Lately, when discussing COVID vaccinations with my pregnant patients, I have become increasingly candid about what could happen if they don’t get vaccinated. I am a high-risk obstetric doctor in New York City, and I have been taking care of patients with COVID, both in and out of the hospital, for almost two years now. I am sick and tired of doing this, to be honest, and I have been hellbent on getting my patients safely to the other side of this. The vaccine is the best way we have to accomplish that.
The vast majority of my patients are either vaccinated or open to it; they just want to talk and ask their questions about safety and evidence. Conversations like these are one of the favorite parts of my job. We talk about how the vaccine works in a pregnant body; we talk about the extensive, reassuring safety data. I share with them that getting the vaccine will actually be a wonderful advantage for the fetus: The antibodies their own body makes in response to the vaccine go through the placenta and provide protection for a newborn baby.
But some patients are more resistant. A small minority are outright hostile. They tell me that the vaccine is dangerous, that it was rushed, that I am spreading propaganda. “You know what’s dangerous?” I say. “COVID is dangerous, that’s what the truth is.” The data clearly shows that COVID is harder on a body if you’re pregnant: You’re more likely than you would be otherwise to end up in the hospital, needing oxygen or even needing to be intubated.
I tell those patients what I have seen with my own eyes. I tell them I have taken care of many pregnant patients with COVID. I have cared for patients with fevers and patients who are vomiting. I’ve cared for patients who needed nasal cannula oxygen, and then face masks, and finally intubation. I’ve even had a small number of pregnant patients who needed extracorporeal membrane oxygenation, essentially a lung bypass machine—our last-ditch effort for someone whose lungs do not work. I have taken care of patients who needed to have their babies delivered prematurely because of the disease. I have taken care of others who lost their pregnancies: patients who came in with pneumonia, and no fetal heartbeat on ultrasound, presumably part of their overwhelming inflammatory response to this destructive virus.
All that happened to patients who were unvaccinated. That tracks with many studies: COVID in unvaccinated pregnant women poses a risk of causing severe disease and pregnancy complications. Those people might have gotten sick anyway if they’d been vaccinated, especially with the omicron variant circulating. But not that sick. Vaccinated people, including vaccinated pregnant people, don’t usually get that sick. They have a cough or congestion, maybe a fever, and they usually get better. But those patients hadn’t gotten the vaccine, and then it was too late. I recount their experiences to my patients who are resistant to the vaccine because I am trying to keep it from being too late, again.
There are parts of my experience that I don’t include in my speech because they are just too dark. I don’t describe the endless worried conversations with other medical staff about how to take care of a deteriorating patient with COVID pneumonia at 24 or 26 or 28 weeks’ pregnancy. At that point, the baby may live outside the mother, but could be severely damaged. Should we deliver anyway to try to reduce the stress on the patient’s overworked lungs? Or could this just result in a premature baby, and no improvement anyway for the mother? Is the patient too unstable for delivery in any case? There are no good options.
I don’t describe the dim conference room where doctors from the NICU, from maternal fetal medicine, from critical care, and from infectious disease gather to make unthinkable plans. I don’t tell them about the times we have put a cesarean delivery kit by a pregnant woman’s bed, ready to deliver her baby if she starts to die. I don’t describe the post–cesarean delivery patient who is now on the ventilator and is lactating. She is not awake, and we don’t know if she will ever be.
Those are the parts I don’t talk about with patients. For the patient who comes to a doctor’s appointment hostile to vaccination, my counseling is dark enough without them. Even the basic facts are too dark to be effective: When I talk about what I’ve seen, patients think I am exaggerating or trying to scare them. I am just telling the truth. And it is strange and confusing to me that these patients will accept my advice on their insulin doses or their blood pressure management, but they can’t believe me on this one crucial thing.
I can’t overcome all the misinformation about vaccines in a 20-minute prenatal care visit, regardless of how much of my own lived experience I share. In fact, I’m starting to realize that trying to do so is counterproductive. These particular patients are so deeply committed to their worldview, to a reality where COVID is always mild and nobody ever dies, and one in which rejecting the vaccine is not just a reasonable decision, but the only reasonable decision. And of course, for that to be true, everything I say, everything I saw, has to be a lie.
It’s hard enough to fail at providing the care I think could be lifesaving. It’s even harder to have my personal integrity refuted. None of what I say is a lie. I did see all that; I will see more of it tomorrow, and next week, and I’d very much like to stop seeing it. What trying to convince patients of this has taught me, it turns out, is that there’s a limit to what I can do to change their minds. And I’m trying to figure out how, exactly, I live with that without entirely giving up.
