Emergency Preparedness

January 29, 2011 at 4:56 pm

Regardless of what type of disaster may strike or how severe it is, there will always be pregnant women in need of special assistance. Pregnant women are among those most at risk in disaster situations, in part because severe stress can trigger premature labor, but also because so many women are forced to give birth under precarious circumstances. When hospitals may be over-flowing with sick and injured survivors, roads or transportation inaccessible, and electricity likely unavailable, women who would otherwise have given birth at the hospital will have to seek alternatives.  It is also a possibility that hospitals will only have resources for the most high-risk pregnant women, leaving low-risk mothers to give birth with little or no assistance from staff.   Even in the absence of a large-scale disaster, on just an ordinary day-to-day basis, sometimes a birth happens too quickly to make it to the planned location or before a qualified birth attendant can be present.

Robbie Prepas, a certified nurse-midwife, saw many such births first-hand during the Hurricane Katrina disaster.  She delivered five babies in the New Orleans airport, twins in an ambulance, and provided impromptu care to hundreds of pregnant and postpartum women, checking fetal heart tones, etc.  She explains, “There were no policies or procedures in place to care for pregnant women or mothers and their babies after Katrina.  We even lacked such basics as diapers, formula, baby bottles and clean clothes” (“Disaster Preparedness for Mothers & Babies: Getting Prepared”).  Midwife Mary Callahan, CNM, MS, also assisted in the Hurricane Katrina relief effort, providing midwifery services to displaced women in a large shelter and assembling emergency birth and prenatal kits for use in other area shelters (“Chicago Midwives Travel to Baton Rouge”).   While we may be fortunate to cross paths with a doctor, midwife, or paramedic with birth supplies in an emergency childbirth situation, we can’t be certain of such luck. Given all of the possibilities, the best course is to have plans and supplies in place so that we can meet our specific needs in emergency situations.

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The American College of Nurse-Midwives has made an important document available through their website:  “Emergency Preparedness for Childbirth.”  This document includes a list of supplies for an emergency birth kit that can be found at most drugstores and should be kept in a waterproof bag away from children and pets. I recommend keeping the kit in an easy-to-carry tote bag in case you have to leave your home quickly and must give birth elsewhere.  You may want to store your emergency birth kit alongside your family’s 72-hour-kits. And, if you don’t have emergency 72-hour-kits, get/make some! Pre-made birth kits can also be ordered online, and they’re actually quite inexpensive! The document also contains instructions for managing an unexpected unassisted labor and delivery.

These are some additional ways we can cover our emergency preparedness bases as pregnant and nursing mothers:

  • Know your neighbors and their professions.  Chances are there are nurses, doctors, midwives, doulas, and childbirth educators living within walking distance of your home. These friends could be literal life-savers in a disaster situation.  Have an idea, in advance, who you might feel comfortable seeking help from in the event that you must give birth under disaster circumstances.  Talk to them about that possibility and whether they’re willing to fill that role.  I hope that my friends would feel comfortable calling on me in an emergency to help them cope with labor discomfort as a doula.  All of this also makes me want to stock pile emergency birth kits so I could be even more helpful to my friends and neighbors in a disaster.  And maybe I’ll start giving them away as baby shower gifts?  Oooh! :-)
  • Learn and practice labor-coping techniques.  Even if you’re planning a hospital birth with an epidural, it’s always a good idea to be prepared to get through childbirth on your own.  Whether an epidural is inaccessible because you’re stranded in a disaster situation, because the hospital anesthesiologist is unavailable, or it is placed but unexpectedly fails to work for you, you’ll be glad you were prepared to cope.  In addition, many of the techniques used to ease labor discomfort would also help you to stay calm in a disaster situation (deep breathing, relaxation, meditation, etc.).
  • Get yourself a good baby carrier, if you don’t already have one, and keep it handy. (Or make one… it’s easy!)  If you are forced to flee during a disaster situation, you’re going to get extremely tired trying to carry your baby in your arms, and you’ll probably need your arms to carry other supplies.  Even if disaster never strikes, baby carriers are life-savers in so many other ways that you should get yourself one regardless.  I’d say they come second only to a pair of lactating breasts as far as their effectiveness in meeting the needs of moms and babies.
  • Ensure you’re equipped to feed your baby.  Breastfeeding mothers are able to easily “carry” their babies’ food, but bottle-feeding mothers will want to be sure to include formula in their emergency kits.  Breastfeeding mothers will also want to ensure that their emergency kits contain plenty of extra water and food to meet their breastmilk-making needs.
  • Prepare for a hospital transfer, if you’re planning a home birth.  Most couples planning home births have birth supplies handy and are equipped to handle giving birth without medical assistance, but what they may not have considered preparing themselves for is an emergency hospital transfer.  One of the requirements for ensuring that home birth is “as safe as hospital birth for low risk women” (as we home birth advocates proclaim it is) is having the ability to quickly and efficiently transfer to a medical facility if an emergency arises.  But just knowing how you will get to the nearest hospital isn’t the only precaution to consider.  This post by Sarah really opened my eyes to the importance of preparing in every way for an unexpected transfer.  For example, a hospital transfer bag can be packed in advance with clothes for mom and baby, diapers, and other essentials.  It’s also a good idea to have a list of emergency babysitters you could call on at a moment’s notice to care for your older children, thus freeing-up your partner to attend to you and your baby.  Some worry that planning for the possibility of a transfer will set them up for that very possibility, a self-fulfilling prophecy sort of thing.  I don’t think we have to dwell on the idea in order to be prepared.  Just like I have my 72-hour-kits sitting in a closet where 99% of the time I don’t even think about them, we can have our hospital transfer supplies/plans put away and forgotten but still ready if we need them.  Preparing ourselves in advance can help ensure that a hospital transfer is as smooth and fast as possible, with as little chaos and emotional trauma as possible.

Here’s a great website from the CDC: “Emergency Planning Tips If You’re Pregnant or Have Young Children.” And another from March of Dimes: “Prepare for disaster.” Also, Be sure to check out Rixa’s post with videos of resuscitating her baby after her third birth here. It was Rixa’s experience that prompted me to become trained in neonatal resuscitation in 2011.

Do you have any other emergency-preparedness tips for pregnant moms and babies?