Pregnant Women in Crisis

Pregnancy and Emergency Risk

Pregnancy is a condition that dramatically changes emergency risk. A pregnant woman must plan for two — and in the case of multiples, more. Physiological changes affect heat tolerance, mobility, stamina, and the nature of medical emergencies that can arise. Displacement disrupts prenatal care at exactly the moment when consistent monitoring is most important.

Globally, complications of pregnancy and childbirth account for a significant proportion of preventable deaths among women aged 15–49, and natural disasters, conflicts, and infrastructure failures substantially increase that risk. Preparation before an emergency is the single most effective action a pregnant woman can take.

Prenatal Records Portability

In a displacement or evacuation scenario, access to prenatal records can be life-saving. Without records, emergency midwives and doctors must start from scratch — and key information about blood type, Rh factor, pre-existing conditions, and test results may be unavailable when most needed.

What Records to Carry

A printed summary of the pregnancy to date: gestational age, estimated due date, blood type and Rh factor, known complications or risk factors, current medications, known allergies.
Results of key screening tests: anatomy scan, glucose tolerance test, Group B Streptococcus (GBS) status if tested, any genetic or chromosomal screening results.
Name and contact details of the obstetrician, midwife, and hospital where birth is planned.
Health insurance information and identification documents.
A copy of the birth plan if one has been written.

⚠️ Keep a physical copy of prenatal records in your emergency go bag and a digital copy accessible from your phone. In a crisis, hospital databases and your own phone may both be inaccessible.

Keeping Records Updated

Update records monthly in early pregnancy, fortnightly from 28 weeks, and weekly from 36 weeks.
After each prenatal appointment, photograph or scan any updated results and add to your digital record.

Emergency Birth Kit

If access to a hospital or birth centre is impossible, a basic emergency birth kit enables safer management of an unassisted or minimally assisted birth.

Item	Purpose
Clean towels and blankets	Warmth for mother and newborn
Sterile gloves (multiple pairs)	Infection prevention for helper
Sterile gauze and clean cloths	Cord management, wound care
Cord clamps or clean ties (shoelaces work)	Tying the umbilical cord
Sharp, clean scissors or sterile scalpel	Cutting the cord
Bulb syringe	Clearing infant's airways if needed
Sanitary pads or clean absorbent cloths	Post-delivery bleeding management
Clean container for placenta	Placenta must be delivered and inspected
Thermometer	Monitoring newborn temperature
Flashlight	Visibility in power outage

The kit should be assembled by 36 weeks at the latest.

Recognising Labour Warning Signs

Knowing the difference between normal pregnancy discomfort and warning signs requiring urgent action is critical — especially when medical help may be delayed.

Signs of Active Labour

Regular contractions increasing in frequency and intensity (pattern: 5 minutes apart, lasting 1 minute, for 1 hour — the "5-1-1" rule)
Rupture of membranes ("waters breaking") — clear or slightly pink fluid
Intense pelvic pressure and urge to bear down

Warning Signs Requiring Immediate Medical Attention

Warning Sign	Possible Cause	Action
Heavy bleeding (soaking a pad per hour)	Placental abruption, placenta praevia	Emergency evacuation to hospital — do not wait
Severe continuous abdominal pain without relief between contractions	Placental abruption	Emergency evacuation
Sudden severe headache with visual disturbance, swelling	Pre-eclampsia	Emergency medical care urgently
Baby not moving for 2+ hours after 28 weeks	Fetal distress	Medical assessment urgently
Fever above 38°C in labour	Infection	Medical care needed
Cord visible at vaginal opening	Prolapsed cord — life-threatening	Emergency evacuation immediately; do not push; knee-chest position
Seizure	Eclampsia	Emergency services immediately; lie on left side

Emergency Birth Procedure

If birth is imminent and no medical help is available:

Prepare the environment. Lay clean towels or cloths on the cleanest available surface. Ensure warmth in the room.
Wash hands thoroughly. If running water is unavailable, use hand sanitiser.
Position the mother. Semi-reclined, squatting, or on hands and knees are all acceptable positions for birth. Lying flat on the back is the least effective.
As the head crowns, do not push forcefully. Gentle, panting breaths help slow delivery and reduce tearing.
Support the head as it emerges. Do not pull. Check if the cord is around the neck — if so, gently loop it over the baby's head.
After the head delivers, the shoulders follow with the next contraction. Support under the head and neck. The body will follow.
Dry and warm the baby immediately. Vigorous drying stimulates breathing. Wrap in clean cloth.
If the baby does not breathe immediately: Rub the back firmly, check for airway obstruction, clear gently with the bulb syringe, begin infant CPR if no pulse.
Wait for the placenta. It usually delivers within 30–60 minutes. Do not pull on the cord. If not delivered within 1 hour, seek medical help.
Control bleeding. After placenta delivery, massage the uterus firmly through the abdomen to encourage contraction. Excessive bleeding requires medical care.
Delay cord cutting. If there is no rush and the cord is intact, wait until it stops pulsing before tying and cutting.
Skin-to-skin contact. Place the baby on the mother's chest immediately after birth to regulate the newborn's temperature.

Post-Birth Newborn Care

A newborn outside a hospital setting requires specific immediate care:

Temperature. Newborns lose heat rapidly. Keep the baby clothed and covered with a hat. Room temperature should be at least 20°C.
Feeding. Initiate breastfeeding within the first hour of birth if possible. Colostrum (early breast milk) contains critical immune factors.
Breathing. Normal newborn breathing is irregular and may include brief pauses of up to 10 seconds. Sustained pauses, gasping, or blue lips require immediate action.
Cord care. Keep the cord stump dry and clean. Do not immerse in water.
Jaundice. Some yellowing of the skin is normal from day 2–3. Severe or very early jaundice requires medical assessment.
Seek medical care as soon as possible. Even if birth went smoothly, both mother and newborn need professional assessment within 24 hours.

Nutrition During Pregnancy in Emergency

Nutritional needs are significantly elevated in pregnancy, particularly for protein, iron, folate, calcium, and iodine. Emergency food supplies often fail to meet these needs.

Prioritise calorie density in emergency rations — pregnant women typically need an additional 300–500 calories per day.
Legumes (lentils, chickpeas, beans) are highly valuable emergency foods — protein-rich, long shelf-stable, and nutrient-dense.
If prenatal vitamins are available, continue taking them. If not, request them specifically from relief organisations.
Hydration is critical. Dehydration triggers contractions and exacerbates blood pressure problems.
Avoid raw or undercooked animal products, soft unpasteurised cheeses, and raw sprouts — food-borne illness is more dangerous in pregnancy.

Radiation and Chemical Exposure Risks to the Foetus

The developing foetus is significantly more sensitive to radiation and chemical exposures than adults, particularly during organogenesis (first trimester) and periods of rapid brain development (throughout pregnancy).

Radiation

Ionising radiation in high doses increases the risk of miscarriage, developmental abnormalities, and childhood cancer.
In a nuclear or radiological emergency: shelter in place behind substantial materials (concrete, brick, soil), minimise exposure time, follow official guidance on evacuation.
Do not take potassium iodide without specific official instruction. While it protects the thyroid from radioactive iodine, dosing guidance for pregnant women differs from standard adult guidance.

Chemical Exposure

In a chemical spill or attack, get upwind and uphill from the source and evacuate the area.
Decontamination (removing outer clothing, washing skin with soap and water) reduces ongoing absorption.
Many chemicals have placental transfer — meaning they can affect the foetus. Seek medical assessment even if symptoms are mild.

Connecting with Midwifery Services When Displaced

Displacement frequently severs the relationship with a prenatal care provider. Re-establishing care quickly is critical.

When arriving at a displacement centre or shelter, ask specifically about prenatal care services. Many large relief operations include mobile maternal health teams.
Present your portable prenatal records to the new care provider.
Contact the nearest hospital's maternity ward — they can usually assess you even without prior registration.
UN and Red Cross operations in conflict zones typically have maternal health services in large refugee camps.
Document the new care provider's contact information and update your emergency go bag records.

Quick Reference

Situation	Action
Heavy bleeding before 20 weeks	Possible miscarriage — urgent medical care; rest; do not ignore
Heavy bleeding after 20 weeks	Emergency — possible placental abruption; evacuate to hospital immediately
Severe headache + swollen hands/face	Possible pre-eclampsia — emergency medical assessment within hours
Labour begins during evacuation	Find shelter; contact emergency services; use emergency birth kit if birth is imminent
No medical help available — birth imminent	Follow emergency birth procedure; prioritise warmth and breathing for newborn
Newborn not breathing at birth	Dry and rub back vigorously; clear airway with bulb syringe; infant CPR if no pulse
Evacuation to shelter — need prenatal care	Ask shelter staff for maternal health team; present portable prenatal records
Chemical or radiation exposure suspected	Decontaminate; evacuate upwind; seek medical assessment for foetal risk
Prenatal vitamins unavailable	Request from relief supplies; prioritise protein, iron, and folate in food choices
Unable to contact original obstetrician	Go to nearest hospital maternity ward; present portable records