Severe COVID-19 among unvaccinated pregnant women causing more premature births in KY
During her 32nd week of pregnancy, a few days after she tested positive for COVID-19, her baby’s heart stopped beating as doctors were prepping to perform an emergency Cesarean section.
The 31-year-old from Eastern Kentucky, who shared her experience with the Herald-Leader but didn’t want her name used or her home city revealed, was unvaccinated. Once she tested positive in early September, it took fewer than two days for mild cold-like symptoms to progress to a 103-degree fever and extreme fatigue.
“I couldn’t do anything on my own, so I went to Clark Regional Medical Center,” where she learned she was in labor. “I had no idea. I couldn’t feel anything; I felt like I weighed 1,000 pounds, so I didn’t know I’d been having contractions,” the young woman said this week.
A pregnancy is usually considered full term around 37 weeks. Unless a person goes into labor on their own after that mark, obstetricians interviewed for this story said they usually induce labor closer to 40 weeks. At 32 weeks — more than a month before that milestone — the 31-year-old’s child was not fully developed, which is why hospital staff acted fast when they learned her body, under extreme distress from COVID-19, had gone into premature labor.
She began to feel contractions in the helicopter as she was airlifted to UK HealthCare’s Albert B. Chandler Hospital. Upon arrival, she gave written permission for doctors to perform an emergency C-section — a risk, itself — “and while we were waiting on the anesthesiologist to get everything ready, my child’s heart stopped,” she recounted. There was no time for a C-section, “so I had to push.”
From her hospital bed, she remembers a nurse, manually squeezing an oxygen bag to help her breathe, grabbing her hand and warning her, “Don’t be alarmed, but a team is about to rush in.”
Traumatized by not knowing whether her son would be dead or alive once he was delivered, she slipped in and out of consciousness. It wasn’t until a few hours later, after her pain had subsided and her oxygen levels returned to normal, that she fully comprehended what had happened: she’d delivered a premature baby whose early arrival required him to be immediately whisked away to the hospital’s neonatal intensive care unit. She would not get to hold him for 12 days.
This dire scenario is unfolding with increasing frequency at Lexington’s hospitals. Not only have they reported a rise in admissions of unvaccinated pregnant patients since early July, many of those patients are becoming sick enough to require emergency C-sections as a way to relieve stress on their bodies — and often their babies’ bodies — racked by the disease, which continues to infect thousands more Kentuckians each day.
Nationally, pregnant people are one of the least-vaccinated at-risk groups. Just 31% have chosen to get a vaccine, according to Centers for Disease Control and Prevention research released last month that accompanied a plea for more people with child to get their shot. Some of the expecting mothers interviewed for this story cited the exclusion of pregnant people from initial clinical vaccine trials, along with the CDC’s lagging recommendation that the vaccine was safe during pregnancy, as playing a part in their hesitancy.
The Kentucky Department for Public Health doesn’t track vaccination status in pregnant people, fetal death rates from coronavirus complications, or birth outcomes in pregnant Kentuckians who have died from the virus, a spokesperson for KDPH said.
But the department is currently working on an analysis comparing “fetal deaths and birth outcomes in pregnant women who have had COVID-19” with those who haven’t. The information won’t be available for several weeks.
Anecdotally, though, five obstetricians and perinatologists at clinics and hospitals in Lexington have noticed a troubling increase.
“We are seeing an uptick in complicated COVID-19 [cases] and COVID admissions in pregnancy during this particular wave, and that’s exacerbated by the relatively low vaccine uptake,” Dr. Agatha Critchfield, a perinatologist at Baptist Health Lexington, said earlier this month.
At her hospital, she estimates a new pregnant woman admitted for COVID-19 requires pre-term delivery “a couple times a week.”
When a pregnant person becomes that sick, “it becomes a balance between the fetus and the mother,” said Dr. John Barton, another perinatologist at Baptist. “Eventually you get to a gestational age where you have a low rate of neonatal mortality, and by delivering the baby, you can improve the mother’s cardiopulmonary function.”
In other words, if a pregnant person develops severe illness from coronavirus, and plenty have, it becomes a balance of delivering early enough to stave off more intense sickness, but doing so at a point far enough along in the pregnancy without risking harm to a fetus. Sometimes, like in the case of the 31-year-old woman airlifted to UK, there’s no room for choice.
‘It’s so common’
Health care providers have grown accustomed to these harrowing deliberations in recent months.
At UK, 49 pregnant patients were admitted with COVID-19 between July 1 and September 30, which breaks down to one new patient every two days. That’s significantly higher than in previous waves, when even one pregnant admission a week was unusual, providers interviewed for this story said.
The university began tracking vaccination status in September. That month, none of the 15 pregnant patients admitted with COVID-19 were vaccinated.
“It’s so common,” said Dr. Katherine Vignes, an obstetrician and gynecologist at UK, “we’ve converted six out of 12 rooms on labor and delivery to negative pressure.”
UK has also converted one out of three of its labor and delivery operating suites into a COVID-only operating room, she said. “That’s how significant it is. We’re dealing with this on a daily basis.”
A spokeswoman at CHI Saint Joseph Health said their women’s hospital saw a 15% increase in pregnant patients hospitalized during the most recent surge. All were unvaccinated.
Like UK and Baptist, St. Joe’s has also logged a rise in pre-term deliveries.
Pregnant people with coronavirus have reported “decreased fetal movement,” at which point they’re directed to the hospital for monitoring, spokeswoman Mary Branham said. “In many of those patients, there is a need to deliver.”
COVID-19 infections have also caused “intrauterine growth restrictions,” which is when normal growth of the fetus is impacted. This, too, has led to early deliveries.
The hospital has also logged one stillbirth in recent months from COVID, Branham said. All providers interviewed for this story said their hospitals don’t track stillbirth rates, but all anecdotally confirmed they’d seen an increase in stillbirths among women who contracted the virus during their pregnancy.
Pregnancy is considered an at-risk condition that markedly increases the likelihood for a severe infection, even death. “There’s a 70% increased risk of death,” Vignes said, referencing CDC data. “I don’t know who that wouldn’t terrify, [especially when] these are people in their 20s, 30s and 40s.”
When someone gets pregnant, their oxygen consumption goes up 20% because their diaphragm is elevated, said Dr. Barton. “So any respiratory [issue] is going to be poorly tolerated by a pregnant woman, particularly in the third trimester.”
On top of that, “the risk for death if you have COVID doubles if you’re obese, and it increases by five-fold if you have diabetes,” he said.
In its “urgent health advisory” issued late last month, the CDC said pregnant people who contract the virus and are symptomatic have a “two-fold risk of admission” into an ICU, not to mention an “increased risk of adverse pregnancy outcomes that could include preterm birth and stillbirth.
Nationally, as of late September, more than 125,000 pregnant people had tested positive. Of the more than 22,000 who needed to be hospitalized, 97% were unvaccinated.
But these decisive findings still haven’t convinced a majority of expecting mothers.
As a result, “delivering a baby early because the mother has COVID is definitely pretty common,” Dr. Vignes said last week. “The COVID infection is causing respiratory distress in the mother, causing her to have complications like preeclampsia. Delivering her child either becomes necessary to help the child, or necessary to help her.”
Last month, she delivered her first baby from a COVID-positive mother in an ICU. Typically, deliveries take place in designated delivery rooms, but the young woman and her baby were so unstable, health care workers didn’t want to risk moving her. The urgent procedure needed to happen then and there.
“This is not something I’ve had to do before in my training or career so far,” Dr. Vignes said, shaking her head. ”But we’ve had multiple cases where patients are so unstable they cannot be moved to a [normal] place to have their child.”
‘Pleading with patients’
In a small, windowless room at the Lexington Women’s Health clinic, obstetrician and gynecologist Dr. Sarah Borders was waiting for the right moment.
Her patient, a 35-year-old woman from Berea in her 27th week of pregnancy, was here for a routine test.
Near the end of the conversation, Dr. Borders, who splits her time between seeing patients in this clinic and delivering babies at Baptist, asked a question she poses to all her patients, sometimes more than once across visits: are they vaccinated? If the answer is no, she probes.
This woman wasn’t inoculated. Like most of Dr. Borders’ patients, she wasn’t a staunch anti-vaxxer, but she wasn’t quite convinced of its benefits. Like most, her biggest worry was the safety of her child.
“I’m just curious: what’s your reason for not wanting to get it while you’re pregnant?” Borders asked, frankly.
The patient said she had avoided taking other vaccines during her pregnancy, and because she takes medicine for epilepsy, she didn’t want to add anything else foreign to her body.
Dr. Borders heard her, nodding: “I’m going to give you my little spiel on it, just because we have been seeing pregnant women getting sicker than ever from COVID. There was actually a record number of maternal deaths last month,” she said.
The OB then walked her patient through the technical aspects of what the vaccine does to the body, including dispelling the oft-recited myth that it somehow permeates the placenta to negatively impact the fetus. It doesn’t.
“The technology that the vaccine uses is messenger RNA. It doesn’t cross the placenta, so none of the vaccine components are going to go to him at all,” she assured. “When [the vaccine] enters your body it degrades within days, so the mRNa disappears. What happens then is your body makes an antibody response to fight the virus.”
More than 150,000 pregnant women have gotten the vaccine, “and they’ve not linked any side effects or risks to babies or moms with it. We know it’s safe,” Dr. Borders continued. She then tried to level with her patient even further, divulging, “I got mine while I was pregnant, and I’m going to go get my booster tonight since I’m breastfeeding.”
The patient again said what she wants most is to protect her son.
“Yes and the best thing you can do is to get the vaccine, because you’re essentially going to give him protection,” Dr. Borders retorted.
These conversations are unfolding every day, several times a day in her clinic. Though Dr. Borders estimates more of her patients are vaccinated than the 31% nationwide rate, it’s not far beyond that.
“I’m to the point now where I almost feel like I’m pleading with patients to get vaccinated,” she said after the appointment.
Another patient, 31-year-old Lindsey Jean, had been considering getting the vaccine when, 10 days prior to her appointment with Dr. Borders, she contracted the virus.
Thankfully, it was a mild case.
Jean said she would’ve gotten the shot already if it wasn’t for her pregnancy. But something about it made her uneasy.
“I don’t know. I think there’s no right answer. I mean there is in one aspect, but the other aspect is like, what if?” she said. “Because it’s so soon and new.”
“It’s a possibility,” that she’ll get it now that she’s recovered from the virus. “If it was just me, I don’t care. But with the baby,” she said, trailing off.
‘Founded in nothing’
This tepid take on the vaccine — not adamantly opposed but not ardently for — is what health care providers say they hear most often.
“There are some who just think the vaccine has a microchip in it, and you can’t reason with those people,” said Dr. Rachel Saunders, an obstetrician and gynecologist in Lexington.
“There are obviously people who think it can cause them to be sterile or have fertility issues,” even though there is no sound evidence linking the two, said Vignes, who like Dr. Borders, was also vaccinated while pregnant. She’s open about this with her patients, especially those who ask if it’ll harm their babies. But “Unfortunately most of the reasons people cite to me are just founded in nothing,” Vignes said.
A “large majority” root their hesitancy in “‘well, we don’t really know all the data yet,’ or ‘I don’t know anyone who’s gotten really sick from COVID,’” Saunders said.
She can empathize with the reluctance to a degree. Recently, a pregnant woman, dubious about the vaccine, explained why it didn’t feel necessary for her: she works from home, avoids crowded spaces, wears a mask in public, and hasn’t yet known someone personally who’s become really sick from the virus.
To her, getting vaccinated is more of a risk, because “that’s her lived reality,” Saunders said.
A prevalent thread linking most patient hesitancy is exposure to misinformation.
“Part of the problem is people want assurances and they can get that from other sources that aren’t real,” said Dr. Critchfield. Most of her reluctant patients aren’t necessarily opposed to the vaccine, “they’re concerned about exposing their fetus to something that, in their mind, is untested.”
She believes her patients do listen to her, “but maybe Dr. Google or what they read on Facebook explains it in a more comfortable way to them that confirms what their anxiety already was — ‘Oh yes, Facebook tells me, ‘This is dangerous, period. Your doctors are lying, period. The CDC doesn’t know what they’re talking about, period.’”
Even though, for instance, vaccination almost entirely eliminates the risk of severe COVID and death, it’s not a 100% guarantee. And patients want absolute reassurance, Critchfield said. They want declarative statements that science and medicine can’t necessarily offer but Facebook can.
‘Not anytime soon’
Since she gave birth almost a month ago, the 31-year-old drives the hour or so each day back and forth between her home and the Kentucky Children’s Hospital to spend time with her son, who’s still in the NICU.
“It’s really exhausting,” she said last week from her car. “I try to get here as early as possible and leave as late as I can.”
For almost the first two weeks of his life, all she could do was look at him, which was “one of the hardest things I’ve ever had to go through,” she said. Now she can hold him, but not for too long; his small body can’t yet regulate his own temperature, and his lungs aren’t fully developed, so he sleeps in an incubator and relies on supplemental oxygen to breathe.
“All these things I’m doing here are restricted,” she said, starting to cry. “I can’t just pick him up and walk around the room with him. I can’t do all the newborn things. It’s hard to see him here and not have him home.”
Though the experience has been agonizing, she doesn’t regret going without the vaccine. And she doesn’t plan to get it in the near future.
Part of her reservation during her pregnancy was the delayed recommendation from the CDC that it was safe for pregnant people. When the federal health agency announced its full-throated support in early August, the 31-year-old was in her second trimester. She figured she could just wait.
“It’s just something I didn’t really want to do while I was pregnant,” she said. But even now, “I don’t plan on getting vaccinated anytime soon. I can’t say otherwise for the future, but right now, not anytime soon.”
Her choice isn’t the one health care providers want to hear. But it’s one they have to accept.
Recently, a patient pushed back when Dr. Vignes encouraged her to re-think getting her shot, citing the overall low mortality rates, especially among young people who contract it.
“I say, ‘You’re right — if you have it, there’s a good chance you’ll be OK. But I bought life insurance when I had my children. This is a little bit like that,” Vignes said. “Do I think something bad’s going to happen to me? No. But If you can avoid not being there for your children, why wouldn’t you take that step?”
