Committee Opinion No. 726: Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care

Climate Change and Children's Health: Building a Healthy Future for Every Child

Observed changes in temperature, precipitation patterns, sea level, and extreme weather are destabilizing major determinants of human health. Children are at higher risk of climate-related health burdens than adults because of their unique behavior patterns; developing organ systems and physiology; greater exposure to air, food, and water contaminants per unit of body weight; and dependence on caregivers. Climate change harms children through numerous pathways, including air pollution, heat exposure, floods and hurricanes, food insecurity and nutrition, changing epidemiology of infections, and mental health harms. As the planet continues to warm, climate change's impacts will worsen, threatening to define the health and welfare of children at every stage of their lives. Children who already bear higher burden of disease because of living in low-wealth households and communities, lack of access to high quality education, and experiencing racism and other forms of unjust discrimination bear greater risk of suffering from climate change hazards. Climate change solutions, advanced through collaborative work of pediatricians, health systems, communities, corporations, and governments lead to immediate gains in child health and equity and build a foundation for generations of children to thrive. This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children's health.

Pregnancy and newborn health - heat impacts and emerging solutions

Evidence is accumulating, both in the US and abroad, of the apparent serious health impacts of various environmental exposures tied to climate change. High ambient temperature, or heat, is a worsening global health risk. Heat risk is affected by many factors such as the magnitude, duration, and timing of exposure - such as specific, critical windows during pregnancy. This article focuses on the association of heat with both adverse pregnancy and newborn health outcomes. Regarding pregnancy, studies link heat and preterm birth, low birth weight and stillbirth. Multiple potential mechanisms support the biological plausibility of these associations. Emerging evidence suggests that heat, via epigenetics, may affect maternal health far beyond pregnancy. For newborn health impacts, heat is associated with increased hospitalization, neurologic and gastrointestinal dysfunction, and infant death. Research gaps include the need to study neonates separately from children and determining the mechanisms linking heat to adverse outcomes. We also highlight disparate adverse reproductive health outcomes for communities of color and low income tied to disproportionate exposures to environmental stressors like heat. Finally, we summarize educational and clinical tool resources for clinicians, information for patients, and opportunities for near-term action using the precautionary principle framework.

Emergency Preparedness in Tennessee Women with a Recent Live Birth

OBJECTIVES

To assess emergency preparedness (EP) actions in women with a recent live birth.

METHODS

Weighted survey procedures were used to evaluate EP actions taken by women with a recent live birth responding to an EP question assessing eight preparedness actions as part of the 2016 Tennessee Pregnancy Risk Assessment and Monitoring System (PRAMS) survey. Factor analysis was used to group preparedness actions.

RESULTS

Overall, 82.7% [95% Confidence Interval (CI) 79.3%, 86.1%] of respondents reported any preparedness actions, with 51.8% (95% CI 47.2%, 56.4%) completing 1-4 actions. The most common actions were having supplies at home (63.0%; 95% CI 58.5%, 67.4%), an evacuation plan for children (48.5%; 95% CI 43.9%, 53.2%), supplies in another location (40.2%; 95% CI 35.6%, 44.7%), and a communication plan (39.7%; 95% CI 35.1%, 44.2%). Having personal evacuation plans (31.6%; 95% CI 27.3%, 36.0%) and copies of documents in alternate locations (29.3%; 95% CI 25.0%, 33.5%) were least common. Factor analysis yielded three factors: having plans, having copies of documents, and having supplies. Specific preparedness actions varied by education and income level.

CONCLUSIONS FOR PRACTICE

Most Tennessee women (about 8 in 10 women) with a recent live birth reported at least one EP action. A three-part EP question may be sufficient for assessing preparedness in this population. These findings highlight opportunities to improve public health education efforts around EP.

Counseling women of reproductive age about emergency preparedness - Provider attitudes and practices

We report healthcare provider attitudes and practices on emergency preparedness counseling for women of reproductive age (WRA), including pregnant, postpartum, and lactating women (PPLW), for disasters and weather emergencies. DocStyles is a web-based panel survey of primary healthcare providers in the United States. During March 17-May 17, 2021, obstetricians-gynecologists, family practitioners, internists, nurse practitioners, and physician assistants were asked about the importance of emergency preparedness counseling, level of confidence, frequency, barriers to providing counseling, and preferred resources to support counseling among WRA and PPLW. We calculated frequencies of provider attitudes and practices, and prevalence ratios with 95% CIs for questions with binary responses. Among 1503 respondents (family practitioners (33%), internists (34%), obstetrician-gynecologists (17%), nurse practitioners (8%), and physician assistants (8%)), 77% thought emergency preparedness was important, and 88% thought counseling was necessary for patient health and safety. However, 45% of respondents did not feel confident providing emergency preparedness counseling, and most (70%) had never talked to PPLW about this topic. Respondents cited not having time during clinical visits (48%) and lack of knowledge (34%) as barriers to providing counseling. Most respondents (79%) stated they would use emergency preparedness educational materials for WRA, and 60% said they were willing to take an emergency preparedness training. Healthcare providers have opportunities to provide emergency preparedness counseling; however, many have not, noting lack of time and knowledge as barriers. Emergency preparedness resources combined with training may improve healthcare provider confidence and increase delivery of emergency preparedness counseling.

Experiences of pregnant women exposed to Hurricanes Irma and Maria in the US Virgin Islands: a qualitative study

INTRODUCTION

Hurricanes Irma and Maria made landfall in the US Virgin Islands (USVI) in 2017. To date, there is no published literature available on the experiences of pregnant women in the USVI exposed to these hurricanes. Understanding how hurricanes affect pregnant women is key to developing and executing targeted hurricane preparedness and response policies. The purpose of this study was to explore the experiences of pregnancy and birth among women in the USVI exposed to Hurricanes Irma and Maria.

METHODS

We employed a qualitative descriptive methodology to guide sampling, data collection, and analysis. Semi-structured interviews of 30-60 min in length were conducted with a purposive sample of women (N = 18) in the USVI who were pregnant during or became pregnant within two months after the hurricanes. Interviews were transcribed verbatim and data managed in MAXQDA. Team members developed a codebook, applied codes for content, and reconciled discrepancies. We thematically categorized text according to a socioecological conceptual framework of risk and resilience for maternal-neonatal health following hurricane exposure.

RESULTS

Women's experiences were organized into two main categories (risk and resilience). We identified the following themes related to risk at 3 socioecological levels including: (1) individual: changes in food access (We had to go without) and stress (I was supposed to be relaxing); (2) household/community: diminished psychosocial support (Everyone was dealing with their own things) and the presence of physical/environmental hazards (I was really scared); and (3) maternity system: compromised care capacity (The hospital was condemned). The themes related to resilience included: (1) individual: personal coping strategies (Being calm); (2) household/community: mutual psychosocial and tangible support (We shared our resources); and (3) the maternity system: continuity of high-quality care (On top of their game).

CONCLUSIONS

A socioecological approach provides a useful framework to understand how risk and resilience influence the experience of maternal hurricane exposure. As the frequency of the most intense hurricanes is expected to increase, clinicians, governments, and health systems should work collaboratively to implement hurricane preparedness and response plans that address pregnant women's unique needs and promote optimal maternal-infant health.

Early Perinatal Workforce Adaptations to the COVID-19 Pandemic

The objective of this study was to describe the system's initial pandemic response from the perspectives of perinatal health workers and to identify opportunities for improved future preparedness. An exploratory survey was designed to identify perinatal practice changes and workforce challenges during the initial weeks of the COVID-19 pandemic. The survey included baseline data collection and weekly surveys. A total of 181 nurses, midwives, and physicians completed the baseline survey; 84% completed at least 1 weekly survey. Multiple practice changes were reported. About half of respondents (50.8%) felt the changes protected patients, but fewer (33.7%) felt the changes protected themselves. Most respondents providing out-of-hospital birth services (91.4%) reported increased requests for transfer to out-of-hospital birth. Reports of shortages of personnel and supplies occurred as early as the week ending March 23 and were reported by at least 10% of respondents through April 27. Shortages were reported by as many as 38.7% (personal protective equipment), 36.8% (supplies), and 18.5% (personnel) of respondents. This study identified several opportunities to improve the pandemic response. Evaluation of practice changes and timing of supply shortages reported during this emergency can be used to prepare evidence-based recommendations for the next pandemic.

Practice Modification for Pandemics: A Model for Surge Planning in Obstetrics

This review highlights proposed pandemic-adjusted modifications in obstetric care, with discussion of risks and benefits based on available evidence. We suggest best practices for balancing community-mitigation efforts with appropriate care of obstetric patients.

Consolidation of obstetric services in a public health emergency

Though much of routine healthcare pauses in a public health emergency, childbirth continues uninterrupted. Crises like COVID-19 put incredible strains on healthcare systems and require strategic planning, flexible adaptability, clear communication, and judicious resource allocation. Experiences from obstetric units affected by COVID-19 highlight the importance of developing new teams and workflows to ensure patient and healthcare worker safety. Additionally, adapting a strategy that combines units and staff from different areas and hospitals can allow for synergistic opportunities to provision care appropriately to manage a structure and workforce at maximum capacity.

Psychological impact of infectious disease outbreaks on pregnant women: rapid evidence review

Objectives

Infectious disease outbreaks can be distressing for everyone, especially those deemed to be particularly vulnerable such as pregnant women, who have been named a high-risk group in the current COVID-19 pandemic. This paper aimed to summarise existing literature on the psychological impact of infectious disease outbreaks on women who were pregnant at the time of the outbreak.

Study design

The design of this study is a rapid review.

Methods

Five databases were searched for relevant literature, and main findings were extracted.

Results

Thirteen articles were included in the review. The following themes were identified: negative emotional states; living with uncertainty; concerns about infection; concerns about and uptake of prophylaxis or treatment; disrupted routines; non-pharmaceutical protective behaviours; social support; financial and occupational concerns; disrupted expectations of birth, prenatal care and postnatal care and sources of information.

Conclusions

Pregnant women have unique needs during infectious disease outbreaks and could benefit from up-to-date, consistent information and guidance; appropriate support and advice from healthcare professionals, particularly with regards to the risks and benefits of prophylaxis and treatment; virtual support groups and designating locations or staff specifically for pregnant women.

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Pregnant women may be particularly susceptible to distress during pandemics.

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Infection fears and prophylaxis concerns may exacerbate distress.

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Disrupted routines, financial concerns and uncertainty are also stressors.

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Disrupted expectations of birth and related healthcare may be distressing.

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Pregnant women may benefit from clear information/guidance and support groups.

Management of neonates after postpartum discharge and all children in the ambulatory setting during the coronavirus disease 2019 (COVID-19) pandemic

PURPOSE OF REVIEW

The present coronavirus disease 2019 (COVID-19) pandemic has created additional challenges with an increased number of presumed healthy, full-term newborns being discharged at 24 h after delivery. Short lengths of stay raise the possibility of mother-infant dyads being less ready for discharge, defined as at least one of the three informants (i.e., mother, pediatrician, and obstetrician) believing that either the mother and/or infant should stay longer than the proposed time of discharge. This public health crisis has reduced the number of in-person well child visits, negatively impacting vaccine receipt, and anticipatory guidance.

RECENT FINDINGS

Extra precautions should be taken during the transition period between postpartum discharge and follow-up in the ambulatory setting to ensure the safety of all patients and practice team members. This should include restructuring office flow by visit type and location, limiting in-person visits during well infant exams, instituting proper procedures for personal protective equipment and for cleaning of the office, expanding telehealth capabilities for care and education, and prioritizing universal vaccinations and routine well child screenings.

SUMMARY

Based on current limited evidence, this report provides guidance for the postdischarge management of newborns born to mothers with confirmed or suspected disease in the ambulatory setting as well as prioritizing universal immunizations and routine well child screenings during the COVID-19 pandemic.

When Disaster Strikes in Rural America-Call the Midwife!

Midwives can play a critical role in emergency preparedness and response. Rural areas have unique disaster preparedness needs but receive less attention than urban centers. Childbearing women and infants are particularly affected during disasters. Midwives are well positioned to coordinate disaster preparedness training and response to optimize the health of women and infants in rural areas.

Ranking Hospitals Based on the Disasters Preparedness Using the TOPSIS Technique in Western Iran

BACKGROUND

Considering the uncontrollable occurrence of unexpected events and disasters around the world and Iran, paying attention to the readiness of hospitals, as the most important place to provide health care services, before occurring disasters is necessary and the identification of hospitals with low preparedness is very important. The present study aimed to rank hospitals based on the level of their preparedness for disasters using the TOPSIS technique.

MATERIALS AND METHODS

This was a cross-sectional and descriptive study conducted in the first half of 2018 to assess the preparedness of hospitals in Ahwaz for unexpected events. In this study, all hospitals affiliated to Ahwaz University of Medical Sciences (8 hospitals) were reviewed. The required data were collected using a standard questionnaire assessing the level of hospital preparedness in terms of structural preparedness (3 indicators), nonstructural preparedness (2 indicators), functional preparedness (13 indicators) and human resources (3 indicators) dimensions. The collected data were analyzed using the TOPSIS technique.

RESULTS

The results showed that the structural (W = 0.4) and functional (W = 0.1) preparedness dimensions had the highest and lowest weights, respectively. Also, Hospital D (CL = 0.778) and Hospital A (CL = 0.224) had, respectively, obtained the first and last ranks.

CONCLUSION

Hospital managers need to get required information about disaster management and train their personnel in the emergencies and first aid by developing educational plans and ensure their active participation at the time of disasters through increasing their knowledge about and skills in different fields of work. In the case of structural and nonstructural preparedness, the hospital buildings should be retrofitted by the technical office of the university and the safe places considered for evacuations should be visited and evaluated every 6 months. It is also necessary to have all the hospitals equipped with the Emergency Operations Center (EOC) and to review its functions and activities regularly.

Emergency Preparedness in Obstetrics: Meeting Unexpected Key Challenges

Large-scale natural or environmental disasters, infectious disease outbreaks, and terrorist attacks are becoming increasingly common in developed countries. In response to these local, national, and international tragedies, many healthcare systems have developed hospital preparedness programs to manage catastrophic disasters while maintaining essential patient care. However, emergency preparedness initiatives that specifically address the unique needs of pregnant women are lacking. The purpose of this article is to identify challenges that impact perinatal patients during disasters and provide strategies and recommendations for emergency preparedness. Specific emphasis is placed on perinatal emergency preparedness including obstetric triage, surge capacity, sheltering in place, trauma in pregnancy, mental health, and management of special pathogens. Guidance to hospitals on the immediate evaluation, stabilization, acute management, and transfer of pregnant patients and neonates following these events is provided.