Emergency Preparedness in Maternal and Child Care– Reconstructing by creative collaboration with community medicine and public healthcare system
Lecture 1: How we can support safe child delivery to build a community with hope
Junichi Sugawara
Professor,
Division of Feto-Maternal Medical Science,
Department of Community Medical Support,
Tohoku Medical Megabank Organization, Tohoku University
1. Immediate Aftermath of the Great Tohoku Earthquake—Crisis in Childbirth(1) Pregnant women and nursing mothers“ Pregnant women could not get information on the state of disaster and/or operational
status of the hospitals at which they had planned to deliver their babies, and did notknow where to go to consult a doctor.”“Even if they wanted to go to hospitals, they had no means of transportation.”“After arriving at shelters, pregnant women did not have a chance to talk about theirpregnancy.”“The nursing mothers were at a loss for how to get essential supplies for their children.”“They were worried about the influence of the harsh environment, such as lack ofhealthy meals, sleep deprivation, stress and concern over the safety of their separated
family members, on their children.”(2) Institutions with Delivery Services
Two of the institutions with delivery services in Ishinomaki City had completely
collapsed, and several others could not provide such services because of complete
destruction of the first floor, disruption of essential utilities, and damages due to theaging of the structure. The institutions that survived the disasters caused by theearthquake became desperately overloaded. The child delivery system in Miyagi
Prefecture faced an unprecedented crisis. According to the statistics, the number ofprehospital deliveries was 23 per year, and the number of expectants rushed tohospitals was 807 per year. During the first two months after the earthquake disaster,
217 pregnant women were evacuated or transported to other locations and delivered
their babies in unplanned medical institutions. 13 pregnant women were transported byhelicopter to university hospitals per day.
2. Research Outcomes and Issues Identified by the Study Group: the Ministry of Health,
Labor and Welfare:Lack of coordination among obstetrical, disaster and emergency medical services.
The staff in charge of perinatal care was not informed of the situation in sheltersand communities”
There is a need for establishing means for communicating information to pregnant
women and nursing mothers, as well as for systems for backing up obstetricalinformation (maternity record book, etc.)”.

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There is a significant difference among local governments in terms of their disaster
preparedness in obstetrical medical service”.

3. Sure to happen again! Preparations for disasters(1) Train personnel so as to save the lives of pregnant women and nursing mothers rightafter the occurrence of a disaster.
⇒ Coordination between the Disaster Medical Assistant Team (DMAT) and perinatal
care institutions.
(2) Information is the most important support factor in disaster situation.
⇒ Establish specific means for communicating critical information to pregnant womenand nursing mothers (preparation of manuals, etc.)(3) Provision of necessary assistance in evacuation.
⇒ Aid to pregnant women and nursing mothers in shelters; coordination with local
governments.
(4) Relevant parties must maintain a high-level disaster preparedness at all times, bycontinuously studying and examining ways of disaster management.
⇒ Disaster drills within communities; Institutionalization to improve disaster
preparedness of local governments.

Lcture2: Effective plans to collect and transmit information to expectant and nursingmothers
Keiko Kasai,
Executive director,Japanese Midwives Association.
1. Introduction
Ordinary information flows are delayed and necessary information constantly changes
at the time of disaster; it is needed to obtain accurate information in an urgent manner.
It is important for expectant and nursing mothers as well as mothers and children, who
are vulnerable to disaster, to strive to obtain information necessary for themselves.
Moreover, supporters such as local government must provide appropriate information tothem.
On the premise that disasters occur unexpectedly, this presentation introduces theimportant points in sharing information that have been identified as the result ofconsidering the following: preparation of information at ordinary times on disasters for
expectant and nursing mothers, mothers and children, and their supporters such as
local governments; and effective ways to understand and transmit information on
expectant and nursing mothers as well as mothers and children in each phase after
disasters.
2. Details of workThe following three points were considered in preparing the manual.
1) The manual is to be prepared at action level
Simple expressions were used so that everyone who reads the manual will take thesame actions on the premise that disasters occur unexpectedly. The announcements at a
shelter in phase 0 ask concrete questions, such as “Are there any women who are
pregnant or after birth?” and “Are there any families (mothers) with children?”2) The contents are divided for ordinary times and each phase after disasters andrespond to changes in situations
The manual shows actions to be taken by expectant and nursing mothers as well as
local governments and mentions actions for understanding and transmitting
information respectively at the time of disaster in the five phases defined by theDisaster and Medical Care Council of the Tokyo Metropolitan Government.
3) Matters to be considered in each phase are mentioned
While the manual mentions actions to be taken in each phase, it also states ways ofthinking that accompany such actions and matters to be considered as “points ofattention.” For example, it states in phase 1, “Because expectant and nursing mothers
as well as mothers and children find it difficult to raise their voice, it is important to
individually check the situations of shelters and conduct interviews with them (paying
special attention to whether or not they are enduring difficult situations).”

3. Remaining issues
There are various issues on how to protect expectant and nursing mothers as well as
mothers and children at the time of disaster. As for expectant and nursing mothers,
appropriate triage should be carried out for symptomatic persons; because mothers
without symptoms are also considered to have a certain degree of risks, it is desirable toconsider them clearly as people vulnerable to disaster. Professional associations in thefield of obstetrics and gynecology are expected to produce proposals in this regard. In
the aftermath of the Great East Japan Earthquake that took place in 2011, it wasobserved that enough support was not necessarily provided for women and children due
to traditional norms on gender roles. Associating support for all women with support for
expectant and nursing mothers at ordinary times contributes to support provided at thetime of disaster, which cannot be predicted.
4. Conclusion
It is desirable to prepare manuals that instruct expectant and nursing mothers,mothers and children, and all supports to take concrete actions at the time of disaster ineach local government and area, depending on their circumstances. I would be delighted
if the content of this presentation was referred to in preparing such manuals.

Lecture 3: Positive efforts by maternal and child-rearing generations after theearthquake.
Yumi Ogawa,Director,
General incorporated association, Mother Wing
After the Great East Japan Earthquake, supporters for child–rearing generation
learned that “urgent support” and “long term compassion” are inseparable even in
ordinary time. In this forum, I’ll report experiences of support for 4 years and theimportant truth that regional supporters should walk with child-rearing generation.
1. Difficult situations in mothers and small children after the disaster
Regional support base for child rearing generation, “Nobisuku IzumiChuo, Sendai City”
has been established by Sendai City Government for mothers and small children. Six
thousand ( / month) mothers and children access this facility. In 2011, after the disaster,over three hundred requests for advice (/year)were received from nursing mothers
including refugees from Fukushima prefecture. We continuously supported recoveries
for mothers and children with midwives, public health nurses and childcare workers.
2. Necessities for long term mental health care and education for disaster preparedness
in mothers and children.
After the disaster, we experienced frequently that mothers could not stop vague
uneasiness after childbirth. Therefore, we continued seminars, for mothers who did notexperience the earthquake and who could not afford to prepare, to learn more about
disaster reduction as a part of daily life.
3. Regional cooperation and multifaceted support network for parent and childTo save parent and child from the disaster, it may be necessary that supporters should
be in touch with parents and children and introduce specialists, reliable base andpersonnel. Furthermore, it would be effective for disaster prevention that establishmentof network between each supporters, regional assistance for expectant and nursing
mothers and continuous activities to build up a face-to-face communication in eachregions.