Introduction
Methods
Study participants
Data collection
• Before Hurricanes Irma/Maria, what were your expectations for this pregnancy? | |
• In the days leading up to the hurricanes, what sort of concerns did you have about your pregnancy? | |
• When thinking about concern for your pregnancy and other potential concerns, such as safety for your family, how did you determine what to prioritize? | |
• Tell me about the night that Hurricane Irma/Maria hit. What was that like for you? | |
• In the days and weeks after the Hurricane, what was it like to get the care that you needed for your pregnancy? | |
• What actions did you take to make sure you received adequate care for the pregnancy? | |
• What made it hard for you, as a pregnant woman, to get through the hurricane? | |
• What complications did you experience during your pregnancy and birth? | |
• What was it like to manage your pregnancy along with your other concerns? | |
• What impact, if any, did the Hurricanes have on your pregnancy/general health? | |
• What were some of the resources you used to help you meet your needs? | |
• How were your expectations for your pregnancy different from what you experienced? | |
• What were some of the differences you experienced between your prior pregnancies and this pregnancy? (If multiparous) | |
• What impact do you think that living in a U.S. territory may have had on your experience? | |
• What might help other pregnant individuals in the future to successfully cope with the changes that come along with dealing with a severe hurricane while pregnant? | |
• What resources should be available to pregnant women during severe hurricanes? | |
• Is there anything else you feel is important to tell us about your experience with pregnancy and birth during and after the hurricanes? |
Reflexivity
Analysis
Conceptually-informed analytic strategy
Analytic procedures
Results
Participant characteristics
Characteristic | n (%) |
---|---|
Age
| |
18–24 | 2 (11.1%) |
25–29 | 6 (33.3) |
30–34 | 7 (38.9%) |
35–39 | 1 (5.6%) |
40–44 | 2 (11.1%) |
Race
| |
Black/African Caribbean | 11 (61.1%) |
White | 4 (22.2%) |
Multiracial | 3 (16.7%) |
Ethnicity
| |
Hispanic | 3 (16.7%) |
Not Hispanic | 15 (83.3%) |
Marital Status
| |
Never Married | 9 (50.0%) |
Married | 8 (44.4%) |
Divorced | 1 (5.6%) |
Employment
| |
Not Employed | 5 (27.8%) |
Part-Time | 1 (5.6%) |
Full-Time | 12 (66.7%) |
Education
| |
Less than High School | 5 (27.8%) |
High School | 5 (27.8%) |
Some College | 3 (16.7%) |
College | 2 (11.1%) |
Graduate | 2 (11.1%) |
Post-Graduate | 1 (5.6%) |
Household Annual Income
| |
$0-$15,000 | 3 (16.7%) |
$15,000-$25,000 | 3 (16.7%) |
$25,000-$60,000 | 7 (38.9%) |
Greater than $60,000 | 5 (27.8%) |
Island of Residence
| |
St. Croix (Hurricane Maria) | 9 (50.0%) |
St. Thomas (Hurricane Irma) | 8 (44.4%) |
St. John (Hurricane Irma) | 1 (5.6%) |
Gave Birth in the USVI
| |
Yes | 14 (77.8%) |
No | 4 (22.2%) |
Type of Birth
| |
Vaginal | 9 (50%) |
Cesarean | 9 (50%) |
Timing of Birth
| |
Full Term | 18 (100%) |
Pre-Term | 0 (0%) |
Hypertension
| |
Yes | 5 (16.7%) |
No | 13 (83.3%) |
Delay or Interruption in Prenatal Care
| |
Yes | 12 (66.7) |
No | 6 (33.3) |
Themes
Individual
Risk
And I lost a lot of weight… a lot. I wasn’t gaining– I gained - I kid you not - nine pounds through my whole entire pregnancy…The food was horrible, canned food. I wasn’t eating healthy…The grocery store didn’t have fresh food as much.
A hurricane is not an ideal situation and– you know, for anybody to be in. But it becomes more complicated when you’re pregnant. And the stress that it puts on you is a lot… a lot of people probably wouldn’t be able to handle some of the stuff that I went through…with no lights and no running water…while you’re pregnant.
I tried my best not to stress, but I was so worried that there was going to be something wrong with her because... I’m supposed to be relaxing.
Even though it was a blessing getting everything that we needed from my in-laws, it was also really– I won’t lie. Just dramatic. And it was like, “Can’t I be a mom by myself? Can I just be in my own privacy? Do I have to live with someone else?“ Emotionally, it was…a lot for me in terms of just not being able to have my own privacy with my daughter as a new mom.
Resilience
I really did not want to have a home birth. That’s why I was really so calm in my head and just trying not to have the pressure of the hurricane induce my pregnancy.
I didn’t get to mourn or go through the process of “we’re going through this aftermath.” I feel like the entire time I was pregnant, I was just focused... on being calm the entire time. I didn’t get to like take in [that] “this is devastating.” It was not after maybe like months after, was when I kind of like broke down and cried and realized we went through a category five hurricane and I was very pregnant and I had my 18-month old.
Household and Community
Risk
Everyone was dealing with their own things and dealing with their houses and things like that. Typically…my mom would have come or my mother-in-law or my sisters in law, but everyone was dealing with their own things at that time. I mean they would still check up on me, but it wasn’t like how it would have normally been.
They didn’t let us [leave work to get sandbags]. I [contacted HR]. I emailed everybody because I was so upset, but it just got ignored, conveniently…Their idea was, “Well, you’re here to serve the public...“ I’m like, “Well, that’s perfect, but who’s here to help out the people who serve the public?“ Who’s here to give us our little opportunity to prepare our homes? And that was an ongoing complaint between the administration and the [employees].
The water was waist deep to me…The water was just so high and dark, and I was scared. I was really scared. So, my parents cupped my hands between theirs… so nobody could trail away, because the current of the water was flowing pretty heavy as well. So, we walked through the water, and I remember stopping a few times because ... not knowing it was contractions ... And, my mom said, “We’re almost there. We’re almost there, baby.“
Yeah, we were pregnant, and people have all manner of, “Oh, this is gonna happen, and this is gonna happen.“ And, and so, you know, a lot of people were like, “Oh, yeah premature babies.“ And I’m looking at people like, “No…We’re not having a baby in the middle of a hurricane,“ you know? So, I’m like, rubbing my belly and talking to the baby. I’m like, “You better stay in there.“
Resilience
Mutual psychosocial and tangible support (“We [shared] our resources”)
My family and friends…they helped me a lot, especially my family [be]cause they came to check up on me to make sure that if we didn’t have anything we would be able to get it. My friends helped me out as well because if somebody was cooking… they would give everybody a place to eat…And we would share our resources of food, [and] water…They was also making sure that, you know, I was safe, and I was okay.
They were a very big support. I was so stressed– I was [not] really combing my hair…. And my aunt was like, like, “Hey, we need to do something at least before you go into the hospital.“ So, she would braid it up for me. So, they were a very big support for me.
And thank God I had such a great boss that, you know, she was very lenient. If I couldn’t come in on certain days…she wouldn’t expect me to come in. I can’t complain…And not to mention as far as my employer, she was pretty helpful, like, “Okay, do you guys need water? Do you guys need this?“ So that was a big help as well too.
If [we were in] in any other country or island, I don’t think we would have been recovering so quickly. And we did have a really good recovery turnover after Maria…I’ve been through Hugo, and, you know, [this time] things wasn’t that bad, you know?
Maternity system level
Risk
There was no hot water in the hospital... The hospital was technically condemned, and so that was a huge stressor for me, but the maternity ward and postnatal ward was supposed to be of good condition...but that was extremely stressful. I remember I really freaked out when I had heard that the hospital was condemned, but I didn’t want to leave island because I didn’t want to be away from my significant other for his first child. I didn’t want that opportunity to be lost. They didn’t tell you that they didn’t have warm water either, so I went in for a shower. I ended up taking a cold, cold shower post C-section and oh my God.
She kept trying to get us on a mercy flight…My pregnancy was already high-risk because I was carrying twins…They wanted to get the people with more serious problems out based off of how much was damaged, pregnant people and people with other problems… At the time they didn’t have the necessary materials in case my babies were born [early].”
Um, it was a delay…I would say about for maybe like 2 to 4 weeks…But their building had got ruined, so they had to move somewhere else. And where they moved [the space was] a lot smaller. It took a little time for them to get over there. But I would say three weeks…
They told [my partner] what to look for and he had ... two older kids [born through homebirth] already, so he knew just in case if I were to have a baby during the hurricane this is what to do. [My family was] prepared in regards to that, and luckily, we didn’t need that… I mean I was thankful that we were prepared, but I really did not want to have a home birth.
Resilience
Continuity of high-quality care (“On top of their game”)
That day, my boss’s husband, who was a federal agent at the time, and his friend went up to the north shore road to see if I was okay. Then, I was fine. Then after that, another [midwife], came by the house to see if I was okay. Everyone was worried because I was 42 weeks and I was still not having any contractions or anything like that.
The office was destroyed…she had to move to a temporary location where she was still seeing her patients at the hospital… So, my prenatal visits were just as frequent or regular, like, if I were– not had the hurricane because she didn’t make it any– um, it’s just that it was not in her office because it was destroyed... And most of her information was, you know, something online. So, she could have used her laptop to access our records. So that was a plus.
So about a week after the hurricane, we had no power or Internet, but in town, there was internet… A lot of the offices would post on Facebook temporary phone numbers. So, I think [the doctor’s] office actually posted on Facebook a cell phone number.
…The nurses and everyone there were amazing…My husband would tell me they didn’t have running water, and they had to, like, boil water to bring it for his first bath. And, I [didn’t] remember, until he told me, because they were just that good. They...really were on top of their game.