The health and well-being of pregnant women during and after natural disasters remains an international concern. In this mixed methods study we described pregnant women's mental health, psychosocial concerns and sources of stress living in New Orleans during long term recovery from Hurricane Katrina. Our survey of 402 pregnant women indicated poor social support was associated with higher levels of depression symptomology, post-traumatic stress disorder, anxiety, and stress. Women were interviewed and described seven common areas of worry. We concluded that pregnant women living in post-disaster communities have stressful lives years after the event, needing innovative models of care to build resilience.Worldwide, pregnant women and newborns are among the most vulnerable populations during natural disasters and in the aftermath (Fordham, 2008). Exposure to natural disasters is common in both the developing and developed world, and groups from both areas have expressed concern that maternal and child health needs are not sufficiently emphasized in the aftermath (Brunson, 2017; Human Rights Watch, 2011; Zotti, Williams, Robertson, Horney, & Hsia, 2013). In the decade following the 2005 Hurricane Katrina disaster in New Orleans, considerable attention focused on improving disaster responses in the United States to address the specific needs of pregnant women and newborns. Disaster guidelines and standards of care were re-designed to meet the unique needs of childbearing women and newborns during disaster and in the immediate aftermath (

Objectives To examine how the recovery following Hurricane Katrina affected pregnancy outcomes. Methods 308 New Orleans area pregnant women were interviewed 5-7 years after Hurricane Katrina about their exposure to the disaster (danger, damage, and injury); current disruption; and perceptions of recovery. Birthweight, gestational age, birth length, and head circumference were examined in linear models, and low birthweight (<2500 g) and preterm birth (<37 weeks) in logistic models, with adjustment for confounders. Results Associations were found between experiencing damage during Katrina and birthweight (adjusted beta for high exposure = −158 g) and between injury and gestational age (adjusted beta= −0.5 days). Of the indicators of recovery experience, most consistently associated with worsened birth outcomes was worry that another hurricane would hit the region (adjusted beta for birthweight: −112 g, p=0.08; gestational age: −3.2 days, p=0.02; birth length: −0.65 cm, p=0.06) Conclusions Natural disaster may have long-term effects on pregnancy outcomes. Alternately, women who are most vulnerable to disaster may be also vulnerable to poor pregnancy outcome.

Nurses who work during disasters must live through the uncertainty of the situation and be prepared to adapt to the needs that arise in patient care situations and self-preservation. Excellent basic nursing skills, intuitive problem solving, and a sense of staff unity are primary resources. Nurses and other caregivers need ongoing supportive interventions to rebound from the experience and cope with symptoms associated with trauma exposure.