OXFORD, Maine — It took breaking her arm for Ashley Wax-Armstrong to finally give up the 80 pounds of firefighting gear she normally wore and work the remaining 12 weeks of her pregnancy behind a desk.
Wax-Armstrong had felt nauseous most of the time during her 2021 pregnancy, but she wasn’t sure why.
“It was hard to tell if it was heat or just not feeling great because of the pregnancy,” said Wax-Armstrong, who now is the fire chief in the town of Oxford. “I don’t think high-heat days were at the forefront of our heads in those days.”
There is more awareness now as a cool state gets hotter. Maine added 13 days of extreme heat related to climate change in the past five years — almost doubling the number — bringing the total heat-risk days for pregnancy to 25 per year, according to Climate Central, a nonprofit science and journalism organization.
Doctors here said scorching temperatures are increasingly stressing the health of expectant mothers, contributing to dehydration, premature labor and strain on unborn babies. Still, many maternity practices in the state don’t warn patients about the risks of heat, and medical schools have an underdeveloped curriculum on it, said Dr. Morganne Robinson, a prenatal and postnatal care specialist at Northern Light Eastern Maine Medical Center in Bangor.
“We could definitely do a better job of specifically highlighting the effect of heat and temperature on pregnancy and warn patients to watch out for signs of heat exhaustion and call us or make a trip to the emergency department,” she said.
Symptoms of heat effects include increased cramping, nausea, vomiting, dizziness, dehydration and altered mental state. Even one high-heat day could elevate a pregnant person’s blood pressure, the U.S. Centers for Disease Control and Prevention says.
Robinson had one patient who felt ill after a day at the beach and experienced swelling and higher blood pressure, which she said is always an alarming symptom in pregnant patients.
Patients may not immediately relate the symptoms to heat and sun exposure, because Maine has traditionally had cooler summers than most U.S. states, she said. Air conditioning became prevalent here in the past two decades. By 2020, 70 percent of Maine households had air conditioning equipment compared to 88 percent nationwide, according to U.S. Energy Information Administration data.
A heat wave pushed temperatures above 90 degrees for the first time this summer when it hit Maine i n June, with Bangor shattering a 30-year record at a high of 98 degrees. On Friday, southern Maine was under a National Weather Service heat advisory, with temperatures reaching 90 degrees in York County.
“This is not your grandmother’s heat wave,” said Kristina Dahl, vice president for science at Climate Central. “July is usually a hot month, but climate change is making this heat wave significantly hotter — and therefore more dangerous — than heat waves of the past.”
Climate Central defines pregnancy heat-risk days as those when the maximum temperature at a given location is warmer than 95 percent at that location. That temperature averages 78.3 degrees Fahrenheit across Maine, but it can vary by several degrees from the southern to northern parts of the state.
Maine is seeing more heat streaks of three days or more than it did in the early 2000s, according to Climate Central. Bangor is seeing one additional heat streak of 82 degrees Fahrenheit or higher now than the three heat waves it had in the early 2000s. Portland’s heat waves have risen from three in the early 2000s to five now.
Data on heat-related visits to Maine emergency rooms is limited. The state does not break out pregnant individuals or seniors, who also are at increased risk from hot weather. When temperatures peaked in York County last month, 10 people were registered at emergency departments with heat-related illnesses in that county’s emergency departments, or about 3 percent of patients seen June 24, according to Maine Tracking Network data.
Heat illnesses are likely underreported, because emergency room doctors may list a different cause for the visit depending on the patient’s complaint. If the patient is lightheaded and has heart palpitations, they might list the visit as cardiovascular rather than heat related, said Dahl of Climate Central. That also could contribute to why physicians haven’t paid as much attention to heat-related illnesses.
“Education is a real challenge,” Dahl said. “There definitely are physicians who recognize this and are talking about it, but I think there needs to be a broader effort about physician education on climate issues, including wildfire and ground-level ozone exposure.”
Dr. Joseph Wax, a maternal and fetal medicine specialist at MaineHealth in Portland, said his practice hands patients a half-inch folder of educational information, but it doesn’t include warnings about the risks of hot days. Wax, the father of fire chief Wax-Armstrong, said he would consider adding that. He also advises patients to have a safety plan for when it gets too hot like a cooling center, the library or the mall. A fan blowing already hot air will not help, he said.
Delani Goeben, a firefighter and paramedic with the Saco Fire Department, is glad to see more interest by doctors in heat-related pregnancy illnesses. Her doctor told her it was not safe to go into toxic environments. Goeben also had read about how going into several 100-degree environments to fight a fire was unhealthy for her baby. She took on administrative work 16 weeks into her pregnancy.
“It’s a newer problem that’s finally starting to come to the forefront and get some of the attention that it needs to make sure everybody is having a healthy pregnancy,” Goeben said.
Lori Valigra reports on the environment for the BDN’s Maine Focus investigative team. Reach her at lvaligra@bangordailynews.com. Support for this reporting is provided by the Unity Foundation, a fund at the Maine Community Foundation and donations by BDN readers.