Know your neighbors and their professions.  Chances are there are nurses, doctors, midwives, doulas, and childbirth educators living within walking distance of your home.
When it comes to emergency preparedness, most people I talk to think that nothing will ever happen to them- I constantly hear “why should I bother”. As a father of 3 small children, I have always tried to protect and provide for all their immediate and future necessities. These pregnancy morbidities can be prevented by developing an emergency plan that addresses them. Although a "one-size fits all" emergency plan is difficult to apply to all disasters, there are common distresses experienced by all pregnant women regardless of the nature of the disaster.
Obstetric care at a designated facility is ideal, and it is the role of public health officials in an area to designate and equip obstetric care facilities, publicize which facilities in a given area will offer obstetric services, identify alternative safe delivery sites, and arrange for the staffing of the facilities. Providing contraception for postpartum and nonpregnant women during a disaster is also important to prevent unintended pregnancies.
La Leche League International, "When an Emergency Strikes Breastfeeding Can Save Lives, Part 2," media release, September 1, 2005. As providers of women's health care, the involvement of the obstetrician–gynecologist in disaster response is essential (see box, "Physician Guide to Emergency Preparedness for Women and Infants"). Contraception should be provided in the form of emergency contraception as well as prophylactic contraception.
The United Nations Refugee Agency, in developing guidelines for prevention and response to sexual violence against refugees, has identified some contributing circumstances: 1) male perpetrators' dominance over female victims, 2) psychologic strains in refugee camps, 3) absence of support systems for protection, 4) crowded facilities, 5) lack of physical protection, 6) general lawlessness, 7) alcohol and drug abuse, 8) politically motivated violence against refugees, and 9) single females separated from male family members (5). No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
To provide for a healthy pregnancy and delivery, pregnant women affected by disasters need to be assured of a continuation of prenatal care. However, when evacuation is not possible, the health care for women in the antepartum, intrapartum, and postpartum periods needs to be safely managed.
Ironically, these same circumstances existed among the Hurricane Katrina evacuees and were likely responsible for the many personal accounts of rape that occurred in evacuation shelters. Establishing safety, order, and the rule of law in shelters for disaster survivors is paramount to the protection of women from sexual assault. The document also contains instructions for managing an unexpected unassisted labor and delivery.
I can only imagine if during a natural disaster where the emergency crews were not so quick to respond what may have happened.
Establishing and maintaining lactation before, during, and after a disaster is important for infant nutrition. As a result, in 2005 and 2006 the National Working Group for Women and Infant Needs in Emergencies in the United States extensively reviewed most U.S.


To prepare, clinicians should make pregnant women who reside in locations subject to seasonal or frequent environmental emergencies aware of the availability of emergency birth kits (see box, "Emergency Birth Kits for Patients").
For example, during Hurricane Katrina, many critically ill hospitalized infants were transported to medical facilities outside of New Orleans without their mothers. 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.
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. I will likely use it for reference for an article for my blog, and will send a link your way to credit the source.
During a disaster, women who are not breastfeeding may have difficulty in providing food for their newborns.
Women and Infants Services Package (WISP), from the National Working Group for Women and Infant Needs in Emergencies, White Ribbon Alliance. 8921 - 'The Essential Survival Guide to Medical Preparedness' by Julie Behling-Hovdal with Rebecca Potter and Col. Pregnant women should be encouraged to develop evacuation plans in the event there is enough forewarning to allow for evacuation. Emergency preparedness is essential to maintaining healthy pregnancies and ensuring good outcomes for pregnant women and their infants who endure disasters.
Department of Health and Human Services, was developed to address hospital preparedness for bioterrorism, natural disasters, and epidemics. The health care system may become inundated with other health emergencies, which could decrease the resources available to pregnant women.
However, if evacuation is not possible, identifying local health care facilities that can provide obstetric care, discussing the availability of emergency birth kits, and emphasizing the importance of lactation are key steps to facing the many challenges of a disaster that are unique to pregnant women. For mothers who are less than 6 months postpartum, even if they have not previously established lactation, relactation can be established and should be encouraged (8).
State and local governments should establish local facilities where prenatal care and obstetric services can be provided for those women unable to evacuate. For those mothers who choose not to begin relactation or are beyond the 6-month period, ready-to-feed infant formula in a single-serving bottle should be provided. The obstetrician–gynecologist has a unique role in developing and carrying out an emergency preparedness plan that addresses the safety and medical needs of women in the event of bioterrorism, natural disasters, and epidemics. American Red Cross, "Preparedness Fast Facts: Emergency-Specific Preparedness Information".
The Essential Survival Guide to Medical Preparedness is an easy, step-by-step guide to handling injury, infectious disease, chronic illness, pregnancy, childbirth, sanitation, personal hygiene, mental health, and more with essential oils, herbs, basic medic skills, basic reflexology and acupressures, and a healthy lifestyle using food storage. For women who are using reversible contraception in the form of pills, the ring, or the patch, these prescription medications should be provided to enable these women to maintain their current form of birth control.


Requests for authorization to make photocopies should be directed to: Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400. In the event that sexual violence does occur, appropriate and sensitive services should be available to victims, including emergency contraception and sexual assault forensic examiners or sexual assault nurse examiners. Women involved in disasters are also at an increased risk for sexual assault and should be provided a safe and secure environment in evacuation shelters. The separation of mothers and their infants can interfere with breastfeeding as well as create additional stress for the mothers. We have grown up in the age of consumerism and take for granted there will always be food on the shelves.
Not only does the health care system become overwhelmed with medical emergencies but it also can be disrupted. Women's health care providers are needed to advise, assist, and support public health authorities in planning for and serving during a disaster. In addition to emergency contraception, sexual assault forensic examiners or sexual assault nurse examiners should be available for victims of sexual assault.
Also, health care providers of prenatal care should increase patients' awareness of the signs of preterm labor and other obstetric emergencies and the action to take in the event of these emergencies. Although great strides have been made in improving the health care system in preparation for disasters, the Evaluation Report from the Hospital Preparedness Program released in March 2009, reveals hospitals in the United States are not currently prepared for a major disaster (1).
Decreasing the number of unintended pregnancies can be achieved by providing both prophylactic and emergency contraception.
After Hurricane Katrina, the Centers for Disease Control and Prevention found that the 14 Federal Emergency Management Agency designated counties and parishes affected by the hurricane had a significant increase in the number of women who received late or no prenatal care. When possible, emergency health care facilities should stock and dispense a variety of contraceptive products. This can be done at the local level through a hospital emergency preparedness committee or a community group attached to the fire department or police department and at the state level through the Department of Homeland Security.
The American Red Cross provides emergency preparedness checklists for specific disasters (7).
However, during a disaster, there may not be access to clean water for sterilization of bottles or access to formula. Providing condoms allows for the prevention of not only unintended pregnancies but also decreases the transmission of sexually transmitted diseases. The Centers for Disease Control and Prevention offers information and resources for mental health care during and after disasters.



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