BASIC DISASTER BIRTH SUPPORT (BDBS)
A PROPOSAL FOR THE CARE OF BIRTHING WOMEN
DURING EMERGENCIES
Ruth Walsh
rwalsh@hsc.wvu.edu
Women approaching or in active labor are a constant segment of our population. They will appear in every disaster affecting large groups of people and they may appear even in very small localized emergencies such as floods and ice storms that prevent transfer to a hospital.
Basic Disaster Birth Support (BDBS) will prepare ordinary citizens and disaster workers to help these women under any circumstances that require birth outside of the ordinary hospital setting. This training may prevent unnecessary deaths caused by ignorance of the birth process.
This course of instruction does not attempt to teach a person to be an OB or a midwife. It does not even attempt to prepare a person to be a doula. The intention is to educate as many people as possible about how a normal birth proceeds and what they can do to support a woman during child bearing under unusual circumstances. It is the intent of this plan to educate as many people in Basic Disaster Birth Support (BDBS) as are certified in CPR by The American Heart Association and the Red Cross.
INTRODUCTION
There are many people who have taken classes in emergency birth. EMTs, firemen, citizens with first aid training, may have studied and practiced the emergency procedures to use when a baby is being born. In general, this is quite adequate preparation for dealing with an unexpectedly fast birth when the woman doesn’t have time to get to the hospital.
Under disaster conditions, a mother at the end of her pregnancy may have an ordinary labor and birth which is a different situation entirely from an unexpectedly fast labor and birth.
There is no training for the ordinary citizen or the disaster worker in how to take care of women during normal pregnancy, during normal labor or in the critical hours and days right after a normal birth. The typical preparation for emergency birth does not teach how to care for a woman through a long labor and the instructions usually end up with the direction to “keep mother and baby warm and transfer to the hospital”. The students are simply prepared to “catch the baby”. In contrast, this course of instruction prepares disaster workers and citizen volunteers to care for mothers during the weeks leading up to and including labor and birth and the weeks right after the baby is born when the option to transfer to a hospital does not exist, when everyone is ‘birthing in place”.
VARIOUS DISASTER SCENARIOS
PANDEMIC DISEASE
Currently for pandemic disease situations the plan is for birthing women to avoid hospitals and the risk of infection. There are vague plans to convert random facilities into little uncontaminated birthing areas. It is also recommended that women “Birth in Place” that is, at home. Ideally, the birth facilities would be staffed with health care workers who have not been exposed to the infected population. The mothers birthing “in place” at home may or may not have a health care worker to help them through an unfamiliar process. Enlightened disaster planners around the country have enlisted the help of home birth midwives who have volunteered their time and resources to prepare other health care workers to manage birth without high tech tools and amenities.
TEMPORARY BIRTHING CENTERS
Everyone can agree that during a pandemic disease outbreak laboring women should stay away from hospitals where infected people are congregated. At first glance, the plan to convert empty health care facilities such as old closed down hospitals, clinics or other facilities into birth centers makes sense. This plan could work to some degree but in a severe pandemic that affects a large proportion of the population, it is probable that victims will go to any kind of health care facility to get help, even facilities that are designated strictly for mothers without disease who are birthing. This would negate the advantage of being away from the hospital. Mothers would be better off staying home. But who can help them there?
BIRTH CARE PROVIDERS
In the case of the extreme pandemic, many health care workers are likely to contract the disease as well as their patients. Every person with a health care background may well be recruited to care for the critically ill. We need a plan that draws on the help of the lay public who are not already committed to participating in the response to the pandemic by the very nature of their existing job descriptions.
MASS EVACUATIONS
MOBILITY
For the evacuation scenario, a scenario particularly pertinent to West Virginia, there is no way to predict where a woman might go into labor along the evacuation route. Roads are likely to be congested to the point of gridlock making it impossible to transport a laboring woman to a hospital along the way. The hospital may be in chaos trying to meet the needs of the normal population as well as thousands of evacuees.
COMMUNICATION
There is no guarantee that there will be reliable communication during a mass evacuation. First responders predict that cell phones will be useless in any truly massive disaster because of overload. Many rural areas in WV do not even have cell phone service.
How do you locate birthing woman along the evacuation route? How do you find a birth care provider to go to the woman or how do you get the woman to the birth care provider?
NATURAL AND OTHER DISASTERS
Nuclear accidents, chemical spills, and natural disasters are varied and individual in the problems they present. They may be small or large.
In large disasters, once the capacity of the available health care resources are exceeded, the birthing woman is at risk.
In natural disasters, such as extreme winter weather or flooding, a mother may be isolated from a health care facility by the impossibility of transport.
WE NEED A PLAN
So we need a plan to deal with the reality that a birth may happen anywhere, any time. Most of the time, it is an easy ride to the hospital or birthing center. But in times of disaster, a laboring mom needs someone who can help her right then and there. Maybe this will be all the care she receives in the case of a long lasting disaster, or maybe it will just be a temporary measure until some plan emerges to get her to a hospital. In either case, she needs the appropriate care immediately, where she is.
This is not an entirely unique situation. For millennia there have been recommendations to the general public for emergency treatment of drowning victims.
More recently, several decades ago, it was proposed that under certain circumstances, a heart attack victim could be revived by instant Cardio Pulmonary Resuscitation. A huge commitment was made to educate massive numbers of people in CPR so that a when a heart attack occurred, anytime, anywhere, someone was around to start CPR and maybe save a life.
This program proposes that Basic Disaster Birth Support (BDBS) be taught to as many people as have been taught CPR.
In a pandemic, the mother to be can stay at home and perhaps a person from her church who has taken BDBS can help out.
In the case of evacuation, if a mother goes into labor, someone along the route who has taken Basic Disaster Birth Support (BDBS) training will be able to help her. Maybe it would be a citizen who lives along the evacuation route, maybe a family member who is traveling with her who took the BDBS training or maybe it would be someone who is also evacuating who hears there is a need a mile up or down the crowded road.
If there is a flood and a community is isolated because a bridge is out and the phone lines are down, the mother in labor can send someone on foot to a neighbor who she knows has taken BDBS or maybe the mom to be took the training herself and she can just tell people around her how to help her.
BDBS works for every type of disaster. There is no need for different training for big disasters or little disasters, no difference for the type of disaster.
BDBS is not a solution for every obstetric patient. High risk and abnormal obstetric situations will likely end with poor outcomes. What BDBS will do, is train people to support healthy mothers in normal, healthy birth. BDBS will train people how not to get in the way of normal birth, how not to cause preventable problems. Broad Basic Disaster Birth Support (BDBS) training will ensure for the laboring mother that in unusual times, someone close by will know something “ ‘bout birthin’ babies”.