The effects of climate change and environmental pollution are already affecting our world.1 The 2022 Intergovernmental Panel on Climate Change (IPCC) report documents climate events that are occurring and expected to worsen, including increasingly frequent and severe extreme weather, human displacement, and water and food scarcity in addition to irreversible changes to land and ocean ecosystems.1

These climate change effects are due to greenhouse gases (GHG) emitted by humans.1 Since the industrial revolution, human emissions have increased exponentially with the most recent estimates being nearly 10 billion tons of carbon per year from human derived sources in 2017.2 Most of these emissions come from highly industrial countries, with China accounting for the highest amount of greenhouse gas emissions in 2017 and the United States in second place.2 More than 65% of global emissions come from the top 10 national emitters alone.2 Globally, the healthcare sector accounts for 4.6% of GHG emissions, which is nearly double the amount of global aviation. In the US, the healthcare sector makes up 8.5% of national GHG emissions and is on track to double by 2050 without mitigation.3 Of all global healthcare-associated GHG emissions, the US healthcare system contributes 25% despite having only 4% of the world's population.3

These healthcare-associated GHGs are from direct consumption by medical facilities as well as from upstream production and transportation of medications, devices, and patient services. In addition to GHG production, healthcare is also a source of a large amount of conventional and biohazard waste, as well as environmental contaminants. Some of these chemicals, such as phthalates and bisphenols, are known to disrupt endocrine pathways and are found in many plastics used in hospital settings.4,5 Phthalate exposure in pregnancy has been associated with an increased risk of preterm birth and impaired neurodevelopmental and respiratory function in children.6, 7, 8

There are no estimates of the exact proportion of healthcare's carbon footprint made up by obstetric and neonatal care. There is good evidence however that pregnant individuals and babies represent some of the populations most vulnerable to the effects of climate change and environmental pollution. Exposures to heat and air pollution in pregnancy have been associated with increased risk for preterm birth, low birth weight, and fetal cardiac anomalies.9, 10, 11 Additionally, increased frequency and severity of climate disasters decreases access to prenatal care, facilitates vector borne diseases such as malaria, destroys clean water and nutrition sources, and also has adverse effects on maternal mental health.12, 13, 14

To protect maternal and neonatal health, there is a strong case to be made for decreasing the environmental impact of labor and delivery units (L&D), nurseries, and neonatal intensive care units (NICUs). While there are very few documented initiatives in these environments so far, such efforts are already underway in other areas of healthcare such as anesthesia and surgery, from which we can glean best practices.15,16

Environmental sustainability in healthcare is not only good for the environment and patients, it is also safe for patients and financially favorable for hospitals.17,18 In this paper we review current efforts to decarbonize and reduce the environmental footprint of healthcare delivery, with an emphasis on lessons for labor and delivery units, neonatal intensive care units, and nurseries (Table 1). Given the paucity of papers pertaining only to L&D and NICU settings, this paper is not a systematic review but rather an overview of broad areas for improvement in sustainability within these healthcare spaces.