Number of vasectomies in England falls 64% in 10 years

Vasectomies appear to have gone dramatically out of fashion, with a decline of 64% in the number of men undergoing the procedure within the last 10 years, leaving women once more shouldering the responsibility for contraception.

But the reasons for the apparent shift are complex, say experts. Part of it is bad publicity, with many men seemingly put off by scare stories about pain and unfounded worries about the implications for their sex lives, but there are also concerns that NHS funding for the procedure may be slipping away.

In 2004-5, there were 31,216 vasectomies carried out in England, but in 2014-15, that fell to just 11,113 according to NHS Digital. Image is definitely an issue, according to Genevieve Edwards of Marie Stopes, who says “the snip” is an offputting misnomer. “That is not what happens. If you were going to launch vasectomy as a product, you wouldn’t start there,” she said.

“People worry massively and have lots of misconceptions about it – how painful it is, the impact on their sex life, whether they will still have orgasms. People are really confused about it.”

The perceptions lag behind the reality, Edwards said. “There is no snipping at all. It is a 15-minute procedure with lots of anaesthetic and Bob’s your uncle.”

But the later age of having children is also a factor, she believes. In the past, a couple may have had several children before they were 30. “If you and your partner had another 20 years of fertility ahead, another two decades of the pill, you might pack him off to the doctor,” she said. But if a woman will be facing the menopause in just a couple of years, they might carry on with contraception rather than opting for a vasectomy.

Suggestions that men no longer want a vasectomy in case their marriage breaks up and they have a second partner who wants children are wide of the mark, she believes.

Marie Stopes is a leading provider of vasectomies for the NHS as well as privately and has been trying to boost interest among men. It ran a campaign this spring on websites and at football grounds called “Have you got the balls?” inviting men to think about it. It appeared to have some effect, because 200 more men came along for the procedure last month than in September the year before.

If awareness and interest is dropping in England, that is not the case elsewhere. Marie Stopes clinics get quite a lot of male clients from France and the Middle East. In the Middle East, the procedure is rarely done, so men head for clinics where it is routine and they feel in safe hands. In France, vasectomy was illegal until relatively recently, under the Napoleonic code that banned self-harm. Although it is legal now, it is not easy to access and men who ask for it must go through counselling and a cooling-off period. Many jump on the Eurostar instead.

But cost in England may be becoming an issue. At a time of increasing financial pressure on the NHS, some clinical commissioning groups are considering reducing the number of vasectomies they will pay for, or dropping them altogether. The North East Essex clinical commissioning group (CCG) will no longer fund it. Its website states: “The community vasectomy and female sterilisation services are considered as one of many forms of contraception and are deemed to have no or limited clinical value.” It will be available, however, “in cases of complex health needs”.

The procedure costs £400, but arguably saves money on other forms of contraception over the long term. It also allows men to take over responsibility from women, who have had to worry about their fertility and the possible side-effects of hormonal contraception for much of their lives.

While vasectomy has declined, the use by women of long-acting reversible contraceptives, known as LARCs – such as implants and intra-uterine devices (the coil) – has risen.

“There has been a huge push on getting women to use long-acting reversible methods,” said Katherine O’Brien, a spokesperson for BPAS, the British pregnancy advisory service. “It is cheaper for doctors to be providing these things. We know that if you speak to women and their partners, if they have discussed the possibility of a vasectomy with their GP, the doctor often says to them, why don’t you just have the coil or an implant?”

The attraction of LARCs is that they can be left for several years but the contraceptive effect is reversible – and a vasectomy often is not. But implants are hormonal, which some women do not want, and sometimes there is bleeding. “When women go back to the GP, they are told to go back on the pill to cope with the bleeding,” said O’Brien. “It is really extraordinary. They chose the LARC because they didn’t want to take the pill.”

The Family Planning Association says it advocates “as much choice as possible”. It too is worried about the decline of the vasectomy and fears there will be a postcode lottery as some CCGs decide to pay for it, while others will not. “We are worried that if men aren’t able to access vasectomy, it does put more of a burden onto women,” said a spokesperson. The conversation heard in the clinic is of the woman in a partnership saying that contraception was her responsibility until the couple had completed their family – and now it is the man’s turn.

The vasectomy is a simple procedure, carried out under local anaesthetic. It involves a small incision on each side of the scrotum, allowing the doctor to access the tubes that carry sperm out of the testicles. These are cut and sealed. It can also be done with keyhole surgery. Ejaculation is as normal afterwards, but the semen contains no sperm.

Number of vasectomies in England falls 64% in 10 years

Number of vasectomies in England falls 64% in 10 years

Vasectomies appear to have gone dramatically out of fashion, with a decline of 64% in the number of men undergoing the procedure within the last 10 years, leaving women once more shouldering the responsibility for contraception.

But the reasons for the apparent shift are complex, say experts. Part of it is bad publicity, with many men seemingly put off by scare stories about pain and unfounded worries about the implications for their sex lives, but there are also concerns that NHS funding for the procedure may be slipping away.

In 2004-5, there were 31,216 vasectomies carried out in England, but in 2014-15, that fell to just 11,113 according to NHS Digital. Image is definitely an issue, according to Genevieve Edwards of Marie Stopes, who says “the snip” is an offputting misnomer. “That is not what happens. If you were going to launch vasectomy as a product, you wouldn’t start there,” she said.

“People worry massively and have lots of misconceptions about it – how painful it is, the impact on their sex life, whether they will still have orgasms. People are really confused about it.”

The perceptions lag behind the reality, Edwards said. “There is no snipping at all. It is a 15-minute procedure with lots of anaesthetic and Bob’s your uncle.”

But the later age of having children is also a factor, she believes. In the past, a couple may have had several children before they were 30. “If you and your partner had another 20 years of fertility ahead, another two decades of the pill, you might pack him off to the doctor,” she said. But if a woman will be facing the menopause in just a couple of years, they might carry on with contraception rather than opting for a vasectomy.

Suggestions that men no longer want a vasectomy in case their marriage breaks up and they have a second partner who wants children are wide of the mark, she believes.

Marie Stopes is a leading provider of vasectomies for the NHS as well as privately and has been trying to boost interest among men. It ran a campaign this spring on websites and at football grounds called “Have you got the balls?” inviting men to think about it. It appeared to have some effect, because 200 more men came along for the procedure last month than in September the year before.

If awareness and interest is dropping in England, that is not the case elsewhere. Marie Stopes clinics get quite a lot of male clients from France and the Middle East. In the Middle East, the procedure is rarely done, so men head for clinics where it is routine and they feel in safe hands. In France, vasectomy was illegal until relatively recently, under the Napoleonic code that banned self-harm. Although it is legal now, it is not easy to access and men who ask for it must go through counselling and a cooling-off period. Many jump on the Eurostar instead.

But cost in England may be becoming an issue. At a time of increasing financial pressure on the NHS, some clinical commissioning groups are considering reducing the number of vasectomies they will pay for, or dropping them altogether. The North East Essex clinical commissioning group (CCG) will no longer fund it. Its website states: “The community vasectomy and female sterilisation services are considered as one of many forms of contraception and are deemed to have no or limited clinical value.” It will be available, however, “in cases of complex health needs”.

The procedure costs £400, but arguably saves money on other forms of contraception over the long term. It also allows men to take over responsibility from women, who have had to worry about their fertility and the possible side-effects of hormonal contraception for much of their lives.

While vasectomy has declined, the use by women of long-acting reversible contraceptives, known as LARCs – such as implants and intra-uterine devices (the coil) – has risen.

“There has been a huge push on getting women to use long-acting reversible methods,” said Katherine O’Brien, a spokesperson for BPAS, the British pregnancy advisory service. “It is cheaper for doctors to be providing these things. We know that if you speak to women and their partners, if they have discussed the possibility of a vasectomy with their GP, the doctor often says to them, why don’t you just have the coil or an implant?”

The attraction of LARCs is that they can be left for several years but the contraceptive effect is reversible – and a vasectomy often is not. But implants are hormonal, which some women do not want, and sometimes there is bleeding. “When women go back to the GP, they are told to go back on the pill to cope with the bleeding,” said O’Brien. “It is really extraordinary. They chose the LARC because they didn’t want to take the pill.”

The Family Planning Association says it advocates “as much choice as possible”. It too is worried about the decline of the vasectomy and fears there will be a postcode lottery as some CCGs decide to pay for it, while others will not. “We are worried that if men aren’t able to access vasectomy, it does put more of a burden onto women,” said a spokesperson. The conversation heard in the clinic is of the woman in a partnership saying that contraception was her responsibility until the couple had completed their family – and now it is the man’s turn.

The vasectomy is a simple procedure, carried out under local anaesthetic. It involves a small incision on each side of the scrotum, allowing the doctor to access the tubes that carry sperm out of the testicles. These are cut and sealed. It can also be done with keyhole surgery. Ejaculation is as normal afterwards, but the semen contains no sperm.

Number of vasectomies in England falls 64% in 10 years

Number of killings by mental health patients falls

The number of killings by patients being treated for mental health problems is falling, probably as a result of improved NHS care, a major new report reveals today.

But the number of suicides has increased across the UK since the financial crash in 2008 – except in Scotland – with middle-aged men the most likely group to take their own life. There are concerns that every year dozens of patients may be killing themselves after they have been wrongly released from hospital because mental health units have too few beds.

Patients with schizophrenia, psychosis or other disorders committed a total of 870 homicides across the UK between 2004 and 2014, which was just over one in ten (11%) of all killings in that time.

But the total number of homicides carried out by patients fell over the 11 years covered by the National Confidential Inquiry into Suicide and Homicide by people with Mental Illness (NCISH). There were 87 such killings in 2004 and 94 the year after, but that had fallen to 67 in 2014 – a decline of 27% over the decade studied by researchers from Manchester University who undertook the inquiry.

“Why that fall? We hope and we think that there have been improvements in clinical care, especially in improving the management of patients’ substance misuse,” said Professor Jenny Shaw, the inquiry’s head of homicide research.

However, their findings raise questions about the NHS’s supervision of patients after they have been released from hospital. Almost two in five patients who killed someone (38%) did so after missing their most recent NHS appointment and so did not receive drugs or talk to a care co-ordinator or psychiatrist, according to in-depth analysis of 662 of the 870 cases.

The report also found that half (52%) of those who committed a homicide had previously been convicted of a violent crime and almost as many (48%) had been in jail. A quarter (24%) had previously been involuntarily detained, or sectioned, under the Mental Health Act and 6% had been in a secure mental health unit.

Killings by schizophrenics have also fallen, from the 53 seen in 2004 to 43 in 2013 and then 36 in 2014. Overall 369 homicides were carried out by people with a history of schizophrenia or other delusional disorder.

However, killings by mental health patients are not falling as fast as the overall drop in homicides. The 27% fall is less than the 37% drop seen in the latter. As a result the proportion of all killings committed by such patients has risen from 9% in 2001 to the 11% seen in recent years.

The NHS needs to undertake “specific clinical measures” to close the gap, researchers led by NCISH director Prof Louis Appleby recommend. It should improve services for those with mental health problems who are also addicted to drugs or alcohol and do more to stay in touch with patients who are likely to stop being in contact, says the report, which was funded by the NHS’s Healthcare Quality Improvement Partnership.

The researchers are warning that around 200 mental health patients kill themselves every year after being put under the care of community-based crisis teams and looked after in their homes, a third after being discharged from hospital in the previous two weeks.

“The report raises questions whether crisis resolution/home treatment was the most suitable setting for their care and raises concerns that crisis teams are increasingly used due to pressure on other acute services, particularly inpatient beds,” the inquiry found.

Appleby added: “Our findings suggest that we are accepting too much risk in the home treatment these teams offer and that the crisis team is now the priority for suicide prevention in mental health.” Overall 28% of all suicides between 2004 and 2014 were of people receiving NHS help for mental ill-health.

Around half of the 1,700 mental health patients a year who take their own lives in the UK had a history of drug or alcohol problems, the inquiry found. In addition, “there is evidence that economic factors are becoming more common as antecedents in patient suicides. Unemployment and homelessness have increased and 13% of patients who died by suicide had experienced serious financial difficulties in the previous three months” it adds.

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here
  

Number of killings by mental health patients falls

Proportion of under-twos receiving first MMR jab falls again

The proportion of children given the measles, mumps and rubella (MMR) jab by their second birthday has fallen for the third consecutive year, figures show.

Last year 91.9% of children received their first dose of the vaccine by age two, down on the 92.3% in 2014-15 and 92.7% the year before.

However, by the age of five, 94.8% of children had had their first dose – a record high. GPs invite children for the first dose of the jab when they are 12-13 months.

The data, from NHS Digital, also shows that 93.6% of children reaching their first birthday had their first dose of the combined jab that protects against diphtheria, tetanus and polio (DTaP/IPV/Hib). This is down slightly on the 94.2% in 2014-15 and 94.3% in 2013/14.

Overall, coverage for most routine childhood vaccinations at one and two years of age fell in 2015-16 for the third consecutive year. Only about one in three children aged two to four were also vaccinated against seasonal flu, despite a huge push for them to receive the immunisation.

Just 30% of four-year-olds were vaccinated in 2015-16, while the proportion was 35.4% for two-year-olds and 37.7% for three-year-olds.

Measles is a highly infectious viral illness. Anyone can contract the disease if they have not been vaccinated or had it before, although it is most common in children between one and four. Initial symptoms include fever, red eyes and sensitivity to light, greyish white spots in the mouth and throat and cold-like symptoms. The measles rash typically appears after two to four days.

Vaccination levels for measles need to be at about 95% to achieve “herd immunity” to prevent outbreaks of the disease. Wherever vaccination rates are lower an outbreak is possible.

After doubts over the safety of the MMR vaccine in a now-discredited scientific paper in 1998, vaccination rates fell as some parents lost confidence in the vaccine.

Izzi Seccombe, chair of the Local Government Association’s community wellbeing board, said: “While routine childhood vaccination coverage at one and two years remains high, it is a concern that the rate has fallen slightly for a third consecutive year.

“These figures are a reminder of how important it is for parents to ensure their child is up to date with their vaccinations, including the MMR vaccine, which has also seen a drop in uptake.

“Measles may not be hitting the headlines every day, but councils, which have responsibility for public health, would encourage people to contact their GP to check their family’s medical records and make sure they and their loved ones are protected. It is important they don’t miss out.”

Proportion of under-twos receiving first MMR jab falls again

Number of UK smokers falls to lowest level

The number of UK smokers has fallen to its lowest level, with just one in six adults now lighting up, according to new official figures, which also show a recent collapse in sales of cigarettes.

Just 16.9% of adults in England now smoke, according to the latest data from Public Health England. Its health experts also revealed that widespread use of e-cigarettes, nicotine patches and gum helped 500,000 smokers last year kick the habit – the highest number on record.

The statistics show that, bar two small blips, smoking prevalence has declined continuously and dramatically over the past 50 years by about two-thirds. In 1974, over 50% of men in Britain were smokers; that had fallen to just 19.1% in England in 2015. Similarly, just over 40% of women smoked back then; last year it was only 14.9%.

There are now just 7.2 million adults in England who smoke. They are far outnumbered by 14.6 million ex-smokers. It is the first time that under 17% of the population are smokers and is down from the 19.3% seen as recently as 2012.

Health campaigners said that smoking’s continuing fall in popularity is due to a combination of tough measures, such as price rises and the introduction of plain packaging, and mass media campaigns urging people to quit.

Doctors welcomed the news but pointed out that about 200 people still die prematurely every day in England as a result of heart attacks, strokes and breathing problems caused by smoking.

Prof Kevin Fenton, PHE’s national director of health and wellbeing, hailed the diminishing appeal of smoking as “amazing”. But he warned that, at 7.2 million, the number of people still lighting up regularly remained worryingly high.

“Alongside unhealthy diet, smoking is the biggest cause of preventable early death in England, accounting for over 78,000 deaths a year,” said Fenton. “Quitters will soon see they have reduced blood pressure, easier breathing and better circulation.”

Graphic

PHE hopes that the figures will encourage even more people to stop using cigarettes. They have emerged just before the start of the annual Stoptober, the agency’s “mass quitting challenge”, which kicks off for the fifth time on 1 October.

Dr Mike Knapton, associate medical director at the British Heart Foundation, said: “Quitting smoking is the single best thing you can do for your heart health. By giving up smoking you’ll be dramatically reducing your chances of having a potentially deadly heart attack or stroke.”

The breakdown of smoking rates in England’s nine regions shows a north-south divide. The north-east has the highest proportion of smokers at 18.7%, closely followed by the north-west and Yorkshire and the Humber, in each of which it is 18.6%.

The south-west has the lowest percentage. Just 15.5% of adults there light up. It is 15.7% in the West Midlands, 15.9% in the south-east and 16.3% in London.

Poorer people are also much more likely to smoke than the better-off. While one in five (20.4%) of the most deprived people in England light up, just 14.3% of the least deprived in society do so.

People of Asian backgrounds are the least likely to smoke – just 10% do so. Smoking is commonest among those of mixed race, of whom 22.4% light up.

Smoking’s decline is also underscored by data from consumer analysts Nielsen showing that the number of cigarettes sold in England and Wales has plunged by 20% in the past two years.

PHE said that about 2.5 million people tried to give up smoking last year. Just over a million of them used e-cigarettes to boost their efforts, while about 700,000 were helped by nicotine replacement therapy products, such as gum and patches.

Of those 2.5 million would-be quitters, one in five succeeded – the best-ever rate. That was up from the 13.6% success rate seen as recently as 2010.

Deborah Arnott, chief executive of the campaign group Action on Smoking and Health (Ash), said: “The continuing decline in smoking prevalence is a tribute to many years when successive governments have implemented comprehensive and progressive tobacco control strategies, including tax rises, mass media campaigns, anti-smuggling measures, smoke-free laws, advertising bans, and last but not least getting rid of tobacco displays and glitzy tobacco packaging.”

However, Ash is “very concerned” that government funding for mass media campaigns – which are proven to be effective at prompting people to try to quit – has fallen sharply from almost £25m in 2009-10 to just £4m in 2016-17. Arnott called on ministers to reverse that trend, increase investment in such initiatives and publish a new tobacco control strategy, as the last one expired at the end of 2015.

Rosanna O’Connor, PHE’s director of drugs, alcohol and tobacco, said: “Marketing campaigns and price increases are especially useful in triggering quit attempts.

“But we are also influenced by the people around us. The more ex-smokers there are among your friends and family, the more likely you are to quit for good and the less likely your children are to start.”

Number of UK smokers falls to lowest level

Number of cot deaths in England and Wales falls to lowest on record

The number of cot deaths in England and Wales has fallen to the lowest since records began.

There were 128 sudden infant deaths in 2014, according to provisional data from the Office for National Statistics (ONS). That compares with 207 in 2004, the first year the numbers were counted.

There were 212 unexplained infant deaths in England and Wales in 2014, including sudden infant deaths and deaths for which the cause remained unascertained after investigation. Just over half (55%) of all unexplained infant deaths were boys.

Related: Sharing bed with baby in first year may raise risk of sudden infant death

Rosie Amery, from the ONS’s health analysis and life events team, said: “Unexplained infant deaths in 2014 were the lowest on record, driven by a decrease in sudden infant deaths.

“A number of factors may have contributed to the fall, including warmer-than-average temperatures throughout the year, fewer women smoking at the time of delivery, and greater awareness of safer sleeping practices.”

Francine Bates, the chief executive of the Lullaby Trust, said: “Whilst it is extremely good news that Sids [sudden infant death syndrome] has gone down in England and Wales, evidence has shown that many more babies’ lives could be saved if all families had access to and followed safer sleep advice.

“It is very important that we work together to ensure safer sleep messages consistently reach all families, particularly those at increased risk such as young parents and families living in areas with higher Sids rates.”

How to avoid cot death

The NHS offers advice for avoiding sudden infant death syndrome:

Number of cot deaths in England and Wales falls to lowest on record

People"s Choice: In This Fall"s Open Enrollment More Health Care Via Private Exchanges

Walgreen Walgreen

By 2018 more people will use so-called private exchanges than similar ones created by the Affordable Care Act, according to a recent analysis by Accenture. 

Walgreen, Sears and Aon Aon Hewitt, among the earlier pioneers in this new approach, give employees a credit to buy insurance in an online marketplace.

Already an estimated 3 million Americans are getting insurance from their employers this way, which is triple the number of active employees that were buying from private exchanges a year ago, according to Accenture Accenture, which projects 40 million Americans will be buying on private exchanges in 2018. Employees get a credit or subsidy, and are sent to buy a plan on a private market place akin to Amazon.com Amazon.com or Orbitz in their respective industries.

Aon Hewitt, the largest manager of a private insurance exchange, says that the approach reduced growth in health insurance costs for its clients’ active employees to 5 percent, compared to 7 percent for most large employers.

So far, Walgreen has been the largest company to disclose participation by workers in its private exchange. The pharmacy giant says more than 220,000 workers and their dependents are getting coverage through the Walgreen proprietary “Live Well Benefits Store,” a marketplace that is an outsourced solution through Aon Hewitt Corporate Health Exchange.

Aon Hewitt, Mercer and Towers Watson (TW) are the leading consultancies pushing the exchange approach for both active employees and retirees with IBM (IBM), AT &T (T) and Time Warner moving their workers to retiree private exchanges. And the consultants are on the verge of having more competition as health insurance companies get into the act like Cigna (CI), Aetna (AET) and others.

“We continue to work to develop our own proprietary exchange called, the Aetna Marketplace, which we believe will offer an attractive alternative to existing multi-carrier exchanges and the current defined benefit model for health benefits,” Aetna chairman and chief executive officer Mark Bertolini told analysts and investors Tuesday on the company’s second-quarter earnings call.

Wondering how private exchanges or Obamacare exchanges will affect your health care? The Forbes eBook Inside Obamacare: The Fix For America’s Ailing Health Care System answers that question and more. Available now at Amazon and Apple.

People"s Choice: In This Fall"s Open Enrollment More Health Care Via Private Exchanges

Residence-birthing pools recalled following infant falls sick with legionnaires" condition

PHE stated most birthing pools utilized at home, like this one, had been filled from domestic scorching-water techniques and so carry much less threat. Photograph: Mary Gascho/Getty

Hired home-birthing pools across the country have been recalled and hire companies place underneath scrutiny soon after a little one born using one particular of the heated pools created legionnaires’ condition.

The NHS and Public Health England (PHE) have banned specified varieties of house-birthing pools till further notice, soon after the child – who remains in hospital with severe pneumonia – became unwell.

Heated pools from the supplier have been recalled, with at least 6 other companies – employing out 60-70 pools – being questioned by PHE on their safety precautions. PHE explained it was “unclear” whether or not or not the organizations had carried out legionella danger assessments.

PHE said the tips was a “temporary” measure, and referred to the residence use of birthing pools with created-in heaters and recirculation pumps, which can be filled up to two weeks in advance of the birth. NHS England issued a patient safety alert on 17 June to alert midwives to the feasible risks associated with the use of this type of heated birthing pools at residence.

This is the very first reported situation of legionnaires’ ailment linked to a birthing pool in England, despite the fact that there have been two cases reported internationally in the late 1990s. Legionnaires’ disease, induced when the legionella bacteria is inhaled from contaminated water droplets, is incredibly rare in childhood, with only one particular situation in kids up to the age of nine reported in England among 1990 and 2011.

The PHE advised that the majority of birthing pools employed at house are filled from domestic scorching-water programs at the time of labour, which carry much less danger as long as pumps do not recirculate warm water. The recalled pumps have been delivered two weeks ahead of labour and, when filled from the tap, had been stored warm by a pump and heater until finally labour and delivery.

Prof Nick Phin, PHE’s head of legionnaires’ ailment, said: “Additional investigation into this incident has confirmed that the kind of legionella bacteria located in the birthing pool is the very same strain which triggered the child to turn into sick with legionnaires’ condition. As portion of the investigation, PHE has been functioning with neighborhood authorities to investigate the provision of these pools by a amount of firms, such as the advice given by the companies on pool filling and on controlling hazards from exposure to legionella.”

The decision to ban the birthing pools was based mostly on the trouble of preventing the growth of legionella in recirculated warm water over days or weeks in houses, he extra. “For this cause, PHE has confirmed its earlier precautionary tips and is recommending that this type of pre-filled, heated birthing pool is no longer used at all at property.”

Louise Silverton, director for midwifery at the Royal College of Midwives, mentioned that women should not be concerned if they were organizing a birth at residence making use of a conventional pool filled when they were in labour or making use of a fixed pool in an NHS unit. “Birthing pools in hospitals are topic to stringent infection-management procedures and monitoring,” she stated. “House-birthing pools filled for the duration of labour come with disposable liners and are only in area for a fairly brief time time period, minimizing possibility for bacterial growth. Any ladies with concerns about using home-birthing pools ought to make contact with their midwife or neighborhood maternity unit.”

Residence-birthing pools recalled following infant falls sick with legionnaires" condition