Community-based maternal health workers’ perspectives on heat risk and safety: a pilot qualitative study

Abstract

In this study the authors examined how maternal health workers (MHWs) perceive the health risks of extreme heat exposure to pregnant women and fetuses. The authors conducted interviews with 12 MHWs (including midwives and doulas) in El Paso, Texas. Using qualitative analysis, the researchers identified numerous themes. Although heat was not communicated as a major health risk, participants expressed some concern with growing heat exposure and communicated standard protective measures. While all participants were familiar with some heat illness symptoms, they were generally unaware of their clients’ vulnerability. MHWs’ minimal heat-risk knowledge leaves pregnant women and developing fetuses at risk of preventable harm.

Acknowledgements

The authors owe much gratitude to the maternal health workers who participated in this research. The authors also thank the anonymous reviewers for offering helpful comments on earlier drafts. The authors would like to thank the following individuals for their expertise throughout all aspects of this project: Dr. Gregg Garfin for supervision of the research team, Dr. Patricia Juárez-Carrillo for insights that greatly improved the methodology, and Sarah Leroy for outstanding administrative support. This work is supported by the Agnese Nelms Haury Program in Environment and Social Justice.

Disclosure statement

The authors declare that they have no conflict of interest.

Notes

1 The authors are not aware of any research that concludes high ambient temperature exposure creates an increased risk of maternal mortality.

2 DONA International, a leading doula certifying agency, defines a doula as a “trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible” (DONA International 2020).

3 Birth with a midwife at home or a birth center is often one of the most affordable options in the region; however, it is important to note that women choose to birth with a midwife and/or separate from a hospital for various reasons.

4 Recruiting and interviewing a random sample of community-based MHWs was not feasible. There is no public or private list of all practicing doulas, midwives, and/or childbirth educators for any U.S. region. This is, in part, because some doulas and midwives practice without certification. Also, many maternal health workers work independently from any formal institution. Both of these practices make it impossible to identify and recruit these workers in a systematic way. Based on these restrictions, the first author relied on personal networks and snowball sampling.

5 Physicians were not included in the sample; our focus was community-based MHW such as midwives and doulas because they are often overlooked as a source of knowledge about environmental risks. Additionally, based on years of formal schooling and a different model of care, including physicians in the analysis would have made comparisons difficult.

6 The word “minority” connotes relative disadvantage and limited access to power as compared to the members of the dominant group. The term does not indicate a small number of people.

7 Readers may be wary that these three participants were still included in this analysis, but their interviews were quite illuminating, in part, because of this minor knowledge of the interviewer’s research focus prior to the interview. For example, their quotes are used ahead, included the doula who responded to heat concerns with, “It’s not like I really encountered it,” and the lactation consultant who referenced her own self-“ignorance.”