Kate Raess read the studies, talked to her obstetrician and consulted with her pediatrician.
After months of consideration, the Illinois mother, who is breastfeeding her newborn baby, decided she would get the COVID-19 vaccine.
So in early January, as a clinical therapist eligible for the vaccine, she found herself sitting in a chair at a Kane County Health Department location, with her arm ready for the injection.
Then, she was told that she couldn’t have one.
“I was so shocked,” said Raess. “Sitting in that metal chair and listening, no, it’s like someone throws a pin into a child’s balloon.”
An official told her, she said, the county decided that pregnant and lactating women should not get the vaccine. In a statement, Kane County Health Department spokeswoman Susan Stack confirmed that they do not provide the vaccine to pregnant or lactating women, citing the lack of breastfeeding or pregnancy data for the Modern vaccine, which the department is supplying.
Since pregnant and lactating women were not included in the initial vaccine trials, data are limited on how this can impact them. The Center for Disease Control and Prevention (CDC) recommends that the vaccine be offered; Maternal health groups, such as the American College of Obstetricians and Gynecologists (ACOG), are asking for data collection and conversations between patient and provider – and that the vaccine should not be denied to pregnant women who are eligible for it.
All of this makes the decision to take the vaccine stressful for pregnant women, considering becoming pregnant or breastfeeding. Pregnant women are at greater risk of serious illnesses if they receive COVID-19, especially black and Latino women. Families are evaluating factors such as exposure risk, personal health factors and potential benefits.
“It was a very emotional decision,” said Raess. “My child’s safety, well-being and health are a priority for me. I don’t want a vaccine to harm him. I also don’t want COVID to do anything bad for my family. “
As a therapist, Raess will end up working in schools and is sometimes called to help a 24 hour emergency line. She wanted to feel that she was protecting herself and her family, which includes a 22-month-old daughter and an 11-week-old son.
Like many, the decision took months for Raess and her husband. Ultimately, she said, it looks like the difference between seeing your customers at risk through telehealth, “versus me being fully vaccinated and being able to provide fully face-to-face services without worrying.”
When she was denied, she said, “Actually, I started to cry.”
She felt “this internalized feeling of shame and judgment – that a city council thought I couldn’t make that decision, and they would do it for me,” she said.
She told the official that the county should make information about the restrictions available. The employee, she recalls, said to her, “I’ve been thinking about it. We denied several women this morning. “
Raess received several emails from the county health department with information about vaccines; the most recent included language specifying that pregnant or breastfeeding women could not make an appointment for the vaccine. An initial email about scheduling a vaccine did not include these restrictions.
Raess said she’ll be fine. She believes that her regular medical practice can also give her the vaccine, although she has monitored her appointments and has not been able to get one so far.
That means, she noted, that with maternity leave ending soon, “that window to be fully vaccinated before I go back to work is gone.”
Raess wonders about people who don’t have the time or ability to log on regularly to find appointments or defend themselves after being denied – people with childcare complications, transportation problems or difficult work schedules.
“What about other women who are breastfeeding and pregnant, other marginalized groups who (the authorities) are saying, no, are we choosing and choosing who gets this vaccine?” she said. “To be honest, a politician is telling a woman what to do with her body.”
Denying women vaccines is worrying for several reasons, said Dr. Emily Miller, an assistant professor in the Division of Maternal-Fetal Medicine at Northwestern Medicine’s Feinberg School of Medicine. Sends the message that women cannot make decisions about their own health and body. And for breastfeeding mothers, this can increase the pressure for weaning.
“It just creates a totally different risk balance that doesn’t need to be introduced,” she said. “It is not fair to put women in this scenario.”
Early conversations with the Society for Maternal-Fetal Medicine task force on COVID-19, of which Miller is a member, included concerns that women might have been denied the vaccine.
“I just don’t think that degree of paternalism has a place in contemporary medical practice,” she said. “This is a place for individualized decision-making, and that pregnant and lactating individuals are able to make differentiated medical decisions and carefully weigh the risks and benefits for themselves and their children.”
These are regular conversations about maternal health, she added, because many drugs are not tested on pregnant women. “We have to start protecting pregnant and breastfeeding women through research, not research.”
The Kane County Health Department statement noted that the CDC does not specify which vaccine pregnant or breastfeeding women should receive and that the potential vaccines from Johnson & Johnson and AstraZeneca will be different from Moderna’s mRNA technology. The CDC guidance notes that experts believe that mRNA vaccines are unlikely to pose a specific risk to pregnant women, but that the actual risks are unknown because they have not been studied.
Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said on Wednesday that further tests included more than 10,000 pregnant women. While monitoring these women, he said, “So far, there are no warning signs.”
For pregnant women who are considering a vaccine, ACOG advised a conversation with their provider and that patients who decide against the vaccine should be supported. People who are considering getting pregnant should get a vaccine, advised ACOG.
And for breastfeeding women, patients must assess the risks and benefits. The Academy of Breastfeeding Medicine noted the limited data, but vaccines generally do not affect the safety of breastfeeding.
Raess said he did not realize the emotional impact the decision to take the vaccine had until it was denied.
“The decision was bigger than me,” she said. “It was about my son, it was about my daughter and it was about my customers, and having this opportunity to be safe.”