Advocacy, Fragile Settings, Americas

Midwifery in the Era of Climate Change: Lessons from the wildfires in Maui

3 May 2024

In August 2023, a wave of wildfires tore through Hawaii, mainly hitting Maui. Fuelled by raising temperatures and Hurricane Dora’s fierce winds, these fires marked one of the deadliest wildfire seasons in recent US history.

Jacquelyn Ingram, a midwife with over a decade of experience, didn’t hesitate when news of the fires broke. As part of the Healthy Mothers, Healthy Babies (HMHB) Coalition of Hawaii, Jacquelyn and her colleagues immediately sprang into action. Having worked in disaster relief internationally, Jacquelyn knew the importance of swift response. Having moved to Hawaii before the COVID-19 pandemic, she was primed for such emergencies.

“I saw the wildfires on the news and social media and kept thinking: we have to do something” Jacquelyn recalls. With the executive director of the HMHB Coalition, Sunny Chen, they coordinated with Direct Relief to send medical kits and needed supplies. Soon after, Jacquelyn and her colleagues arrived to provide care on the island. With roads closed, they embarked on a journey by boat and ultimately arrived on a jet ski to Lahaina.

“It was a dramatic entrance,” Jacquelyn reflects, “but once we were there, it was about setting up a makeshift hub. We pulled together chairs, tables, and supplies from our backpacks, and got to work attending to those in need.” With each passing day, their humble hub expanded—first with a tent for shelter, then generators for power, and a continuous influx of supplies and people seeking assistance.

“As a certified lactation consultant, one challenging aspect was navigating the provision of infant feeding in emergencies,” Jacquelyn explains. “I aimed to prioritise breastfeeding support, finding the supplies to make it possible to preserve breast milk and ensuring women had a safe and private space to nurse.”

Jacquelyn and her midwife mentor Robin Lim had previously taught a course titled ‘Birth in the Era of Climate Change’ in Maui, equipping local midwives and birth workers with the skills necessary for crisis response. Modules like water, sanitation, hygiene, and post-traumatic stress disorder management proved invaluable during this particular crisis.

“It was truly serendipitous,” Jacquelyn remarks. “That preparation better equipped all of us for this moment.”

After a week, Jacquelyn returned home for the first time, but a rotation of HMHB colleagues continued providing aid in Maui, even to this day. Their solar-powered, mobile clinic proved indispensable, ensuring refrigeration for vital supplies like insulin and tetanus shots when fuel was scarce.

Jacquelyn underscores the significance of sexual and reproductive health services during the initial stages of the response, emphasising the community’s request for contraception as they contemplated their uncertain future.

Much of the post-disaster work focused on supporting pregnant women, offering reassurance with prenatal visits, giving prenatal vitamins, utilizing point of care ultrasounds, and providing crucial psychological support.

Now, nearly a year later, the situation in Maui has changed, but challenges remain. Access to prenatal and obstetrical care was already limited before the fires, yet HMHB continues to fill the gap.

Jacquelyn and colleagues remain committed to caring for families affected by the fires, recognising the need for further research into the long-term effects on pregnant women, especially as wildfires become increasingly prevalent in a warming world.

Reflecting on her experience, Jacquelyn issues a timely call to action for policymakers: “They must recognise midwives as essential caregivers in all circumstances. If the trials of COVID and the wildfires have taught me anything, it’s that we must be prepared, supported, and valued. As midwives, our dedication to providing care knows no limits, and that’s a resource the world cannot afford to overlook.”