Sustainability in Obstetrics and Gynecology

ABSTRACT The greatest threat to human health, otherwise known as the climate crisis, disproportionately affects women and pregnant people via exposure to air pollution, heat, extreme weather events, and toxic substances. These effects lead to increased mortality and morbidity in patient populations, but the overall role of the healthcare system and its contribution remains unknown to medical professionals. This review aims to educate clinicians on the effects of the climate crisis on health outcomes and how the current US healthcare system practices drive climate change. Solutions for decarbonizing operating rooms (ORs), neonatal intensive care units (and nurseries), and labor and delivery units are also addressed. The impact on health can be categorized by the effect of heat (rising temperatures), air pollution, and toxic substances such as microplastics. These have variously been shown to impact fertility; rates of miscarriage, stillbirth, and preterm birth; and hypertensive disorders of pregnancy. Notably, the healthcare industry contributes more carbon emissions than even global aviation, with the US healthcare industry producing 27% of the world’s healthcare carbon emissions through its energy and water usage, but also via the supply chain, its waste, and pharmaceuticals. Petroleum-based plastic single-use supplies (ie, gowns, instruments, drapes) in hospitals are also a major contributor to this crisis. Up to 95% of the environmental imprint of the healthcare supply chain stems from these single-use supplies. In addition, biohazard waste must be incinerated prior to landfill disposal, further adding to the environmental impact. Evidence supports the immediate impact of systemic change in terms of decarbonizing healthcare. Replacing single-use instruments with sterilized reusable ones, for instance, has a major impact, such as replacing acrylic specula with stainless steel ones. Another study indicated lower rates of surgical site infections when single-use materials were unavailable in the OR. Beyond this, many single-use supplies are never utilized for patients and go directly to waste. In addition, over carbon dioxide, inhaled anesthetics such as desflurane have 2540 times the potential for global warming while lacking noticeable benefit over other anesthetics. Instead, intravenous anesthetic use can greatly decarbonizing surgeries due to the lower carbon footprint of these medications. Finally, decreasing energy use in climate control measures within buildings can also impact the environment for the better. Powering down unused ORs saved one institution $33,000 annually. Powering down computers over weekends and on nights can also greatly reduce carbon emissions.