This lesson outlines the essential procedures for safely removing a birthing person from the pool in the event of a medical emergency. Emergency removal may be necessary if the mother feels faint, loses consciousness, or experiences other signs of physiological distress. The protocol emphasizes rapid, coordinated action using a specialized rescue net and the support of four trained individuals. Each team member holds one handle in each hand, distributing weight evenly to ensure safe and stable removal.

The rescue net must be easily accessible at all times, whether stored in a central location in a hospital or carried by midwives in homebirth settings. Most nets are designed to support up to 200 kg (approximately 485 lbs). In clinical environments, positioning the bed perpendicular to the tub facilitates smoother transfer. During removal, the head and neck must be carefully supported to maintain an open airway and prevent potential cervical spine injury, particularly to the C4/C5 region. The entire procedure should ideally take 30 to 45 seconds.

Emergency removal may also be indicated if the mother is exhibiting pre-syncopal symptoms or expresses that she is not feeling well. In such cases, providers should allow 3 to 5 minutes of delayed cord clamping before initiating removal. A key takeaway from this lesson is the importance of early intervention: if there is any doubt about the mother’s ability to exit the tub independently, the rescue net should be brought immediately.

A video demonstration from Sanatorio Otamendi in Buenos Aires is included to illustrate best practices in hospital-based emergency removal.

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.