Homebirth baby dies of virus contracted during waterbirth

underwater sunbeams

Just about every practice central to homebirth midwifery has never been tested or has been tested and shown to be dangerous. Waterbirth is no exception.  The American Academy of Pediatrics Committee on the Fetus and Newborn released a comprehensive report in 2005 that waterbirth is not safe for babies and the central conclusions were reaffirmed at a conference of the committee in 2011.

The report, Underwater Births, notes:

Throughout human existence, women have typically given birth to their offspring on land. Over the last 25 years, however, underwater birth has become more popular in certain parts of the world despite a paucity of data demonstrating that it is either beneficial or safe.1–22 Underwater birth occurs either intentionally or accidentally after water immersion for labor, a procedure promoted primarily as a means of decreasing maternal discomfort. A review of the available literature indicates that the risks of underwater birth to the newborn seem to outweigh the benefits, and caution is urged before widespread implementation.

After reviewing the existing scientific literature, the committee concludes:

The safety and efficacy of underwater birth for the newborn has not been established. There is no convincing evidence of benefit to the neonate but some concern for serious harm. Therefore, underwater birth should be considered an experimental procedure that should not be performed except within the context of an appropriately designed RCT after informed parental consent.

Homebirth midwives have ignored this report and continue to conduct what amounts to uncontrolled experimentation on newborns by recommending under water birth. I have written about deaths and injuries of babies at waterbirth from freshwater drowning, hyponatremia from ingesting large quantities of pool water and uncontrolled hemorrhage from snapped umbilical cords.

Now comes report of an infant who died following a home waterbirth into a pool containing her mother’s virally contaminated diarrhea. The paper is Case Report: Severe Disseminated Adenovirus Infection in a Neonate Following Water Birth Delivery published in this month’s issue of the Journal of Medical Virology.

A female infant was born at home by spontaneous vaginal delivery at 40 weeks and 4 days gestation via a planned water birth. The pregnancy was complicated by a maternal diarrheal illness with low-grade fevers for about 1 week prior to delivery with maternal defecation occurring into the water bath during labor. Following delivery, the infant appeared healthy until 4 days of age when she developed a rectal temperature of 388C. She was hospitalized and a sepsis work up was initiated. A chest radiograph showed findings consistent with viral pneumonia…

The patient was started on two antibiotics and one anti-viral medication to presumptively treat for the most common neonatal infections (group B strep and herpes simplex). She did not respond to the treatment and became progressively worse.

At 10 days of age, the patients breathing became labored requiring transfer to the neonatal intensive care unit (NICU). She was placed on high frequency oscillatory ventilation followed by venoarterial extracorporeal membrane oxygenation (ECMO) due to worsening chest radiograph, respiratory acidosis, and poor oxygenation…

Further testing for unusual organisms revealed adenovirus in the baby’s trachea and blood stream. Cidofovir was started but it was too late.

The infant developed a coagulopathy and became anuric on ECMO day 5 (17 days of age) and then developed worsening metabolic acidosis, poor perfusion, grossly bloody stools, and bloody endotracheal tube secretions. Her parents decided to withdraw medical support at this point, and she died shortly after being taken off ECMO (19 days of age).

Autopsy findings were consistent with adenovirus pneumonia.

The baby did not have to die.

In the present case, the neonate’s HAdV infection likely occurred by vertical transmission during the water birth since the mother had symptoms of gastroenteritis with defecation into
the water bath immediately prior to delivery (maternal laboratory testing was not performed). Delivery into water laden with HAdV may have increased the infant’s risk of pathogen contact with mucous membranes (eyes/nose), the gastrointestinal tract by swallowing, and the lungs by aspiration.

The baby could have been infected with adenovirus by vaginal delivery in the absence of waterbirth, but it could not have helped to be submerged into virally contaminated pool water.

There is nothing natural about waterbirth. Yes, water is natural and birth is natural, but the combination is not. Pretending that it is natural and therefore beneficial is the intellectual equivalent of pretending that since poisonous mushrooms are natural and eating is natural, eating poisonous mushrooms is natural and therefore beneficial.

No primates give birth in water, and waterbirth was first proposed for humans only 200 years ago. There is considerable evidence that being born underwater is dangerous for babies and there is no evidence that it is beneficial for babies in any way. This case report adds yet another death to the waterbirth literature.

  • Captain Obvious

    “What reason did the OB give for not getting the area looked at and assessed immediately? Do what you feel is best. If you think you should go to the ER, then go. Its your body. Feces coming through an open wound can’t be good. Feces is filled with bacteria and the stuff your body rejects. You just had a baby and your immune system is not back to optimal level yet. I would be concerned about infection.”

    http://community.babycenter.com/post/a41951404/episiotomy_stitches_-_stitches_between_anus_and_vagina_fell_off_now_feces_coming_out_from_there

    Yes, the advice is hypocritical. The feces is the devil, unless it is in a birthing tub. And even if its a fistula, it probably is not best to try and repair it now. But these educated women have no clue.

  • The realist

    –Review of 2.225 underwater births in a single istitution. Does water birth increase the risk of neonatal infection?—

    “OBJECTIVES:

    We reviewed 1600 water births at a single institution over an 8-year period.

    METHODS:

    We compared 737 primiparae deliveries in water with 407 primiparae deliveries in bed, and 142 primiparae on the delivery stool. We also evaluated the duration of labor, perineal trauma, arterial cord blood pH, postpartum maternal hemoglobin levels, and rates of neonatal infection. In 250 water deliveries we performed bacterial cultures of water samples obtained from the bath after filling and after delivery.

    RESULTS:

    The duration of the first stage of labor was significantly shorter with a water birth than with a land delivery (380 vs. 468 minutes, P<0.01). The episiotomy rate in all water births was lower with a water birth than with a delivery in bed or a delivery on the birthing stool (0.38%, 23%, and 8.4%, respectively). The rate of perineal tears was similar (23%, respectively). There were no differences in the duration of the second stage (34 vs. 37 minutes), arterial cord blood pH, or postpartum maternal hemoglobin levels. No woman using the water birth method required analgesics.**THE RATE OD NEONATAL INFECTION WAS ALSO NOT INCREASED WITH A WATER BIRTH***(1.22% vs. 2.64%, respectively)."

    RED FULL PDF OF STUDY: http://www.gimnogravida.pt/Documentos/Estudo%20de%202225%20partos%20na%20agua.pdf

    You ma'am, are full of sh*t, lol. Thank for this super extra rare case of a waterbirth mishap, did you see the case about the hospital birth when the doctors pumped a healthy newborn's lungs with too much oxygen until her little lungs were destroyed? of course not, why would you talk about that?

    • Box of Salt

      I’m curious – exactly when and where was this published? Your PDF does not appear to be from a journal. And the data goes through 2006, which was 7 years ago. Surely it’s in print by now?

      • Box of Salt

        I’ll also note this quotation from your PDF, in case anyone is wondering where the “sh*t” really is:

        “It is evident that faeces are discharged into the tub during the bearing down phase and contaminate the water with various organisms. Although a high level of faecal bacteria was established in the water after delivery, babies born in water did not experience an increased rate of infection or aspiration pneumonia (14,15).”

        I don’t have the time at the moment to look up those references at the moment, which are from studies done by others in 1999 and 1994, not the subjects of this study.

        • Box of Salt

          Though evidently I do have time to type “at the moment” twice, but not enough time to proofread before I hit the submit arrow. Apologies!

        • realist

          “lthough a high level of faecal bacteria was established in the water after delivery, babies born in water did not experience an increased rate of infection or aspiration pneumonia (14,15)”

      • realist

        Department of Gynaecology and Obstetrics, Vipiteno/Sterzing, Italy
        2Central Biological Laboratory, Environmental Agency, Bolzano/Bozen, Italy
        3Hospital Direction, Vipiteno/Sterzing, Italy
        Correspondence: Albin, Thöni, MD, Department of Gynaecology and Obstetrics, Via S. Margherita 24, I-39049, Vipiteno, Italy, 39 0472/774322

        Read More: http://informahealthcare.com/doi/abs/10.1080/14767050500140388

        • Box of Salt

          Thanks! By the way, did you notice that the published title reads “Review of 1600 water births. Does water birth increase the risk of neonatal infection?” -consistent with the abstract- instead of the 2,225 (american punctuation) in the title you quoted?

          Is there any particular reason you chose to post the inaccurate title? All that did was suggest the researchers can’t do math.

    • Young CC Prof

      Yes, this outcome was rare, however, hyponatremia (low blood sodium levels) from water birth is less rare. This study did not examine that outcome, nor did it measure how many newborns had low APGAR or required resuscitation.

  • Aaron Ingebrigtsen

    Nothing natural about water birth? Try telling that to whales and dolphins. Humans can give birth squatting in a jungle over some leaves, or in a nice clean pond. Giving birth in a very uncomfortable and unhelpful position on a table, with drugs to induce, and slicing women up, seems like a bad idea to me. A sick mother giving birth and exposing her child to her viruses also seems like a bad idea. It’s not the water, or lack of it, that is the problem in this instance, it’s exposure to viruses. If they had done everything possible to keep this baby from being exposed to viruses that would have been a good thing. The only thing I take away from this article is that water birth is no guarantee of a healthy situation for a baby, and all possible effort should be made to protect the new baby from infection and other complications.

    • Tim

      I wasn’t aware that humans were marine mammals. Good to know – when do I get my enormous prehensile penis?

      • Young CC Prof

        I want to figure out how to sleep while floating, because that would be awesome. And hold my breath for 20 minutes, when do I learn to do that? Let’s not forget the milk as thick as toothpaste, either. I bet baby would grow so much faster on that stuff.

        • KarenJJ

          Well I don’t know what you guys do all day, but I just float around and eat krill..

          • Bombshellrisa

            Speaking like a dolphin or whale would definitely keep my daughter from being able to figure out what DH and I were planning!

          • Tim

            weeeee neeeeed too finnnnnd his soooooooooon. caaaaaan youuuuu giiiiiive ussssss direeeeeccccttiioooooons?

      • dr.midnight

        my name is dr.midnight,.my 1st baby was born 20 weeks and 2nd is 30 weeks now I am pragnant again with my 3rd hope so this time full term plzz pray 4 my baby,contact them on(dr.midnight5@gmail.com)

    • Captain Obvious

      Ok ok, so both baby and momma can get exposed to unnecessary bacteria and viruses at birth. Why on earth would you propose for woman to an increased exposure risk to her birth with a water birth? Floating feces and possibly other bacteria contaminating the water. On line a waterbirth underwater camera showed a baby centimeters away from feces. And come on now, a clean pond? Have you ever been camping or to Maui? Leptospirosis can contaminate open wound if you swim in the waterfalls. I would hate to have an infection like that in a vaginal laceration. An on line video of a woman birthing in a remote creek showed flies landing on the baby’s head immediately after birth. Nice plan for your baby maybe. But I will have my children on land in a hospital.

    • Young CC Prof

      So tell me, where is this clean pond? Personally, I’ve never in my life seen a pond that was sterile, except possibly ones that were so horribly polluted nothing could live there.

      Matter of fact, I’ve never seen a birthing pool that was sterile, not after it’d had a laboring woman in it for several hours.

      • Bombshellrisa

        By definition, isn’t a pond supposed to be still water? Ewwww

    • Elizabeth A

      Do you really think your primitive ancestors were dumb enough to hork up sources of potable water by having women give birth in them? What does the tribe drink from for the next few weeks?

      Waterbirth for humans is an invention of the last hundred years, facilitated by modern plumbing, heating and sewage systems. I don’t understand why natural birth advocates haven’t subjected the idea to the same scrutiny and suspicion they hold for other obstetrical developments of the same period, like epidural anesthesia and Vitamin K shots.

    • Dr Kitty

      I don’t think you’ve asked the right questions.

      Why are inductions done?
      Why are CS done?
      What are the risks of not doing them?
      What are the risks of doing them?

      Why are water births done?
      What are the risks of not doing them?
      What are the risks of doing them?

      Doing everything possible to prevent exposure to viruses would have meant NOT doing a water birth.
      The risk of not doing a water birth, is that you don’t get to brag about doing a water birth.
      The benefit of not doing a water birth is that your baby won’t drown, aspirate faecally contaminated water, or suffer hyponatraemia secondary to swallowing lots of water.

  • Sarah

    is this article available anywhere without having to pay $35? I would love to read the whole thing if its out there!

  • Naomi

    I just posted some information on The Birthing Site, a facebook page, regarding waterbirths and the dangers. And they removed it! Removed it. From a birthing site. You know what i learned? There is no point with these people. Even if given facts, truths, stats, they will never listen, because they think that they know more. I am disgusted with them.

  • Debbie

    I have been reading many of these articles this afternoon that all seem to be against natural childbirth and midwifes. I have to say the problem here isnt that the mother had a water birth (which is safe and there have been lots of articles written in the UK about water births both at home and in hospital) but that the mother had diarrhea and should not have been giving birth in water – probably not at home either. In the UK all midwifes train for at least 3 years in University and hospital. My training was for 4 1/2 years. We are taught to know the difference between a natural labour and what is out of the ordinary and will need assistance. I certainly do not feel contempt for women who need pain relief. An epidural is not the only form of pain relief. Giving birth is not an illness. Homebirths are popular in the UK with low risk mothers and midwifes are trained to know if things are going wrong and can transfer a mother to hospital quickly. If everything goes as expected a mother will not need a doctor present at birth

    See these videos
    http://www.youtube.com/watch?v=cpkBxJpUGQA

    http://www.youtube.com/watch?v=pQ9vjCAlLpM

    http://www.youtube.com/watch?v=oFJa2GGU5NA

    • Bombshellrisa

      Debbie-UK midwives are totally different than US homebirth midwives, if a midwife “specializes” in homebirth and waterbirth in the US you can BET that she has very little if any formal training. Homebirth midwives in the US don’t have any kind of nursing or medical training and they learn to be midwives by attending 30 homebirths. They take on patients who are far from low risk and treat any complication as a “variation of normal” and use herbs, chiropractic and special diets as a means of treatment.

    • Captain Obvious

      Natural birth without medications is fine. VBAC is fine. As long as it is done in the hospital. Patients have options for pain meds and epidurals. The OR and NICU are close by. You are interpreting this blog wrong.
      Water birth is as water birth does. No car “should” ever crash, but they do. You suggest no water birth leads to neonatal death or that at least they are safe. But water births have lead to infections, hyponatremia drownings, near drownings, and death. Delivering a baby is inherently dangerous for the mom and the baby, why increase the risk by delivering under water in tepid water mixed with feces and bacteria? Again, water birth is as water birth does, and so many woo mothers risk their babies life’s needlessly. Labor in the water in a hospital but deliver out of the water. I can show you mounds of evidence that most people driving drunk get home safe, most people who don’t wear seat belts don’t die when driving home, that most kids who are not put in car seats survive, but why incur more risks to an already risky process?

  • What were they thinking? Giving birth in a pool when the mother has recently had diarrhea, and continuing to labor in the pool after the mother has done diarrhea in the pool? Regarding water birth being natural. Most women (at least that I talk to) see water birth as ‘natural pain relief’ not ‘natural like the birds and the bees’. I think a better description would be that water birth is commonly known as ‘safe’, and the risks involved are not widely known.

  • Thundermama

    I am very grateful to have found this blog. I was planning a hospital waterbirth, and now there is no way in hell I would ever risk my baby. Thank you.

  • Allie P

    The thing I never understood about waterbirth (I mean, aside from wanting to sit in tepid bloody poop water) is that the NCB people are always talking about how giving birth on your back is so unnatural and etc. and yet there they are, on their backs in the tub. Even ricki Lake, after several minutes of showing on BOBB what a terrible, c-section causing position that is, gives birth in her bath tub in that position.

    • Amy

      When I was on the gurney giving birth in the ER, I was flat on my back, and sat up while I was pushing because I was still kind of “oooh don’t push flat on your back!” but my CNM was like “you should lay back because you’ll be less likely to tear as much.” So down I went! lol

  • Enabler:

    “No midwife would take a high risk pregnancy to delivery, knowningly.
    Twins is not automatically “high risk”, nor is baby being breech.
    While
    these events are tragic, they would have happened at the hospital as
    well. I am sure the midwife had an oxygen tank, and had a way to help
    mom with the bleeding until the ambulance arrived. At least, every
    midiwfe I know, does have preparations for these kinds of incidents,
    despite them being so infrequent.

    Hospitals have their place in society, and with child birth, but for the average woman, they are just trying to make a buck.

    I hope that the little babe pulls through quickly, and that mom can forgive herself enough to realize that it is not her fault.”
    http://www.cafemom.com/group/115189/forums/read/18088706/My_friend_may_lose_her_new_baby_Small_update?next=131#replies

    • Aunti Po Dean

      homebirth, 41 week twins, one baby breech, mother having her 7 and 8th baby, past history of complicated birth…..I ASK you what could POSSIBLY go wrong???

      • We don’t know what prenatal care she had either.

        I vote for a post on the impact that prenatal care or lack of proper prenatal care has on outcomes.

        • Lisa from NY

          Prenatal care probably would not affect the outcome.

          If she was not overweight, had no diabetes and no high blood pressure, and no positive herpes or strep, then prenatal care would not have affected the outcome.

      • Captain Obvious

        Hope for the best, but prepare for the worst. Mockwifes seem to forget about the but part. The second twin IS the biggest high risk with twins, even if both twins are head down.

        • Dr Kitty

          Risk…I do not think HB people understand the concept.

          1) Breech

          Head entrapment- something that occurs at breech delivery that cannot occur at cephalic delivery.

          Cord prolapse- something that occurs more frequently at breech than at cephalic deliveries.

          Prolonged labour- more likely with breech delivery.

          Perineal tears- more likely with breech delivery.

          Meconium- more likely with breech.

          On these four measures alone, breech delivery is objectively riskier than cephalic delivery.

          2) Twins

          APH

          PPH

          Foetal distress

          Prolonged labour

          Cord prolapse

          Stillbirth

          Head entrapment if breech/SD if cephalic

          Meconium

          Again- on these measures alone twin is riskier than singleton.

          3) Postdates

          Meconium

          Foetal distress

          Stillbirth/IUFD

          Macrosmia

          Shoulder dystocia

          Once more- on these measures alone post dates is riskier than term.

          Risks are additive- so a postdates, twin pregnancy with at least one breech- it isn’t “high” risk. “You go mama! Trust Birth! Trust your MW” is completely inappropriate.That was, predictably, a disaster waiting to happen.

          Wanting something to be safe is not enough.
          Believing something to be safe is even worse.

          That was risky. Evidently risky. Proven to be risky.
          All the air quotes and magical thinking in the world will not turn a risky situation into a “risky” one.

    • Captain Obvious

      AMA is high risk, twins is high risk, breech is high risk, grand multiparity is high risk, having a previous high risk issue pregnancy is high risk, approaching 42 weeks is high risk to watch for decreased AF, meconium, placenta insufficiency, having a homebirth is high risk. Any pregnancy that causes you to do things that you don’t normally do for a routine low risk pregnancy is basically high risk.
      A 20 something year old having her 2nd or 3rd kid with spontaneous labor with a head down singleton pregnancy in the hospital is low risk.

  • Guest

    I had the stomach flu with my last baby, went to L&D because I wasn’t sure if I was in labor or just sick like everyone else at home. I had a low grade fever and spent most of the night vomiting (God bless my nurse, she was so nice and sweet about it!). Hubby spent my labor curled up in a chair chugging pepto. He came out and was perfectly fine. I’m not sure if he came into contact with any sort of fecal matter or not. I do know that the delivery was done in a pretty sterile environment and NOT underwater. I can’t imagine delivering in water when you’ve had a diarrhea illness and got it in the water. Common sense *should* tell you that it is NOT a good idea.

    • Certified Hamster Midwife

      No, no, don’t you know that being born into poo water is the best way for the baby to get some gut flora established extra early?

  • Amy

    I was into woo and had a waterbirth in the hospital with my first. It was pretty unpleasant, just for the simple fact that I wasn’t allowed to have the water super hot (no hotter than body temp, which does not feel good. Just tepid bathwater.) Luckily, I did not poop, and my daughter is perfect and healthy. But I was sitting in a pool of my own blood afterward, and it was just gross. My husband said it smelled like pond water, and had to ask them to drain the tub as they were stitching me up and weighing my daughter because he couldn’t stand the smell! To top it off, another woman puked RIGHT outside our door, so we had gross smells from both ends of our room!

    I will never have a waterbirth again, especially after my easy “dry” birth with my son!

    • Amy

      P.S. It really bothered me that no one warned me the water would be tepid, and not soothing like a hot tub. I would probably have changed my mind about having a waterbirth!

      • quadrophenic

        The idea of being in a jacuzzi in labor sounds great. Lukewarm bath water does not! Of course I do wonder if many of these water birth lovers break the rules and keep it warmer with everyone saying how amazing it is. Of course even body temperature water is probably a great temp for bacterial growth!

        • Amy

          I think they MUST be breaking the rules with the water temp…I don’t know of anyone who wants to sit in body temp bathwater when they are in extreme pain!

  • Sue

    Here’s the thing: if radical HBers had any sense at all, and wanted to make the experience as safe as possible while still using home and water, why aren’t they out there saying “once you’ve pooped in the water, YOU MUST get out of the pool when you’re baby is being born”. Is there even one single HB proponent out there saying “we need to prevent this from happening”? If they are, let’s see them loudly protest about this outcome.

    • The Bofa on the Sofa

      For some reason, I have had the phrase, “If you aren’t part of the solution, then you are part of the problem” running through my head for the last couple of days.

  • Just saw a post on the Mayo Clinic website written by CNM/RN who said among other things “water birth doesn’t increase the risk of infection” and she talks about the dive reflex. I’m appalled. Not only are untrained midwives perpetuating the myth that water birth is safe but, trained providers at reputable institutions as well! Sad.

    • quadrophenic

      Can you imagine if there was a place on a death certificate for death caused to misinformation? Homebirth deaths, vaccine preventable illnesses, sepsis due to GBS, the poor baby who didn’t get the vitamin K shot…. What kind of numbers would that generate? Enough to create a response? Even one dead baby should create an uproar, but there’s an epidemic of bad advice and its not getting front page headlines like autism and no one’s wearing ribbons for these lost children.

      • If a baby dies in utero, or fails to “make it” how much real, open curiosity is there about the reasons? Once the baby is gone, attention is going to focus back on the devastated parents, and it is human nature surely to console them with the “nothing would have changed it” line. The thought of subjecting an infant to an autopsy must be ghastly, and wouldn’t there be a feeling that not much would be gained? I find it rather difficult to believe that their are doctors – or midwives – who would dare own fault in the uncertainty surrounding such things. The lawyers would have them for breakfast if they did. Hospitals probably do enquire further – but are the findings always shared with the parents?

        And when it comes to the kind of injuries that lead to disability the picture is even more murky – very difficult to predict long term outcomes from condition at birth. My daughter was “fine, narrow escape” for months, and she was an adult before the full extent of her problems became apparent. No-one is over keen to link late diagnosis to events around birth.

        Such huge progress has been made that death and disaster is comparitively rare, thank goodness. I still think it would be useful to have clarity about the difference between inevitable and avoidable, even if only so that the fiction of “trust birth” can be dismantled.

  • I don’t have a creative name

    Dear God in heaven. So many things wrong with this. NCB’ers, please, please, please think twice about what you believe. Your children are paying the ultimate price for it.

    There’s no doubt in my mind that this mother was being cared by CPM’s, not CNM’s. Only CPM’s would be stupid enough to believe that a weeklong bout of diarrhea and fever at the end of pregnancy was just a “variation of normal”. Anyone with ANY common sense would’ve referred this woman to a qualified practitioner.

    Furthermore, besides the transmission of viruses and bacteria, isn’t the ick factor of sitting in a big bowl of diarrhea, let alone putting your baby in it, enough of a reason to say, hey, let’s go ahead and get out of the tub?

    Even if it’s not diarrhea, the ick of factor of forcing your baby to be submerged in a bowl of your poop seems hideously cruel to me. If they’re not willing to stick their own heads under the water into this soup of pee, feces, and whatever other bacteria they brought in or was already growing there, and hold their breath for however long, they shouldn’t expect their baby too either.

    Once again, though, I do truly feel badly for his mother. Most likely she read or was told how peaceful and gentle it was and just bought into it without question…. or, after she did “research” on the internet, which consisted of reading other women’s opinions and experiences, and nothing about the darker side of such practices. How very sad. 🙁

    • Lisa

      Heck, in a pool, if a child poops, they get everyone out and close it down. I bet these women would gag and raise hell if someone just fished the turd out and told everyone it was ok to get back in.

  • Awww, no Andy today to argue with everything everyone says?

    • Captain Obvious

      I wonder…

      Andy says:
      January 11, 2013 at 9:20 pm
      I’m actually the newborn in this photo, 23 years old now. I was the first water birth and home birth in our family, with three after me. After the traumatic hospital births, which were physically damaging to my mother and life risking to my brothers, and after the cold way the hospitals handled her miscarriages, it was a beautiful relief for her to experience such an easy birth at home without complication, with less pain and more beauty for mother and child, and for their family, too. It was something everyone was so happy about.

      We lived in a nudist camp in those days. Nudity wasn’t anything shameful or erotic or gross to us. It was a beautiful way to try to live. Only a couple years after my birth, my parents left the nudist camp. We all lead a pretty normal life today, no therapy was required for anyone after the birth, ha, and a good shower solved all.

      I don’t really mind that you’ve all made a spectacle of my birth. It was wrong of you, to make yourselves gossips and judges like that, but whatever, I get it. This photo did get around my little sister’s high school today, though, and some of her friends told people it is her family in the photo. A lot of people in the school were talking about it, and today was really hard for her. She wasn’t really embarrassed; she was just hurt. And she had a hard time understanding why people would be so petty.

      My parents have shown us great love over the years, a love you can see in this photo, and we have passed on that love to each other and to others. I’m thankful for it. Sadly, though, that love is not normal in the world. I wish it were. Then more of you would know it and understand. And then my sister wouldn’t have had such a hard day.

      http://awkwardfamilyphotos.com/2012/12/22/the-red-sea/comment-page-2/#comment-2097831

      • Charlotte

        He lost me at “We lived in a nudity camp in those days.”

        • LibrarianSarah

          I don’t know. In the summertime up here I sometimes fantasize about quitting my job an joining an nudist colony, Fortunately, (I guess) New England winters shoot that fantasy down wicked quickly.

          • Alenushka

            Just go to Burning Man for a week. Be as nude as you want. Have fun for a week and come home. There 2 clinics on site (With MD’s and RNs) and a helicopter available for an airlift to the hospital if needed.

          • Ennis Demeter

            I think David Sedaris has an essay about nudist colony. People have to bring a towel everywhere to sit on so they don´t dirty the chairs.

      • Lisa from NY
        • Looking at that makes me feel ill – can’t imagine inviting children to join me in it. How very strange people are.

          • thepragmatist

            Holy hannah… that’s left me speechless. That’s rare. …

        • Susan

          I still think that picture is a fake.

          • Lisa from NY

            I wish it was fake, but it’s not. I got it from Captain Obvious’ post. I just posted the direct link to the photo so you could see the thumbnail on this site.

      • Bombshellrisa

        If this is the same Andy, then this really explains a lot of his reasoning. The pool is just filthy, I don’t care if “a good shower solved all”. I would need a shower of bleach to ever feel clean again.

  • Mrs. W

    My sympathies to this family, they have paid the ultimate price. I just wish that the level of misinformation on birth was a lot lower – there is a lot of garbage being passed around as truth and it needs to stop. Babies are dying unnecessary deaths – which strikes me as being the ultimate travesty. Further, can you imagine the guilt that would come from knowing that your choice harmed your child?

    • I would have thought that guilt was inevitable whatever the reason for the loss of a child – inevitable, but not at all helpful, and it has somehow to be assimilated. What I find so much of a problem is the distance between the dream and the reality – the lovely “benison of warm water” washing away and soothing the pain, the natural intimacy of your own home, the anticipated bliss – and a reality as ugly as this. Did they all sit around for the photographs beaming in relief, ignoring the fetid mess because bodily functions are oh so natural? None of these mothers mean to harm their child – fantasy just has them firmly in its grip.

  • Dr Kitty

    Baby born in Washington state, so almost certainly not an OB or CNM attended HB from what I can gather.

    So, I’m guessing no maternal viral swabs, stool cultures, U&E, LFTS, FBP or MSSU checked.

    So, no way for the MWs to know that this WAS a simple viral gastroenteritis, other than assumption and wishful thinking. Jolly good.

    7 days of pyrexia is NOT a normal stomach ‘flu people, ESPECIALLY not in a pregnant lady at term. It’s a PUO with diarrhoea until you find the source of infection or causative organism.

    If ANYONE has a fever for more than 3 days I’m not happy, because most viral infections will burn out after 72hrs…7 days is too long not to be suspicious of the cause.

    The list of infections that cause diarrhoea and a fever is pretty long.

    Listeria

    Clostridium

    Salmonella

    Shigella

    Cryptosporidium

    VTEC

    E.Coli 0157

    Campylobacter

    None of them good.

    None of them safe for waterbirth.

    http://www.rcpe.ac.uk/journal/issue/journal_36_3/N_CME-diarrhoea.pdf

    • Bombshellrisa

      Most certainly a CPM-I wonder which midwives these were?

  • Dont know if someone already pointed this out but I think she didn’t neccesarily poop in the water as much as she had the virus on her perenial area as baby was emerging but of coudse the virus spread to the water also

    • BCMom

      “….with maternal defecation occurring into the water bath during labor.”
      In other words, this pool became a large petri dish. Instead of the chance of limited exposure from a limited area in an out of water birth (which could have been mitigated), this baby received an onslaught through his eyes, nose, ears, stomach, and lungs via the contaminated bathwater. Very tragic.

  • Poor baby – what a horrible way to go.

    Never fancied labour that much – but the idea of having it follow on or happen at the same time as diarrhea is stomach turning. Things like this count as a beautiful, peaceful birth? Did the mother mention that the baby had been swimming in poo?

    Like many things in NCB, relaxing in warm water sounds lovely – the reality is something else. And how do you get a large wet woman in pain out of there?

    • Courtney84

      What a horrible way to go indeed. I was just starting to think about how much suffering this baby must have gone through in the short 19 days of life.

      I can’t imagine living with the guilt that my decisions, or the decisions of the individuals I hired, caused my baby to suffer such pain and sickness before an untimely death. I’m sure this mother thought she was educated and was making the safest choice for her baby. I wish we could come up with the magic answer to combat this misinformation out there about childbirth.

  • GiddyUpGo123

    My two year old was hospitalized for three days because of that virus. That’s definitely not the sort of thing I’d want to expose a newborn to. How awful.

    • Courtney84

      My nephew had this last summer. He was visibly not well for a month, though he was never hospitalized. Most of his crib sheets have tiny blood stains from his bloody tears, boogers, and ear goop when he was sick.

      • Dr Kitty

        Not just kids. I remember a rather inconsiderate visitor who managed to infect their elderly relative who was recovering from a stroke and a heart attack in our HDU, back when I was a junior Dr working in hospitals. Hint- if you have a fever, diarrhoea, conjunctivitis and a cough, maybe don’t come and visit an elderly and very unwell person who is on clot busting drugs unless you want to watch them weep, vomit, cough and poop blood.
        Adenovirus sucks.

        • thepragmatist

          Wow! That’s crazy. I knew adenovirus could be deadly… but I didn’t realize it makes you that sick!

  • Antigonos CNM

    On a slight tangent: NGM has a new post about being a monitrice, which sounds like a super-doula, and sounds very dangerous to me. Another twist to the pseudo-midwife game. One certainly gets the impression that there are those who will do ANYTHING not to get a proper midwifery credential.

    • Bombshellrisa

      Remember the Trudy doula person that parachuted in not too long ago, railing against epidurals because they “make women give birth as a paraplegic”? SHE is a monitrice. Seems that there were lots of those in Seattle before the doula movement caught hold.

    • Awesomemom

      It sounds really dangerous to me. Why are you hiring this person? So you can stay at home as long as possible only to show up in heavy labor at the hospital so you can avoid a repeat csection? It seems to me that that scenario would be the big one. A Monitrice would not be able to have continuous monitoring in that case and could miss a rupture in it’s early stages. Why not just go into the hospital if you think you are in labor and let them be the judge? It is not like it is going to cost you extra, all that is part of the whole birth.

      • The Computer Ate My Nym

        I’ve never gotten this “show up late to avoid a repeat c-section” thing. I can see staying at home during the early stages of a normal labor to avoid the whole hospital routine thing, but if there’s a chance of a rupture, I’d think you’d want to be in the hospital as soon as possible. (Like, say, before labor started for your scheduled c-section.)

        • Awesomemom

          I was always crazy paranoid that I would go into labor before my scheduled section. I could not imagine risking it. Thankfully my kiddos behaved and stuck around until the csection date although #3 it was lucky we had to schedule him a bit early because I was in early labor with him when I went in.

  • Kalacirya

    Well, I guess the usual fish net trick doesn’t work so well when the woman has diarrhea.

    It doesn’t take a genius to realize that waterbirth is silly. It especially doesn’t take a genius to realize that waterbirth is a bad idea when you’re on the mend from a diarrheal disease.

  • Antigonos CNM

    Nothing about this post surprises me, except that the dangers of water birth have been known — and passed over — for some time now. Right after the year I spent in Cambridge studying midwifery [mid-70s] there was an incident where a baby aspirated fecally contaminated water and died during a water birth. Two midwives were charged with, IIRC, negligence and manslaughter. The mother was not ill; the feces were expelled when she pushed, but apparently she refused to leave the pool — the judge told the defendants they should have “forcibly removed her from the pool” once the contamination was obvious, which was rather unrealistic. [They were reprimanded but not judged guilty of the charges against them]. It seems impossible that birthing pool water could be anything BUT contaminated since all sorts of fluids are introduced during the second stage — blood, amniotic fluid, etc. and the water is never chlorinated or treated with any anti-bacterial agents. There is also no proof whatsoever that submerged babies don’t gasp and inhale either. The so-called “diving reflex” is just a joke. And there’s no way a midwife can control the birth of the head so that the mother is liable to tear.

    I remember, also, a case where a ceiling nearly collapsed under the weight of a birthing pool in a NYC apartment several decades ago. People generally don’t realize how much water weighs [as well as the person or persons in the pool].

    Yes, a warm bath can be analgesic. But to give birth in water….

    Simply insane, IMHO.

    • auntbea

      Even if a baby doesn’t breathe under the water, there will presumably still be contaminated water on and near its eyes, nose and mouth when it DOES breathe. If a baby can die from aspirating baby oil off its face, why not poop water?

    • AmyP

      “I remember, also, a case where a ceiling nearly collapsed under the weight of a birthing pool in a NYC apartment several decades ago.”

      Oops. Now that you mention it, I remember reading that if you want to get one of those currently trendy soaking tubs, you need to ensure that your home is structurally capable of supporting it. Presumably, a birthing pool would be much larger and heavier.

    • desiree

      I read a woman’s blog not too long ago (a friend was her birth photographer), and she transferred to the hospital, but her birth pool sprung a leak while everyone was gone and did something like $50,000 worth of damage to her apartment and the one below. I’d be surprised if renter’s insurance covered leaky birth pools. Totally irresponsible to not check and make sure the building can support the weight and insurance will cover any damage.

      • Are you nuts

        Please post this blog link! Sounds like a must-read!

      • KarenJJ

        I hope the water wasn’t contaminated when it sprung the leak!

    • The Computer Ate My Nym

      Forcibly removing someone sounds like assault to me, but they shouldn’t have ever agreed to attend something as unsafe as a water birth.

      Also, isn’t the diving reflex something that happens in cold water? Maybe I’m misremembering, but I seem to think that it only occurs when you have water enough to cause a cold response.

      • Chi-Town_MotorCity

        You are right, Computer. The mammalian diving reflex happens when at least the face of a person or mammal is submerged in icy water.

    • INeverSaidThat

      I don’t get how they think it’s healthy for the baby to be delivered in the water. Isn’t it usually a concern if there is meconium in the amniotic fluid, so what happens if there’s meconium and/or mom’s feces?? My water didn’t break until I started pushing with my last baby and there was a lot of meconium (4 days overdue). What happens if there’s a shoulder dystocia under water? How long is the baby’s head out and in the water before they realize there’s a problem? (I had 2 shoulder dystocias so I always think of that)

  • Lisa from NY

    The baby died in the hospital. Therefore, the hospital killed the baby.

    • Gene

      I figured it would be that the INFECTION killed the baby, not the birth. Therefore, the home water birth was blameless.

      • Captain Obvious

        Right, like all the critics of Hurt from Homebirth try to counter with those are not really homebirth issues as much as midwife provider issues. Well homebirth is as homebirth does. Taking everything that happens or can happen into consideration, homebirth is more dangerous.

        • The Bofa on the Sofa

          Right, like all the critics of Hurt from Homebirth try to counter with those are not really homebirth issues as much as midwife provider issues.

          Of course, if that’s what it is, then you would think that those critics should agree with Dr Amy.

          We hear that all the time. Homebirth, if done right with only low-risk cases, etc, etc, is perfectly safe.

          And that may be true. But if it is true, what it means is that there are a ton of providers who are not restricting their practice to properly low-risk cases. Shouldn’t that be a problem for everyone?

          I have said it before, if it were actually the case that most midwives were as discriminating as what the defenders claim is needed for HB to be safe, this blog would not exist. Alas, they aren’t.

          • Lisa from NY

            But no MW tests for diarrhea.

          • this blog would not exist.

            I would still want to make a noise. In the UK, the system is, of course, much better. Two well trained midwives, stringent rules for risking out, relatively easy transfers in a small country, recourse in cases of negligence. Things still go pear shaped. Hard to tell how often, but certainly just as badly. The problems with homebirth are structural (and also habits of mind – in my risk averse view, any midwife who feels strongly about attending homebirths is on the wrong path, and more likely to take risks) To me, it isn’t homebirth itself which is the problem, but the lack of awareness of just what you are risking. I just don’t really understand how a view that says birth is natural and unproblematic has taken such a hold apart from wishful thinking. It is for the majority and the risks look manageable, but the consequences of getting it wrong are hidden and underestimated.

        • quadrophenic

          I read a thread on a message board recently where they were discussing whether water birth was safe, and several chimed in that accidents only happened when the midwives were negligent. Well in my book water birth is below the standard of care anyway so it’s always negligent, you just don’t always have injuries. Like when I drive 90 mph on the freeway – I’ve never had an accident, but it doesn’t mean it’s safe.

          I also don’t get why water birth is ok but you’re not supposed to bathe the baby after birth.

    • I don’t have a creative name

      Much like a commenter on a blog I saw recently whose proof that babies die in the hospital too was that “my son died just a few minutes after we got to the hospital”. 🙁

  • Lisa from NY

    And we shall hear the refrain, “The baby would have died in a hospital, too” and “Nothing could have prevented its death.”

  • Meagan

    Tragedy aside, I can’t comprehend how sitting (or kneeling) in a pool of your own diarrhea could be comforting. I did the water labor thing, it helped some (though it was not, as our birth instructor promised, a “natural epidural”… HA!) but I don’t think I would have found it remotely helpful if it had been a warm giant toilet. Ick. I have to think she (the mother) was pretty ill to be talked into that.

    • mollyb

      I’m a total waterbaby. I take a bath almost every day, love to swim, etc etc. I was so looking forward to laboring in the big tub in my hospital room (although you were not permitted to give birth in it). It did jack shit! I was just in excruciating pain and wet. So disappointing.

      • Bombshellrisa

        The midwives here call the tub “the midwife’s epidural”. Yeah right.

        • quadrophenic

          If labor is “work” and “pressure” and “waves” rather than intense pain and birth is “orgasmic” why would you need a “midwife’s epidural” anyway? I don’t get how there is a denial of pain yet there is a constant discussion of ways to “manage” pain naturally.

          • TheHappyPappy

            Yeah, it’s like the obvious contradiction between “homebirth is completely safe, even safer than hospital birth! Birth is as safe as life gets!” but then if something happens… “Life and death are on a continuum. Some babies just aren’t meant to live. You can’t control every outcome.” Which one is it?

        • Minerva

          Yes, I prefer the anesthesiologist’s epidural.

      • Guest

        I actually preferred hot shower to bath while in labor – it eased the back pain, and I was standing, and it was easy to get out when I needed to. When I was deep into the woo I fantasized about waterbirth, but it held no appeal to me after actually having been in labor twice.

        • Meagan

          I found the tub helped some when the doula poured water over my back… so I think a shower would have been better for me as well. I don’t really think it had much do an impact on the pain overall, but then, I don’t know what it would have felt like without the tub, so I can’t say for sure. Next time I’m getting the epidural before I hit transition.

        • PH Student

          Me too! My poor husband had the fun job of moving the shower wand over my back for about an hour. That still didn’t stop me from getting nauseous during transition and wondering why in the holy hell I had decided to have a natural birth (though I was glad afterwards). I gave birth with a CNM and she actually strongly recommended the shower over the tub for pain relief.

      • Jessica

        I liked the jacuzzi a lot, but I liked the epidural more.

      • Spiderpigmom

        ” I was so looking forward to laboring in the big tub in my hospital room”: hah, I felt the same. Until I was actually laboring, that is. At this point, the prospect of sitting in lukewarm water felt nothing close to tempting to me, and I passed. I’m *so* happy in retrospect that I did.

  • Sophia

    Water birth is about as natural as epidural for pain relief except there’s ample data supporting the safety of the epidural. I’m sure someone will parachute in at any moment to say this this baby died in a hospital because of delay in diagnosis. Poor kid.

    • theadequatemother

      There wasn’t a delay in diagnosis…Dr T didn’t quote this part but a nasal swab taken on admission or close to it was positive for human adenovirus at least one day before she was transferred to a tertiary care facility (before then just some fever and appearing ill with small supplemental oxygen requireiment) and three days before she developed respiratory distress and was transferred to the ICU.

      It sounds like she got very ill, very quickly. Neonates are known for that. The case report also says that adenovirus is a very rare infection in neonates. The use of the antiviral was compassionate/ experimental as it hadn’t been studied in neonates….last ditch attempt to kill the virus before time on ecmo ran out.

  • Guest

    “Homebirth midwives have ignored this report and continue to conduct what amounts to uncontrolled experimentation on newborns by recommending under water birth.”

    Don’t forget all the hospitals around the world that offer waterbirth.

    • Staceyjw

      There are a few that offer water birth here, but most only offer water labor, which is different.
      In my area, the CNMs (primarily) and hospitals offer it in hopes of getting HB Moms into the hospital. I also think some of their anti pain relief ideology trumps any safety concerns. They local HB death and disability rate is high, and hospitals have implemented every single thing NCBers want in order to offer choice.

    • Anonomom, LLLL, IBCLC

      Are there really hospitals that allow deliveries to be done in the water? My Birth center CNM freaked out when I was laboring in the pool and started to push. She made damn well sure that the baby was delivered directly into the air.

      • Anonomom

        And in hindsight, I would have asked for enemas before my deliveries! I’m glad my husband saw our babies being born, but I would have preferred him not to see me pooping. Maybe those 1950’s OBs had it right lol

        • Bombshellrisa

          That was a huge lesson for me-I thought “What the heck, it’s ok, it gets cleaned up right away if someone poops”. Until I was the someone that pooped. Thank goodness my husband had watched his two siblings being born and the concept of push=poop wasn’t a new one for him.

          • JC

            This was one of those things I was totally prepared for. My husband I even joked about it before the births. It happened during both of my sister’s births (one of which I was present for). But then it didn’t happen during either of my vaginal births. I will go into the third birth prepared for it, but I am shocked it hasn’t happened to me yet.

          • Guest

            My husband and I still laugh because I was always terrified of pooping while in labor, and had avoided it during my first son’s birth, but when I was about to push with my second baby, I yelled out to my OB something like: “I am warning you, I am going to poop, because I ate a big dinner tonight!” And, I was correct. TMI, I know, but kind of hilarious.

        • To my amazement, I ended up a big fan of enemas. Sure beats constipation after a CS. (Squeemish and horrified before I gained some experience.)

        • Amy

          Pooping was one of my BIGGEST fears going into childbirth! I lucked out and am 2 for 2 not pooping…here’s hoping my luck continues, lol

          • Sue

            That’s what the enemas used to be for.

      • Andy

        yes, this is our regional perinatal center (very advanced NICU) and actual waterbirths happen there almost everyday: http://www.atlantichealth.org/morristown/our+services/maternity

        many of them are attended by these popular women who have had a busy hospital practice for almost 20 years and just recently started offering home birth:
        http://www.facebook.com/HackettstownMidwives

        • Bombshellrisa

          That is a very pretty birthing suite. The midwives there are obviously CNMs (since they work at the hospital). That doesn’t always mean what it should (I have had my fair share of experience with CNMs), but it’s better than the alternative. Even so, the great majority of waterbirths happen with CPMS, in homes or their birthing centers. That means the woman is getting mediocre care from the start, from women who are trained merely by apprenticeship. To me, the tragedy started when the woman in the story had care providers who failed to follow her illness and compounded it with letting her give birth in the water.

        • US system a complicated mystery to me. Atlantic health impressive publicity materials – but if they are that wonderful, why do they transfer?

          The midwives page gave out enough signals to put me off, so looked for their web page. Didn’t find it but found this on a local forum:

          “Hackettstown midwives have been careless in some of their past births and have caused irreversable problems.”

          But I am sure they are just super if you do stay low risk.

          And Andy, it is clear that you are quite certain that your wife did, and will. And smugly happy with that, so who cares, really. You didn’t say how many children you have or intend to have, but it doesn’t sound like one a year, so no problem really. Your luck will hold and you will continue to condescend.

          • auntbea

            Their website is here: http://midwives.evpod.com/.

            It is normal in the US to have a separate maternal-fetal medicine specialty that takes referrals but does not do regular OB care or delivery. You go there if you have a specific risk, like a clotting disorder, that is not something every OB would be expected to be an expert in.

          • Sheila

            They are no longer “Hackettstown Midwives” they are Midwives of NJ. And they are all CNM’s and have a remarkable reputation throughout the region.

        • Sue

          Andy – are you sure you mean “actual waterbirths” and not “actual labor in water, getting out for birth”? I’d check again.

      • Bombshellrisa

        There is a hospital in Oregon too, is it OHSU? They also have free doulas.

        • Staceyjw

          Yes, OHSU offers it.

          • Legacy Emanuel does as well, but only with the CNM’s.

      • Meagan

        Yep. The hospital birthing center where I had my baby offers it… My midwife was actually excited that I wanted to do water labor but no water birth… I was the only one of her patients who DIDN’T intend to birth in the water and she needed people birthing out of the tub for a control group in a waterbirth infection study she was contributing to.

      • multimom

        Here in the PNW, yes, both hospitals in my city offer waterbirths. You have to arrange it first, but the option it there.

      • Amy

        I’m in the PNW too. Gave birth in the tub in a hospital in Tacoma. I just had to let them know I planned to ahead of time, so they could try to keep the room available for me when I was in labor. (They only have two rooms with birthing tubs.)

      • Desi_redux

        Yes, I am about to deliver in a hospital with CNM’s and their USP is waterbirth. The NUCB community has pummeled a LOT of medical establishments in our city to start letting women deliver in water, despite them not being able to communicate or evaluate risks effectively, which FRUSTRATES me. I initially chose this practice with much temerity– I was extremely on the edge with NUCB propaganda and had NO idea what to make of waterbirth. I’m a complete germaphobe and the idea didn’t appeal to me at all. After a lot of reading (thanks, Dr. Amy), I ruled it out anyway.

        I’ve stuck to the practice because I didn’t receive any whitewashing about the “benefits” of waterbirth–it was merely mentioned to me during my first prenatal visit that the option was available to patients of the midwives and that the regulations governing it were extremely “strict” -no meds, no pit, no epi, no glitches during intermittent fetal monitoring, no fluctuation in BP.. etc. In fact, I came home from the first appointment thinking that hardcore woo-believers would be VERY disappointed because, as usual, they would have taken it as proof that hospitals and hospital-based CNM’s are the very incarnation of evil and don’t know anything about “spiritual” midwifery, etc. I can understand how some women may not feel comfortable working with my CNM’s, but hey, I love the hospital, the backup OB, and as long as no one is forcing me to deliver my baby in poop-filled water, I’m cool with it.

    • Charlotte

      I know of a hospital in the UK that used to allow waterbirths, but they had to stop soon after because several babies drowned.

      • AmyP

        Several!!!

    • KarenJJ

      Yes a good point. I think there are some in Australia that offer them? I wonder how long they will still be available if reports like this keep happening? That said, I would hope that a hospital would recommend a woman in labour with fever and diarhea to get out of the tub.

  • DiomedesV

    Wouldn’t most people consider deliberately bathing a child in diarrhea-infested water child abuse? Why is this any different? If CPS heard that a parent had diarrhea, had taken a dump in a toilet, and then washed their baby in it, would the child be removed from their custody?

    • Captain Obvious

      Protocols. History and physicals. Vaginal and rectal swabs prior to labor. Medical record documentation. These midwifes performed malpractice. Failure to risk out patient. Failure to document negative cultures. Failure to share important medical information with collaborative physicians.

      • BCMom

        What I understand from reading this account was that this was a viral illness, (the baby ended up with a viral pneumonia which I’m assuming was from the diarrheal virus). What I know of viral gastrointestinal illness in adults is that basically symptoms are managed and it has to run it’s course – antibiotics are ineffective. Would a caesarian be the recommendation in a case like this (to mitigate contaminating the baby), or would initiating phrophylactic antiviral medication for the baby during and after labour suffice?

        • Dr Kitty

          Probably very good perineal cleaning and getting the baby well cleaned off after birth would suffice. I think aspirating water faecally contaminated with Adenovirus was probably the issue, rather than simply being exposed to the virus.
          Antivirals are good for only very specific viruses, they wouldn’t be likely to have helped in this case.

          • theadequatemother

            Adenovirus is also spread via respiratory secretions. The real failure here, as you mention in another comment, dr kitty, was not making an effort to get a diagnosis after a week of fever and diarrhea in a pregnant women near term. I wonder if she also had URI symptoms or conjunctivitis….

  • Anthropologist Underground

    Two in a row. Terribly sad. I was thinking today that these poor moms try so very hard to avoid a relatively casual hospital stay of a day or so for birth, but end up staying days under the worst possible emotional conditions in the NICU. Awful.

    I’m not a doctor, so let me see if I understand the mechanism. Mother is immersed in water and ejects a slurry of infectious fecal matter into the water that she is sitting in. She remains immersed in contaminated fecal matter and baby emerges into/through the slurry and is subsequently coated and covered by the infectious fecal matter and goes on to develop an infection. This would have been different in a hospital vaginal birth because when the mother ejected a slurry of infectious fecal matter, nurses would have immediately cleared it away and cleaned mom up such that the chance of baby aspirating feces or otherwise becoming infected is greatly reduced? Does the hospital team do anything else, like aggressive suctioning or whatever to further reduce the chance that baby will become ill?

    • quadrophenic

      Not a doctor either, but if you poop while pushing (I think that’s the medical term) they do clean it up right away but I’m not sure if they use anything antibacterial. Also I think they would have noticed the diarrhea and maybe caught it earlier or diagnosed it quicker which would have had a better chance to save the baby?

    • Antigonos CNM

      It doesn’t require obviously visible fecal material in the birthing pool for the water to be contaminated. Just imagine, a laboring woman who’s been walking around barefooted, collecting normal house dust on her feet, who then gets into untreated water, and the baby aspirates when born…that can also result in infection. Birthing pools themselves are not rigorously disinfected after each use, and the warm water must be heavenly for all sorts of organisms…
      How many of us would use someone else’s bath water, even if it looked “clean”?

    • Captain Obvious

      The nurses use a hibiclens in water prep of the vulva prior to birth. As the woman pushes, if any feces comes out it is wiped downward with the hibiclens soapy water prep. I place a towel over the perineal body separating the vagina from the anus to keep bulk solid feces away from the delivering baby. It is pretty rare to get the baby in contact with maternal feces this way. Unless there is a shoulder dystocia or large laceration will the baby be at the perineum for a lot of time where prolonged manipulation to help deliver the baby may result in some contact of maternal feces and the baby’s face.

      • Calla

        I don’t think the hibiclens is being used that much anymore. I’ve seen some use baby shampoo but a lot of others, nothing. Just my personal observations, not scientific at all.

        • Susan

          I thought it was contraindicated now too. We used it a long time ago though. I just googled it and I am still not completely sure. There is one article that says it is contraindicated on mucous membranes that appears to be written by an OR nurse. That fits with what I thought was the reason. Another that says it is neurotoxic so can’t be a LP prep. Irony that most of what I found are regarding GBS and homebirth midwives. Are you sure the nurses are still using that prep?

  • Durango

    Having a baby born into diarrhea-tainted waters is even more disgusting than the usual toilet bowl of water birth. That poor baby.

    • GiddyUpGo123

      And supposing your baby survives, later on you will be telling her about her “beautiful natural waterbirth,” hopefully leaving out the details where the pool was so brown and murky with your own poop that you couldn’t see the bottom. I don’t get how your brain could ever translate that experience into “beautiful.” Giving birth in a toilet would actually be more beautiful, because at least in a toilet you can flush the poo away.

      • Bombshellrisa

        Oh and don’t forget, these women always take photos and videos, so EVERYONE can see them naked in the tub and see what’s IN the tub.

  • Courtney84

    So heart breaking, and for what? This to me seems like another case of overly prideful or ignorant midwives. It’s one thing to encourage/support waterbirth, but shouldn’t a diarrheal illness risk you out of birthing in water? I’m not doctor, and I’m no genius, but I know the diarrheal disease spreads through contaminated water.

    • Are you nuts

      Really terrible. I’m thinking back to my summers spent at public pools. Even the 16 year old lifeguard knew that when someone poops in the pool, you get out of the water! And that’s with chlorine treatment!

    • Durango

      I would bet that both the midwife and the mom thought that it was normal, pre-labor diarrhea. I remember being told that that was a possibility because it was “your body’s way of making room for the baby to come out.” Ugh ugh and ugh.

      • Courtney84

        I’ve heard that at the onset of labor one might experience acute diarrhea, but for a week…? That sounds cray-zay to me.

        • quadrophenic

          I think it would depend on the symptoms – with a fever? It would concern me. Really crampy watery BMs several times a day for a week? Yes. Runny a couple of times a day for a week? As a FTM whose stomach turns upset at the drop of a pin (stress, lack of sleep, change of schedule, period) I may not have been worried. I’m not a doctor but the presence of a fever would probably have worried me. I also would never have a homebirth so I’d have told the hospital staff who would have hopefully known something was up.

          • Durango

            I think in the worldview that everything is normal no matter what, even a week of diarrhea becomes nothing to worry about.
            (this topic leaves my own stomach churning, ugh)

          • deafgimp

            FTM? Female to Male transgender? Full time mom? Furry toed monster?

          • quadrophenic

            “First time mother” but I do recall a piece on Jezebel where the author described the horrid shorthand on parenting boards and that “FTM” meants something way different than she was used to in the past, meaning FTM transgender. I usually try to avoid the shorthand, “DH” and “DD/DS” really bug me.

      • auntbea

        I had that! And you know what? I would not have dunked my baby in it!

        • Rea

          Seriously. I had two waterbirths and my midwife was scrupulous in making sure I had a bowl movement before going into the water. Otherwise, enema or no waterbirth. No poo is allowed in the water, period. Do do otherwise is neglectful.

  • Dr Kitty

    Poor baby.
    Why did the birth attendants think that waterbirth at home was still a good idea if the mother had a febrile diarrhoeal illness?
    Why did the mother’s fever and diarrhoea not prompt the birth attendants to exclude occult sepsis or risk out of homebirth?

    What if it wasn’t Adenovirus, but instead had been viral hepatitis, Norovirus, colitis, or a UTI which had caused those symptoms? How would they have known? How could they be sure homebirth was still appropriate?

    At the very least I would have been concerned about maternal dehydration and renal function.

    • The Bofa on the Sofa

      Why did the birth attendants think that waterbirth at home was still a good idea if the mother had a febrile diarrhoeal illness?

      Because diarrhea and fever are merely variations of normal?

    • Laura

      You are thinking like a doctor. Imagine that! And unfortunately, whether these midwives were CNMs or a less medically trained class of midwives, they were not thinking of the medical and health ramifications of either of their patients. Sad, very sad

  • Karen in SC

    Would extra precautions be taken had this mother been in the hospital? Or would normal procedures guard against spreading this? I’m sure bottom was kept clean by nurses during my labor, though I can’t really remember.

    • auntbea

      Everyone I know who had a fever while in labor got their baby sent to the NICU for preventative monitoring, if nothing else.

      • mollyb

        Indeed. My first daughter was born almost 24 hours after my water broke and by the time she was born, we were both slightly feverish. Because she wasn’t having trouble breathing, she wasn’t sent to NICU but we monitored constantly for about a day until our fevers went away.

  • Allison

    That is unbelievably gross.

  • AmyP

    Poor baby.

    • Aunti Po Dean

      poor poor baby..died an agonising death from the sound of it

      • Dr Kitty

        Hopefully not, because I’d imagine heavy sedation/analgesia was used for ECMO and terminal care.