Hurricane Birth Plan: How Pregnant and Postpartum Women Can Prepare for Hurricane Season

Hurricanes are a reality for everyone living in Houston, but they represent a particular threat to pregnant women. With the Atlantic hurricane season lasting six months, there's a chance the due date falls around the time a storm is looming in the Gulf.

There's no shortage of general guidance about hurricane preparedness, of course, but pregnant women and their families require extra prep to help prevent a storm from disrupting their care — a hurricane birth plan.

We spoke with Dr. Fatima Syed, an OB-GYN with Houston Methodist (and native Houstonian), about the considerations pregnant and postpartum women should make to get through hurricane season safely.

What risks do hurricanes pose to pregnant women and babies?

"Studies show that because of the stress, disrupted health care services and environmental hazards they cause, hurricanes and other big natural disasters are associated with adverse pregnancy and birth outcomes," Dr. Syed says. "That includes increased levels of preterm birth, low birth weight, small for gestational age fetuses and increased neonatal intensive care unit (NICU) admissions."

Specific studies have been conducted about the effects of storms in the Houston area on pregnant mothers and children, including one that focused on preterm and early-term births during Hurricane Harvey or within the following weeks.

The study showed no association between spontaneous preterm births within one week of the hurricane but 14% higher odds of spontaneous early-term birth. A preterm birth is when delivery occurs before 37 weeks of gestation, while an early-term birth is when delivery occurs between 37 and 38 weeks and six days.

Another study evaluated the association between maternal and neonatal morbidity and Hurricane Harvey. The study indicated that exposure to the hurricane showed a 27% increase in maternal morbidity, and neonatal morbidity increased by 50% compared to a cohort of Houston-area births without hurricane exposure.

How to plan for hurricane season if you're pregnant or postpartum

The Atlantic hurricane season begins on June 1 and lasts until November 30, with named storms most likely to strike between mid-August and mid-October. But one recent exception occurred last July, when Houston was hit by Hurricane Beryl, which reached Category 5 intensity two weeks earlier in the Atlantic season than any previous storm on record, according to Space City Weather. This is why the Federal Emergency Management Agency (FEMA), state and local governments recommend hurricane preparedness measures for the entire season.

Even if a hurricane doesn't hit around the due date, there's a good chance that some or all of a pregnancy can overlap with hurricane season, given that the average pregnancy lasts 40 weeks and hurricane season is 26 weeks. Dr. Syed says taking some proactive steps can help prevent women and families from having their care disrupted during an emergency situation.

Include items for an emergency birth as part of your overall first-aid kit

Storm prep will include much of the same guidance for pregnant women and their families, including having a storm radio, stocked hurricane pantry and water. Storms can create barriers to getting care — flooding can make roads impassable even for emergency services, or hospitals may be working under emergency conditions and overcapacity — so expectant parents will want to keep extra items on hand for their first-aid kit just in case.

As part of any emergency preparedness kit, the American College of Obstetricians and Gynecologists (ACOG) recommends stocking tools to help with an emergency birth. This can help women be prepared if they cannot get to a hospital or emergency services cannot reach them.

An emergency birth kit should include the following:

• Ten blue pads (often called "bed pads" or "chucks")
• One plastic peri bottle
• One newborn hat
• Six packs of lubricant jelly
• Four gloves, sterile surgical pairs
• Two plastic newborn cord clamps or cord ties
• Scissors
• Twelve alcohol prep pads, individually wrapped
• A dozen sanitary pads
• A dozen sterile gauze pads
• A bulb syringe
• A bottle of sterile water
• Neonatal thermometer
• Ten newborn diapers
• 1-2 newborn blankets
• Battery-powered radio with extra batteries

If you need to evacuate for a storm, this emergency birth kit should be part of your emergency supply "go bag" in case you need it in transit.

Keep track of your medical records

Telecommunications infrastructure, including cell towers, can be seriously impacted by a hurricane. In many climate emergencies, communications may be among the first services affected. Our phones connect us not only to our family and friends but also to critical information such as our financial and medical information. Should cell service be down, how can you access this information?

As old-school as it sounds, keeping paper records of your prenatal (and any postnatal) care may help if you evacuate or there are widespread telecommunications outages.

"It certainly depends on the health care system where you're seeking care, but, luckily, our patients at Houston Methodist will have access to MyChart, which has a very comprehensive record of everything that would be important for another OB provider to pick up where we left off," Dr. Syed says. "That includes a list of all their prenatal care labs, the important ultrasound and their vitals. They would also have access to any notes their OB-GYN at Methodist has written."

Should you evacuate and need care, you should be able to share your MyChart medical record whether or not the hospital uses Epic, the health care software system that powers MyChart.

"I think that having their MyChart records would probably be sufficient, but if they want to be extra prepared, I think there is utility in having some of that information printed out," Dr. Syed says. "I would say after every OB-GYN visit, get into the habit of printing out those records and doctor's notes. That way, you have a growing record at home that you can pick up and evacuate with if you need to."

Have a detailed evacuation plan (that includes an alternative birth location)

Depending on the severity of a hurricane, evacuation may be necessary. Local officials may order evacuations, or individuals may choose to evacuate to avoid the dangers of a storm and its aftermath.

Dr. Syed says pregnant women should always follow evacuation orders as directed by local emergency officials and weigh the risks and benefits of a voluntary evacuation if their ZIP code is not included in an evacuation area. Flood water can contain bacteria and pollutants that can be harmful to both mother and baby. If you live in a flood-prone area, consider evacuating.

"In general, if you have an idea that it's going to be a weaker storm, it might be to your benefit to stay close to your primary hospital so that your care isn't disrupted," Dr. Syed says. "For category 3 hurricanes, which are more severe storms and higher, I would at the very least have a contingency plan in place."

Dr. Syed says developing an evacuation plan for pregnant women will require additional research about the area where they will be traveling so that they can receive care if needed.

"For a natural disaster birth plan, I give the same advice I give my patients considering international travel late in the third trimester," Dr. Syed says. "You should have a list of emergency contacts on hand. You should identify the nearest hospitals in the area you're traveling to, and ideally, you want a hospital that has OB and NICU services, especially if there's any increased risk for early birth. Plus, you need to make sure that you have a ready supply of any medications you need."

Additionally, Dr. Syed says this hurricane birth plan should include:

• Identifying a safe place to evacuate: The critical first step is to have a place to go, whether a family member or friend's home or a pre-designated shelter.
• Identifying a hospital near your evacuation site: Use your health insurance plan's care finder to identify a hospital or OB-GYN in that area. If you have a high-risk pregnancy, look for maternal-fetal medicine specialists in the area.
• Knowing how you will evacuate: Identify reliable transportation and know the evacuation routes (having paper maps in your go bag can help).
• Having reliable transportation at your evacuation location: It is critical to make sure you have a way to and from the hospital you identify at your evacuation location in case you need medical attention.
• Having a ready supply of any medications: Dr. Syed recommends talking to your OB-GYN before any storm (or travel) to get necessary refills for essential medications so that your care is uninterrupted. You should have two weeks' worth of any prescriptions and/or prenatal vitamins on hand.

Hurricane preparedness for postpartum women and families

Emergency preparedness guidance for women in the postpartum period is similar, with key distinctions for child care. They need access to necessary supplies as part of a regular emergency kit and to aid in their recovery and childcare while in transit or sheltering in place.

Have tools on hand to safely feed your infant

"Breastfeeding women need to have access to several pumps, especially pumps that are battery operated or have a hand pump," Dr. Syed says. "Postpartum women will also need to have access to any medications that they or their child will need. And similar to pregnant women, they should identify a hospital, ideally with OB services, as part of their evacuation plan."

Breast milk, naturally sterile, can be readily available and is the preferred option for children aged six months and younger according to the American Academy of Pediatrics (AAP). Pumped milk can last close to eight days refrigerated, and previously frozen milk can last about 24 hours in a refrigerator. Breast milk, formula and baby food need to be temperature-controlled and stay below 41 degrees to prevent bacterial growth — keep this in mind if you're using a cooler during evacuation or sheltering in place.

Ready-to-feed (RTF) formula is recommended for hurricane kits as no water is needed to prepare it. Having disposable cups on hand may also help conserve bottled water for consumption rather than cleaning dishes. If you only have powdered formula, make sure to only use bottled water or boiled water that has cooled to prepare it. Likewise, all nipples and bottles must be cleaned using sterile water.

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Have a support system

To say that the "fourth trimester" can be challenging for women as they navigate parenthood and the changes to their bodies might be an understatement. Dr. Syed says that another part of hurricane preparedness for postpartum women should include a support system. Do you have family you can shelter in place with? Can you evacuate to a family member or friend's home? Having people around to help postpartum women, including giving them breaks to get adequate rest, can help ease the stress of dealing with a natural disaster on top of childcare.

"We know that there are adverse maternal and fetal health outcomes in these big storms because of destruction to health care and increased stress levels," Dr. Syed says. "The postpartum state already comes with a lot of big hormonal changes, mood changes and stress, and so those scenarios combined can potentially be very disastrous. So it is very, very important for women to make sure that they have a contingency plan in place that includes what their maternal health support system is going to look like as well."

Plan ahead to ease stress

It's OK if a tropical storm or hurricane in the weather forecast scares you. As a native Houstonian, Dr. Syed says we can become numb to the threat of these storms. However, preparedness is often the most significant antidote to the stress or fear that can accompany hurricane season

"It's never a bad idea to be overly prepared," Dr. Syed says. "The more you think through the possible scenarios, the less anxious you'll be. Maintaining an open line of communication with your OB-GYN is key, so they can be part of helping build that plan for you. It is really important for pregnant and postpartum women to be diligent about any severe weather changes because you can't be someone that plans last minute."