Disaster Preparedness Is Care Work: Lactation Planning for All Communities

by Dr. Victoria Royal-Williams

In New Orleans, we do not talk about disaster like it is hypothetical. It is part of the calendar. Hurricane season comes around, and so does the boil water advisory, the week-long power outage in August heat, the apartment that takes on water after a hard rain, the family that has to leave home before dawn. The emergency plan that shows up in the pamphlet usually assumes you have money, a car, a hotel room, and somebody waiting for you on the other end.

Now put a three-month-old baby in that picture.

When the lights go out here and the air gets heavy, feeding a baby is not simple anymore. It is physical, urgent, and tender all at once.

A nursing parent may be trying to stay hydrated in dangerous heat, keep milk safe without steady power, and calm a baby while also figuring out whether the family needs to be on the road by morning.

In my work with Birthmark in New Orleans and across the Gulf South, I have come to see this clearly. Disaster preparedness is not a checklist. For lactating families, it is care infrastructure. And too much of that infrastructure has been built for households that do not look like ours.

Why Generic Plans Miss Our Families

A lot of standard emergency guidance starts from assumptions that just do not hold for the families we serve. It assumes stable housing. Refrigeration. Reliable transportation. Money to buy supplies ahead of time. English fluency. Access to clean water. The freedom to move without fear of who might stop you.

On paper, it is called a family emergency plan. In practice, it leaves out the realities of a nursing parent with a baby at the breast/chest.

The gaps show up fast.

Breastfeeding is one of the safest ways to feed a baby during a disaster, especially when the water system is compromised, because formula brings its own risks around access, safe water, cleaning supplies, and storage. But chestfeeding still needs support. Breastfeeding parents need to drink plenty of clean water and rest as much as they can after a disaster, and that matters a lot in a city where heat can take so much out of the body.

If a parent gets displaced, hospitalized, or separated from the baby, feeding gets harder fast, especially when there is no private place to nurse or express milk.

That burden falls hardest on families who were already running on thin margins.

That is not a parent failing. That is a structural one.

Care Work in the Gulf South Key

For me, disaster planning belongs in the same conversation as feeding, mothering, parenting, resting, checking on each other, and making sure somebody has eaten. It is care work. It is the labor of helping people stay alive and stay connected when the systems around them are unsteady.

Down here, we know something about that. New Orleans carries deep memory of what happens when official systems fail and neighbors have to become the safety net. Across the Gulf South, people share food, share rides, pass on information, and find each other a place to land. That is the lineage of Black birth work, community care, and mutual aid that has carried families through storms and through the long recoveries that follow them. A lactation disaster plan is not a piece of paper sitting by itself. It is one piece of a wider circle of care.

We also know something about being talked about more than talked with. After a storm, the news rolls in and the cameras roll out, and the families on the ground are still doing the slow work of holding babies, feeding them, and figuring out the next two days. That slow work is where lactation preparedness actually lives.

A Client-centered Lactation Plan

The best plans are not fancy. They are honest, and they start with the life the family is already living.

1. Start with client context.

• Who is in the home? Who is there during the day?

• Who else feeds the baby?

• Who else needs caregiving, whether that is other children, an elder, or a disabled family member?

• Is the housing stable?

• Is there a car?

• If they have to evacuate, where can they actually go?

• Do they have family out of state, or is the network mostly local?

The answers shape what preparedness looks like once you take it out of the abstract.

2. Then look at lactation status and medical needs.

• Is the parent exclusively nursing, combination feeding, pumping, or weaning?

• Are there current supply concerns?

• Are there medical needs for the infant?

• Is the parent taking medications or managing chronic conditions that need to be part of the plan?

Infants and children - alongside pregnant and postpartum families - with special health care needs can face heightened risk during emergencies.

3. Hydration and nutrition do not get nearly enough airtime.

Chestfeeding parents need to drink plenty of CLEAN water and rest often after a disaster.

Clean water, I tell you, because that part never seems to get the memo.

In practice, that means walking through with a client what water, snacks, and quick calories will actually travel with them. Peanut butter, dried fruit, crackers, nuts, seeds, electrolyte packets. Small enough to throw in a bag, and they go a long way when somebody is in transit or sheltering in place.

If the family eats a certain way day to day, the disaster pantry should match and accommodate allergies and diet requirements.

A plan that hands somebody food their body cannot tolerate is not really a plan.

4. Skills over stuff.

Hand expression does not need power, batteries, or equipment. It works in a dark house, in a car on the interstate, in a shelter, or in any place a parent finds themselves waiting.

When we teach it during pregnancy or early postpartum, before any crisis, we hand somebody a tool they carry in their own body. That kind of confidence holds up when nothing else feels solid. It also means a parent is not depending on finding an outlet or a working pump in the middle of an evacuation.

5. Community and mutual aid pathways, mapped with the client and not just for the client.

So who is on this family’s list? A local IBCLC. A WIC peer counselor. A La Leche League leader. A doula. A church mother. A cousin across town. The neighbor who will pick up at two in the morning.

Names, on paper. Not just roles.

6. Communication and reunification.

Families do sometimes get separated during emergencies, which creates real feeding challenges for breastfed babies.

• So who has the feeding plan written down?

• Who knows what the baby is eating right now?

• Who can safely prepare ready-to-feed formula if it comes to that?

• Who can bring the baby to the parent, or milk to the baby, if the family is split up for a while?

This part feels invisible until it is not.

7. A small emergency lactation kit helps too.

A manual pump, milk storage bags, nipple care, electrolytes, shelf-stable snacks, the feeding plan written out, and a contact card with the key phone numbers.

The point is not perfect.

The point is function.

Birthmark also keeps Infant Feeding Kits as a resource for families, because having something already gathered can make a hard moment feel a little less impossible.

Rooted in What Families Already Know

The families hit hardest by disaster are often the same families carrying generations of wisdom about how to feed babies during hard times.

People know what foods help the body heal. What drinks support it. How postpartum rest protects a parent. How family networks fill in. That wisdom is not an extra. It is part of preparedness.

Our job as birth workers is not to walk in like practical planning started with us. It is to listen, make room, and help braid together what the family already knows with cultural tradition and public health guidance.

If a client does not speak English comfortably, the plan needs to be in the language they actually use. If their people are family, chosen family, neighbors, faith community, or the folks who show up with a pot of red beans and a flashlight, then those are the people the plan needs to name.

It also means being careful not to write over the family’s own rhythms. Some folks evacuate every storm. Some folks ride it out every storm. Some folks do not have the same options either way.

A good plan honors the choices the family is actually making, not the choices the pamphlet wishes they would make.

What Birth Workers Can Do

We are not first responders. But a lot of the time, we are the first call. So we can make disaster planning feel normal and doable instead of scary.

Bring it up at prenatal visits, at postpartum check-ins, in feeding conversations, the same way we talk through birth preferences or newborn care. Teach hand expression early. Come back to it. Let clients practice before they need it.

Keep a living resource list of local lactation support, WIC contacts, peer counselors, mental health providers, and mutual aid networks. Nobody should be trying to build that list in the middle of a storm.

And we have to be real about our limits.

At Birthmark, we know there are moments when New Orleans itself is in the storm, when our own staff and doulas and families are also sheltering, evacuating, or grieving. In those moments, we cannot always show up the way we usually do.

That is why partnership matters.

Birthmark has had to think seriously about what it means to keep care going when a hurricane hits the city. Part of our preparedness is admitting we cannot hold all of it alone. We build relationships with organizations in neighboring states and nearby regions before the storm, so they can help hold our people while we are in the middle of an active emergency, and we can return that for them when it is their community in crisis.

That reciprocity is preparedness too.

It is honest. It is humble. It is how care survives.

Closing

In New Orleans, we know the storm is always coming in some form. Sometimes it is wind and water. Sometimes it is heat, displacement, disconnection, or the steady pressure of systems that were never built with our families in mind.

That is why lactation preparedness matters.

A nursing parent with a plan is not just organized. They are claiming their right to feed their baby with dignity and flexibility and support, whatever the conditions turn out to be.

Disaster preparedness is care work.
Care work is survival.
And joy sought is joy sustained, even when the lights go out.

Dr. Victoria Royal-Williams is a New Orleans-based maternal child health consultant, advocacy director, and member-owner with Birthmark. With a background in social work, lactation support, Pushin’ Policy, and equity-centered organizational change, she works to strengthen care systems for families across the Gulf South. Connect with her at @victoriathedoc and @birthmarkdoulas.