Pioneers Push Prenatal Environmental Health Care

Hospital prenatal programs about environmental safety are mainly grassroots initiatives with independent funding. Advocates hope they will pioneer a more established place in mainstream prenatal practices.

(WOMENSENEWS)–A small but growing number of hospitals across the country are adding warnings about environmental toxins to their prenatal programs.

"Eat salmon instead of tuna when you’re pregnant, and you’ll avoid mercury contamination that can trigger a miscarriage."

"Use traps instead of pesticides to rid your home of insects, and you’ll protect your baby from chemicals that can cause low birth weight."

"Replace bleach with gentler cleansers that don’t irritate airways, and you’ll prevent your toddler from suffering an asthma attack."

Hospitals that have recently launched prenatal environmental programs that dispense such tips include Berkshire Health Systems in Pittsfield, Mass., and Magee-Womens Hospital in Pittsburgh, Pa. Both are grassroots initiatives funded by grant money from independent foundations.

Advocates, however, say they represent the latest sign that hospitals are becoming increasingly sensitive to environmental-health programming.

"These prenatal programs illustrate a dramatic shift toward environmental consciousness that the health care industry has undergone since 2000," says Laura Brannen, executive director of Hospitals for a Healthy Environment, a nonprofit in Lyme, N.H., that promotes environmental sustainability in health care.

"As recently as the mid-1990s, health care was the leading cause of mercury contamination. Back then, there were mercury thermometers and blood pressure cuffs in nearly every hospital. But now, the thermometers have been replaced with digital ones, the cuffs are being phased out and incinerators dedicated to burning mercury have shut down."

Stacy Malkan, communications director for the Arlington, Va., nonprofit Health Care Without Harm, a coalition that promotes environmental sustainability, agrees.

"Hospitals are getting better about using environmentally friendly products," says Malkan. In response to studies that show chemicals can harm a developing fetus, more medical centers are also now beginning to teach parents-to-be to practice environmental safety, she adds.

When fetuses are exposed to toxins in utero, it can disrupt the most delicate stage of growth. During the first five months of gestation, 100 billion neurons are formed. "Synthetic chemicals can impair the nervous system," says Malkan. "They can interfere with gene expression and interrupt hormones during critical windows of development."

Two Recent Programs

Berkshire Health Systems’ Healthy Beginnings program is a joint project of three local groups: the Center for Ecological Technology, the Berkshire Visiting Nurse Association and Sprout: the Berkshire Initiative for Children’s Environmental Health.

Since 2002, with funding from the U.S. Environmental Protection Agency, Healthy Beginnings has taught 300 low-income pregnant women how to guard against lead, mercury, pesticides, tainted water, secondhand smoke and PCBs.

Nurses spend 20 to 30 minutes at the hospital teaching each patient how to shop right, eat right and keep her home green. In addition to individualized counseling, patients get follow-up phone calls and a worksheet with advice like "don’t use bug spray on babies under two months" and "wash or peel fruits and vegetables so your children don’t eat pesticides."

Many of the program’s tips are customized for the local population.

"Fish caught here have high levels of PCBs, so we tell women to avoid eating them," says Laura Dubester, the Center for Ecological Technology’s co-director, referring to the pollution of the Housatonic River by factory and landfill waste. "Houses tend to have old lead pipes, so we teach women to run tap water for several minutes before use to flush lead sediments out. Many homes have old lead paint, so if women are doing renovations, we teach them to contain dust and debris so their children aren’t exposed."

Broadening the Reach

While Healthy Beginnings is small and focused, Magee-Womens Hospital in Pittsburgh has a broader reach.

Since 2005, Magee has worked to include environmental education in its childbirth and newborn care classes and in its programming for women who are up to 15 weeks pregnant.

"We tell women to buy baby mattresses that don’t contain flame retardants," says Judy Focareta, a clinical education specialist at the hospital. "We give them federal guidelines about mercury and fish consumption. And we hand them a ‘Pediatric Environmental Health Toolkit’ created by Physicians for Social Responsibility."

In addition to educating women in three specialized programs, Magee reaches out to all 9,000 patients who give birth at the hospital each year, giving them free calendars with tips on how to minimize toxin exposure in the home. The hospital’s environmental initiatives are funded by the Pittsburgh-based Heinz Endowments.

Health advocates say these are still exceptional projects and the medical industry has far to go in making environmental changes on a programmatic as well as a practical level.

"Medical schools often don’t include environmental training in their curriculums," says Siobhan McNally, a pediatrician in Lenox, Mass., and the director of Sprout. "Since health care providers don’t get this kind of education, their patients may not either."

Supporters of green prenatal initiatives say these programs fill the gaps by having nurses, pamphlets, flyers–and grassroots volunteers–teach pregnant women what their doctors don’t. These programs target the right audience, since women typically make shopping and health care decisions for their families. They come at the right time, since pregnancy is a "teachable moment" when women are undergoing and are responsive to change.

Responding to Maternal Interests

These initiatives also take advantage of what appears to be mothers’ growing interest in the environment.

"Surveys show moms want to know about environmental health more than any other subject, but that this is a topic their pediatricians tend to talk about the least," says Joel Kreisberg, executive director of the Teleosis Institute, a nonprofit in Berkeley, Calif., that promotes environmentally friendly medicine. "Thanks to new programs like these, we’re hoping there will now be more dialogue."

Fifty-six percent of mothers say pregnancy inspired them to recycle, buy "green" products and in other ways lead a more environmentally conscious lifestyle, according to a survey conducted this month by the San Francisco-based BabyCenter.

An estimated 100,000 synthetic chemicals are in the soil, air and water. They are also getting into pregnant women’s bodies. A 2005 study by the Washington-based Environmental Working Group found 287 chemicals in umbilical cord blood, 180 of them known carcinogens. Other research shows toxins are in breast milk and placenta tissue.

Exposure is also dangerous in the first years after birth, when children grow rapidly. Proportionally, children inhale twice as much air as adults and drink two and a half times as much water, reports the Washington-based Alliance for Healthy Homes. Children also absorb extra toxins when they crawl on the floor and place objects in their mouths.

Research shows toxins can trigger a whole host of pediatric ailments. Lead can lower the IQ, mercury can damage the brain, pesticides can cause childhood cancers and polychlorinated biphenyls (PCBs, used as coolants) can speed puberty in girls.

Just as alarming as these problems is their growing prevalence. One in 6 women under 45 has enough mercury in her blood to harm a developing fetus, reports the Atlanta-based Centers for Disease Control and Prevention. One in 20 U.S. children has elevated lead levels, says the Bethesda-based National Institutes of Health. And up to 75 percent of children have byproducts of secondhand smoke in their blood, reports the New York-based American Lung Association.

Molly M. Ginty is a freelance writer based in New York City.

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