Pregnant women, neonates, infants and children have unique needs, particularly in times of disaster. Women experience greater rates of health complications associated with pregnancy, including premature labor and births, low birthweight infants, and neonatal and infant deaths. Approximately 99 percent all births in the United States occur in a hospital setting. In times of disaster, those facilities may not be available and/or accessible. Specially trained professionals and necessary supplies to provide care for this population may not be available. Without access to appropriate supports and emergency medical services in the antepartal, intrapartal and postpartum period, there is a possibility of both short-term and long-term negative outcomes with increased mortality and morbidity.
During an emergency, stress is increased tremendously which can significantly impact pregnant women. This, in conjunction with a lack of proper nutrition and fluids, can result in premature labor and delivery if not addressed. Pregnant women need access to skilled professionals for proper assessment and methods for hydration (including intravenous hydration) as well as tocolytics as needed. Appropriate supplies must be assembled into emergency kits to enhance professionals’ ability to assess maternal, fetal and neonatal status, proceed with appropriate treatment measures, deliver infants as needed and properly treat postpartum women and normal and high-risk neonates. All newborns must have access to a dry, clean, warm environment to promote thermoregulation and access to medication, equipments, supplies and professional expertise to address issues such as respiratory distress syndrome that may result form prematurity. Medications and supplies must be readily available to treat pregnancy-related and chronic health issues of pregnant women such as medications for essential and pregnancy induced hypertension, diabetes and postpartum hemorrhage.
Facilities must be available to perform emergency surgery as needed, such as emergency Cesarean Sections and intervention for postpartum hemorrhage. The treatment of women and children can also be complicated by the lack of access to medical records and basic provisions such as diapers, formula, baby bottles and clothing. Staff with the ability to assist new mothers in breastfeeding is imperative since there may be little access to infant formula.
The stress of the disaster may be compounded by the separation of mothers and neonates, infants and children. All measures must be taken to ensure whenever possible that mothers and children are evacuated to the same location or a method is developed to promote communication so families are aware of where their family members are located and are reunited as soon as reasonably possible.
Although a priority of professionals will be immediate health care issues, mental health resources are imperative for women and children. Approximately 1 out of every 8 women experiences perinatal depression, which is exacerbated tremendously by a disaster.
Women also need to have ready access to methods of birth control. The availability of condoms is essential for birth control as well as protection of sexually transmitted infections. Women and children may be especially vulnerable to sexual violence during disasters where chaos overtakes law and order. Sexual violence may become more prevalent, or women and children may be coerced into sex for basic needs such as food and safety.
The public health impact of disasters, especially in times when appropriate resources are not available, will have significant short-term as well as long-term impact.