A Matter Of Life Or Death: Doctors On The Grim Reality Of Treating Pregnant Covid Patients

When Sarah* woke up in the ICU, the new mom initially didn’t realize she was no longer pregnant. Days earlier, she’d been rushed to labor and delivery straight from the emergency room, though she was only 33 weeks along. “She was coughing up pink froth due to blood in her lungs. I could see the muscles in her chest straining… she could barely breathe,” Sarah’s OB-GYN, Dr. Omar Young, recalls. Covid had wreaked such havoc on the pregnant woman’s lungs that her blood gas level was considered “pre-death,” so his team delivered her as soon as they possibly could in a desperate attempt to save both mother and baby.

Sarah spent 10 days in the ICU before being well enough to go home and care for her newborn. “I saw her on a video visit last week, and for about 30 minutes she just bawled,” says Young, who is also an associate professor of obstetrics and gynecology at the University of North Carolina, Chapel Hill. But, he adds with relief, his patient did tell him that she has since received her first dose of the vaccine and was looking forward to her second.

Sarah's case is a success story of sorts, but doctors like Young have seen too many unvaccinated pregnant people desperately ill with Covid-19. And now, these professionals are exhausted and traumatized. Pregnancy causes a 70% increase in the risk of death from Covid-19 as well as an increased risk of stillbirth, according to recent data from the Centers for Disease Control and Prevention (CDC), and doctors across the nation are begging those who are pregnant or trying to conceive to get their vaccinations.

I always have to think about the decision I'm writing in the chart. It will have consequences for the next 50 to 60 years.

Just this week, the CDC released data showing an alarming spike in deaths among pregnant Covid patients this summer. “I can tell you, when I hear about a pregnant woman in the community who is not vaccinated, I personally pick up the phone and talk to them," CDC Director Dr. Rochelle Walensky told ABC News' chief medical correspondent, Dr. Jennifer Ashton, on Dec. 8. "It's just shocking," she said of the number of pregnant people who died in August; she’s now "very concerned" as we head into an uncertain future with Omicron.

Young feels he has been battling a war on two fronts for the entire pandemic. The first is against misinformation surrounding pregnancy and Covid, and the second is for the lives of mothers and their babies themselves. He is full of emotion as he recalls Sarah’s ordeal when we catch up with him on Zoom between rounds and deliveries. “Truly, it is exhausting day in and day out to have repeated, well-intentioned discussions with patients regarding the Covid vaccine in pregnancy,” he says. “To know that patients are so consumed by misinformation from social media, as well as family members…”

Sarah is just one of countless stories that have broken Young’s heart and worn him down over the pandemic. He tells us of making the choice for another patient to deliver at 24 weeks as the virus ravaged her body. Mother and child both survived, but the baby is still in the NICU months later, facing an uphill battle. “It wasn’t safe, in my expert opinion, for her to continue pregnancy, but I always have to think about the decision I'm writing in the chart,” he says. “It will have consequences for the next 50 to 60 years.”

Why is Covid so risky in pregnancy? Young says that in addition to pregnancy producing a temporarily immunocompromised state, it is often very difficult for pregnant people to breathe in enough oxygen to sustain both them and their fetus when Covid-19 infects their body. Even if not critically ill, many pregnant, Covid-positive patients require oxygen support such as a nasal cannula or BIPAP. Many with comorbidities will need to be intubated.

Two months later, the baby is in the NICU, while the mother remains in the ICU. The damage to her lungs is too severe for her to be intubated, so she is hooked up to an ECMO machine, which removes the blood from her body and oxygenates it for her before returning it to her body.

Everything about Covid-19 and pregnancy is fraught with risk. In addition to being 22 times as likely to die as uninfected pregnant people, and the increased risk of miscarriage and stillbirth (infected moms are four times as likely to have a stillborn child), positive pregnant patients are also five times as likely an uninfected pregnant people to enter an intensive care unit.

Young tells me another story about a woman his colleague had to deliver at 27 weeks due to Covid complications. Two months later, the baby is in the NICU, while the mother remains in the ICU. The damage to her lungs is too severe for her to be intubated, so she is hooked up to an ECMO machine, which removes the blood from her body and oxygenates it for her before returning it to her body.

“Now all of her extremities are black,” Young says. This means her body is auto-amputating her limbs as the tissue dies from damage. “It’s bad.” His team is frustrated and angry as they watch people struggle and die who could have easily prevented their situation with a safe vaccination.

Many pregnant people right now are the victims of misinformation, and that is what doctors like Young are working hard to dispel. Only about 35% of pregnant people are vaccinated, with less than a third of Hispanics/Latinos and only 1 in 5 Black Americans being fully vaccinated prior to or during pregnancy. That number, these doctors say, needs to be much, much higher.

Dr. Jessica Kiss is a mom of four in private family practice in Los Angeles. She is fearful for her patients who have heard untruths about the Covid-19 vaccinations. “Lots of this stems from misinformation that the vaccine causes infertility and miscarriage. The reality is that studies have shown this is not the case. But the risk of miscarriage from Covid is real. The risk of death from Covid for the mother is real.”

“I will be honest, there have been certain points where I wondered why I was still doing this when I felt so much like most of the world no longer cared,” Kiss says.

Young also sees a high level of distrust among his BIPOC patients, many of whom, he knows, are wary of the medical community. This is reflected in the lower vaccine numbers among pregnant women of color. As Dr. Manisha Gandhi, chief of the Maternal-Fetal Medicine Clinic at Texas Children's Hospital Pavilion for Women, told CBS News in November, “while health officials have tried to address racial disparities in care, historical distrust has been hard to overcome.”

“I think … it probably has to do with mistrust and issues of racism, issues of bias, that are leading women to not pursue this vaccination and distrust of how it may affect the pregnancy,” she told the outlet.

If you are compromised or must go to the ICU, your fetus goes with you.

Young urges his patients to put aside their fears about past racism. He points out that he himself is a Black doctor. “One of the [vaccine] creators is an African American female,” he adds. “This is not the Tuskegee experiment. When you see white people running to get this vaccine, that should tell you something.”

Not surprisingly, many people’s most potent fears — whether they are trying to conceive or are pregnant — surround fertility and risks to the unborn baby. Though scientists and doctors have repeatedly debunked claims that the Covid-19 vaccine might affect fertility or fetal development, some remain skeptical.

“I tell my patients this: I understand that you want your body to be in good shape and don't want anything to interfere [with fertility or a healthy pregnancy]. Please know that we have science on our side,” says Dr. Nicole E. Williams, an author and the founder of Chicago’s Gynecological Institute. “What we do know is that there have been women from the original vaccine trials who have since become pregnant. That's the best data we have!”

A Covid infection, Williams adds, is far more dangerous to a fetus than vaccination. “If you are compromised or must go to the ICU, your fetus goes with you,” she says.

When Kiss spends time with her patients attempting to increase their confidence in the vaccine, she shares the story of a friend of hers who underwent years of infertility treatments. “She finally became pregnant right around the time she became vaccination eligible,” Kiss says. “At this time, misinformation was flourishing on the internet in regards to the vaccination potentially being harmful to pregnancy, which we now know is not the case.”

At 27 weeks, Kiss’ friend was rushed to the hospital, short of breath, her body struggling to provide oxygen for her baby. The disease was severe at that point, and though the medical team fought hard for both of them, she miscarried her unborn child while intubated in the ICU, and died herself several days later.

Kiss asks others to get vaccinated in her memory. “Can you imagine being a significant other in this situation?” she says. “You lose your partner and your unborn child from a disease that is largely now preventable with vaccination. Many patients and friends have had family members die since the vaccination became widely available. In all but one case, they chose not to be vaccinated.”

Kiss also uses her TikTok platform to “try to counteract all of the blatant and often deliberate misinformation out there” — an effort that, she says, has helped shift her mindset from despair. “My reward is every time someone tells me they got vaccinated or they vaccinated a family member,” she says. Kiss is still frustrated, but she says, “Now I feel strong.”

While all the experts we talked to understand the stress of navigating pregnancy during a global health crisis, they want readers to know they themselves would, without any hesitation, get vaccinated — and boosted — during their own pregnancies and recommend the same for their loved ones. And their patients.

“Mr. Rogers put it best, in an emergency you should look to the helpers,” says Kiss. “In this ongoing emergency of Covid, the helpers are your health care providers. Talk to us. Ask us about what you hear. We want you to feel comfortable having these conversations with us. We have the training and experience to help you understand the risk. Please don’t Google. Don’t listen to social media warriors.”

From the depths of his exhaustion, Young offers up one last plea. “I tell patients that I don’t want to be harsh, but, ‘Do you want to live or do you want to die?’ Stop the foolishness. This is a matter of life or death.”

Experts:

Dr. Omar Young, M.D., associate professor of obstetrics and gynecology at the University of North Carolina, Chapel Hill.

Dr. Jessica Kiss, D.O., family medicine specialist in Los Angeles.

Dr. Nicole E. Williams, M.D., author and founder of Chicago’s Gynecological Institute.

This article has been updated to clarify Dr. Young’s role at UNC, and to reflect updated statistics about the risk of death and of stillbirth for pregnant covid patients.