The Price Of Birth: the cost to the planet and our pockets of modern maternity care

As the world has burned and the cost of living has spiralled this summer, like a lot of people, my mind has turned to sustainability. And like a lot of people, I’m angry. We have been told for a generation that we hold the key to climate change – if only we can sort our yoghurt pots and buy a bike – yet only 100 corporations are responsible for over 70% of carbon emissions.

But what has birth care got to do with the environment and the cost of living crisis, I hear you ask. Well here goes – I have some thoughts.

The NHS is a massive organisation creating tons of waste each year and burning most of it in incinerators that have mostly been sold off to private companies and rented back at tax payers’ expense – make of that what you will. At every birth I see enormous bin bags of waste; single use equipment and packaging, incontinence pads, innumerable plastic gloves, PPE, plastic cups from the drinks machine…the list goes on. Even at a homebirth I witness the midwives making, then carrying away, enormous bags of rubbish. As one midwife I know says:

“I’ve seen a change over the years from reusable to disposable. Even things like speculums and cord scissors which are metal. Even drapes and curtains are disposable these days.”

Vicki Matthhews

If individuals are being pressurised to think more carefully about what we throw away, why isn’t the NHS getting on board? As well as more patient-centred, informed choice focused, evidence based and compassionate, our healthcare system also needs to work on being greener.

Apparently, they agree with me. At least they did pre-pandemic. In January 2020 NHS Chief Sir Simon Stevens announced immediate action to work the NHS towards zero net carbon emissions.

“The NHS will be taking immediate action in 2020, with a proposed new NHS Standard Contract calling on hospitals to reduce carbon from buildings and estates, whilst switching to less polluting anaesthetic gases, better asthma inhalers, and encouraging more active travel for staff.“

Then, of course, the pandemic caused a veritable tsunami of single use PPE and the government compounded the issue by buying milions of quid’s worth of unusable stuff. The impact is obvious everywhere I go – there is even a seagull with a paper mask in its nest outside my bathroom window.

After a birth with a multitude of interventions and consequential waste, the assault on the environment can continue. Putting aside conversations about individual choice and physical ability, the impact of formula feeding is rarely mentioned. An article in the British Journal of Midwifery stated:

“The production of unnecessary infant and toddler formulas exacerbates environmental damage and should be a matter of increasing global concern,” argue experts in The BMJ today.

Furthermore, Dr Natalie Shenker, UKRI Future Leaders Fellow at Imperial College London, and colleagues highlight research showing breastfeeding for six months saves an estimated 95-153 kg CO2 equivalent per baby compared with formula feeding.

For the UK alone, carbon emission savings gained by supporting mothers to breastfeed would equate to taking between 50,000 and 77,500 cars off the road each year, they write.

There is a ton of research to suggest that highly medicated births are more likely to lead to lower breastfeeding rates, and so the landfills are filled ever fuller with the detritus of formula feeding – they even sell single use bottles and teats!

Then we have disposable nappies and wipes. Not disposable at all. In fact your average paper nappy, filled with chlorine and super absorable sodium polyacrylatem, takes around 400 years to biodegrade. If Shakespeare’s baby bum had been clad in these chemical laden monstrosities, his poo would still be moldering away somewhere, together with the wipes his mother used, contributing to the next enormous fatberg in our sewers.

Hospitals contribute to the almost universal use of disposable nappies and wipes by making it difficult to use washable nappies on the wards and providing such miniscule cotton wool balls to wipe sticky meconium off tender bottoms that parents can’t wait to use something more effective.

We do see some steps in the right direction within NHS Trusts. Some single use equipment is now being made of cardboard, such as the tubes you blow through to test CO2 levels and sick bowls. But overall, not enough is being done, which is entirely unsurprising during the worst staffing crisis in NHS history. After all, on an average understaffed, busy shift, who’s got time to ensure that stocks of equipment are used in date order to avoid things going out of date and having to be binned? And when staff are just trying to survive, no one has the time or energy to think about novel ways to save time and money and mitigate environmental impact.

So how can doulas make a difference? Well on one very fundamental level, when we have clients who are aiming for a physiological birth, perhaps at home, we help make that happen. These kinds of births have the smallest impact on the environment and the least cost to the taxpayer.

Having doula support also increases the likelihood of parents reaching their breastfeeding or chestfeeding goals, which not only reduces carbon emissions and landfill waste, but saves money.

Doulas can support you to save cash and the environment in myriad other ways. How about not deciding to allow the midwives to take away your placenta and burn it? Perhaps you could bury it under a tree for your baby to play under or encapsulate it. Why not explore washable nappies? These days they can be affordable, convenient and easy to care for. We can also point you in the direction of washable wipes or show you how to make your own.

We can teach you how to carry your baby in a wrap or carrier, meaning that you might choose a cheaper buggy or even not have one at all! And we can look at the list of equipment you think you need to buy and talk to you about cheaper alternatives or even whether you need to buy it at all, thus saving you time, money and waste when you find you never use said piece of equipment.

We can also support you in feeding your baby. Whether you choose or need to breastfeed or formula feed, we can support you to save money and care for the environment. From bottles and teats, to brands of formula, we have the facts. ‘Follow on’ formula? An unnecessary expense that impacts the environment. Highly processed weaning foods? High in salt, sugar and preservatives, impacting the environment, expensive and totally unnecessary!

Being eco-friendly as a parent can seem out of reach to many. ‘Natural’ baby toiletries, clothes and toys are marketed to the most well off. But it doesn’t have to be that way: a doula can show you how thinking about the impact on the environment can actually save you money and off-set the cost of employing the doula in the first place.

Meanwhile, what is the NHS doing to ensure their environmental footprint reduces? During the pandemic, highly medicalised birth practices have spiralled out of control. If this is the kind of birth you need, or want, you’ll get no judgement from us. But if you’re planning a natural birth, you can feel proud that your plans not only maximise the chances of a happy and healthy birth experience for you and your baby, but have less of an impact on the environment. Having a doula can help tip the scales in your favour; ensuring you have the practical and emotional support, together with enough information to help you navigate your way through a system that isn’t always fit for purpose.

What we’d like to see is the multi-national conglomerates having less of a strangle hold on birth and babies. From Big Pharma to Big Formula and Big Food, there are people making enormous profits off parents and pumping out greenhouse gases like there’s no tomorrow.

And there’s the rub. If we want a tomorrow for these babies, maybe we need to start thinking about the environmental impact and calling on government to limit the marketing of environmentally unfriendly, unhealthy, unethical products to the health service and directly to parents. Consumer pressure is powerful; together we can call for more action, demand better from our health service and stop lining the pockets of fat cats by boycotting environmentally unethical, totally unnecessary products.

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Additional point by DD Siobhan Ridley, whose husband manufactures eco-friendly paints.
“standard household paints need solvents in them to make them dry quickly. Standard paints have VOC levels including formaldehyde. During the drying process there’s a chemical reaction and the VOC gasses are released into the breathing space. So even if someone is wearing a mask and well ventilating the house during painting, the gasses leach at high levels into the home for 2 weeks after painting. Then for up to 5 years after.”
So if you or your clients are figuring on decorating the nursery, it may well be prudent to seek out a more eco-friendly and less toxic way of doing it.