Mental Health Impacts of Climate Change for Birthing People and the Provider's Role

Exceptional care delivered by midwives and other birth professionals has significantly decreased global infant and maternal mortality rates in recent decades1, 2; however, these positive gains are threatened by human disruptions of our Earth's natural systems. Destruction of our environment, including climate change, impact human physical and mental health as well as the health of all life on the planet.3 It is important for health care professionals to recognize the potential impacts that environmental disruptions can have on women during pregnancy so that appropriate teaching and safety measures can be put in place. The mental health impacts of climate change may be particularly overlooked by health care providers who do not recognize the risks or know how to respond.4 Birth professionals have an important role to play to ensure that mental health and well-being are emphasized in this increasingly climate-changed era. The life of every child born today will be profoundly affected by climate change, with populations around the world increasingly facing extremes of weather, food, and water insecurity, changing patterns of infectious disease, and a less certain future. Without accelerated intervention, this new era will come to define the health of people at every stage of their lives. Continuing education (CE) is available for this article. To obtain CE online, please visit http://www.jmwhce.org. A CE form that includes the test questions is available in the print edition of this issue. We are in the fight of our lives. And we are losing. Greenhouse gas emissions keep growing. Global temperatures keep rising. And our planet is fast approaching tipping points that will make climate chaos irreversible. We are on a highway to climate hell with our foot still on the accelerator… Humanity has a choice: cooperate or perish. It is either a Climate Solidarity Pact – or a Collective Suicide Pact.8 Clearly these are sobering messages for everyone to hear, but the reality of the climate crisis will significantly impact people of childbearing age, as the perinatal population and their children are likely to experience the worst consequences of inaction. Climate change concerns are gaining momentum as the impacts to our physical and mental health become more defined, but there is a distinct clinical care and research gap around climate change and the mental health of the perinatal population. Barkin et al9 have produced the most comprehensive summary of research related to climate change as an emerging threat to perinatal mental health; however, they acknowledge “In terms of the mental health effects of climate change, the child population has been a primary focus while the impacts on pregnant and postpartum women have exacted less attention.”9(p 2) A scoping review by Ma et al10 found that 92 studies focused primarily on the traumatic impacts following exposure to a natural disaster but only 4 studies examined the climate change and mental health impacts for younger people. More recently, health care professionals are becoming informed about the ways that climate change can impact mental health and well-being. A review by Charlson et al11 found that climate impacts such as wildfires, floods, heat, and droughts can prompt psychological distress, exacerbate mental health conditions, and increase the risk of suicide rates. The American Psychological Association and ecoAmerica12 report that acute climate-related disasters may precipitate shock, posttraumatic stress disorder (PTSD), and strains on social relationships, including intimate partner violence, whereas long-term impacts of climate change include mental distress, insecurity, and heightened anxiety. It is important for health care professionals to recognize the continuum of mental health symptoms that may impact pregnancy, postpartum, and early parenting. In addition to generalized mental health stressors that are exacerbated by climate change, eco-anxiety and solastalgia are 2 concepts that are becoming more prominent in the literature. Eco-anxiety is an accepted term that describes a rational fear and concern related to climate change. Eco-anxiety can be mild, or it can have a debilitating impact on activities of daily living. According to the 2020 report Climate Change in the American Mind,13(p 10) 27% of Americans are very worried about climate change, and 66% of Americans are somewhat worried. People may manifest eco-anxiety even if they have not directly experienced a climate disaster. Again, young people and pregnant individuals may find eco-anxiety enhanced as they consider the future their children are likely to experience. Solastalgia is a term coined by Australian sustainability professor Glenn Albrecht. Solastalgia refers to the sense of loss and distress that is “produced by environmental change impacting on people while they are directly connected to their home environment.”14(p S95) All people can experience this sense of grief and loss as climate change brings about obvious changes to the environment around us. Solastalgia can impact our sense of hope and our belief in a positive future. Therefore, it is important for birth professionals to know how to respond. The perinatal population is more vulnerable to mental health concerns, with 10% to 20% of individuals being affected by perinatal or postpartum mood and anxiety disorders15 Considering the unique mental health needs of the birth community, Canadian researchers Olson and Metz16 report that climate change multiplies the vulnerability and threatens the resilience of at-risk populations, which ultimately contributes to adverse pregnancy outcomes and impaired child development. The authors highlight the urgent need to “intervene to reduce stress and increase resilience in pre-conceptual women and men, pregnant and postpartum women, and their young children.”16(p 1) Although we see some emerging research examining the effects of extreme weather events (EWEs) specifically on perinatal mental health, there remains a gap of knowledge about eco-anxiety and solastalgia and the impact that other slower shifts in climate change will have on overall mental health. For example, worsening exposure to prolonged heat or cold, poor air quality/wildfire smoke, and displacement due to rising oceans may not have the same traumatic or PTSD response as EWEs but may still impact perinatal mental health and well-being.17 The birthing body and mental health are deeply connected. Physical changes can impact the mental health of those giving birth, and vice versa. Poor mental health can also have adverse outcomes for neonatal health18 and childhood development19; therefore, in addition to literature on the impacts of climate change on mental health and well-being, birth professionals must also be well versed in emerging literature on the physical risks that climate change poses during pregnancy and postpartum. It is especially important to recognize that even though everyone will experience adverse impacts of climate change, underresourced and marginalized communities are known to suffer “first and worst.”20 Birth professionals have an obligation to patients to be aware of the expanding impacts of climate change on mental health and well-being and an opportunity to advance research in this area. Health care professionals are often tasked to allay anxieties about potential events that we know are statistically uncommon. We hold the evidence-based information of the lower risk of said concerns becoming reality and impart that knowledge with compassion and kindness to shift a patient's worry. With climate change, we may hold the same concerns as our clients, so one of the first things we need to do is educate and care for ourselves. We must work to find our seed of hope so we can pass it forward. Nurses Climate Challenge,21 an initiative cosponsored by Health Care Without Harm and the Alliance of Nurses for Healthy Environments, provides many tools to assist health care workers to gain knowledge and a sense of fellowship in addressing climate change as a community. Clayton et al12 provide a list of recommendations on what professionals can do to mitigate the impacts of climate change on mental health. Birth professionals can also represent the needs and concerns of perinatal clients in policy dialogues related to climate change and support efforts to decarbonize the health sector. By joining other health care professionals in advocacy, climate mitigation efforts are strengthened.22 Our changing climate is highly relevant to clinicians including obstetric and pediatric providers who are tasked with evaluating women for perinatal depression and anxiety. As the effects of climate change continue to broaden geographically, more patients will be affected, requiring providers to screen for mental wellness and adjust their advisement and approaches with environmental factors in mind.(p 4) This is where midwives, labor and delivery nurses, doulas, and other birth professionals will begin to play a big role. Midwives hold the unique role of simultaneously being rooted in the medical world and being able to hold space for all that is present, including the anxieties and concerns raised by patients. One of the greatest tools that can be used by birth professionals to combat the rising tide of eco-anxiety and climate change related mental health concerns is compassionate listening and acknowledging that the fears held are a reality. Climate change and its impacts are becoming a necessary topic to address in scheduled prenatal care. Not only does this mean we need to adjust to providing resources on how to stay physically safe during EWEs or addressing how to know when there may be poor air quality days related to climate-precipitated wildfires, but we also need to discuss ways to mitigate the mental strains, anxiety, and stressors that accompany climate events. This will mean making mental health screenings more robust by incorporating questions related to climate change, continuing to build out programs where patients have further access to mental health care in pregnancy and postpartum, and encouraging clients with eco-anxiety to join organizations where they feel they are making a difference. The way that climate concerns manifest in patients varies greatly based on the population being served and the prevalent worries currently present in the community. Birth professionals may be engaged in discussions about the new realities of climate change: how to stay safe in extreme heat or air pollution, how to get to prenatal care or a birthplace during volatile storms or unexpected weather, and heightened anxiety around long-term climate change impacts for children. Whereas our current health system frequently focuses on the acute needs of a patient, the ongoing, long-term impacts of eco-anxiety, solastalgia, and climate change-related mental health crises will need to be addressed. The Substance Abuse and Mental Health Services Administration offers resources to help professionals strengthen their disaster behavioral health responses.23 Although some of the risks of climate change, such as EWEs and other disasters, have clear ways that midwives can assist, others, such as eco-anxiety and mental health strains, require a more nuanced approach. Acknowledging and holding space for eco-anxiety is the first step to mitigating it, but the impacts on families experiencing heightened anxiety can often far outweigh what birth professionals are able to support in day-to-day work. In the years to come, the need to address access to mental health therapy and building more comprehensive prenatal and postpartum care to monitor the well-being of patients will directly influence the way climate change related mental health concerns play out in the health of a family. The antidote to eco-anxiety is to be informed, to find others who share your views and concerns, and to act. Social media and doom scrolling can augment anxiety, so it is important to seek knowledge from reputable sources. In the United States, one important, regularly updated resource for patients is the Climate Change and the Health of Pregnant, Breastfeeding, and Postpartum Women webpage on the Environmental Protection Agency's website.17 The site offers specific action items for women to follow. There is no more powerful force for change than women mobilizing to protect their children. We know that when we come together for climate, racial, and social justice to tell our stories and share our dreams for our children, we cannot fail.24 In conclusion, compassionate care, delivered by informed health care professionals, can aid in decreasing climate-related stress, potentially improving perinatal mental health and birth outcomes. Birth professionals have a unique opportunity and growing obligation to patients to provide education and support on the expanding impacts of climate change. Neither author has conflicts of interest.

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