Caring For Moms and Babies in Disastrous Times, by EMT Tina

Thursday, Mar 14, 2013

Having a baby under normal circumstances is a great and beautiful thing, but when disaster strikes there’s going to be some issues.  Obviously in dark times one might not be able to deliver at a clean, safe hospital, or run to Walgreens in the middle of the night to get formula and diapers, or to Target to get extra pajamas for baby.   As a mom (and EMT 3 years, 8 years as a First Responder before that) I feel a certain responsibility to help others and to encourage preparedness in others.  Here are some helpful shopping tips, knowledge, and other items that are always good to have on hand for moms and babies in times of emergency. 

I live in a state where we have disasters and evacuations every year, so the concept of getting out of Dodge quick is something that we are familiar with.  As an EMT and as a Venturing Scout I have responded to and given aid to those struck by disaster many times, and in between I teach others how to be better prepared.  I know that sometimes response to emergencies can be delayed, resources get stretched thin at big disasters and you may not get help at all if your problem isn’t immediately life threatening.  This is why everyone should have a bag ready with supplies and waiting by the door readily accessible and more importantly a place to go to that is safe.  As a parent and wife I have a responsibility to protect and care for my son and husband and vice verse, this should be your priority too.   
 
If you have a member of your group who is pregnant and or has small children you’ll need to take extra care for them.  While pregnant women can do a lot of things, they will need help and, for certain duties, partnering up for safety.  Some light duty jobs you could consider are working the ops desk, the communications desk, KP, or watching the groups other children.  Jobs that you might have a partner for could be laundry, gardening, milking cows or goats (no horse riding if it can be avoided), feeding livestock, water hauling (with cart, don’t push to hard) or other not too strenuous work.  There are going to be some exceptions to this list as pregnancy progresses and morning sickness gets better or worsens.  For instance I couldn’t handle the smell of raw meat when I was pregnant, so I couldn’t cook certain things. 

There are also some comfort items that you can keep at the retreat for anyone who is or becomes pregnant.  Candied ginger and ginger ale are always great to help with nausea.  Saltine crackers are also good for this purpose.  Pregnant women will also need a good multivitamin with folate in it to ensure good gestational health and neural tube development in the baby.  A good stool softener (such as Colace) and extra fiber in the diet are both highly recommended and pregnant women will also need and extra 300 -350 calories a day.  Some pregnant women might become anemic and requite an Iron supplement.  There are also some things that pregnant women should avoid like cleaning the litter box, over exertion/lifting, and excessive stress.  Taking care with your words and actions can go a long way (like not saying that the pregnant woman is a burden or implying it).  Stress can adversely affect not only the mom, but also the baby.  When you are stressed your body secretes a lot of hormones that then affect the baby and put it under stress which can then affect fetal health.  All pregnant women should have regular Blood pressure and blood sugar tests throughout the pregnancy.  You will especially want to monitor for preeclampsia and diabetes.  Make sure you get a thorough medical history prior to delivery especially important are has the mother had a ultrasound and if so what was the placement of the placenta, medical issues like diabetes or preeclampsia, past pregnancies and any complications with those, and finally any signs of possible health issues with the baby.  

In times of disaster there is a great likelihood that the mortality rate will rise when it comes to deliveries and pregnancies.  So it is here that I shall list a little about miscarriage.  According to The Everything you need to know about pregnancy book, “up to 20% of all detected pregnancies miscarry before week 20.”  After week 20 your chances of miscarriage greatly decrease, but are not totally eliminated.  Sometimes miscarriages happen because of trauma to the baby and mother, but other times the baby could have genetic abnormalities.  Some bleeding does occur after implantation and is normal, but all bleeding should still be taken seriously.  If it’s bright red blood then this would be the time to seek out a professional.  If there is a doctor or midwife in the area then get the mother to them quickly.  A paramedic from the local fire department would have some training in child birth and complications and could also assist.  Signs and symptoms of a miscarriage are: Bright red bleeding in copious amounts, severe abdominal cramping, low back pain (contractions), high fever, extreme nausea and vomiting beyond morning sickness with quick onset, amniotic fluid leakage, and severe headache.  One of the first things that you can check for, before advanced help arrives, is a fetal heart rate by using a stethoscope. If it’s a good scope you should be able to hear the heart rate post week 10.

If the mother does miscarry or lose the baby after the delivery this will affect her not only physically, but mentally as well.  It doesn’t take long to fall in love with your baby, and when a woman miscarries or the baby dies post delivery she’ll go through the full spectrum of mourning plus additional guilt, doubt, and depression.  Again other members of the group should support, offer help, prayer, and counsel the mother.  Allow her and the father time for grieving.  It is also advisable to let her rest and recover so that she can deal with her loss.  Don’t let her rush off to work to avoid grief as this may compound the problem.  Grieving is a very individual thing and only that person will know how they need to deal.  Most importantly watch for depression and suicidal symptoms and get the mother professional help and medications if at all possible.
 
I won’t comment on the actual birthing process itself as this was well covered in Mr. Rawles' book.  Some additional helpful reading if you are interested thought, would be any Recent EMT Manual published within the last 3 to 5 years as these have a detailed chapter on field childbirth and complications.  You can find used copies on Amazon.com or BN.com.  I would also advise taking a Emergency Medical Responder (previously First Responder) level aid course and few ambulance ride-alongs or hospital clinicals.  These will give you a lot of valuable training and experience and can make all of the difference in a bad situation.  Volunteering at your local hospital in the birth center can also provide you some valuable experience and you can gain helpful knowledge from the experienced RNs.  Above all else keep your head cool and mind calm, your most important tool is the one on your shoulders.               

Now let’s talk a bit about some supplies for baby.  As a parent you learn to budget (money, time, sanity), and prepping for an emergency is no different.  You must have a budget and plan in mind well before you head to the store.  When it comes to baby clothes a great, frugal place to buy is the second hand store.  From 25 cents to a dollar an item secondhand stores are a great place to stock up.  You can find all seasons of clothing, shoes and toys there for a fraction of the cost new.  Just use your head and watch for the quality of the items you buy.  Usually for a baby all through the toddler stages you want 6 outfits, 3 PJs, 6 pair of socks, 2 pair shoes, a light and heavy jacket, and a few hats and mittens per size (Remember little babies grow at a very exponential rate through years one and two,& go by months).  You will also want a stuffed animal or two, some pacifiers, extra sheets, and at least 5-7 warm blankets with 3-4 light ones.  Look into a decent port a crib (either foldable mesh or collapsible fixed material) a new one can cost as little as $20 new.  It is not advisable to co sleep with infants as there is a high risk of smothering.  The only time you might consider co sleeping is if you are on the run and sharing a sleeping bag, even then much caution must be taken.     

Let’s talk bathing and medication for baby.  Go to your local big box store (Costco/ Sam's Club) and get the double pack of baby body & hair soap.  This will last you two years if used conservatively.  You might also want to buy extra of this for wound cleaning, trade or charity.  As far as babies go there are some basic must haves for your kit: baby acetaminophen (Tylenol), baby Vic’s vapor rub, nasal saline, Pedialyte, band aids, Neosporin, and Baby Ora-gel for teething.  Children’s Benadryl would also be prudent to have, but check with a doctor on dosages for children under 4 years of age.  When babies are sick, these are the top fall backs, a humidifier would be nice but if the power is down you can use a few tea pots and a towel or bed sheet to make a steam tent.   

Making sure that babies stay hydrated and fed is a must.  Here are some good things to have:  lanolin ointment, a manual breast pump or if there is power a portable pump (I like Madela), in case of latching difficulties a nipple shield, nursing and sleeping bras, feeding and storage bottles, and a firm pillow for nursing.  A note on the shields, these are very handy for women who have odd shape nipples (flat tops or inverted) when babies have a hard time nursing, if you don’t use them you can always trade them.  If there is a problem nursing don’t be afraid to employ the pump and bottle feed off and on, get that sustenance and hydration in the baby.  Long term storage of liquid formula may be difficult and costly, but having even a little on hand can be handy in case something happens and mom can’t nurse (the powdered formula stores longer, but you will need a clean water source).  When babies get bigger you can use a hand grinder to make fresh baby food. 

Diapering can be a difficult topic to broach when it comes to emergencies, do we use cloth or buy bulk disposable.  I say do a bit of both.  During the first week or so while you’re waiting for the umbilical stump to fall off and getting through those first very dark and sticky poops my recommendation is disposable.  This will save you a bit of time while mom is healing up and decrease the risk of infection.  After this time I would go with cloth (disposable diapers might become hard to come by in a long term scenario), but the eventual decision will be up to you.  A note on the cleaning of cloth diapers, boil to rinse and then dry in direct sunlight if you can.  Between the sterilization in the water and the UV rays the bacteria should be killed.  You will also want to stock up on the big box store wipes, if not for baby then they work well for general hygiene needs.  My husband was deployed to Afghanistan for a year while I was pregnant with our son and one of the top 3 things he would ask for was baby wipes.  His unit was often assigned to FOBs (Forward Operating Bases for those who don’t speak Army) that were little more than flattened earth and concertina wire so he used the wipes to bathe. Disposable diapers also make for very absorbent abdominal wound pads so keep a few in your field first aid kit.  I would recommend getting the big box store double pack of diaper cream, at least 2 of them (it lasts forever & it’s good for trading). 

Let’s talk about some things we can do for Mom post partum.  Good things to have for sore mommies are tucks pads (or witch hazel and gauze), sanitary napkins, pain killers (Ibuprofen [Advil] or Acetaminophen [Tylenol] are generally considered safe but check with a doctor first; aspirin should be avoided), Epsom salts, stool softener, disposable ice packs, seat cushions, and a back brace or girdle.  Buy in bulk and you can always trade later.  When it comes to post partum pads the bulkier, cheap variety work best for this purpose (burn after use).  For moms who have had to get sewn up a sitz bath at night, ice packs, and the tucks pads/ witch hazel go a long way for relief.  The girdle will help shore up a new mom while her abdominal muscles repair acting as a back support.  Moms should ideally take a good 4-6 weeks off minimum to heal, but can perform light duty tasks during that time.  Don’t let the mom over do it and hurt herself (Been there, done that, Got the PT bill to prove it).  If you need to have a new mom up and on duty put her at a watch desk for short watches and make sure she takes a nap in between, eats, and nurses or pumps. 

Lastly I wanted to mention a few things about children and getting out of Dodge.  Kids don’t like big sudden changes, so keeping them apprised of any plans would be prudent.  If they know the plan it’s easier on them mentally and they know what’s going to happen.  You may have to leave in a hurry and leave many things behind, but don’t forget their lovie (security object, toy never seen without).  It may be the only thing they have to play with and their only comforting object if you have to leave during an emergency, so don’t forget it.  Have copies of birth certificates, updated family pictures that show you all together as a family, and any other important papers in your go bag (preferably in a waterproof box like Otterbox or Pelican).   If you become separated from your children you may need proof that they really are your kids when you find them again (as seen in the aftermath of Hurricane Katrina).  You might consider sending copies of your papers to the family members you will be staying with if you trust them implicitly (if not then a bank safety deposit box near them could work also).  When leaving town one of the better options is to go at night and right away, don’t hesitate and don’t wait.  If possible take those back roads and avoid the highways as these will not only clog up but become targets for looters and banditos.  When driving out have an adult in the back seat with the kids ready to help them bail if it comes to that.  Above all else remember operational security and do what you have to do to protect your family.  Hopefully this knowledge will be helpful and informative for any preparedness savvy parents out there.


Copyright 2005-2012 James Wesley, Rawles - SurvivalBlog.com All Rights Reserved