These were the three first things I did after I discovered I was pregnant in February. Six more tests were taken. I then called my doctor to schedule an appointment. A few days later I had signed up for the Covid-19 vaccine. To get my shot, I stood frozen at the high school in Coney Island.
Even though I was a former health reporter and used to reading medical journals, it was difficult to decide to get the vaccine in the same month. I felt a personal and visceral responsibility for the bean-shaped bundle that was growing in my body. Although there were no studies on vaccine safety, they did show that the vaccine was safe if participants didn't know they were pregnant at the time of testing. As many as have reached consensus, Gynaecologists (and family physicians) still had not reached full and open consensus on their recommendations.
My family and close friends, who are mostly advocates for mainstream health recommendations, expressed concerns about miscarriage.
We now know that Covid-19 is more dangerous for pregnant women than it is for their babies. With 21 deaths, August was the most severe month for pregnant Americans due to Covid-19. We know from other studies that there have been no significant risks to those who are trying to conceive, pregnant women, and breastfeeding mothers who take the mRNA vaccinations, Moderna and Pfizer.
However, only 31% of pregnant Americans were fully vaccinated as of 18 September. This is compared to 52% of the population. It also appears that trust has been broken by a long history insufficient science and fear-driven prenatal advice. Many mothers are left with misinformation and anecdotes. These women find condescension from the media and medical establishments to be both ineffective and unfair.
Contrary advice
Kim, a 34 year-old woman in her second trimester in pregnancy in the UK, told me that she isn't taking the vaccine due to concerns about long-term effects on her baby. Although there aren't any longitudinal studies yet, she said that other medications prescribed to mothers in the past were dangerous. She cited Thalidomide as an example of a 20th century sedative expecting mothers used for morning sickness. It was later discovered to cause severe birth defects.
She said via email that most information seemed biased towards making sure everyone gets the vaccine. There are many possibilities. If I get Covid, it would be bad news for my unborn child. I am trying to balance these against the vaccine, and the unknown effects on long-term babies.
Recent research shows that 99% of infants born to fully vaccinated mothers have Covid-19 antibodies.
Kim stated that midwives gave her information about the vaccine in leaflets and encouraged her to make the right decision. She feels that media outlets are pushing her buttons. Her partner is the only one she can trust to help her make a decision. To protect herself against the virus, she uses a mask and avoids contact with other people while she is unvaccinated.
Maddie, who had her son in spring 2021, was recommended vaccine by her Philadelphia doctor when she was in her third trimester. Her husband, a doctorate holder in cellular and molecular biological biology, and a lawyer in pharmaceutical patent law, requested that she wait until after her son was born to be vaccinated. There wasn't enough data available at the time to provide him with any assurances. To be vaccinated, she waited a few more weeks after giving birth.
He should feel respected and included in the decisions that would affect our baby. So I waited. I regret not getting it when I was pregnant, after seeing the data regarding antibodies passing through the placenta.
Being pregnant means to lose control of your life on a daily basis
Trusted messengers (such as relatives who work in healthcare) are often the ones that make personal health decisions. They can help you find a common language about risk and fear that is appropriate for your culture and makes sense for you. These tools are what drive our decisions about medical treatment. They push data and scientific studies aggressively, regardless of the urgency.
For example, it wasn't the recommendation of the American College of Obstetricians and Gynecologists that I signed up for a shot. My husband is a doctor with a strong epidemiology and public health background. We discussed the mRNA vaccine's mechanism with him. Modern and Pfizer are the main US vaccines. The vaccine triggers your cells to make a protein. After that, the mRNA is dismantled. I felt a strange sense relief knowing there would not be any live viruses or foreign bodies in my body.
Control loss at its worst
True scientific reasoning would have me admit that the information that changed my mind was completely random. To be pregnant means to experience a profound loss of control every day. Your body will experience new sensations every day. There may be a tug, sharp pain, or a primal exhaustion. There are many options: you can choose to take an additional genetic test, pick one vitamin over the other, or decide whether to fly on an aircraft.
Clinicians and their loved ones offer these dilemmas with a lot of fear and opinion. This is combined with a history of low research on pregnancy-related options, particularly studies that involve minority communities. This doesn't include those who are dealing with fertility issues or treatments.
Divya, a Houston doctor, has seen almost every aspect of the process firsthand. To protect her baby and herself, she decided to temporarily stop working as a hospitalist in her last trimester. In June, she gave birth to her son.
She and her husband debated the safety of the vaccine when it was presented to them in December. They were breastfeeding at the time and the data was not available on how the vaccine affected breastmilk. After consulting with other mothers, she decided to stop breastfeeding so that she could receive the vaccine.
Are I doing the right things? Think about what you bring home. It can feel a bit stressful.
Divya was undergoing IVF (in vitro fertilization) when she had to have a booster shot. This has been made available to healthcare professionals and people with immunocompromised who are at high risk. Her doctor recommended that she wait until her second trimester to receive the booster shot, as more of the fetal anatomy had formed, after she was pregnant.
She said that there is no evidence to support the decision to wait. However, she had heard of independent OB-GYNS recommending the same thing in the first trimester. Some doctors are confident while others ask people to wait for a few more months.
Divya had a miscarriage and decided to get a booster shot shortly afterward. Given the high mortality risk for the baby and the complications of the virus, she said that she would recommend that pregnant women get the Covid-19 vaccination.
She said that it is very important to consider these decisions. Do I do the right thing? Think about what you bring home. It can feel a bit stressful.
High speed, iterative
This stress is made worse by the constant changes in recommendations for pregnant women. For example, in the past, episiotomies, which are cuts to the perineum to prevent tearing, were common. Different cultures and countries view risks like drinking alcohol or exercising differently.
Similar studies on the vaccine were also iterative at an even faster speed, updating in real-time as scientists rushed to find out what we know about new variants of the vaccine and when protection wane after a single dose.
In the New England Journal of Medicine was published a study on pregnancy and the Covid 19. It found preliminary evidence that vaccines are safe. The study was soon updated with additional context. It also stated that follow-up information was not available for women who were vaccinated after 20 weeks gestation. The actual results were unchanged: those who received the vaccine were equally at risk of stillbirths and miscarriages as the pre-pandemic group. However, the correction made many anxious and prompted a campaign for misinformation.
Pregnant women face serious consequences. Pregnancy reduces your natural immunity and makes it easier to contract Covid-19 complications. As a result, hospitals across the country have raised alarms about the deaths of pregnant women and their infants in intensive care units. Mississippi officials last month confirmed that at least one Covid-19-positive baby and multiple pregnant women were unvaccinated died in a single hospital. According to the CDC, 97% of pregnant women had not been vaccinated as of September 27, there were more than 125,000 confirmed cases.
It's been frustrating but mostly it's just been sad. Dr Jennifer Thompson is a Vanderbilt University maternal fetal medicine physician. The political divide and its impact on public health are evident. She said that at least 39 women were admitted to her ICU in August alone. Unvaccinated women with Covid have been intubated, had stillbirths, or were placed on extracorporeal membrane oxyation (ECMO), which is an external machine that pumps and oxygenates blood. Or, they can die.
Thompson often sees patients who fear getting the vaccine or tell Thompson they will get it after having children. It all comes down to perseverance, Thompson said. She ensures that approximately three quarters of her patients have been vaccinated. If they don't, she will discuss it with them every time they visit the doctor.
She tries to do this without shame or politics.
She said, "I need them to understand that Im here because they care about me and their babies." That could be enough for many. For the wider public health system, understanding how messaging can be tailored and tolerant of pregnant women dealing with conflicting information would reach a lot more people.
Many women, like me, are afraid of causing harm to their babies or themselves by getting the vaccine at a time that every little choice could have devastating consequences for their lives. I took the shot and have never regretted it. It is not an easy decision.
