Birth during times of disaster: Keeping women and babies safe

I am impressed and surprisingly moved by this video of a NICU evacuation drill at Beth Israel Deaconess Medical Center in Boston. Drills like these are so important for patient safety.

As the hospital CEO points out in his blog, there is a “dearth of literature on NICU evacuations”. The same is almost certainly true for labor and birth, in which evacuating hospitals means telling at least some women to give birth at home. Other potential disasters, such as prolonged loss of electricity, can mean access to anesthesia and surgical care is rationed severely, or not available at all. And of course more widespread disasters such as pandemics, natural disasters, or terrorist attacks might mean that a labor and delivery unit is closed indefinitely.

In 2006, Lisa Summers wrote about representing the American College of Nurse-Midwives (ACNM) at a government meeting discussing healthcare system preparedness for pandemic flu. In an article in ACNM’s newsletter, she shared:

They are planning for three levels of care. There are pamphlets to educate the public about how to provide appropriate home care that will meet the needs of most flu victims (hydration, isolation, comfort measures); they are working with local hospitals to assess surge capacity and their ability to meet the needs of the sickest (perhaps ventilator dependent) victims; and they are designating places such as hotel ballrooms and convention centers (places with adequate bathroom and food facilities) to be used as influenza care centers for those too sick for home care but not in need of (or who cannot be accomodated in) limited hospital beds.

Summers goes on to ask, given that one-quarter of hospitalized people are childbearing women, and pregnant women and newborns may be among the most vulnerable populations to flu infection, “What plans are being made to determine the best level of care for childbearing women? Will the influenza care centers be appropriate places to give birth?” She provides two compelling reasons that midwives should be front-and-center in efforts to address these questions:

The fact that midwives are experts in normal birth – that we are comfortable and skilled at attending a birth outside of a standard delivery room and without an OR down that hall – makes us uniquely well prepared to care for childbearing women in a disaster situation…The other important skill that midwives have honed well is that of triage of childbearing women – knowing which women are likely to safely give birth without medical intervention, and which women need IVs and an OR.

She also points out that all hazards preparedness should involve educating the public about safe home birth and assessing the surge capacity of birth centers.

In addition to Summers’ article, the ACNM also offers a number of other resources on All Hazards Preparedness, including a handout for women who may be vulnerable to giving birth unexpectedly remote from a skilled provider or prepared birth setting. (Whether it’s because of a terrorist attack or the epidemic of roadside births due to the closure of community-based maternity units.) The handout notes that childbirth education classes and prenatal breastfeeding education, along with infant CPR classes, are essential to preparedness, and gives step-by-step instructions for supporting a woman to give birth at home, including how to handle the most common complications.

I’d love to know, what are the hospitals in your communities doing to prepare labor and delivery units for events such as fires, floods, and loss of electricity? Does anyone have a video of an L&D drill similar to the NICU drill from BIDMC? And how are your health departments preparing for disasters that render hospitals unsafe or inaccessible for childbearing women? How many of my readers have contacted their health departments to offer assistance for childbearing women and newborns in disasters?  (Confession: although I’ve been meaning to for ages, I haven’t!)  Do any of you teach about disaster preparedness in prenatal classes?

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  1. | #1

    I do have time set aside in my childbirth classes to discuss how the dad can handle a “roadside” birth. Just the basics: don’t pull on the baby, don’t pull on the cord, don’t cut the cord, etc. After the historic flooding here a few months ago, when several births happened at home unplanned, the dads were quite attentive!

  2. | #2

    These are great questions. I don’t have any answers, but it certainly gave me good food for thought.

  3. | #3

    Great topic! And very timely, as I’m taking a series of emergency preparedness classes in my community right now. Good questions for me to ask them about!

  4. | #4

    Hi Amy,

    Thank you for this thoughtful blog post. As a resident of New York City, a city that has experienced several terrorist attacks as well as closures of bridges and tunnels, outbreaks of the H1N1 flu, etc. AND currently has no legally-practicing home birth midwives, this is an issue that has been on my mind for the last couple of months. In May, National Advocates for Pregnant Women submitted a letter to all the legislators and many of the executives at both the city and state levels to bring to their attention the work of the White Ribbon Alliance for Safe Motherhood’s National Working Group for Women and Infant Needs in Emergencies in the aftermath of Hurricane Katrina. That body, made up of all sorts of experts in maternal and infant health, made the very same observations that you shared above in their report. In short, the public health demands that there be people who know how to deliver babies without the benefit of epidurals, electronics, or operating theaters, and having all such practitioners in some sort of “illegal but notorious” limbo isn’t conducive to the upkeep of this important skill set. I know that the midwives had been negotiating with the agency in charge of the City hospitals to get a backup agreement, but the negotiations didn’t seem to be going well last I checked. This is a matter of public safety, and if the HHC won’t address it, the City or State need to step in.

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