The issues of global warming, climate change and our over-usage of the Earth’s resources are hitting the news more and more often these days. Increasingly, we understand that we can all do our bit on an individual level to help redress the problem, yet I wonder how many people are aware that modern health care services are leaving an enormous ecological footprint?
When I first wrote about these issues, in 2001, NHS staff in England and Wales travelled 25 billion passenger kilometres. This is the equivalent of nearly 33 million trips from the Earth to the Moon and back.
Additionally, the NHS:
• Consumed 2.4 million tonnes of resources, excluding water and oxygen. This equalled the weight of 600,000 fully grown male elephants.
• Discarded 400,000 tonnes of this as solid waste and sent 3.2 million tonnes of emissions (mostly carbon dioxide) into the air. If you piled all of the solid waste onto a football pitch, it would reach roughly the same height as a 5-storey building.
• Consumed 12 650 GWh of energy – one per cent of the total energy consumed in England and Wales – most of which came from non-renewable sources. This is the equivalent of leaving nearly 86 million televisions turned on for a whole year.
• Was supplied with nearly 50 million litres of water, which is enough to fill nearly 50 Olympic sized swimming pools. Unfortunately, 14 per cent (or 7 pools’ worth) of this water was lost as leakage.
Original data from Royal Society for Nature Conservation (2006).
Interestingly, changes in how the NHS is structured makes this data harder to come by these days. But that hasn’t stopped people discussing the issues. In a 2006 BMJ editorial, Anna Coote raised the question of whether the NHS is too focused on efficiency and not focused enough on the environment. She pointed out that,
“If medicine is about saving lives, not just by last ditch interventions but by trying to avert illness, then working to alter patterns of behaviour that contribute to climate change could arguably become a priority for clinicians as an urgent preventive measure.” (2006: 1343)
She goes on to argue that, as one of the largest employers in the world, the NHS could make far more of a contribution to the reduction of climate change than it is currently doing. Yet real change often begins from a ‘bottom-up’ approach, where the individuals who work in large organisations can better see how improvements can be made.
Towards Greener Birth?
I know many midwives who are very committed to recycling, conservation and other ‘green’ issues in their homes and at work. In the early part of the twenty-first century, environmental issues around women’s health and childbirth tended to be linked to discussion around the impact of disposable menstrual products and nappies. To a lesser extent, infant feeding has become an environmental issue, not least because exclusive breastfeeding leaves no carbon footprint unless you start adding accessories such as pumps to the mix. Even then, the carbon footprint of these is far lower than the carbon footprint of artificial milk, bottles, sterilising equipment and the energy used to boil tens of litres of water every week. Given this, and the fact that 8 million disposable nappies – each of which will take hundreds of years to decompose – are thrown away each day in the UK, it’s clear that a difference can be made in the arena of birth.
Striking a Balance
Addressing these issues is not about using no energy. It is about using energy and other resources appropriately. As such, there is a need to ensure that energy is being used well. This does not necessarily mean that we should automatically decrease things like the postnatal support that new mothers receive, as this is a fundamentally important way of helping them ease into their new role and can also be a vital arena in which to discuss these issues with women and families. It does, however, mean that we need to think about what is being consumed on a local level and whether this is appropriate. If midwives can become more involved in this debate, we can help ensure that the most significant footprint babies leave as they enter life on Earth are the ones that are created when their tiny, squirming, environmentally friendly ink-covered feet are gently pressed onto recycled paper.
There are many things that we can do to reduce the enormous ecological footprint that modern health services leave each year. Many of the things that serve the Earth also serve women and babies. The carbon footprint of a vaginal birth, for instance, is far lower than that of a cesarean section. Each cesarean section uses a lot of fossil fuels and water and generates more waste than a vaginal birth. Power and water are needed for the appliances that clean the theatre, for cleaning and sterilising equipment, for diathermy, for disposing of waste, even for washing the scrubs worn by the multitude of attendants. Although a few of these things such as the sterilisation of instruments and the disposal of waste – still occur following a vaginal birth, they generally occur on a much smaller scale.
In general, low-tech options are ‘greener’ than high-tech options. CTGs and dopplers leave a carbon footprint which is far greater than pinards and fetoscopes; not just because of the comparatively high ecological costs involved in making them and powering them when in use, but also because of the cost of disposal when they are no longer useful. This is the case almost across the board, and the list on the remainder of this page discusses a number of Earth-saving suggestions; all of which have been tested, recommended and shared by midwives. I mentioned above that, in total, the NHS consumes resources equivalent to the weight of 600,000 elephants every year. If every midwife could reduce their ‘birth carbon footprint’ by even a tiny bit, we could still save a good few elephant’s worth between us.
What can midwives, doctors and other staff do?
• Encourage hospitals, surgeries and other facilities to follow ‘green’ practices such as using low-energy light bulbs and having plenty of on-site recycling facilities.
• Support paper recycling. Where confidential documents are involved, shredded paper is just as easily recycled as ‘whole’ pieces of paper.
• Encourage those with purchasing power to buy recycled products (e.g. paper, pens, loo roll) where possible.
• Find out whether food provided to staff and service users is or could be being sourced locally. Local supply schemes are working well in some areas of the UK.
• Participate in – or suggest – car pooling schemes where possible.
• Find, buy or borrow a Pinard or fetoscope; used properly, they last a long time and, although energy is consumed in manufacture and waste created in disposal, they don’t use energy in use.
• Don’t use a CTG machine to intermittently monitor a baby’s heartbeat just because it is nearby – it uses far more energy than a Pinard, fetoscope or even a Doppler.
• Take a hard look at the ‘delivery packs’ available locally. Do they contain instruments or disposables that are regularly discarded or re-sterilised without having been used? Is there an alternative option which would generate less waste or energy consumption?
• Do a ‘disposable waste audit’, where you ask colleagues to make a list of what is unused at the end of a birth. Then, as well as seeing what things might not need to be in the delivery pack, people will find out where they may be opening things that they then don’t use.
• Talk to parents about the environmental issues of breastfeeding, ‘real’ nappies and consumerism. Put up posters in waiting rooms if the direct approach turns you off!
• Become involved in discussions about whether and when more high-tech equipment is needed and ensure that any electrical equipment which is necessary is turned off when not in use.
• Put things like paper recycling bins in sensible places (like the labour ward station) so that people can access them quickly when they are busy; otherwise they won’t bother.
• Don’t open sterilised equipment or draw up drugs like syntometrine unless you definitely know you will need them or you can really justify the decision; that way, if you don’t need them after all, they can be saved for next time.
• Find out how different kinds of ‘birth waste’ are disposed of in your area, and use the appropriate bags in order to reduce the impact of burning or dumping waste inappropriately.
• “My Trust lists the prices of things like needles on the boxes, so we considered the financial cost when we decided what we needed. Now, I’ve added a notice in the cupboard noting that many of these things also ‘cost the Earth’.”
• If I have clean pads or gauze etc left over from the delivery pack, I give them to the woman so she can use them up afterwards rather than throw them away. Some women have even found uses for the disposable green sheets when I’ve not got them in place in time!
Many thanks to the midwives and students who shared their tips and thoughts for this article.
Royal Society for Nature Conservation. Material health: a resource flow and ecological footprint of the NHS. www.materialhealth.com/downloads/Material% 20Health%20-%20summary.pdf