This story was produced through a collaboration between The Tributary and Climate Central.
Kelly Googe has a lot of stories from her 32 years as a doula coaching women through their pregnancies. But, especially in the summer, she returns to one story repeatedly: A Jacksonville client, seven months pregnant, whose electricity was turned off because she couldn’t keep up with the bills.
“Her home was ridiculously hot, and she worked on her feet in a warehouse. She fainted, and when they got her to the hospital, her core temperature was very, very, high,” she said. “She was going into shock, and her amniotic fluid levels had dropped drastically because of dehydration, and because she had sustained days of heat exposure without relief.”
After hospitalizations costing more than $60,000, the mother — who had suffered heat stroke — recovered, as did her baby. But she lost her job, which did not provide medical leave, and suffered debilitating headaches for the rest of her pregnancy.
For decades, seniors, children, outdoor workers and people affected by certain illnesses and disabilities were regarded as being among the most vulnerable to heat. A 2017 paper by a pair of George Washington University researchers was among the first to add pregnant people to this list.
The researchers determined that the impact of extreme heat on a mother or their unborn baby can be immediate, or it could be delayed. They reported that risks appeared to increase globally, “regardless of the relative warmth of the climate.”
Climate change is driving up daily temperatures and intensifying humidity and heatwaves across the globe – and residents of Florida are being hit particularly hard because of a convergence of climate, historical and political factors. Legislators’ failures to require meaningful guarantees of air conditioning for residents in a famously stifling state are being experienced most acutely by communities of color. They tend to occupy the hottest neighborhoods, where housing discrimination dating to the 1930s led to a lack of green space and cooling tree canopies.
In a hotter Florida, stories like this Jacksonville mom’s will become more common.
Studies have linked extreme heat exposure to higher risks of preterm birth, low birth weight, and stillbirth, as well as to higher risks of complications for expectant mothers like hypertension and gestational diabetes. A scientific review of dozens of studies in a medical journal published by the American Medical Association overwhelmingly showed that heat and air pollution increased the likelihood of problems during pregnancy.
Rupa Basu, an epidemiologist at the University of California at San Francisco and one of the review authors, says it’s important that pregnant people realize they’re more sensitive to heat.
“We’re still not seeing pregnant people on heat alerts … how are people going to take any precautions if they don’t realize they’re at high risk?,” Basu said. “Or they might be feeling these things when they’re pregnant, and just thinking it’s part of the pregnancy, this is how I’m supposed to feel … there’s often not that connection made back to, oh well, it’s actually the heat.”
Heat risk rises for pregnant Floridians
Climate Central analyzed worldwide temperature data from 2020 to 2024, and used statistical models to find that in most countries, climate change at least doubled the average annual number of dangerously hot days for pregnant people.
Of all the cities analyzed, West Palm Beach and Miami experienced the highest number of heat-risk days added by climate change in the country, at 34 and 30, respectively. In Jacksonville, Orlando, and Tampa, climate change more than doubled the occurrence of pregnancy heat-risk days.
The biological mechanisms that explain why heat can cause problems like low birth weight are well understood.
READ MORE: Heat illness: What are the symptoms?
“If you have chronically elevated temperatures, and a woman who’s pregnant has to thermoregulate and cool herself off, she accomplishes that by shunting more blood to the skin, which means taking the blood as well as the nutrition and oxygen within it away from the uterus,” said Dr. Bruce Bekkar, a licensed OBGYN and climate advocate.
“So you can imagine, if that is a prolonged exposure, that the baby’s going to be getting less of those two things that it desperately needs, which could lead to an undergrown child,” he said.
Preterm birth can be caused by dehydration, which becomes more likely as temperatures rise.
“Dehydration triggers the release of oxytocin, which is the labor hormone,” Bekkar said. “Whatever the source of the dehydration, that can trigger contractions.”
Vonda Boyd, a Jacksonville doula with Asherah Birth, said that “pretty much every year, at least one of our clients has gone to labor and delivery and had to get fluids and get rehydrated.”
“What happens is their body starts cramping and going into early labor,” Boyd said.
Even after birth, heat remains a danger, because dehydrated mothers struggle to produce milk.
“If they’re continuously dehydrated, it’s going to make their milk production go down,” said Boyd. “They have to take in as much as they’re putting out, and then you add in the heat, which is going to take it out, too.”
Dallas Arthur, another Jacksonville doula, said dehydration can cause Braxton-Hicks contractions, which are also known as false labor pains and are considered a healthy part of pregnancy — but they can lead to preterm labor if not monitored and controlled.
“It’s definitely a common side effect of being overheated, is having a lot of those Braxton-Hicks contractions,” Arthur said. “That’s just the body kind of signaling that they’re overdoing it.”
While advances in pediatric care mean children born prematurely are more likely now than ever to survive, Bekkar stresses that premature birth remains dangerous.
“Preemies are much more likely to suffer major health problems in adulthood, all the way to old age. Things like cardiovascular disease and other serious metabolic disorders are correlated with prematurity. So we shouldn’t think of a preemie, even if it survives, as a good outcome. It’s really not,” he said.
While much of the public messaging around high heat tends to focus on extreme daytime highs, research shows that overnight heat poses a greater risk of preterm birth. According to research from the the Heat Policy Innovation Hub at Duke University, when overnight temperatures remain at or above 75 degrees Fahrenheit overnight, there is a 4% increase in preterm births in the days that follow. Overnight temperatures at or above 80 degrees were found to increase the preterm birth risk by 7% to 8%.
In Florida, air conditioning is not a right
Combatting the dangers of extreme heat is particularly difficult for pregnant renters in Florida, where there are no laws requiring landlords to provide air conditioning in spite of climbing temperatures. While landlords must provide heat for the few below-freezing days Florida experiences each winter, no corresponding law exists mandating A/C in the summer.
And while landlords must “make a reasonable effort” to maintain air conditioning units present at lease-signing, the law doesn’t specify what those efforts must entail, creating a system where landlords are free to make inefficient, low-cost repairs to a unit that never functions optimally.
Even if residents have access to a functioning unit, they may not use it because they can’t afford the utility payments. Or they may have stopped paying their bill, and had their service cut off. Twenty-three states have disconnection protections for hot weather; Florida is not one of them. That means utility companies are free to cut off services for nonpayment, even in the middle of a heat wave.
Risks are sharply divided along demographic and economic lines. Googe, the doula, has had multiple clients who’ve had their electricity shut off in the summer for their inability to pay. They are impacted by energy poverty, the inability to adequately heat or cool one’s home, a dire concern as temperatures trend hotter.
The problem is compounded by Florida law which considers air conditioning an amenity, not a necessity for a safe and healthy living space. But heat is the number-one cause of weather-related deaths in the country, according to the National Weather Service. It’s responsible for roughly 2,000 deaths in the U.S. annually, based on data from the Centers for Disease Control and Prevention. And according to the Florida Policy Institute, Florida is the state with the highest numbers of heat-related illness, with the most recent data showing 31,011 emergency room visits and hospitalizations between 2018 and 2022.
Experts see the lack of regulation around air conditioning as a way that policymakers have failed to keep pace with climate change. Energy laws, drafted when summers were cooler, focus on protecting residents from the cold, not the heat — roughly twice the number of states have utility protections during the winter as do those that have protections during the summer months.
Trapped in a ‘heat island’
Not all pregnant Floridians are at equal risk of heat exposure. Urban areas get hotter than rural ones, a phenomenon known as the urban heat island effect: concrete buildings and paved roads absorb and re-emit heat more than natural terrain, like forests and lakes. More than 11,000 Jacksonville residents live in neighborhoods where Climate Central modeling shows temperatures can be more than 9 degrees warmer than rural regions or wealthy neighborhoods with generous tree cover.
Though courts have long since ruled the practice unconstitutional, redlining — the discriminatory policy of refusing to offer loans to those in majority-black neighborhoods deemed “high-risk” — continues to affect cities today. Of the 108 cities surveyed in a 2020 study published in the science journal Climate, Jacksonville had the fifth-largest temperature gap between neighborhoods, with formerly-ranked “desirable” neighborhoods like Avondale and San Marco registering temperatures substantially cooler than “undesirable” ones like Moncrief Park and LaVilla.
And while neighborhoods in the urban core are often hotter than surrounding ones, those very same neighborhoods are less likely to have access to air conditioning, according to both a nationwide study by Boston University and a more localized one by Florida State University. This makes residents of those neighborhoods doubly disadvantaged.
Even disregarding differences by neighborhood, Black and Hispanic women are twice as likely to experience preterm birth or stillbirth when exposed to heat than white women. Very young and very old mothers are also at higher risk.
Climate change poses risks to pregnant people beyond extreme heat. It increases air pollution, also correlated with negative maternal health impacts, and increases the likelihood of flooding and other extreme weather events. In Florida, storms are a concern for those pregnant during hurricane season.
“If you’re on any side of a bridge that gets closed, you’re not making it to where you need to deliver,” says Googe, describing the effects of hurricane-level winds.
Storms can cause power outages that can leave residents stranded without air conditioning during the hottest months. In 2017, Florida nursing home deaths rose 25% in the weeks following Hurricane Irma — mostly a result, researchers say, of heat exposure when the buildings were left without power for air conditioning.
For the most vulnerable, lack of air conditioning is a daily reality that doesn’t just come after storms — and for pregnant people and their unborn children, that reality is dangerous. As the Florida summer heats up, Googe is anxious for the 10% of her clients who struggle with air conditioning access.
The intensity of a heatwave that began in late July, affecting tens of millions of residents of Florida and other southeastern states, was made three times more likely by the effects of heat-trapping pollution, according to a Climate Central forensic analysis.
“I’m worried,” Googe said. “I’ve got two clients right now who are due in August that are in that socio-economic shelf, and I worry … it’s going to be another hot one.”
