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When Lori learned that the COVID-19 vaccine would be available to her as a University of Utah Health employee in February 2021, she faced a daunting question. She'd given birth to her second son in late June 2020, in the middle of the COVID-19 pandemic. She was breastfeeding her baby, Parker. Should she take the vaccine or not?
She reached out to a federal government agency for guidance. The agency informed her that lactating women had not been included in the original vaccine trials, but based on general experience with other vaccines, the benefits outweighed the risks. "It was a very general response," Lori says. "That was not good enough for me." She trusted her provider, Erin Clark, MD, who is U of U Health's Maternal-Fetal Medicine division director in the Department of Obstetrics and Gynecology. Clark delivered her first baby, Ryder, two and a half years before Parker was born. "She is my source of truth," Lori says.
They talked on the phone for half an hour. Clark told her, "If it was myself or somebody close to me, I would highly recommend getting it." The provider told her that typically giving breastfeeding women vaccines such as the flu, help give both her and the baby immunity through the passing of mom's antibodies post-vaccine through the breast milk. The COVID-19 vaccine might work the same way, Lori learned.
Clark says that because of the pandemic, counseling patients takes up a good proportion of most visits. "My general approach is that parenthood and pregnancy are a sort of leap of faith. They're a marvelous time but also one of uncertainty and anxiety. Add COVID to the formula, and the vaccine and more anxiety and uncertainty follows." She has to tread a complex line caring for people and their families with limited information while acknowledging their autonomy.
What is clear, Clark says, is that the virus is dangerous for pregnant women. Preliminary data from a large U.S. observational trial showed that pregnancy was definitely a risk factor for more severe COVID-19 symptoms. "If you're pregnant, you're more likely to be hospitalized, more likely to need breathing assistance and other critical care, and you're more likely to die of COVID compared to women your age who aren't pregnant," she says.
By February 2021, data was emerging on pregnant women receiving the vaccine from several sources. Anthony Fauci, MD, and director of National Institute of Allergy and Infectious Diseases, she notes, has said there is limiting but accumulating observational data about vaccination in pregnancy. Thus far, no safety signals have been seen.
There remains what she calls "theoretical concerns," however, for example, that a vaccine-related maternal fever in the first trimester might be detrimental to fetal development. "Some health care workers are waiting past the first trimester to be conservative," she says, before getting the vaccine. "Others say, 'As soon as I can have it.'" More safety information will rely on the completion of randomized clinical trials in pregnant women.
Some Utahns are not receptive to the concept of vaccinations and decline standard vaccines such as flu and whooping cough, both of which Clark notes have demonstrable benefits in pregnancy and are known to be safe. There's a large community camp in the middle who, like Lori, rely on their provider to talk them through it and make the decision with their health care team.
Exposure to the virus inevitably varies from individual to individual, and Clark and her team have to guide expectant mothers and moms of newborns through what still remains confusing and conflicting information from recognized sources, as well as having to address rumors from unofficial, internet-based sources that some patients peruse.
Clark cautions everyone to bring any concerns they have to their health care provider rather than rely on external sources. "We can tell you what we actually know and don't know rather than have you rely on potentially incorrect information on the internet, of which there is a lot, and hearsay," she says.
"We have this conversation every day," Clark says. "We talk about the uncertainties and couch it in terms of their individual situation and then apply it to their family. 'What is your exposure to the virus? Can you mitigate it?' Most people come out of these discussions feeling good about their decision to be vaccinated or not, even when we don't have all the data yet."
When it comes to lactating mothers, Clark says the vaccine is recommended for all breastfeeding mothers. "There is no data or biological reason to feel it would be harmful or interfere with milk production," she says.
Katy is also an employee of U of U Health, but she does not plan to get the vaccine before or after her baby's birth. She's been married since 2017 and three years later they decided to try for a baby. She got pregnant "super fast," she says, only to suffer a miscarriage at seven weeks. "It rocks your world," she says. "You lose a family member. That baby is real."
She's now pregnant and has a due date to deliver a baby girl in early May 2021. Katy believes in vaccines and feels morally conflicted about not getting the COVID-19 vaccine, but such conflict doesn't alter her decision to not get the vaccine while she's pregnant. "It's a good first lesson in being a parent. Sometimes you have to make decisions that are right for your kiddo but maybe aren't the most popular," she says.
After birth, she isn't sure if she will get the vaccine or not. "I'm waiting for more information," she says. "I'm not super comfortable without the data."
Lori's confidence in her decision to have the vaccine was further consolidated by the Mountain West Mother's Milk Bank to which she donates her excess breast milk. She asked if they would accept her milk after she had had the vaccine and they said yes.
She encourages other mothers of newborns who aren't vaccinated to consider getting the vaccine. "For me, if I can help my child stay healthy and not get sick from a certain disease by getting this vaccine, I would do that and would encourage other people to do so as well. Because we don't know when children will be able to get the vaccine so they have the antibodies to fight it."
That said, she wants other expectant women or lactating moms to know that it's up to them. "People have to do their own research and make their choice on their own," she says. "It has to be a decision you make yourself in the end as the mom." As Clark told her, she recalls, "I will support you in whatever choice you want to make. It's your body, your child."