Like any loving, expectant mom, Brittany Kass approached the news that she was pregnant in January 2021 with excitement, joy, and at least a little anxiety.
Of course, many people were anxious. COVID-19 was wreaking havoc and the vaccination process was just getting started.
The COVID-19 vaccine was available then only for select groups, such as healthcare workers. As Kass’ pregnancy progressed, she tracked the news about the vaccine but was still worried about its safety for pregnant women. She didn’t think she was invincible from COVID, but she just wasn’t sure. Besides, at 18 weeks gestation, everything looked great during her checkup.
Two weeks later, she contracted COVID-19, likely from a friend at a birthday party. Her husband, Rob, had traveled to California for business. Alone and caring for a toddler, Kass felt OK the first week, with cold-like symptoms.
The second week, “it really hit me,” she said. “I had crazy body aches, fever, chills.” She lost 10 pounds. Kass mother-in-law arrived to help.
She fully recovered and even flew to California to visit friends and family. While there, she realized she didn’t feel the baby moving quite as much as she had before her illness.
Her next visit to the doctor for a routine ultrasound would change her life.
A birth at 24 weeks?
Dr. Amelia Sutton, Kass’s obstetrician with Novant Health Maternal-Fetal Medicine - Charlotte, was shocked by what she saw during Kass’ visit at 24 weeks.
Before Kass came down with COVID-19, she and the baby were healthy. But now, “the baby was really, really small and had very little amniotic fluid around him,” Sutton recalled. The evidence suggested the placenta had stopped working well, with a lack of adequate blood flow through the umbilical cord.
“I don’t want to alarm you,” Sutton told Kass, “but you need to pack a bag and go to the hospital.” The doctors might need to do an emergency cesarean section to try to save the baby.
Kass could hear herself cry out, “No, no!” to the doctor and Rob. This couldn’t be happening. She didn’t know anything then about the survival rate of a baby born at 24 weeks, the physical and developmental delays that could be triggered by such a premature birth. She just knew she wasn’t ready.
Sutton kept her composure. But she was deeply worried. “We were very concerned about the chance of this baby surviving.”
Recent research showed a serious increased risk of pre-term delivery in pregnant women with COVID-19. Another research paper found COVID-19 is associated with placental injury, even in mothers with no symptoms. Some reports indicated the disease increases the risk of stillbirth.
Kass drove home in a fog. She called her family and friends.
She thought, “I’m going to go to the hospital, deliver this baby, and have a few hours with him.”
That might be all she would get.
Babies the size of a hand
At the Novant Health Presbyterian Medical Center maternity unit, she saw other women checking in, heavily pregnant and in the early stages of labor. Her own belly looked so tiny in comparison.
Sutton and Kass other doctors knew that a baby at 24 weeks gestation was just on the cusp of possible survival. They monitored the baby’s heart rate and soon started Kass on magnesium and steroids. Ideally, the magnesium would provide neurological benefits for the baby. The steroids would push the baby’s lungs to mature.
A doctor came in to talk about a possible C-section. If the baby had to be born now, he would weigh about a pound. Effects of such an early delivery could include cerebral palsy, developmental delays and other lifelong effects.
Later, someone else on the hospital team asked her and Rob to fill out a birth certificate, just in case. The simple request left them stunned. They hadn’t picked out a name yet.
Kass set a goal for herself: Make it through the next 24 hours without delivering.
She accomplished that, then another 24 hours. “It was literally day by day, every day, every hour, just keeping him inside,” she said. “There’s nothing like the mother’s womb.”
Though she had Rob’s strong support and a stream of visiting friends and family, Kass lay awake a few nights, crying. She knew an emergency C-section could still happen at any moment, with a possible lifetime of repercussions for her son’s health.
A nurse thought it might help her to tour the neonatal intensive care unit and understand what happens there. Brittany was frightened to see 26-week-old babies the size of a hand. But she was also comforted by the care she witnessed from the doctors and nurses.
And then her own team at Presbyterian went to work. Following the two doses of steroids, the team constantly monitored the baby’s heart rate for any signs of distress. They administered frequent ultrasounds to assess the baby’s breathing, see how much he was moving, and track the level of amniotic fluid in the womb.
Kass was healthy when she entered the hospital, but just as a precaution, the team monitored her heart rate and vital signs, such as oxygen level, every four hours. Kass received lots of healthy food and ample time to rest. Then the waiting began to find out how the baby would respond.
The medical team initially expected Kass to be hospitalized until delivery, whenever delivery might occur. But with treatment, the baby began making more amniotic fluid, which after about 20 weeks comes from the baby’s urine. The volume of amniotic fluid is a marker of how much blood flow the baby is receiving through the placenta and umbilical cord. The doctors were surprised and encouraged: the baby was rebounding.
About 10 days into her hospital stay, things were going so well that the team planned to discharge Kass. Then the baby’s heart rate unexpectedly slowed. The plan to leave was scrapped.
But her unborn son’s health improved four days later. Kass was released from the hospital with the promise of lots of follow-up doctors’ appointments – and hope for the future.
The baby grew rapidly and has reached a normal size. Kass is 37 weeks pregnant now and plans to get the COVID-19 vaccine. She knows that she and her child were lucky, and that not all pregnant moms and their babies will have such a positive outcome during or after a bout with COVID-19.
Kass hopes to inspire other pregnant moms who may be on the fence about getting the vaccine to talk with their doctors and prevent a situation like the one she endured. Two of Kass’ close friends who are also pregnant ended up getting the vaccine after seeing what Kass and her baby went through.
The top organizations for maternal health care, including the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, recommend the COVID-19 vaccine as effective and safe for expectant mothers.
“Not getting vaccinated could be devastating for Mom, but also could be devastating for baby,” Sutton said. Getting the vaccine is a single step to protect two lives.
Since their frightening time in the hospital, Brittany and Rob have settled on a name for their son. While they haven’t revealed it to anyone yet, they will say they chose a name that means “powerful” and “strong.”
Credit: Top photo by Allison Kuhn
