The day I got my first COVID vaccine, I wept with relief. It was the weekend of Mother’s Day, and I couldn’t think of a better gift to give to myself and to my toddler son, who goes to daycare all week.
This shot, this absolute miracle of modern science, was for me a light at the end of a tunnel lined with thousands of deaths, overburdened intensive care units, and the daily anguish of staying apart from loved ones in hopes of keeping them safe.
Then, in the weeks before becoming eligible for my second dose, I got pregnant.
The day I missed my period, I joined a high risk group—a population considered extra vulnerable to respiratory viruses and serious illness, and COVID-19 specifically. In the third and fourth waves of the pandemic, unvaccinated pregnant people are getting admitted to hospital ICUs at an alarming rate. In fact, the Centers for Disease Control and Prevention (CDC) has just issued an urgent warning with updated data: Pregnant people with symptomatic COVID have a 70 percent increased risk of death. There's also an increased risk of preterm birth, stillbirth or NICU admission for the baby.
Despite these very real, very scary outcomes we now know about, provincial data in Ontario, where I live, shows that as of September 12, only 54 percent of pregnant people were double-vaxxed. (This is compared to over 81 percent of the general adult population.)
In the U.S., rates are even lower: the CDC says only 31 percent of currently pregnant people are vaccinated, even though the surging Delta variant is more infectious and more deadly. (Health Canada does not track the vaccination rate of pregnant people across all the provinces.)
In fact, under the umbrella of high-risk groups in Ontario, pregnant women have the lowest vaccination rate of all. People with a history of organ and stem cell transplants, neurological diseases that affect respiratory health, blood cancer and kidney disease are all getting vaccinated more than pregnant people are. It’s alarming, but, on some level, it makes sense, given the high-stakes, high-judgment experience of pregnancy.
When we're pregnant, we're medically and socially conditioned to be extremely careful with what we put in our bodies, now shared with a vulnerable growing fetus. Is it OK to exercise? Is my skin cream safe for pregnancy? Will a sip of wine or bite of sushi harm my baby? What if this bath I’ve drawn for myself is just a little too hot? It's hard not to obsess over even the smallest risks, or feel overwhelmed by the sheer volume of questions and anxieties. We also routinely face judgment from perfect strangers policing our behaviour and commenting on our choices, even if it’s just one cup of coffee a day.
But if you're skipping or delaying vaccination during pregnancy because you're worried about your unborn baby’s development, you should also consider the risks of getting a COVID infection in pregnancy—in addition to the heightened risk of maternal death, it can cause you to go into labour too early. And longitudinal research links preterm birth to poorer health and social outcomes, including heart and lung issues, and greater risk of ADHD.
This is one of the reasons why I was not among the vaccine-hesitant, even after learning I was expecting. The minute I could snag an appointment for my second shot, I leapt at the chance. I didn’t just want it because I craved hugs with vaxxed friends and family and a worry-free meal on a patio. I did it because I knew it was the single best thing I could do to protect myself and my baby. We now have reassuringly solid data to prove that the vaccine does not penetrate beyond the placenta, but the good stuff—like the COVID-19 protective antibodies your body makes after vaccination—does get passed on to the fetus, and may protect your vulnerable newborn from infection.
The alternative—gambling that you won’t catch COVID for those nine months—just seemed much more terrifying to me. After I read news stories about ICUs becoming packed with unvaccinated pregnant patients in particular, I couldn’t shake the horrific images from my mind. These extremely sick patients are hooked up to ventilators or ECMO life-support machines, and have to lie prone on their pregnant bellies (cushioned by lots of pillows). They often need to deliver their babies by C-section, while in a medically-induced coma, even if the babies are too young to survive outside the womb.
I think about it this way: Delaying a vaccine during my pregnancy does me—or my unborn baby—absolutely no good if neither of us survive that pregnancy. It would also leave my toddler son without a mom.
It's true that this horrifying scenario isn't, typically, what a pre-Delta COVID infection looked like for a healthy woman in her thirties. And it isn't what COVID looked like back in January, when health agencies first started issuing vaccine recommendations for pregnant people like me. But the virus has changed since then—and so has my own personal risk calculation.
As vaccines became more widely available and their impacts studied, the conversation about safety for pregnant people has “evolved,” says Tali Bogler, the chair of family medicine obstetrics at St. Michael’s Hospital in Toronto, and co-founder of the Pandemic Pregnancy Guide, a popular social media resource for anyone expecting during COVID.
The ever-changing messaging and lack of evidence earlier in the vaccine rollout was extremely frustrating to women’s health advocates like Bogler, who worried about the "downstream impacts" of the way the safety guidelines were handled. “If [pregnant] systematically excluded [from], we lack safety data from the get-go," she says. "Then there’s unequal access to vaccines and conflicting messages from Health Canada and other health agencies about whether pregnant individuals are eligible." Sometimes, initial messaging sticks, she adds, even if it isn't, ultimately, the most accurate information.
Bogler says the number one question she gets from her pregnant patients is an understandable one: “What about the lack of long-term data?”
“We actually have great long-term data on other vaccines we give in pregnancy, and there are no adverse effects and no red flags,” she says, pointing to two major studies about flu and whooping cough (also known as pertussis) vaccines. These are shots routinely given in pregnancy, she says, right there in the obstetrician or midwife’s office.
Neither of these shots are mRNA vaccines, however, which alarms some patients who are hesitant about COVID vaccines, but feel comfortable with other vaccines during pregnancy. “The mechanism is slightly different in how it’s delivered," explains Bogler, "but our immunological response is exactly the same.”
She says the third wave of COVID, in April and May 2021, became a “turning point.” Once experts began to recognize how at-risk pregnant people are of COVID complications, some provinces started prioritizing vaccine clinics for anyone expecting.
That's where I got my shot—a pop-up run by my local hospital, specifically for pregnant people. This gave me an extra dose of confidence that this was the best decision I could make for my baby, with the information I had. After all, I will ultimately trust the capable staff at this very same hospital to deliver my baby.
Bogler wishes the COVID vaccine could be administered in OB/GYN and midwives’ offices, just like other vaccines given in pregnancy, because that’s an important venue of trust. Approaching the issue with compassion is key, she says. Pregnancy is an already heightened time, so ignoring the context, and all the unknowns pregnant people already have to navigate without a pandemic interrupting their prenatal care, is not going to get more shots in arms.
Despite not being vaccine-hesitant myself, I really feel for those still holding out. Pregnancy is a strange, anxiety-riddled state during which so much is at stake—and it can feel like it’s all on you.
Ariel Dalfen, a perinatal psychiatrist at Mount Sinai hospital in Toronto, says that there’s a “range from cautiousness to anxiousness in pregnancy, so if you fall anywhere on that continuum, which most people do with pregnancy, getting vaccinated is understandably a very momentous decision to make.”
On that spectrum, she notes that I sound relatively laidback. It probably helps that this is not my first baby, my pregnancy isn’t considered high-risk, and that I didn’t experience any difficulties with conceiving or pregnancy loss in the past. It can be an understandably more tense experience for first-time pregnant people or for those who encountered complications with previous pregnancies, Dalfen says.
Five months later, I can happily report that being vaccinated has indeed given me the security to live my life a little bit more, prior to our new baby’s arrival. My partner and I got to take a babymoon trip, and I was able to safely throw my son a small outdoor party to celebrate his third birthday. I have had no side effects, and, best of all, I get to enjoy a whole lot of peace of mind.
My great hope is that this pandemic will be on its last days by the time my new little one arrives, and I truly believe the fastest way to get there is to vaccinate as many people as possible.