EBB 383 – Impact of Extreme Weather on Pregnancy with Alicia Race, Climate Resilience Policy Advocate

Dr. Rebecca Dekker – 00:00:00:

Before we get started I just wanted to share a quick reminder that early bird tickets for the 2026 Evidence Based Birth® conference open to the waitlist on Wednesday January 21st. Being on the waitlist means early bird pricing and an invitation to an exclusive live Q&A session with me. So make sure you’re on the waitlist by going to ebbirth.com/waitlist and get all the latest details about the Evidence Based Birth conference happening virtually on March 17th and 18th of 2026. And now, on today’s podcast, we’re going to talk with Alicia Race about how climate change and extreme weather during danger season can impact pregnant families. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. Hi, everyone. Today, I am so excited to welcome Alicia Race to the Evidence Based Birth® Podcast. Alicia is a climate resilience policy advocate for the Climate and Energy Program at the Union of Concerned Scientists. In her role, Alicia works with scientists, partners, and community leaders to advance just and equitable solutions at the state and local level. Alicia earned her master’s in political science from the University of Illinois at Chicago and a bachelor’s in political science and Spanish from Northern Kentucky University. She has been published in The Hill, and she lives in Kentucky with her spouse, toddler, and her dog, and she’s here today to talk with us about the impact of climate change and extreme weather on pregnancy. Alicia, welcome to the Evidence Based Birth® Podcast.

Alicia Race – 00:01:25:

Thank you so much for having me. I’m glad to be here.

Dr. Rebecca Dekker – 00:01:27:

Yeah. So, Alicia, can you start off by explaining a little bit about what danger season is and tell us also a little bit about how you got interested in this subject?

Alicia Race – 00:01:40:

Yeah. So I’ll flip it and start with the second question first. So, I got interested in working on climate change, climate resilience, actually coming from the immigration advocacy space. So that was my background before getting into climate and clean energy advocacy, I worked for an immigration and refugee organization and then was doing immigration work, and I noticed that so many stories that we’re hearing were people getting displaced from the places that they live because of climate impacts. And so, I made a career jump and started working in the climate and advocacy space so that I could really work kind of at the intersection of those two issues. And we are seeing kind of both of those things, I think, a spotlight in this day and age. They are just like so connected to me at this point. There’s really no separating them. And so I’m really glad that I’ve gotten to the space where I am in my career to be working on, be able to work on all the things that I’m passionate about.

Dr. Rebecca Dekker – 00:02:43:

And so that’s like a term now, right? Climate refugee. Is that essentially what you were seeing? Immigrants who are fleeing the impacts of climate change?

Alicia Race – 00:02:51:

Yeah, people use a lot of different terms and there’s not an internationally recognized term when it comes to people who are displaced from climate impacts. It’s definitely something that a lot of groups are working on trying to define and trying to make sure that we have human rights-based policies to ensure that if people are displaced, whether that’s within their own country or across borders, that they’re able to be met with safety and dignity as they’re playing different events, different disasters. And I think finally researchers and advocates are really getting ahead on this issue finally after years of not really talking about it as much, trying to define how we can protect people across the world.

Dr. Rebecca Dekker – 00:03:36:

What were some of the situations that you met people that they were fleeing from?

Alicia Race – 00:03:41:

Yeah. So, we hear a lot about people who are displaced from hurricanes, from drought conditions. So really, climate change is an economic issue. It’s a social justice issue. And so, there’s a lot of reasons why people might be displaced from where they live. And then a lot of times, we like the places where we live and we don’t want to leave them. And so, climate impacts can really exacerbate conditions that have already been challenging, whether economically or socially. Politically or otherwise, it can kind of be that tipping point of why people might have to leave or choose to leave the place that they call home.

Dr. Rebecca Dekker – 00:04:18:

So then what is danger season exactly? And how does it relate to like these increasing risks that we’re seeing with climate related disasters?

Alicia Race – 00:04:30:

Yeah, so danger season is a term that my colleagues at the Union of Concerned Scientists came up with a couple years ago to really capture the record-breaking extreme heat and climate impacts that we were seeing year after year. So we define Dangerous Season as the months between May and October in the United States and Caribbean territory. When heat, hurricanes, flood conditions, or wildfires and bad air pollution that come with them, are at their worst. So we previously would say things like, “This year is the hottest year on record.” In fact, the last 10 hottest years on record have been in the last decade. 2025 is shaping up to be the second hottest on record. And really, people are starting to reframe it instead of saying “This is the hottest year on record,” to say, “This might be the coolest summer for the rest of our lives.” And heat is the number one weather-related killer. I think sometimes people don’t know that and don’t really understand how dangerous extreme heat is, especially as we’re seeing it in places where people aren’t used to it, like New England states. Places that don’t have air conditioning and other infrastructure to stay cool. And what makes danger season so dangerous is that a lot of times these events can happen at the same time and put people even at more risk. So one example of when this happened was in 2021. Hurricane Ida, a Category 4 hurricane, hit Louisiana. And over 2 million people were left without power in the wake of this hurricane. And at the same time, there was a heat wave. So, of course, people are dealing with the initial impacts of the storm, flooding damage, damage to their home, loss of power. And now with a heat wave, people may not be able to find somewhere to stay cool. Putting them at higher exposure and risk of extreme heat. And another example of kind of when these issues can compound was when I was pregnant two years ago in 2023, and in the summer, it was a very hot day, the heat index. So the combination of heat and humidity was really high. So for sensitive groups like pregnant folks, it meant that I had to take precautions if I was going to be outside for long periods of time. And at the same time, there were wildfires burning all the way in Canada, which is very far from Kentucky, where I live. And it was making the air quality here dangerous for me to breathe as well. And research shows that the combination of heat and air pollution are especially dangerous for pregnant people. And so, when these hazards start compounding on each other, then it puts more people at risk and makes the response a little bit more complicated.

Dr. Rebecca Dekker – 00:07:27:

Mm-hmm. And it reminds me of how, you know, one of the ways this was brought to my attention is when Dr. Sara Ailshire, who you are familiar with, she was publishing the research updates on ruptured membranes, like premature rupture membranes when your water breaks before the start of labor. And she found all this evidence that’s been published recently showing that rates of preterm, premature rupture of membranes go way up in these extreme weather events. So, it has an impact physiologically on the onset of labor in some cases.

Alicia Race – 00:08:03:

Yeah, and that’s what’s in my research for this article found as well, that all of these impacts have associated research with pregnancy. So people who are pregnant, who are nursing and postpartum especially, are at risk of heat, air quality, hurricanes, and as you mentioned, it’s not just physical effects, but can also be the mental effects as well.

Dr. Rebecca Dekker – 00:08:26:

Mm-hmm. Yeah. So can you give us an example of how like, a hurricane might affect a family that’s expecting a baby?

Alicia Race – 00:08:36:

Yeah. So, there are many factors that when we think about who’s at risk of climate change and these weather events. We’re all exposed in a way with these major storms and events. Even hurricanes, I would say, you know, not just confined to people along the coast because we saw hurricane Helene. It was the trajectory initially was going to go straight from the coast up here to Kentucky, and it veered to the east and went through western North Carolina, the Asheville area, and caused a lot of destruction there. So we kind of have to think about everyone who’s going to be in the path of a hurricane and the following storm path. And so what that might look like for a pregnant family is like, starting first and foremost, we need to make sure that everybody is safe at home where they live. And home looks like a lot of different things for different people. And we know, of course, that there are people experiencing homelessness, or people who are incarcerated, or people who maybe have inadequate housing that’s unsafe. And so really, like, kind of at the basic level here, we need to be ensuring that that people are living in safe, affordable, and climate resilient housing. And so, when a hurricane is coming for a family of course, there’s a lot of emergency planning, evacuations, and things like that, but some of the risks that are associated with hurricanes, include flooding and floodwaters so, a lot of times floodwater can contain contaminants that could make anybody sick, but especially somebody who’s pregnant who might be more sensitive, or if that sickness might affect their pregnancy. This was just the 20-year commemoration of Hurricane Katrina in Louisiana that we all remember and really has put a focus on the United States’ response to major disasters. And a study in 2008 came out showing that after Hurricane Katrina, the rate of preterm birth was increased by 230%. And the researchers think that that’s a lot because of the stress and the toll that the aftereffects of that hurricane took on survivors who experienced all of that with the hurricane. So it is really important, as we’re raising awareness about these events, to really talk to your care providers, doctors, doulas, midwives about how to be prepared if there is an event like this how to seek medical care. Especially if your usual route of transportation is affected by flooding, your doctor’s office is closed, how to take care of yourselves and how to really be prepared so people can feel empowered to make a plan and know how to seek care in the event of a major disaster or storm.

Dr. Rebecca Dekker – 00:11:29:

Mm-hmm. It reminds me of an episode we did with a midwife that I think we’ll have to put the link in the show notes where she talked about midwives as responders in disasters and particularly home birth midwives, how they can be great for helping. I always think about when there’s these major weather events, if someone goes into labor, what do you do? You know, in the middle of a hurricane or in the middle of a severe winter storm. And then also, I know there’s organizations on the ground, especially in places like Louisiana, Puerto Rico, that are helping families with babies, you know, when you’re trying to feed your baby during one of these storms and you’re worrying about the quality of water or being able to keep your milk refrigerated, things like that.

Alicia Race – 00:12:17:

Exactly. Yeah. And I think that one of the things I think is really important is the need to know our neighbors. So when we talk about like ways to be prepared. I think having that community around you, if that’s possible, is so important because if a storm hits, those are going to be the people who are able to be there next to you, kind of helping in that initial situation before first responders. Even make it there. And so having that connection with neighbors is so important. Or having people who know that you’re in your home and know that you need support, whether You’re pregnant or you have little kids or especially for older adults who or just people with disabilities who may not be mobile. Like really knowing And this, I think, applies to any of these. Disasters, events. Even extreme heat, you know, calling to make sure that. Your neighbor is able to turn their air conditioning on, if they have one or find cooling. It’s so important to have that community. Of people who know who needs a phone call before and after a situation takes place and just building that resilience and connectivity throughout a community, I think, is one of the most important things that we can really try to do, especially a lot of times we feel so disconnected from our neighbors. So, yeah.

Dr. Rebecca Dekker – 00:13:39:

Mm-hmm. Yeah, building that community is really important. Do you have any other ideas for how we can better prepare families and communities for the challenges of other climate stressors like extreme heat or the wildfire smoke that you mentioned earlier?

Alicia Race – 00:13:55:

Yeah, so when we look at wildfire smoke, extreme heat and air quality. There’s a lot of tools that are available to be able to look at your phone or look online and see what the conditions are for where you live. A lot of these also offer subscription services so you can get an email. Like this morning, I actually got an email saying that the air quality in my county was potentially unsafe for different populations. So, these tools make it really easy to kind of know when you might need to adjust your schedule. And when we’re talking about the impacts on pregnant folks. We know that heat can cause dehydration, hypertension, preeclampsia, low birth weight. And when we look at a combination of like, heat and air pollution, like I mentioned before, that can also be associated with preterm birth, low birth weight, and even stillbirth. And a lot of folks, I think, who maybe live in wildfire areas, closer to where they’re burning might be more familiar with how to stay safe from wildfire smoke. One of my colleagues would talk about. Her and her kids putting on their N95 masks as they were getting ready to go to school. Because the smoke quality was so bad. In those cases, you know, sometimes the sky would be orange, and so it was, like, very clear that there was an issue. But as I mentioned, like, when the wildfire smoke was burning from Canada, here in Kentucky, it wasn’t as easy for me to just look outside and know that there might be a problem. And so that’s why I really like communicating these risks to people is important because sometimes we’re just not aware that that’s happening. And then when it comes to being prepared for all of these things, there’s a lot of approaches. There’s the community and individual response of things that we can do to keep each other safe. Talking about it, learning about it. And then there’s also the responsibility of our elected officials and policymakers to ensure that people are safe. From these impacts in extreme weather. So at The Union of Concerned Scientists we work on climate resilience. And we define that as needing to phase out our use of fossil fuels so that we can reduce the pollution in the air that is is causing and has caused climate change so that we can, where we can make a difference, then we can reduce the severity of some of these impacts in the future. We are already are living in a climate changed world. And so it’s also really important that we protect people here and now, which is exactly what we’re talking about today. And so that means having policies in place that keep people safe. So one of the areas that I’m really passionate about also is when it comes to people who may lose power or not have access to heating when it’s dangerously cold or access to cooling when it’s dangerously hot. And that comes from a personal experience that I had growing up when I was In high school and I had the flu and I was home and it was very cold. It doesn’t seem like it gets that cold in October anymore in Kentucky, but it was really cold. And because my family was going through financial difficulties, we couldn’t afford to keep our power on or our water on all the time. And so I was home sick with the flu. Shivering and luckily we had a fireplace and my dad was able to like light a fire and keep me warm. I remember sleeping by the fireplace, which can also have so many hazards and risk of fire. And breathing in air pollutant. But I say that this like situation made me feel so powerless, which is a little bit of a pun, but also like we were struggling. We needed support. Probably could have found support because there are programs available for people who are struggling. Exactly for those reasons. But it’s hard to find. And then there’s also stigma, right, of like accessing resources when you’re in need of help. And I feel like looking back, that’s what really got me into this work as well, is advocacy and making sure that people have the tools. And the resources that they need in order to make change so that they can not just survive, but really thrive. And so all that said is that one of the major policy solutions we could do today would be to keep utility companies from turning off people’s power. Especially when it’s extremely hot or extremely cold. Because the outcome is that people will die if they cannot stay cool in the places that they live. And so that’s a huge equity issue, a huge policy issue and it’s like the, this solution is so simple and could be done across the country today.

Dr. Rebecca Dekker – 00:18:59:

Mm-hmm. And we know the cost of utilities keeps going up for people. And then you have to use it more during these extreme weather events.

Alicia Race – 00:19:07:

Yeah.

Dr. Rebecca Dekker – 00:19:08:

And there’s the potential for power outages that maybe are, you know, rolling power outages or unintentional from overload of the system. You mentioned that Union of Concerned Scientists has developed some tools or resources. Can you tell us what those are and just kind of give us an introduction to some of those?

Alicia Race – 00:19:27:

Yeah, so one of the tools that we’ve developed is the Danger Season mapping tool. So at dangerseason.ucs.org, we have a map that shows United States and territories in the Caribbean. And it keeps track of how many people today are experiencing one of these elements, whether it’s extreme heat, air quality alerts, wildfire, storms and flooding and has the air quality alerts as well. Which is something that we’ve added just the last year or two here. And it really paints a picture of like how these impacts our experience across the country. And we also look at the percentage of people who live in places under alerts that are considered disadvantaged and the methodology for that comes from the, from census tract data as well as the climate and environmental justice screening tool. Which looks at vulnerability based on where people live, like their energy burden. So, whether or not they are able to pay for or afford their energy costs. What kind of housing they live in. What kind of pollution they’re exposed to, what kind of transportation options they have, and other categories that are used to designate a county as disadvantaged or underinvested in. And we know that disproportionately people who live in communities that have been made vulnerable over time from things like redlining, history of systemic racism, underinvestment, overdevelopment of industry and things like that put people at increased risk when it comes to these climate impacts and events. And we disproportionately see those in low-income communities and communities of color across U.S. So it’s important for us to track that when we’re talking about social vulnerability and vulnerability to climate change and climate impact. So we, we, capture that percentage on this map. We also put it into perspective of how many people have experienced an alert since the start of the danger season in May. So by the end of May, about 70% of the country had already experienced one of these alerts. And as of today, about 99% of the area that we’re looking at has experienced this. This is really like a kind of science communication tool. Just to really make people aware of of what they might experience. And we have other tools and resources on different weather events. Sea level rise. Extreme heat. And one of the tools that I find really helpful is from a 2019 analysis we did called Killer Heat. And we looked at historical heat rates. And looked at future projections for heat index across the country. And we have a widget, an interactive tool where people can go in and put their county or their city in and a different heat index level, so over 90 degrees, over 100. 105. Or, these temperatures that are off the charts, which basically the formula for the National Weather Service gets broken at a certain point because of the heat humidity being so high. For these especially dangerously hot days. And you can use this to look at what historically has happened for your where you live. And I pulled this up for Louisville today and our projections show that if we continue on the path we are now, like, burning fossil fuels. And not taking meaningful action to really switch to clean, renewable energy, then my county can expect to have about 79, 80 days of temperatures over 100 degrees in a given year on average by the end of the century. But if we were to take like, Really. Robust action, we could reduce that to more like 35 days. Which a month of temperature is still over 100 degrees sounds unbearable. But these are where our choices really matter. So when we’re talking about like the choices we make today are going to matter for our future, for our kids. For ourselves. There is a chance we really should have been acting decades ago, and we knew we should, but there’s been so many barriers. Including obstruction by the fossil fuel industry. To prevent us from taking those actions that we really need to do everything that we can with the time that we have to act. And that’s what our tools seek to do is put information in the hands of folks. Not just scientists. But people who are experts in their own right. Based on their lived experience to understand the risk, understand the solution, and then use these tools, hopefully, to talk about it and then advocate with their lawmakers and policy makers on solutions. To keep us safe when we’re experiencing these threats.

Dr. Rebecca Dekker – 00:24:39:

Yeah, it seems like there’s like macro level things that need to be done, like the policy and societal level. And then we have micro level things like knowing the risk where you are today or where your clients, if you’re a birth worker, like maybe sending out an alert to your clients about air quality. How do you get to the website you mentioned where you could look at the predictions for numbers of days above 100 degrees?

Alicia Race – 00:25:03:

Yeah, that’s definitely something I can share with

Dr. Rebecca Dekker – 00:25:06:

The show notes?

Alicia Race – 00:25:09:

Yeah. Googling killer heat interactive tool.

Dr. Rebecca Dekker – 00:25:16:

Any other apps you recommend or you use that are perhaps free for our listeners? You mentioned the wildfire smoke. What’s the best way to track the air quality?

Alicia Race – 00:25:27:

Yeah, there’s the they are now, website so you can look at air quality alerts there. And you can also subscribe to get notifications. There’s a local one here in Louisville that I used, so I was able to subscribe for my county. And it sends me notifications when there is an alert. Makes it really helpful. And then the link for the National Weather Service has heat alert information. And so, we could also link to some of those so that it’s easy for people to find that. And there’s also a smoke and fire map as well that people can use, and just because we talk about danger season being the month from May to October where these climate impacts and events are at their worst. It doesn’t mean that other seasons aren’t and Texas in 2021 experienced Winter Storm Yuri, which was an extreme cold event that a power grid was not able to keep up with so people lost power and were not able to stay warm and stay safe in their home because they lost power for many days. And that was a really a compounding hazard event with people trying to stay warm. And ways that were not safe, you know, lighting candles and things like that that could lead to fire. So that’s an example of like, yes, there are still extreme cold events that can have hazards for people and present challenges and then as you mentioned, here in Kentucky, the tornado activity has really seemed to shift further east, and some of the scientific developments that have been really improved are around communication of forecasting tornadoes, of of getting early warning systems out there.

Dr. Rebecca Dekker – 00:27:55:

Alicia, thank you so much for coming on the podcast and sharing info with us on these really important topics. Do you have any final words of advice or wisdom or something you wish that we would take action on?

Alicia Race – 00:28:08:

Yeah. Yeah. Thank you so much. It’s been an absolute pleasure. And what I really want people to take away is that we talk about climate-fueled events, when you talk about danger season, it’s really not like, let’s all just be scared and not do anything. I really want people to know that this information is out there, that you can get trusted resources. from the Union of Concerned Scientists, from the American Public Health Association. From, you know, practitioners in your network. I’m sure you have amazing birth workers who are, you know, experts on this and know everything they need to know, too, to make sure people are safe. And so, learning this information and sharing this information is the first step in keeping ourselves and each other safe. Being in solidarity with our neighbors. So, recognizing that these climate impacts don’t hit everybody equally. I mentioned this in the article, and I think it’s really important to make sure that we say it here too, is that the year that I was pregnant, the data shows that Black women in the U.S. died at a rate of nearly 3.5 times higher than white women around the time of childbirth. And that was in the year that I was pregnant in 2023. And so, we know that while pregnant people are more sensitive to climate impacts, the vulnerabilities are not equal. There are disparities within populations. And similarly, the mortality rate for Indigenous, Native American, and Alaska Native people is rising. And the maternal mortality rate in the U.S. far exceeds those of other high-income nations. And studies have shown that 80% of the youth deaths are preventable. So I really appreciate the work that you and folks in your network are doing for birth justice, for reproductive rights, and making sure that people are safe and that climate change is just something that exacerbates social and economic vulnerability, putting people at more risk. So we need to share our stories. We need to share information. We need to talk about it. And we need to get involved with local groups, and we need to vote.

Dr. Rebecca Dekker – 00:30:24:

Awesome. Thank you, Alicia. We’ll make sure to put in the show notes links to all the resources you mentioned, as well as a few extras. And thanks everyone for listening and for learning about this important topic. I’ll see you next week. Bye. Today’s podcast episode was brought to you by the online workshops for birth professionals taught by Evidence Based Birth® instructors. We have an amazing group of EBB instructors from around the world who can provide you with live, interactive, continuing education workshops that are fully online. We designed Savvy Birth Pro workshops to help birth professionals who are feeling stressed by the limitations of the healthcare system. Our instructors also teach the popular Comfort Measures for Birth Professionals and Labor and Delivery Nurses workshop. If you are a nurse or birth professional who wants instruction in massage, upright birthing positions, acupressure for pain relief, and more, you will love the Comfort Measures workshop. Visit ebbirth.com/events to find a list of upcoming online workshops.