Canberra, Australia – Mother-of-two Caitlin Buttress knew about the dangers of bushfires, but never thought to worry about the smoke.
“I watch a lot of news so I felt as well informed as I could be, but no one ever said to me that my baby’s problems could be smoke-related,” Buttress said, glancing at three-month-old baby Emily dozing next to her.
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Emily was born in mid-June, two weeks early and slightly underweight. Buttress had just entered the second trimester of her pregnancy when massive bushfires swept through southeastern New South Wales (NSW), sending Canberra’s Air Quality Index to 434 – anything above 200 is considered hazardous – on New Year’s Day 2020.
“I had two miscarriages last year, so I was already worried about losing her,” Buttress said. “It’s already hard to breathe when you’re pregnant, so the bushfire smoke made it even more exhausting. I felt physically ill.”
“You feel so responsible as a mother,” Buttress adds. “Did I put her at risk?”
While it is hard to pinpoint exactly what causes health issues in babies, doctors say the catastrophic bushfires that ravaged Australia in 2019 and 2020 probably contributed to problems with newborns.
“Last summer was a terrible bushfire season,” Dr Steve Robson, Buttress’s obstetrician-gynaecologist told Al Jazeera. “The region had the worst air quality in the world at the time.”
Bushfire smoke contains a complex mixture of chemicals, gases, and solid particles. Tiny particles like PM2.5 are particularly dangerous because they penetrate deep into the respiratory system and bloodstream.
“Women tend to bear the brunt of climate change globally,” said Dr Robson, with pregnant women particularly susceptible.
Research from the United States – where the west coast has also endured devastating wildfires – shows that prolonged exposure to the smoke during pregnancy increases the risk of high blood pressure, gestational diabetes, premature birth, and low birth weight.
Dr Robson acknowledges it is hard to attribute health outcomes to bushfire smoke, but he cannot see what else could have caused the complications he has seen this year.
“All I can go on is what I personally experienced,” Dr Robson said. “Babies born during the height of the smoke ended up in ICU with breathing problems that we couldn’t explain.”
Dr Robson is also seeing unusual developments in women who were in the early stages of pregnancy in January. “Their babies that are inexplicably small, and there are abnormalities with the placentas … This is not something I usually see.”
‘Grainy and coming apart’
With bushfires becoming more severe and more common, doctors and scientists are increasingly concerned about the health of women and babies.
General practitioner Dr Rebecca McGowan, who works in Albury in rural New South Wales, is another doctor speaking out after an alarming recent birth.
“This woman’s baby was small, but the horrifying thing was her placenta. She wore a mask and she’s never smoked in her life, but her placenta looked like that of a pack a day smoker,” Dr McGowan told Al Jazeera.
The placenta was in such bad condition – “grey, grainy, and coming apart” – that the woman needed surgery to remove it.
On the NSW south coast, where bushfires raged for 74 days before being extinguished, obstetrician-gynaecologist Dr Michael Holland said he has seen similar problems.
“We’ve had an increased number of pregnancy complications this year,” Dr Holland said. “There have been three stillbirths, including two due to bleeding … Stillbirth usually affects one percent of pregnancies, mostly due to foetal abnormalities, so these were unusual cases.”
More Australian-focused research is under way to determine exactly how bushfire smoke affects mothers and babies.
“We do know a little bit, but our understanding is still evolving,” Sotiris Vardoulakis, professor of global environmental health at the Australian National University told Al Jazeera. “There has been more research on urban pollution [than on bushfires], but we know that the composition is equally toxic.”
Vardoulakis is the smoke exposure lead for the Mother and Child 2020 survey, a research project that is examining how mothers and babies have been affected by last summer’s bushfires and COVID-19.
“Any increase in exposure [to smoke] increases the risk,” Vardoulakis explained. “What is most important is the duration and level of exposure: with bushfires, the exposure is shorter than exposure to urban pollution, but it is still a substantial amount of time and the levels are much higher.”
‘I couldn’t breathe’
Residents of Bateman’s Bay on the south coast of NSW never expected that bushfires would threaten their town of 17,000 people.
“It was my first experience with bushfires,” said Shadiya Nellikurussi. She and her young family moved to Bateman’s Bay in 2017 from southern India. “We didn’t know what to do.”
Nellikurussi was five months pregnant with baby Eva when the bushfire swept down towards the home where she lived with her husband and four-year-old daughter.
“Suddenly, the heat went up, all the surroundings went red,” she recalled. “Our neighbour told us to go to the beach, so we went. I felt like I was suffocating; I couldn’t breathe.”
Nellikurussi spent three weeks in temporary accommodation before being allowed back home. She remembers the time was very stressful, with thick smoke hanging in the air for weeks.
“The day after the fires, we went to the hospital because I was mentally very low, very down,” Nellikurussi said. “I didn’t know what to do about my health. I had gestational diabetes and meeting those dietary needs was very difficult with limited supplies.”
Rupa Basu, chief of air and climate epidemiology at the California Office of Environmental Health Hazard Assessment, agreed that stress is a major problem for pregnant women in natural disaster situations.
“Maternal stress is a risk factor that is heightened during wildfires and can increase risk for adverse birth outcomes,” Basu said.
Casey Douglas had good reason to be stressed during her pregnancy. Living half an hour from Bateman’s Bay in the small town of Nelligen, she lost nearly all her family’s property to last summer’s bushfires; only the house was left unburned.
“I was three months pregnant during the fires, plus had a one-year-old and a five-year-old,” Douglas told Al Jazeera. “We evacuated three times to Bateman’s Bay and the smoke was so bad, my friend gave me a wet cloth nappy and put it on my face.
“I’m so glad we did that because I didn’t realise until days later just how toxic the smoke was,” she said. “When I had Laura Grace in July, I was really concerned. I had it in me that bubba would have something wrong… I knew bubba was small: small head and torso, and that freaked me out. I worried what she’d been exposed to, but she came out normal.”
Monitoring the future
To enable mothers to better protect themselves, Vardoulakis said better air quality monitoring is needed.
“We need real-time monitoring and information on PM2.5 – it must be updated hourly, not over 24-hour averages,” he argued. “Local authorities are working towards this, but we need more monitoring stations and faster information, as well as better education on how to modify activities and avoid exposure.”
Back on the NSW south coast, having survived last summer’s catastrophic fires, Nellikurussi and Douglas worry about what the future holds as another fire season approaches.
“I don’t think I’ll ever get over it,” Douglas said. “Laura Grace was the one good thing that happened last summer… Summers are just different now.”
“My eldest daughter draws pictures of the fire all the time,” Nellikurussi said. “She asks me if summer is coming and if the bushfire will come again or not.”