California Nurses Create Disaster Plans for Childbirth

Aug. 24--Robbie Prepas, a certified nurse-midwife, helped deliver five babies in the New Orleans airport during Hurricane Katrina.

Hoping never to experience anything similar in Orange County, Prepas is teaming up with another local nurse-midwife to educate the public about disaster preparation for mothers and infants.

If a severe flu outbreak hit Orange County, women in labor could be turned away from quarantined hospitals. Prepas and Lorri Walker want to let people know about alternatives to hospital births: birthing centers and home births. Currently 1 to 2 percent of babies are born at places other than hospitals. In a disaster, midwives and other medical personnel could deliver babies in offices, homes or businesses.

Prepas, who lives in Laguna Beach, has been a member of a federal Disaster Medical Assistance team for seven years and has been deployed to Afghanistan, Guam and New York City in addition to New Orleans. Lorri Walker owns South Coast Midwifery in Irvine.

The businesswomen are members of the newly formed Disaster Preparedness Committee of the American College of Nurse-Midwives.

QUESTION: Why should people be worried about pregnant women in a natural disaster or flu pandemic?

Prepas: The last thing you want is a healthy mother and baby to be in a hospital during a pandemic flu. We need to talk about emergency preparations for birth. How are we going to take care of newborns? How are we going to vaccinate newborns? There's going to be pandemonium in terms of moms scrambling. That's why I like the idea of trailers in front of community centers that are equipped for births.

Walker: If there is another disaster (like Katrina), pregnant women are going to be the last ones on the agenda of the triage. The mothers and the children would have to fend for themselves.

Q: What happened during the hurricane?

Prepas: When we were in Katrina there was nobody to take care of these women. They delivered in the airport. They didn't have equipment. They didn't have clothes. We had no supplies for those infants. I felt like if anything happened to those babies I'd never deliver another baby. My goal is to get midwives on every DMAT (disaster medical assistance team) in the United States. The ultimate goal would be to reduce neonatal and maternal mortality.

Q: What about after the hurricane? What about funding?

Prepas: They kept talking about disaster preparedness. Nobody was talking about mothers, babies and infants. There's no money going into disaster preparedness for mothers and babies. Why is there not millions of dollars in funding for mothers and children? One year later, we're completely unprepared. We want to formulate resources and guidelines for hospitals, doctors, midwives, nurses, paramedics. People on our committee want to develop training materials that other providers can use.

Q: What do you want people to know about their birthing options?

Prepas: This gives us an opportunity to legitimize home births and birth centers. It's a resource for the community that's not well-used. There's been such poor acceptance in the United States. This is an opportunity of a lifetime for our organization.

Walker: If there was an emergency we need an immediate site for people to go to besides the hospital. We are educating them that this is a safe, legitimate option to utilize for normal, low-risk mothers and babies. The good byproduct is a reminder to society that midwives can safely take care of low-risk births. Midwives have a sincere interest in providing a safety net for mothers and babies.

Q: What is needed for a birthing center or home birth?

Walker: IVs, medications, oxygen. Everything you would need in an emergency. If I had a Winnebago, I could make a birth center in an hour. The bare necessities for a safe birth are something to cut the cord with, something to tie the cord with, bottled water, plastic bag for the placenta.

Q: What should people do to prepare?

Walker: If they're pregnant, talk to their health care providers about what to do in an emergency. Get their home prepared in case they have to deliver at home. Know the alternatives to giving birth at the hospital. Get all their prenatal records so if they have to be evacuated they'll have that.

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