Adrienne Stewart sat in her doctor’s office in Kenner in July, six-and-a-half months pregnant, for a routine prenatal visit. She had no intention of getting a COVID-19 vaccine.
This was a pregnancy seven years in the making, her third attempt at fertility treatments and her first healthy pregnancy. In her mind, there hadn’t been enough evidence to prove the vaccines’ safety for pregnant people and their developing fetuses. She thought it would be safer to wait.
The date of her doctor’s visit was just the beginning of what would be a deadly fourth surge, including for pregnant people. Across Louisiana, at least six pregnant people and 10 fetuses have died of COVID-19 since the beginning of July, all cases where the pregnant person was unvaccinated.
During the visit, her physician, Dr. Veronica Gillipsie-Bell, described how pregnant women sick with COVID-19 were filling up hospital intensive care units.
Due to a suppressed immune system brought on by pregnancy, they were often in respiratory distress. To aid their breathing, they needed a ventilator, so they were admitted to an ICU. The pregnant person might also need to be sedated and intubated for a preterm delivery.
Stewart remembers Gillispie-Bell telling her that not every patient or baby was guaranteed to survive.
“I literally ran downstairs to get the vaccine,” Stewart, 36, said. “Right after I left her office.” She couldn’t imagine losing this pregnancy.
Two weeks after her first vaccine shot, Stewart saw a friend post on Facebook about a family member. Just like Stewart, the young woman was pregnant. Just like Stewart, she’d had a baby shower. Only at this shower, both the expecting mother and father were infected with COVID-19. The father survived, their baby — delivered early — survived. But the mother did not.
“She never got a chance to hold her baby,” Stewart said. “It could have been me.”
By the numbers
The deaths of pregnant people are part of a trend across the South and the nation, driven by the delta surge and low vaccination rates. In Mississippi, at least eight pregnant people have died of COVID-19 in the fourth surge. In Alabama, at least seven pregnant people have died since the onset of the pandemic.
August saw the greatest number of pregnant people die from COVID-19 in the U.S. since the pandemic’s outbreak. In all, there have been 161 COVID-19 deaths and 22,000 hospitalizations of pregnant people, 97% of whom are unvaccinated, according to the CDC.
In a striking alert issued by the Centers for Disease Control and Prevention in late September, among those who contract COVID-19, pregnant people are 70% more likely to die.
CDC issues urgent health advisory, strongly recommends #COVID19 vaccination for those pregnant, recently pregnant or trying to become pregnant or who might become pregnant in the future to prevent serious illness, deaths, & adverse pregnancy outcomes. https://t.co/UmM8L5YSNd pic.twitter.com/HOiZNGyLpm
— CDC (@CDCgov) September 29, 2021
But COVID-19’s risks for pregnancy are even more varied. It also increases the risk of preeclampsia, which is dangerously high blood pressure, preterm birth, stillbirth and the need for the baby to be cared for in a neonatal ICU. Fetal deaths in Mississippi have doubled among unvaccinated pregnant people during the pandemic.
One study in the journal Clinical Infectious Diseases found that underlying conditions, including lung disease and diabetes, can increase the risk of bad outcomes, but so, too, can the simple fact of being pregnant and over the age of 25.
Research published by the CDC and based on data from Kentucky has shown that immunity gained from vaccination is stronger than immunity gained from a COVID-19 infection, and a separate study in the American Journal of Obstetrics and Gynecology found that is true specifically in pregnant women. Studies also show antibodies can be transmitted through breast milk and the placenta.
In August, as the delta surge peaked in Louisiana, the CDC, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine switched their recommendations.
Instead of stating that the COVID-19 vaccine was safe during pregnancy — a conclusion based on the participation of tens of thousands of pregnant people in a vaccine monitoring program and studies conducted after the vaccines were released — these organizations now explicitly urge pregnant people to get vaccinated. Doctors are encouraged to recommend the vaccines to their pregnant patients at every visit.
And yet, far fewer pregnant people are vaccinated than the national average. According to the CDC, only 31% of expectant patients have received the jab.
'Fight all the myths'
Stewart said she’s grateful to be among that number, and grateful to Gillispie-Bell for laying out the dangers of COVID-19.
“She didn't try to press anything on me,” Stewart said, who was aware of the severity of COVID-19 after her husband became ill during the initial wave of the pandemic. But in the absence of that conversation around vaccination, “without a shadow of a doubt I would not have gotten it.”
Gillispie-Bell, an OB-GYN with Ochsner Health, tells every patient that the vaccine is in their best interest. Many, like Stewart, tell her they’re worried the vaccines are too new.
“And then of course, there are 101 myths on the internet,” she said.
One of the most pervasive is that the vaccines impact fertility — a false and baseless suggestion that misunderstands the basic functioning of the mRNA vaccines manufactured by Pfizer-BioNTech and Moderna.
“And so I'm just having to fight all of the myths,” Gillispie-Bell said. “And then to get the data out to make sure patients understand that the vaccine is safe.”
It can be a hard message to sell, she said. Most days when she’s on call, she’s ends up admitting a pregnant patient with COVID-19 to the ICU.
The fact that these illnesses and deaths are preventable only make them more difficult to take, she said. It’s a feeling that Dr. Judette Louis shares.
“The misinformation you keep hearing from [patients] is so frustrating because you're literally in the hospital full of unvaccinated people who are sick, but they're talking to you about [the vaccines’] adverse effects,” said Louis, the department chair of obstetrics and gynecology at University of South Florida and the immediate past president of the Society for Maternal-Fetal Medicine.
Louis recently had a patient who had to be intubated for three weeks. Others have needed ECMO, which stands for extracorporeal membrane oxygenation, essentially a machine that does the work of the heart.
“It's something that was rare to encounter for pregnant people before COVID. And now increasingly, we're seeing patients who are sick enough that they need it. It's a big deal,” she said, noting that every pregnant person currently in her ICU is unvaccinated.
At her practice, staff wear T-shirts that say “Ask me about the COVID vaccine.” They give handouts for people to take home, in a variety of languages, for families to use in making an informed decision.
Doctors talk to their patients about getting vaccinated at every appointment because “if you never bring it up, then you're complicit.”
Patients often weigh the risks of the vaccines against the assumption that they won’t get sick with COVID-19, Louis said. Most of her unvaccinated hospitalized patients are surprised at how ill they become.
Many don’t get vaccinated in a misguided attempt to protect their fetus, when it has the opposite effect. And rarely does the conversation focus on what’s best for the mother, she added.
“What about the mom?” she asked. “At some point, we need to value the lives of the moms, too. And absolutely, if you're valuing the lives of the moms, the vaccine is the right thing.”
