This lesson reviews the evidence-based protocols for infection prevention during waterbirth, with a focus on protecting three key individuals: the mother, the baby, and the provider. Providers are encouraged to begin with clean, potable water and to have a system in place for regular water quality testing. Filtered or bottled water is not required, but proper maintenance of the birth pool is essential. The lesson covers universal precautions, equipment handling, cleaning protocols, and appropriate chemical agents as approved by the EPA, including chlorine, hydrogen peroxide, and quaternary ammonium compounds.

Group B Streptococcus (GBS) is addressed with reference to a 2007 study by Zanetti-Dällenbach et al., which showed no increase in neonatal GBS colonization following waterbirth, and in fact found a trend toward less colonization compared to land birth. Other pathogens, including HIV, hepatitis B, E. coli, pseudomonas, and legionella, are also discussed. HIV is considered non-communicable in water, while legionella risk is associated with stagnant or improperly maintained equipment. All items used in the tub—such as hoses, pumps, and thermometers—must be either fully cleanable or disposable.

The lesson outlines recommended practices for cleaning and storage, including drying and labeling tubs, using disposable liners, and employing non-sudsing or bleach-based cleaners. Adding substances such as essential oils, magnesium sulfate, or antibacterial agents to the water is discouraged due to potential absorption or disruption of the natural microbiome. In cases of contamination—such as feces, blood clots, or meconium—the principle “the solution to pollution is dilution” is emphasized, with protocols in place for water replacement and tub sanitation.

Finally, research related to premature rupture of membranes (PROM) is presented. A study of 1,385 births found no increased infection risk from waterbirth, even with prolonged latency following PROM. The CDC’s statement on COVID-19 is also included, noting no evidence of transmission through properly maintained pools. The lesson concludes by reinforcing the importance of formal waterbirth policies, strict infection control, and provider accountability in maintaining safe environments for aquatic birth.