The Conversation broadcasts a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can find all the stories here.
I put on a gown, gloves and mask to enter the hospital room of a new mother who is sick with COVID-19.
She is lying in her bed, exhausted between two bouts of coughing; her day-old baby lies comfortably across the room. She contracted COVID-19 the week before her due date and was hospitalized when her labor began.
Considering the mother’s illness and her inability to care for the newborn, we are making plans for the child to go home with his father on the second day of life. But her mother will have to remain hospitalized to recover from COVID-19 and her delivery.
The couple’s other two children at home also need care. The road to recovery will be long for this family, but fortunately the mother’s illness does not end up requiring intensive care or mechanical ventilation. This result is not what the family had imagined when they made the decision not to get vaccinated against COVID-19 during their pregnancy.
Unfortunately, scenarios like this have become far too common for me and other healthcare providers during the COVID-19 pandemic. During the omicron’s last pushit was not uncommon to have four or five patients with active COVID-19 infections in the labor and delivery unit at a time.
Decision making during pregnancy
Pregnancy is often a time of sweet expectation. But the continued pressure to make the right decisions for the health and well-being of the pregnant person and the unborn child tempers this excitement. And no doubt, decision-making around COVID-19 vaccination adds another layer of stress. The relative newness of COVID-19 to our lives, fear of the unknown, and abundant misinformation often complicate these decisions. During pregnancy, advice comes from many directions, including well-meaning friends and family members, and sometimes even strangers.
It should be noted that the decisions a person makes during pregnancy stem from a desire to avoid doing anything that could cause complications during pregnancy or harm the fetus. At the same time, it is also important for a parent to do everything possible to protect the well-being of the couple.
Like a family physician specializing in maternity, I often hear about the challenges and confusion pregnant women experience in making these important decisions. My role is to respect pregnant people in their autonomy and to provide factual information that can help inform their decision.
In making the decision to get vaccinated against COVID-19, pregnant women should consider the potential risks of the vaccine, as well as any potential harm from infection with SARS-CoV-2, the virus that causes the virus. COVID-19. These two sides of the same coin are important in the discussion and the final decision that the patient makes.
Simply avoiding action is not the answer. Each pregnant person should carefully consider their decision and not passively accept doing nothing as the safest option, because the choice to do nothing is likely a choice to accept the risk of avoidable harm.
COVID-19 disease during pregnancy
COVID-19 caused serious illness requiring hospitalization in more than 30,000 pregnant women in the United States, with 292 deaths as of mid-March 2022. The risk of serious illness is higher in pregnancies complicated by advanced age, high body mass index, hypertension and diabetes.
Pregnant women infected with COVID-19 are three times more likely to need intensive care than people who are not pregnant. Death is rare in pregnant women, but COVID-19 causes a significant increase in this risk.
Health disparities have become more obvious during the pandemic. Black and Latino populations have disproportionately experienced COVID-19 infection, serious illness and death. This disparity remains among pregnant womenwith an infection rate among pregnant Latinos nearly double that of their white counterparts.
Vaccination protection during pregnancy
Vaccinations to protect against serious illnesses from COVID-19 are recommended for all pregnant women or those planning pregnancy through major health organizationsincluding the Centers for Disease Control and Prevention, the American Academy of Family Physicians and others.
mRNA vaccines developed by Pfizer and Moderna are recommended for pregnant people in a first series of two doses followed by a booster vaccination five months later. The immunity produced has been shown to reduce disease severity, pregnancy complications, stillbirth and maternal death.
Mid-February, 68% of pregnant women over 18 were fully vaccinated, compared to 75% in the general adult population. Vaccine complications are rare and mild, similar to complications in patients who are not pregnant. There are no increased risk miscarriage, infertility or vaccine-related pregnancy complications.
In addition, vaccination during pregnancy provides important protection for newborns. Pregnant women who are vaccinated pass antibodies in the blood through the umbilical cord to the fetus, and this has been shown to provide protection against serious illness from COVID-19 for the newborn for up to six months.
Research on newborns at 20 pediatric hospitals in 17 states showed that 84% of hospitalized infants under 6 months were born to unvaccinated people. And infants born to people vaccinated with two doses of mRNA vaccines were 61% less likely to be hospitalized with COVID-19. Given that vaccination is unlikely to be available for newborns in the foreseeable future, protecting this vulnerable population by vaccination during pregnancy is the best option.
It is natural for pregnant women to have decision uncertainty to receive the COVID-19 vaccine. They are likely to be uncertain and have their own conflicting feelings about it, and they may receive conflicting advice from family and friends. I think it’s important to show empathy and respect for this ambivalence while sharing information about vaccine safety and COVID-19 disease risks.
Pregnant people should receive the latest evidence-based information to help guide their decisions to get vaccinated. If they decide to get vaccinated, it can be helpful for family members or others to remove any access barriers that may be in the way. On the other hand, a pregnant person who decides not to get vaccinated should receive other additional supports such as advice on masks and how to avoid high-risk exposures to reduce the risk of disease.
The ripple effects of COVID-19 go far beyond the infected person, especially during pregnancy. It is clear that the vaccine can help prevent serious illnesses in pregnant women and is a means of preventing newborn babies from going home without their mother, either temporarily or permanently.[Get fascinating science, health and technology news. Sign up for The Conversation’s weekly science newsletter.]