by Rachel Crumpler, North Carolina Health News
October 25, 2024

By Rachel Crumpler

Hailey Jones will never forget the first baby she delivered: Her neighbor and best friend’s baby girl entered the world at a home on the banks of the Swannanoa River in Buncombe County on Thursday, Sept. 26, at 9:16 a.m.

While a home birth was always planned, Mother Nature inflicted more challenging circumstances than they’d envisioned. 

Days of rain washed out the road, which led to the two-family home the women’s families shared. This meant the seasoned midwife who’d planned to lead the delivery was stuck in Burnsville, an hour away. Jones, a student midwife who had only attended a few births, needed to step up. 

One of the biggest challenges, she said, was tuning out the worsening weather conditions. 

“She starts feeling all this pressure, and she gets in the pool, which is on her porch,” Jones recalled. “I can literally see water just rushing — about to come over the edge of our property from where we were sitting.” 

Jones FaceTimed the midwife for guidance. 

About two hours after the mother’s water broke, the baby was safely in her arms. 

“She was a powerhouse,” Jones said. “She completely ignored all the talking and stress around her. She had no idea that it was as bad as it was.”

With the birth complete, Jones’ adrenaline subsided and she had to confront the next challenge — Helene’s imminent arrival. The area was already flooding, and they knew they had to leave.

“Having to rip her out of her bed at three hours postpartum was really hard for me, because I know how important it is to rest and relax,” Jones said.

A temporary break in the water’s rise allowed the two families to evacuate together to higher ground in Black Mountain. They threw only a few items into a car because they expected to be back at their house on Sunday or Monday.

Instead, fewer than 24 hours after the birth, the remnants of Hurricane Helene tore a path of destruction through western North Carolina, decimating their beloved property. 

Helene tore the house to shreds, washing most of it away. The Swannanoa River reached historic levels, peaking at 27.33 feet on Sept. 27 at 3:45 p.m., according to U.S. Geological Survey gage data. 

Just three days earlier, it flowed at less than 2 feet.

The nursery the mother spent weeks perfecting, the baby clothes she had neatly organized, the freezer full of postpartum meals prepared in advance — all of it gone. Her vision of where and how she would raise her newborn was upended. 

For Jones — 10 weeks pregnant with her third child when the storm hit — the destruction was just as bleak. The life she had built with her family and her plans for raising her third vanished in the raging waters.

“We’re still just kind of shell-shocked,” Jones said. “I had everything saved. I actually planned to give birth in the same pool that my sister had her baby in — and that’s gone. Everything’s gone. All the baby stuff I had saved from my first baby — those are things you can’t get back.”

Both families have had to relocate — and they’re still figuring out what the future looks like.

Many other pregnant and newly postpartum women have found themselves temporarily or permanently displaced by Helene — confronting challenging circumstances and stressors on top of already physically and emotionally demanding pregnancies. 

Providers across the state and grassroots community efforts have worked to support pregnant women with care coordination, donations and fundraisers. And despite the harrowing conditions, families are also taking time to appreciate the new lives brought into the world amid the devastation.

“We were on the brink,” Jones said. “We could have not made it. We are literally just grateful that we’re alive and with our kids … to see another day.”

Pregnancy amid a natural disaster

Helene’s powerful winds and historic rain toppled trees, damaged power lines and cell towers, and devastated water infrastructure, roads and homes. Gov. Roy Cooper’s office announced on Oct. 23 that initial damage assessments from Helene totaled $53 billion, making it the worst storm in state history. 

For pregnant women, this destruction caused temporary clinic closures and canceled OB-GYN appointments, turned birth plans upside down and led to evacuations to safer areas for deliveries and caring for newborns.

It’s been a lot to process, said Alex Glitz, a Buncombe County resident who was 34 weeks pregnant when Helene hit. While she said she made it through the storm with minimal damage to her condo in Asheville’s River Arts District, the surrounding area wasn’t as lucky.

By Sunday evening, she and her partner decided it was in their best interest to evacuate. They had just enough gas — even using what they had stored in their shed for their lawnmower — to make it to Wake Forest to stay with friends.

“I had been in fight or flight mode for three plus days, which doesn’t necessarily mesh well being in your third trimester of pregnancy,” Glitz said. 

Helene has taken a toll on her mental health, she said, particularly the survivor’s guilt she felt. Friends lost their businesses and belongings, and 42 people died in the county. Glitz said she even felt guilty for fleeing to a safer location.

The storm and its aftermath have taken a toll. Amelia Cline, an OB-GYN at Mountain Area Health Education Center in Asheville, has talked to many stressed-out pregnant patients.

“There’s so many sort of unknowns and things you can’t control in pregnancy. That’s true at baseline,” Cline explained. So conditions brought by Helene have taken that to a new level.

Outflux of patients

Hospitals in the region stayed open throughout the storm — on generator power and backup water — but Lisa Carroll, a high-risk OB-GYN, who worked at Mission Hospital during the first days after the storm, said that care was initially limited to emergencies and people in active labor. 

This meant scheduled C-sections and inductions were canceled.

Once the extent of damage to western North Carolina was revealed more clearly after the first days, MAHEC — the largest obstetric provider in the region — advised patients who were 36 weeks pregnant or greater to leave and establish care with providers outside of the disaster zone. Carroll explained that one of the biggest concerns driving this recommendation was the lack of clean running water in Buncombe County due to “catastrophic damage” to Asheville’s public water system.

“We didn’t want to be in the situation of delivering people and then discharging them from the hospital to go back to homes where they didn’t have clean running water,” Carroll said. “That was not safe for newborns or infants.”

This recommendation led to a flurry of relocations and massive coordination to transfer patients and their medical records. Carroll said the MAHEC staff divided into essentially two teams — one focused on patient care and another on patient logistics.

“I’ve never cold-called so many hospitals and OB-GYN practices in far-flung regions trying to get people in and get people appointments,” said Cline, an OB-GYN at MAHEC, who evacuated to Raleigh with her newborn for reasons similar to her patients. Temporarily leaving western North Carolina also meant she got better cell service to help with care coordination. 

Providers across the state stepped up to take on patients, she said.

Kali Crudup, a resident of Arden (10 miles south of Asheville), was 37 weeks pregnant when Helene hit. Fortunately, she said, she never lost power or water. But the medical recommendation that she seek care elsewhere was hard to process and forced her to quickly rework her birth plan.

“Honestly, it was super scary and unsettling,” Crudup said. “Knowing that I was going to an OB who I had never met before, and I might meet them one or two times before I chose them to deliver my baby? That’s kind of unsettling.”

Crudup said she loved her provider at Biltmore OB-GYN and was looking forward to delivering at Mission Hospital. After having a daughter at the beginning of the COVID-19 pandemic, when family could not be present, she was eager for a different experience this time around.

Doctors suggested she move to Charlotte in case she went into labor early, but that didn’t work for her family.

“That sounds like a great idea if you’re able to do something like that,” Crudup said. “But we have our 4-year-old daughter, so we would have to either leave her here for however many weeks while we’re just sitting there waiting, not to mention finding a place to stay. We don’t really have any relatives in Charlotte that we’d be able to just crash with for a couple weeks, so we’d have to be looking and paying for a hotel for that amount of time. And my daughter’s school is closed, so where’s she gonna go during the day?”

Improved conditions

Nearly a month after Helene barrelled through western North Carolina, the birthing landscape in the region is much improved — though challenges remain. As of Oct. 15, all MAHEC clinic sites had resumed seeing patients. Hospitals aren’t deferring inductions or scheduled procedures anymore, and they have sufficient potable water to provide care. Mission Hospital in Asheville even dug a well to bolster water supplies. 

Another notable improvement came on Oct. 21, when the City of Asheville announced that 99 percent of water service had been restored. But the water coming out of faucets is still not safe for drinking, cooking, brushing teeth and hand-washing dishes unless it’s boiled beforehand. Asheville residents are under a boil water notice because of lingering sediment in the water.

City officials said returning to potable running water is a long process.

Glitz, now 37 weeks pregnant, is back in Asheville — at least for the time being. While she said the city has made tremendous progress in restoring water, she doesn’t feel that she can bring her baby home to a house without potable running water. 

But she’s clinging to hope that safe drinking water is restored before her due date. She knows good water will be key for washing bottles and other baby items, mixing with formula, cleaning breast pump parts and bathing the baby.

“Obviously, I would love to bring my baby home to our house because that’s kind of what we’ve been planning on doing for the whole time but a lot of it still is up in the air,” she said. 

However, she said she’s fortunate to have options. She’s connected to a provider in the Triangle where she could deliver, or she could deliver in Asheville and use a friend’s clean well water if needed.

Worries about care gaps

While the immediate focus after Helene turned to the pregnant people who were furthest along and finding them a safe place to deliver, Carroll is acutely aware that gaps in care caused by Helene will affect pregnancies delivered at Christmastime and into the new year. 

Research shows that natural disasters bring exposure to environmental pollutants, psychological stressors and lack of access to health care that can worsen health outcomes for the most vulnerable women and infants.

For a couple of weeks, MAHEC and other OB providers were operating at reduced capacity, leading to canceled appointments and straining a region that’s already considered a maternity care desert.

“The reason why we do routine care is to catch the elevated blood pressure, or catch the slowing of growth for the fetus, or so many other things that we’re trying to catch so that we can either intervene on, provide treatment for or sometimes just say it’s time for delivery — even if you’re kind of at an earlier gestational age,” Carroll said. “I’m just worried about the complications from gaps in care.”

Cline, the MAHEC OB-GYN, also expressed concern about how health outcomes will be affected by Helene.

“Anytime we have disruption — whether it’s COVID or this — and we’re having to prioritize some patients over others, people get bumped and that means that preventative care gets bumped and delayed,” Cline said. “That’s annuals, that’s Pap smears, that’s us not finding cancers because we need to prioritize our high-risk OB patients first and the sickest patients first.”

Community support

Despite the turmoil brought by Helene, grassroots efforts quickly popped up to support affected western North Carolina families. 

Taylor Broussard is a doula based in the Madison County town of Marshall — another area devastated by floodwaters. She found herself isolated and without cell service for several days, unable to reach her clients. It was a scary feeling to have no information, and she didn’t want that for her clients or other pregnant women in the region.

So she quickly set up online forms to help connect people who needed emergency care. Hundreds of people filled out the forms — people requesting help and those offering assistance. 

The volume of responses quickly became too much, so Broussard teamed up with other birth workers to create a more robust system of assistance. They launched North Carolina Reproductive Care Disaster Relief, a website where pregnant and postpartum families in western North Carolina affected by Helene can request medical care, infant feeding, doula care and housing assistance.

“It’s just been really amazing to see the way people come together to help support these women and families through such a scary and confusing time,” Broussard said.

Other efforts, like a Facebook group created for new and expecting mothers and families with young children going to Charlotte after Helene, sprung up as a place of mutual support. It’s full of posts requesting help, offerings of donated items, people eager to volunteer and more. 

There have been huge efforts to get diapers, formula and other hygiene products to those who need it. The Diaper Bank of North Carolina alone has delivered over 2.5 million such products to western North Carolina. 

Communities are also working to raise funds to support birth workers who have lost income from reduced patient loads.

Glitz said she’s found gratitude in seeing the community come together to support each other.

“While this was not on the radar of how I would spend my last trimester of pregnancy, throughout the devastation and the heartbreak, it’s been a really incredible thing to watch this community come together,” she said. “It really just reiterates why I love the people here and why I want to raise my family here.”

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