Editor’s note: On April 23, 2021, federal health officials advised pregnant people to receive a COVID vaccine after following over 35,000 pregnant women who received an mRNA vaccine. Furthermore, in July, ACOG and SMFM recommended that all pregnant people be vaccinated after evidence was obtained from “tens of thousands of reporting individuals over the last several months.”
On September 29, 2021, the CDC recommended “urgent action” to increase vaccination rates among those who are pregnant, lactating, trying to become pregnant, or might become pregnant in the near future. Data indicated that 97% of hospitalized pregnant people who were diagnosed with COVID were not vaccinated.
I have been an obstetrician and gynecologist at the same practice for over 12 years, and I have patients and families that I’ve been seeing throughout them all. They will sometimes take my advice without asking me to go through any risks or benefits. They’ll say, “Oh, I trust you!” and I’ll hit back with, “But let me tell you what could happen.”
When it comes to the COVID-19 vaccine — despite the fact that I am somebody who, for other issues, patients unquestionably trust my education, my ongoing continuing medical training, my experience, and my understanding of science — everything has shifted.
It’s become a regular occurrence for me to hear, “Well, Facebook says it can cause dot-dot-dot, insert-side-effects-here.” I’ve really had patients ask me if their arm will become magnetic because of a microchip. Some of the younger patients didn’t see the need to be vaccinated because they’re healthy. One of my patients was told it heads straight to her ovaries. And some are just legitimately scared the vaccine will harm them or their baby in some way. It’s incredibly frustrating from a healthcare provider standpoint.
I tend to have a good read on my patients and can deliver a message tailored specifically for them. It’s my job to understand their concerns and have a conversation about the scientific process, especially with those who consume 90% of their news from social media or some random internet site. There was definitely an evolution of theories, but I keep going back to the science and the data we’ve all collected in the last year.
Back in December, when the U.S. Food and Drug Administration issued the first emergency use authorization for a COVID vaccine, I was telling my patients that despite The American College of Obstetricians and Gynecologists’ (ACOG) best efforts, there were no pregnant women enrolled in the vaccine trials.
Others may have been told otherwise, but theoretically, professionals like myself didn’t think there would be any risk to pregnancy based on the mRNA technology medical manufacturers were employing. The same could be said for the adenovirus platform used by Johnson & Johnson. This was based on the fact that this particular vaccine technology has been around for decades. Given the way they work — by stimulating the immune system to produce antibodies — we didn’t think there would be any risk.
Later that month, ACOG, along with the Society for Maternal-Fetal Medicine (SMFM), announced pregnant women should not be prevented from getting the vaccine. So the initial position was: We shouldn’t be preventing pregnant women from getting the vaccine if they would like to be vaccinated. And we were told to continue to examine new data and follow the science as more information emerged.
Hundreds of thousands of healthcare workers were then vaccinated in December and into the new year. Some of those women were pregnant, some of those women were lactating and some of those women were becoming pregnant after having been vaccinated. And healthcare providers were not seeing any adverse effects.
Monitoring for any potential side effects or downsides was always a consideration, as more and more women shared information that was collected in the V-safe pregnancy registry. I’d say healthcare providers were becoming more proactive in vaccinating their patients. For those who are unaware: The v-safe after vaccine health checker is an ongoing survey conducted by the Centers for Disease Control and Prevention (CDC) officers, where people share any side effects they may have experienced days and weeks after receiving the vaccine (whether or not they know the side effects were related to the vaccine). Pregnant women have been placed into a special, crucial subset group.
While promising, the emerging data didn’t give us an official nod yet from federal health agents to begin recommending the vaccine.
That didn’t stop me from adjusting how I counseled my patients as more data came out in winter 2021. It went from being: “People were not enrolled in the trials, but theoretically we think there is no risk,” to: “Many pregnant women have been vaccinated since we started giving it to healthcare workers and other people in high-risk industries, and we have not seen an increase in adverse outcomes.”
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Some patients were hesitant simply because the vaccine was new, while others were believing in giant conspiracy theories. That changed when the first official recommendation came down the line in April, and I had to share it with my patients.
This brings us to late September when the CDC came out with a statement saying vaccine hesitancy has become a crisis and we really need to get pregnant women vaccinated — all of these things have added crucial poignancy to the counseling I give my patients.
At this point, I would say between 10 and 20% of my pregnant patients are vaccinated, which is lower than the national average. The CDC reported on September 29 that approximately 31% of pregnant people had been vaccinated.
But as far as patients who are rationally hesitant towards a COVID-19 vaccine, I would say I am really working on 20% to 30% of my patients as a whole, discussing it in depth during their visits. How are we defining hesitancy? When it’s a flat “no,” which is about 60% of my pregnant patients, I don’t know if I would call that hesitancy. To me, hesitancy is someone who is open to considering the possibility, someone who has questions and concerns. When you are telling me, “I’m just not going to do it!” — I don’t consider that hesitancy. It’s really challenging. Rationality has sort of left the building in some cases.
It’s a very strange situation, being in West Virginia and experiencing the kind of pushback we’re seeing. Even though I feel like I’m banging my head up against the wall half of the time, the other half I am either thanking someone for getting the vaccine or I’m potentially making an impact on another.
We do patient satisfaction surveys and I’ve had them come back with the complaint that I asked about their vaccine status or talked to them about the vaccine. We have accepted that this is where we are in healthcare right now. But I worry about my patients and still ask them if they have been vaccinated. There is definitely compassion fatigue — but you have to keep going.
The bottom line: According to the latest information from the CDC, the benefits of getting the COVID vaccine “outweigh any known or potential risks of vaccination during pregnancy.” The agency also states there is “currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems in women or men” and that both pregnant people and those who were recently pregnant “are more likely to get severely ill” with COVID compared to those who are not pregnant.
Anne Banfield, M.D., is an obstetrician and gynecologist, as well as the Director of Women’s Health Care, at Davis Medical Center in Elkins, West Virginia. She is a Fellow of The American College of Obstetricians and Gynecologists (ACOG), is the past Young Physician-At-Large at ACOG, a board member on the West Virginia Perinatal Partnership, and treasurer for the West Virginia Medical Association.
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