In the days leading up to Hurricane Harvey, I found myself having disaster preparedness conversation with my patients as part of their routine prenatal visits. Disasters, natural or man-made, disrupt people’s lives, families and the community. In addition, disasters affect access to your physician and medical services. Disasters also place an individual and their body under increased stress and may affect the health and outcome of pregnant women and their newborn. My biggest fear is of my patients delivering at home without assistance.
Have a conversation with your physician- This is the first step. Have a discussion with your physician regarding early signs of labor or preterm labor. These signs could include symptoms of regular cramping or painful regular contractions. Review the signs of pregnancy complications such as leaking of amniotic fluid, vaginal bleeding or decreased fetal movement. Develop an emergency plan with your doctor. Emergency plan could include: what to do in an emergency, how to contact your doctor, what to do in the event you cannot reach your doctor, getting to your hospital, and/or what to do if you cannot make it to the hospital.
Have an emergency plan with your family- It’s all well and good if you have an emergency plan, but it may be useless unless shared with your family. After discussing your emergency plan with your physician, it is a good idea to share with your family. Have copy of your Identification, medical insurance cards, cash, a list of emergency contacts and your doctor’s contact information. It is also important to make a backup plan to get to the hospital. You must also identify the closest hospital in your vicinity; this may not always be the hospital where your doctor delivers. Your emergency plan should also include keeping emergency supplies in your home to meet your needs and that of your family for at least 3 days. Emergency supplies to consider are: water, non-perishable foods, personal care items, baby care items, first aid kit, clean towels, gloves, sanitary pads, baby clothing and instruction for infant CPR.
Keep a copy of your prenatal records- It is important to keep a copy of your prenatal record with you during a disaster. This medical record should be among your important emergency supply ready “to go” items. Parental record can include your complete medical record, any pregnancy complications, ultrasound records and consult notations if a part of the record. Keep your doctor’s contact information with you at all times. You may want to consider adding it to your cellular phone and keeping it in writing. This record is important in the event you deliver at a facility not accessible to your physician or are delivered by someone other than your physician.
Take all medications with you- Your medical records usually have a list of medications you are taking. However, it is extremely important that you take all your medication with you. It is important that you refill medication when a potential disaster is known, such as hurricanes or tropical storm. It is equally important to continue any medication regiment you may be taking. These items should be a part of your emergency “to go” bag.
Evacuation-Take every emergency or severe weather warning seriously. Tornadoes, flash floods or fire danger alerts may include instructions specific to your location. With these warnings sometimes come the need to evacuate quickly. You should have an already prepared emergency “to go” bag.
Infectious Disease Prevention- It is extremely important to refrain from standing in floodwaters. The risk of diseases increases with standing in contaminated floodwaters. Check the World Health Organization website for further information http://www.who.int/hac/techguidance/ems/flood_cds/en/
Emergency Birth- First, let me preface this by a disclaimer. I am a Board-Certified Obstetrician/Gynecologist, and I never advocate for home births. I have seen enough home births go wrong and have had to be the “clean up” physician in situations like that. However, we do know that a baby will come at any time. In the event of an imminent birth with no medical personnel in site, the family may have to assist in delivery. Have someone call 911 to get help headed toward you. Make sure they know the address where you are located. A woman in active labor will usually have regular, painful contractions that cause cervical change or dilation. It is important to stay calm, supportive and keep mom comfortable. You can place a towel under mom to catch fluid when her water breaks or for vaginal bleeding that occurs during labor. Once mom feels the urge to push she is most likely ready to deliver. The pushing stage can last for minutes or hours for a first-time mom. When the baby’s head is visible, stay calm and support and assist mom. Have mom place her hands behind her knees to help open up the pelvic space. As soon as the head is out, feel around the neck for the umbilical cord. If the cord is around the neck, gently lift it over the baby’s head. Once this is done, have mom push and the shoulders should come. Once the shoulders deliver the rest of the body should deliver quite easily. Once baby is delivered, place baby on mom’s bare chest immediately, wipe the baby dry and then cover with a dry towel and blankets to keep baby warm. If baby does not cry or breath easily, rub the baby’s back up and down firmly. If the baby is still not breathing, turn the baby over looking up at the ceiling and tilting the head back while rubbing the back. It is extremely important that moms and dads take infant CPR classes. In the event the baby still does not breathe, you may need to start CPR. A baby that is not having difficulty breathing will turn pink. It is normal for the hands and feet to remain blue-ish for a while. Tie the umbilical cord in two places. The first approximately 3-4 inches from the baby and the second 1 inch from the first. Cut the cord between the two tied spaces. An attempt at breastfeeding/latching should be done immediately. This in will cause mom’s natural oxytocin to help with placental delivery, uterine contraction, decrease bleeding after placental delivery and help keep baby warm and provide other benefits for baby. A placenta usually delivers a few minutes after delivery of the baby. I do not suggest pulling on the cord, but to let the placenta naturally come. This is usually signaled by a gush of blood and the cord noticeably becomes longer. Once the placenta is visible at the vagina, have mom push and remove the placenta. Normal bleeding is typically that of heavy cycle. Encourage the newborn to latch and nurse and await medical personnel. This is typically an unplanned medical emergency for families.
Benefits of my virtual practice- In situations such as these, I encourage the patient to contact their physician. Patients can reach me via my virtual practice http://www.rowedocs.com/sharonsmith/ in this instance and can be guided through the process via teleconference in the event of an emergent delivery at home during a disaster situation like we are currently faced with during Hurricane Harvey. Please visit www.rowedocs.com for a list of physicians offering virtual visits.
Author: Dr. Sharon Smith OBGYN