Like many expectant mothers, Jen Spears is anxious about the impending arrival.
But the resident of Tura Beach, near Bega on the NSW Far South Coast, has another reason to be nervous.
She’s waiting to see if smoke from the disastrous summer bushfires — which hit early in her third pregnancy — will affect the health of her baby girl.
“I’m just really nervous and worried that once I get this baby out, that’s not the last of it,” she said.
“We could be in hospital for a week or two, or my placenta could fail and I could lose the baby.”
She’s not alone in being worried.
Highly-experienced obstetricians working in bushfire-affected areas have told the ABC of their concerns that not enough is being done to investigate the long-term effects of bushfire smoke on mothers and newborns.
The ABC has been told there have already been babies born early, underweight and requiring special care and doctors, midwives and patients suspect it could be linked to smoke exposure.
Moruya obstetrician Michael Holland said he had seen some deeply concerning cases since the bushfires.
We’ve had, unfortunately, three late pregnancy losses, three stillbirths in the early half of the year,” he said.
“Now, I don’t know whether that’s a random thing that’s occurred or whether any of those adverse outcomes were associated with the bushfire disaster.”
Dr Holland said more babies had been transferred to Canberra Hospital for delivery before 37 weeks’ gestation, and he had seen 10 more babies than usual who were born underweight.
Dr Holland also said some women’s placentas had shown signs of calcification or had stopped growing.
“It’s the sort of placenta you’ll see in mothers who smoke basically — and that was occurring in women who didn’t smoke,” he said.
Canberra-based obstetrician Steve Robson said he had recently delivered babies who were “unexpectedly and unpredictably small”.
“You can only wonder whether it was something to do with the mothers inhaling the smoke for so long at the height of the bushfire, in the early stages of their pregnancies.”
NSW Health said there was “no data or evidence about the effect of the recent NSW bushfires on pregnant women and/or their babies”.
There is not a huge body of scientific knowledge on the long-term effects of smoke on pregnant women.
A Colorado study published last year showed that exposure to smoke from wildfires during the first trimester was linked to decreased birth weight and an increase in gestational diabetes and hypertension.
Exposure in the second trimester was associated with pre-term birth, while third-trimester smoke exposure contributed to lower birth weights.
Research from the 2003 southern California bushfires showed babies exposed in utero had lower birth rates than those born before or more than nine months after the fires.
While an Australian study of more than 3,500 women exposed to Victoria’s Hazelwood Coal Mine fire in 2014 found an increased likelihood of gestational diabetes, but no effect on birthweight or gestation at birth.
The bushfire royal commission this week heard nine Australian research projects investigating the long-term effects of bushfire smoke on health had been “put on ice” due to COVID-19.
Midwife Hannah Dalen said it was difficult to know how much of the negative pregnancy outcomes were due to women’s high stress levels during the bushfires.
“It’s very difficult to separate out the stress of the event from the effects of smoke,” she said.
The professor of midwifery at Western Sydney University said stress could also lead to early births and smaller birth weights.
It also caused the body to be flooded with cortisol, which could increase blood sugar levels and cause gestational diabetes.
Both Dr Robson and Dr Holland stressed the pressing need for more local research to help health professionals give informed advice to expectant mothers.
Jen Spears agrees.
While she stayed mostly indoors, wore a mask and placed wet towels under doors to stop fine particles entering her home, it wasn’t until her 28-week appointment at Bega South East Regional Hospital that a midwife told her those measures might not have been enough to keep her baby safe.
“I thought I was doing the right thing and in hindsight I’ve been told it wasn’t enough, which is upsetting,” she said.
“You just felt really helpless that you couldn’t get into a time machine and go back six weeks and change what you did or changed where you were,” she said.
Ms Spears evacuated to Canberra at one point, with her sons Finn, 3, and Dane, 18 months, while husband Scott stayed to help protect the property.
But the smoke followed them there “like a horror movie, this sort of creeping menace that stayed with us”.
Dr Robson said about early January in Canberra he was delivering babies “into smoky birth rooms”.
“I’d never encountered anything like that before and I think it was distressing for everybody involved — there was just no escape from the smoke.”
He said there were significant health implications for newborns too.
Courtney Collins gave birth to her daughter Quincy in Canberra in May, six weeks early after experiencing pregnancy complications unrelated to the bushfires.
“She was born early so she had a breathing machine and was in the NICU (neonatal intensive care unit) for two weeks,” Ms Collins said.
The family farm in Buckajo, west of Bega, was threatened by fire in January, but Ms Collins said she was still cleaning ash and soot from the home.
She said it wasn’t worth the risk for pregnant mothers to stay during bushfires, if they could avoid it.
“If I was going to have another child, there’s no way.”