The night Hurricane Jeanne hit in September 2004, Kisha Hartman stayed up all night, staring anxiously out her window at the ominous green lights bursting over the highway — transformers exploding in the distance. It was the third major storm to hit her Lakeland, Fla., home in six weeks. Eight months pregnant, she had already experienced weeks of power outages after Hurricanes Charley and Frances hit in close succession.

The night “Mean Jeanne” came to town, Hartman looked out at the dark, rubbing her belly and listening on her shower radio to the local weatherman who had for weeks been her only lifeline. Throughout the night she heard loud thuds. Hartman, now 49, assumed they were branches tumbling down. In the morning, she discovered they were actually whole trees.

But the worst was yet to come. Hartman and her husband were uninsured — not so poor that they qualified for assistance, she said, but they didn’t make enough to stock up on supplies and leave town.

In the weeks that followed the back-to-back storms, Hartman and her husband scrounged together cash to pay for jars of peanut butter and cans of tuna at whatever stores still had goods to sell. They waited in line at a church where they could get bags of ice, powdered milk and three hot meals a day.

And then there was the blistering, late-summer Florida heat. All she could do was lie down and sweat, she said.

The day the power came back on, Hartman’s water broke as she bent over to pick up a load of laundry. Her baby girl was due Nov. 14; she was born on Oct. 3. Because Hartman’s baby had not yet turned over in the womb, doctors performed an emergency Caesarean section. Later, a doctor told Hartman she was severely dehydrated the day she went into labor.

Hartman believes the stress from the back-to-back disasters led to her premature delivery. When Jeanne hit, she said, “I think my body just had enough.”

Watching news of Hurricane Ida this week, Hartman, who now lives in Tennessee, vividly remembered the helplessness and desperation she felt driving around with her hand on her belly.

She especially worries about those who are pregnant and navigating disaster. As these kinds of catastrophes become more frequent, experts say, expectant parents, providers and policymakers need to be more aware of the adverse effects they have on pregnancies.

Almost any stressor will have more of an impact on pregnant people, said Nathaniel DeNicola, an OB/GYN with the Johns Hopkins Health System. This is true of natural disasters, which he said have been a growing concern for health-care providers as more places in the country experience these kinds of traumatic events.

In Louisiana, Ida forced at least three hospitals, already overwhelmed by a surge of covid-19 cases, to evacuate patients. Because of how quickly the storm developed, residents of New Orleans had to scramble at the last minute to leave the city — city officials had not ordered an evacuation ahead of time.

On Sunday night, the Category 4 hurricane left 1 million households without power. Its damage wasn’t limited to Gulf Coast states: The storm’s remnants battered New York and New Jersey on Wednesday night, shutting down travel in New York City and leaving at least 17 people in the region dead.

DeNicola noted that pregnant people face specific challenges in these situations. They are more at risk from dehydration and needing go to the emergency room. And because a mom’s physiology is “directing a lot of resources to developing a baby,” DeNicola said, her immune system is weaker. In the case of a massive storm, this makes pregnant people more at risk for the vector-borne illnesses that can come with floodwater.

Then there’s loss of resources and infrastructure that come with natural disasters: a lack of electricity, extreme heat, taxed medical systems and housing insecurity.

These conditions during a disaster and recovery period are taxing for pregnant people, as well as new parents and infants. A hospital’s newborn intensive care unit may be shut down, requiring infants to be separated from their parents in some situations.

The challenges continue once the parent and child return home or to a shelter. Under normal conditions, a mother should be resting in the days and weeks after giving birth, but that’s challenging if you lack food, water, shelter and your typical network of caregivers. Breastfeeding also becomes more difficult without refrigerators to store milk, and intense heat can have adverse health effects on parents and babies, DeNicola said.

“You have to anticipate days or weeks without access to resources,” DeNicola said. “It’s a lot to put on a mom, because she already is managing a lot.”

Annekathryn Goodman, a Harvard professor and OB/GYN who has been part of emergency response teams in major disasters, pointed out that first responders don’t always have the proper training to care for a pregnant person in distress. In Haiti after the 2010 earthquake, for example, she saw medical teams “overreact” to pregnant people caught in rubble — including performing emergency C-sections.

Caesareans come with their own risks, including infection of the wound and the womb lining, which can lead to fever, increased pain and heavy vaginal discharge and bleeding. Babies born via C-section can also have health issues, such as difficulty breathing.

“Sometimes people will overreact and do interventions around the pregnancy,” Goodman said. “Like all you see is a belly and, in fact, you just have to take care of a leg.”

The indirect effects of natural disasters on pregnancy is still being explored, Goodman noted, and there is debate about whether the stress of a catastrophic event is related to increased infection or preterm births.

Even if you are able to evacuate a disaster zone, the effects of a natural disaster can last for weeks or months, disrupting vital care, experts say.

Madison Bonton, 25, was 12 weeks pregnant when Hurricane Laura hit Lake Charles, La., in August of last year. She safely evacuated to another part of Louisiana with her father, but when they returned to their home a week and a half later, there was no water or electricity.

She was displaced for three months after the storm. Her anxiety about her health and the health of her baby spiked after she went weeks without hearing from her from her doctor, she said, and for six or seven weeks she had no idea whether her baby was all right.

Finally, she drove to Texas, where her fiance was and where she knew an OB/GYN who could see her.

She “cried like a baby,” she said, when she got to her appointment and heard the baby’s heartbeat for the first time. Finally, she received confirmation that her baby was okay. Months later, Bonton returned to Lake Charles to give birth to her son, Noah.

In a natural disaster, there are things individuals can do to help prepare themselves for massive disruptions. DeNicola suggested preparing a “go bag.” Under normal circumstances, this is the bag a pregnant parent will have on hand in case they suddenly go into labor, but DeNicola recommends revamping it for disaster situations — pre-packing potable water, weeks’ worth of medications, and printed medical records in case digital files can’t be accessed.

The pandemic has also increased access to medical care in ways that can support pregnant people during disasters: More routine checkups, including the monitoring of fetal counts and blood pressure, are being done remotely. Visits can also be done with doctors outside of your home state — an important change for evacuees, who often have to cross state lines to seek shelter.

But to pack a go bag or access telehealth, you need resources — enough money to stock up on supplies and broadband Internet or cellphone service. Caring for pregnant people without these resources is a major concern for doctors, DeNicola said.

He noted that people with lower incomes and less access to medical care tend to live in areas that are the most affected by climate disasters, such as “heat islands” where temperatures are hotter than surrounding areas and flood-prone communities. In those places, the health issues quickly begin compounding, especially when disaster strikes.

And natural disasters are happening with greater frequency, and in more places, DeNicola noted.

Wildfire season in California is now year-round, he said, heat waves are getting worse and once-in-a-lifetime superstorms now seem to happen every year. Doctors need to start incorporating these environmental factors into their consultations with patients, DeNicola said, such as OB/GYNs warning pregnant people about inhaling particle pollution during wildfires or drinking contaminated water during floods.

But there’s only so much individual doctors and patients can do, he added. DeNicola wants to see more people lobbying for systemic changes — such as the Protecting Moms and Babies Against Climate Change Act, introduced in the House and the Senate this year.

The bill — part of the “Black Maternal Health Momnibus” effort — would fund training programs, create a Consortium on Birth and Climate Change Research within the National Institutes of Health and charge the Centers for Disease Control and Prevention with identifying areas for that are high-risk for birthing parents because of climate change.

Hartman, still rattled by the slew of hurricanes she experienced in 2004, has been trying to stay off social media this week. “I can’t stand the judgment,” she said, referring to those saying that people who stayed during Ida should have known better.

Hartman knows that something as simple as prepping a go bag is extremely difficult when you’re living paycheck to paycheck.

The same people who can have weeks of medication, water and dry food on hand are the same people who are going to be prepared to evacuate, she said.

In 2004, Hartman almost bled out during her C-section, but her daughter, Molly, was born healthy and did not have to go to the NICU. She went home four days later; it took three weeks for her to fully recover, she said.

The experience was so traumatic that when she gave birth to her third child, Jase, in Tennessee, she wrote goodbye letters to her children in case she didn’t make it. Molly is 16 now, a soccer player. Her eldest daughter, Kate, is 27 and still lives in Lakeland.

The last time a hurricane passed through Lakeland was 2017. With her daughter still living in the area, the memories and anxieties from 2004 came surging back.

“Evacuation is a luxury. People don’t realize this,” Hartman said. “No pregnant woman would stay if they had a choice. There’s not much choice for a lot of people.”

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