Water birth for women with GBS: a pipe dream?

lthough only a relatively small proportion of women give birth in water, many more use birthing pools during labour. Most UK maternity units have plumbed birthing pools, as well as portable ones used for home births. For some women, labour and birth in water are important features of their birth plans – but this is not available for all women. The Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives (RCM) stated in April 2006 that, ' All healthy women with uncomplicated pregnancies at term should have the option of water birth available to them and should be able to proceed to a water birth if they wish' (RCOG/RCM 2006). Approximately 25 per cent of labouring women in the UK are likely to carry Group B Streptococcus (GBS) (Easmon 1986). Although GBS is the most common cause of life-threatening infection in newborn babies in the UK (Heath et al 2004), this is still a relatively uncommon occurrence. More than 99 per cent of babies don't have a problem even if their mother carries GBS, so should simply carrying GBS (without any other risk factors) prohibit a water labour or birth? Most GBS infections occur within the first week of life (Heath et al 2004) – early-onset GBS disease. It usually presents as sepsis or pneumonia, and less often as meningitis. Late-onset GBS disease occurs in babies aged one week or more, with most infections evident in the first three months of life. They are more likely to have meningitis, osteomyelitis or septic arthritis. Babies unlucky enough to become infected with GBS often require long stays in hospital. Even with the best medical care, 10 per cent of infected babies die (Heath et al 2004) and up to half of the survivors of GBS meningitis suffer permanent, long-term sequelae (Bedford et al 2001). These range from mild learning disabilities to severe mental retardation, impaired sight, impaired hearing and lung damage. Intrauterine infection of the fetus results from GBS ascending from vaginal colonisation – this is very rare if the membranes are intact. Babies are usually exposed to GBS when the membranes break and during their passage through the birth canal. Most only become colonised (Centers for Disease Control and Prevention 2002) and remain well, but the unlucky ones develop early-onset GBS infection. Although GBS can cause clinical infections (for example, a urinary tract infection) in pregnant women, colonisation …