are forced to sit with their legs and feet splayed wide apart which is not only uncomfortable but places considerable strain on her lower back.
If you’re considering a pool with one of these systems I suggest that you talk with midwives who’ve used them, look at photos and videos of them in action and then consider how much better off you’d be with an Active Birth Pool.
From a mothers standpoint I can’t imagine how she feels sitting in a big elevated bath tub in the middle of the room with people standing around her.
Mothers need to be grounded to give birth not hydraulically lifted.
The Active Birth Pools approach:
The crucial elements that make the difference are the rounded extra-wide rim and flowing concave skirting panel.
Look at the midwife in the photo above.
Notice how comfortable the she is?
Grounded with her feet forward, body upright, head aligned and arms resting comfortably on the wide round rim.
No other birthing pool on the market comes close to giving mothers and midwives this level of comfort and support.
Swan neck taps are often seen mounted on the rims of water birth pools.
However, swan neck taps retain larger volumes of water which then stagnates and HFN 30 and HPSC recommends that swan-neck taps should not be used as they do not empty after use and could be prone to microbial biofouling with microorganisms including Legionella and P. aeruginosa the latter of which was associated with a swan neck tap during the neonatal outbreak in Northern Ireland (HPSC, 2015).
Taps for water birth pools should be wall mounted, NOT rim mounted and conform to WRAS regulations.
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