The Heat is On: Imperative for Midwifery Engagement in Climate Change.

Abstract

As the world continues to grapple with the devastating impacts of climate change, the effects on perinatal and newborn outcomes are becoming increasingly evident. Extreme heat events related to climate change are becoming more frequent and intense and are linked to a range of health problems during pregnancy and for newborns. This Journal of Midwifery & Women's Health (JMWH) theme issue on Climate and Environmental Effects on Perinatal and Reproductive Health aims to provide midwives and others with concrete information to help identify the health effects of climate change and provide suggestions to mitigate those effects, including proposing action to be taken individually and as a profession. It is imperative that midwives develop expertise in this area, educating ourselves, our patients, and our students, and amplifying the calls for immediate change. As highlighted in advance of the recent United Nations (UN) Conference of the Parties, or COP 27, the first of these important global climate meetings to focus on the nexus of climate change and human health, health must be at the center of climate change policy going forward.1 The UN Secretary General was recently quoted as stating “there is no Planet B: we must fix the world we have.”2(p 1) Those of us involved in perinatal health, whether in policy, research, education, or clinical care, must understand the broad impacts of climate change on those we care for. Climate change related events are already affecting health outcomes. Midwifery is a necessary voice to help identify and implement new solutions through interprofessional engagement in improving health systems and in our individual provision of care every day.3 The UN International Panel on Climate Change (IPCC) reported that greenhouse gases have already caused 1.1°C (34°F) in global warming as well as “widespread adverse impacts and related losses and damages to nature and people”4(p 17) and that “vulnerable communities who have historically contributed the least to current climate change are disproportionately affected.”4 (p 6) IPCC warned that steep cuts must be made quickly or harms will increase with fewer opportunities to adapt.4 One direct impact of extreme heat on maternal health is the increased risk of dehydration and heat stroke in pregnancy. Pregnancy increases the body's need for water, and the body is physiologically sensitive to high temperatures during pregnancy. Heat exposure can lead to pregnancy complications, such as preterm labor and low birth weight. The number of stillbirths and premature births has been estimated to increase by approximately 5% for every 1°C increase in temperature according to a recent systematic review and meta-analysis.5(p 8) In this JMWH issue, Baharav et al have provided a comprehensive state of the science review documenting the effects of extreme heat on newborns and pregnant people.6 The authors summarize the negative impacts on perinatal morbidity and mortality in the United States and globally. Implications for practice are addressed and a number of resources are provided, along with specific recommendations for patients that can assist clinicians in their practice.6 Atkin et al offer an educational case study, a composite of actual patient situations, to educate students on the risks faced by pregnant persons when exposed to high heat levels.7 Midwifery faculty and others may freely use the case study in their education programs along with the list of readings provided.7 Continuing with a practical approach to environment and health effects, Sanders and Davis use a clinical case study to highlight the impacts of climate change and air pollution on perinatal health.8 Air quality is critical to human health, particularly in pregnancy. Respiratory physiologic changes during pregnancy are reviewed along with effects of air pollution as the authors provide clinical guidance for managing allergic rhinitis and asthma in pregnancy. Although climate change affects everyone, the impacts on resource-constrained and marginalized communities are greater and must be better understood and addressed through concerted policy action. The role of midwives as part of humanitarian efforts in climate related disasters, especially when positioned within communities at the local level, is described in the article by Purno et al.9 The response to flooding in Bangladesh provides an example of the importance of maintaining access to reproductive care in disasters. The lessons learned in this case may be helpful globally in other similar situations. Two commentaries call our attention and action to the effects of climate change on perinatal mental health and to the devastating effects plastics are causing to human and environmental health.10, 11 Two other articles examine outcomes of the COVID-19 pandemic and suggest how lessons learned in that situation may transfer to actions needed to reduce climate change and address impacts on health.12, 13 And finally, in a surprising reversal of direction, a framework of vulnerability to climate change is adapted in developing a new maternal adaptive capacity theory. This theory, proposed for use in future research, focuses on maternal strengths and how to remain well during pregnancy despite existing risks.14 Climate change is also exacerbating existing health inequities, particularly for persons in marginalized communities who are often more vulnerable to extreme heat.15 This “environmental injustice” will likely make existing racial inequities worse,15(p 459) including for families with low-income, Indigenous and people of color, and those living in urban areas with limited access to green spaces. Additional barriers to accessing midwifery care during heat waves may exist in marginalized communities, which can further increase the risk of adverse perinatal and neonatal outcomes, including low birthweight, preterm birth, and stillbirth. Studies in the United States and globally have described the additional effects of excessive heat on pregnant farm and agricultural workers and the need to reduce heat exposure to reduce poor outcomes,16 as well as the need to provide information for pregnant workers and health care professionals.17 To address the impact of extreme heat and climate change on midwifery and perinatal health, it is crucial to take a comprehensive approach that addresses both the direct and indirect effects of rising temperatures. This includes investing in public health infrastructure, such as cooling centers and air conditioning in health care facilities, to provide relief during heat waves. It also requires accessible information on screening for at-risk populations and clinical guidance for midwives and other health care professionals on the front lines of caring for pregnant persons and their newborns. JMWH readers may appreciate a collection of articles in a recent issue of the International Journal of Obstetrics and Gynecology, Special Section: The Impact of Global Warming on Women's Health.18 Midwives have the power and the voice to advocate for change and to prevent, recognize, and address the impacts on pregnant persons and newborns, and across the span of reproductive and primary health care. Let us all commit together, as midwives, to take action, individually and collectively, to reduce climate threats and support the necessary adaptations to mitigate climate change related impacts on both midwives and our patients, starting now. Consistent with the recently updated ACNM Position Statement on Climate Change and Maternal Fetal and Infant Health,19 midwives have a responsibility to engage in the future of perinatal and reproductive health through advocating locally and nationally, working to mitigate emissions at the local level, and sharing accurate information about the damaging effects of fossil fuels. We have no time to waste because the heat is on and “there is no Planet B.”2(p 1)