Dr. Amelia Sutton is a physician with Novant Health Maternal-Fetal Medicine – Charlotte. She and Dr. Navin Bhojwani, an ob/gyn at Novant Health Bradford Clinic OB/GYN and leader of Novant Health’s Women & Children's Health Institute, recently shared their expertise with the media and public. The number of pregnant women on ventilators right now is unprecedented, Sutton said. “ICUs are filling with pregnant women. And … the vast majority are not vaccinated. We are urging patients strongly to get this vaccine as soon as possible.” We asked her to tell us more.
We often have the luxury of thinking of labor and delivery as routine. You go to the hospital to have a baby, and you come home – exhausted, but happy – the next day.
As a maternal-fetal medicine doctor, I see patients for whom pregnancy isn’t so simple.
Anyone can have a high-risk pregnancy. If your family has a history of a genetic condition, if you have multiple medical conditions or even if you’re perfectly healthy, you still could have one.
Complications may be unavoidable
Most of the time in my practice – in normal (not COVID) times – the complications I see are things that just can’t be avoided. There are certain risk factors that may complicate pregnancy. There may be risk factors that could be modifiable, though. But for the vast majority of my patients who must consider a catastrophic outcome, there was nothing they could do to avoid the predicament.
But now we find ourselves treating patients who could have avoided terror and heartbreak. They could have gotten the COVID-19 vaccine, which is safe for expectant mothers, breastfeeding mothers and women hoping to get pregnant.
I was pregnant during the early days of COVID — before a vaccine was available — and would’ve given anything to get inoculated. But for the past several months, all these complications, and even deaths, were 90% preventable. The vaccine is saving lives.
Some complications are avoidable
It's traumatic for a pregnant person to have to hear she has complications. As a doctor, it’s profoundly sad to take care of patients who have these devastating complications, especially if they could have been prevented.
It's not the time to be preaching to the patient. By the time they get to me, they know. Their family knows. It’s understood by this point that this could have been avoided. Women have expressed regret to me that they didn’t get the vaccine before having a severe outcome. They feel guilty because their decision isn’t affecting just their health. It’s affecting their baby’s health, too. It’s heartbreaking to witness.
Respiratory issues are what we worry most about in patients with COVID. The reason that pregnant women are so extraordinarily susceptible to severe complications with respiratory viruses like influenza – and most notably with COVID – is there are changes in the way their lungs work during pregnancy that are most pronounced in the third trimester.
They are three times more likely than a non-pregnant patient to go to the ICU or be placed on a ventilator. They are also at increased risk of stillbirth, and we are certainly seeing that in the Charlotte area.
When mom is on a ventilator
If baby’s ready to come and mom is on a ventilator, she delivers the baby. Sometimes – especially when there’s an infection with a lot of inflammation – patients in the ICU on a ventilator may spontaneously go into labor and have a vaginal delivery. Sometimes we must use forceps to help the patient deliver.
Sometimes we see the baby's heart rate drop because mom's not getting enough oxygen. In that case, we may have to do an emergency C-section.
I have seen women who are near death give birth. They are getting CPR as the baby is being delivered.
When the woman is on a ventilator, she’s not even aware she's had the baby. If she’s critically ill, establishing her breast milk supply is not always at the top of the list of priorities. However, if the patient has expressed to her doctor or family that she wanted to breastfeed, a nurse can start pumping. This would only happen with the patient’s prior consent.
If a woman is on a ventilator and has her baby, there is no guarantee she or the baby will have anything close to a “normal” life. Not getting enough oxygen can lead to brain injury for baby and/or mom.
If a baby is born prematurely, they’re already at significant risk of complications. With a severe COVID infection, there’s a 60% higher chance that moms are going to have to deliver prematurely. We may have to induce labor just to help mom breathe better.
And of course, premature babies are at risk for long-term developmental issues.
When I was a medical student, my first rotation was ob/gyn. I had just completed my Ph.D. in pharmacology, and I thought: There’s no way I’ll go onto obstetrics. I was wrong. The very first doctors I worked with were maternal-fetal medicine specialists. Their patients had high-risk pregnancies. They did ultrasounds on babies, and I was fascinated by it.
I got really interested in complicated pregnancies, how they manage them in labor and delivery and how they manage them in the hospital. And so, even though I had never intended to go into this line of work, it became absolutely clear that it was what I was meant to do.
I did my residency at the University of Alabama in Birmingham. It was one of the biggest hospitals in the state, so we ended up getting patients from throughout the state and from surrounding states.
There’s a COVID tie-in here. When I was a third-year resident – and that's when you're working with high-risk OB patients admitted to the hospital and the ICU – H1N1 flu was sweeping through the country. We had countless young women who were pregnant or recently delivered intubated with horrible infections.
That was the first time I had seen, or even envisioned, a pregnant woman on a ventilator. It was devastating. Of course, now I've seen it countless times.
It was a profound experience. I was the resident and was rounding on all these patients every single day for the six-week rotation. I saw so many maternal deaths. It was extremely traumatic to me as a young physician, but at the same time it inspired me to continue on with what I already hoped to do, which was to take care of complicated pregnancies.
I’m happy to say most of my patients have great outcomes.
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Birth and death
When I think back to those Birmingham patients, especially with what's going on now, I can remember their names. I know where their rooms were. I remember how many weeks pregnant they were when their babies came, if they had boys or girls. Those memories are ingrained in me.
I remember what it felt like to go with my attending physician and talk to their families and tell them the awful news. So, when COVID started, it felt like I was right back there. It was a deeply emotional, as well as an academically important experience. I hate that I’m having to do it again – but I am now using all that training and knowledge I gathered from that time and applying it to my patients now.
When I was in Alabama, I did a lot more labor and delivery call than I do now, so there were times I had to tell someone they’d lost their partner and their baby. I'm not as much “boots on the ground” anymore, but during the H1N1 outbreak, we had several moms and their babies die.
My message to expectant moms who haven’t gotten the COVID vaccine
Here’s what I want you to know.
I am also a mother. I understand your hesitation to take medication, including this vaccine, during pregnancy. I was recently pregnant myself. And given my “advanced age” – 44 – I was considered high-risk. As a mom and as a patient, I certainly thought carefully about everything I put into my own body and how that would affect my baby. But there's no question that if the vaccine were available to me last year, I would have taken it.
I want to keep patients safe. I don't want to see them admitted to the hospital, struggling to breathe, contemplating an early delivery. I don’t want to see them in the ICU, and I certainly don't want to see them on a ventilator.
With COVID, given that there's a vaccine available, there is something proactive expectant moms can do. The COVID vaccine is safe – and recommended – for expectant and nursing moms and those considering getting pregnant.
There are many things we can't change about our conditions and our health. When there is a disease that’s preventable, we all should take the precaution. The vaccine is 90% effective in preventing hospitalization and severe disease. And that's extraordinary.
I spend all day educating patients on the need for this vaccine and asking them what hesitations they have.
I encourage every pregnant woman to have a conversation with her doctor who understands these vaccines and this disease. Be wary of friends brimming with scary information. Stick to internet sites like the CDC.
Not all my patients act on my advice. When someone does, and she gets the vaccine, it means everything to me.