COVID vaccine & pregnancy/breastfeeding.

ec1212

Saw some discussion come up in the appointments thread, so wanted to share what I watched and learned this week, and have a central place where we can start to share what we’re hearing from our doctors (tho I expect most of us won’t get a strong rec either way anytime soon). 

A pregnant OB shared some info on the vaccine during pregnancy / breastfeeding. You can skip first 7 min if you’ve been following all the vaccine development news: https://youtu.be/smsmsM1RbIg

Basically the Society for Maternal Fetal Medicine released a statement this week where they state they believe pregnant women should get the vaccine if they want it (in consultation with their drs and taking any risk factors into consideration) and that getting it while breastfeeding should confer some immunity to the baby too. 

*For healthcare workers: Around the 13 min mark, she talks about the SMFM’s statement re: pregnant healthcare workers (basically SMFM believes they should be prioritized for the vaccine due to their increased exposure / risk). I found it very informative!!

Here’s the SMFM statement: https://s3.amazonaws.com/cdn.smfm.org/media/2591/SMFM_Vaccine_Statement_12-1-20_(final).pdf

Personally, I plan to get the vaccine as soon as it’s offered to me. I think it’s clear from my reaction to the baby aspirin rec that I’m very thoughtful and conservative about pharmaceuticals 😂 - based on what I’ve learned to date, I feel this is best for me. 

The doc in this video will get it while pregnant. 

My best friend, who is also pregnant and working as an ER nurse practictioner, will likely wait until after she delivers. We discussed the SMFM statement and I said I wondered if the stress of being exposed for her is worse than the worry she might have about the safety of the vaccine. This is also in light of her best work friend testing positive this week. She said “Honestly i think they are about equal but at least i have control over my ppe. Once the vaccine is in me i am at the mercy of science.”

littlelibelula

@ec1212 Thank you for posting this. I haven't been following the vaccine progress very closely and was pretty surprised when I saw the post in the appointments thread. Especially since I hadn't heard any of the breast-feeding claims in my breastfeeding groups and my liga de leche is pretty good at sharing relevant information. 

mkc3888

@ec1212 thank you for all the info. I watched the video and plan to ask about the smfm statement at my mfm appointment in 2 weeks. 

Mama dr Jones also did a video on the vaccine and she talks a little more about how this vaccine is similar to others. 

https://youtu.be/xTQ3cf81KUs

I’m leaning towards getting it based on the info I have but I’ll talk to my dr about my specific risks to make sure I’m not missing anything. 

texas_t

As much as my brain says it should be ok, I just don't think I will get it while pregnant. With no studies done and being so early in release, I just don't think I can bring myself to do it. I literally have zero judgment for those who choose to do it. I'm at unsuccessful with breastfeeding (I produce so very little) that I will get it directly after delivery. Even if I did breastfeed, I'd get it then. 

@mkc3888 Also, I love Mama Doctor Jones!

littlelibelula

@mimser I have no idea when they'll start offering it over where I am either. 

@ec1212 I'm really hoping that it will be safe with breastfeeding because it will be a while until I give that up. 

@texas_t I feel the same way. I want to wait a little after it comes because it had to be developed so fast. 

@mkc3888 I 💖 Mama Doctor Jones. 

nsk489

@ec1212 and @mkc3888 thanks for posting! I haven't watched yet but definitely will. 
With pregnant women being excluded from these vaccine trials, I am extremely hesitant to get it if its offered to me. I would have no issue getting it if I weren't pregnant though!

spartan4life

Thanks for posting! I am a healthcare worker and as I mentioned in my appointment thread, my OB told me Thursday they didn't have enough information yet to make a recommendation. I expect to be offered it within the next few weeks, but am very hesitant. I am very much pro-vaccine but this one is so new. That said, each year the flu vaccine is a new variety, and the COVID vaccine is using the same technology as a lot of other vaccines so I'm not too worried about the quickness of the development. I'm still hesitant tho being pregnant. If I wasn't pregnant, I would definitely be getting it as soon as it's offered. 

ckmb_1250

I hadn’t even asked my Dr yet at my last appointment, I guess I figured we wouldn’t be offered it! Does anyone know if they would offer it to pregnant women who are not healthcare workers, before the general public? 

I guess my question to my doctor will be whether it’s safer to get it while pregnant or while breastfeeding. I hope to nurse 2+ years as I have with my daughter but def wouldn’t want to wait that long to get the vaccine. I also wonder if it would be safer to get after the point of viability. 

mkc3888

@ckmb_1250 there weren’t any studies on pregnant women. However there were a few studies on lactating women. I haven’t seen the results but we should have more info on that in the near future. Certainly ask your dr about it. Our governor in Louisiana said we don’t know who the next group of people to be offered the vaccine yet. That’s still up in the air. 

yellingbanana

I’m definitely pro-vaccine as well over here, I do believe in science! With that in mind, I didn’t make my teenage daughter get the hpv vaccine because it hasn’t been around that long for term studies. (I’m concerned it could interfere with fertility). So I told her it was up to her, and that as she gets older she can choose when to get it. 

With that in mind, I don’t want to get the covid vaccine while pregnant because of the lack of studies and the swiftness that it is coming out. I do approve of it overall and cannot wait for it, but I will personally wait to get it until after the baby is born. But will it be available to us by then? Maybe? My husband is considered a healthcare worker, he works in hospitals but not everyday. So he qualifies to get it when it is available, and will be able to get it before everyone else in the household. And when it is available for the kids, they’ll get it too. 

ckmb_1250

@mkc3888 right, but they don’t test any vaccines on pregnant women & we still get tdap/flu shots so we should know something about how vaccines could affect baby while pregnant vs while breastfeeding.

mkc3888

@ckmb_1250 I don’t think there are any studies on the flu shot but I think there are some on tdap, but I could be wrong. I know it’s hard to do research on pregnant people, due to them being classified as a vulnerable population. 

brynn_mamaof4

I don’t plan to get it while I’m pregnant. That stuff makes me super nervous! I do vaccinate my kids but I do a delayed schedule and I don’t start hep B at birth (there isn’t really a need to) but they are caught up before they start school. This year was the first time I’ve gotten a flu shot in 14 years! I got it because I got the flu for the first time in my life in Feb and I was really, really sick. And I figured I might as well not worry if it’s “flu or covid” this year and rule one out. I’m really not concerned with getting COVID, I fully believe I will be just fine and probably feel a lot better than I did with the flu. But I do mask, avoid crowds and don’t do anything unnecessary because I don’t want to spread it to vulnerable people. 

When I was in the military and going through MEPS prior to boot camp, they put us in a long line we had to walk through and I was literally vaccinated with things I don’t even know. Im probably some weird test subject and immune to random illnesses lol. 

I don’t even know if I will get the vaccine ever! I just feel like there are some things I’d rather deal with naturally that aren’t like actual diseases you know.. I do the necessary stuff and so do the kiddos. Idk, I feel like there’s no right or wrong answer here. Whatever makes you feel comfortable and like you are making the best decision! The only thing that makes me think hmmm is the possibly passing immunity during breastfeeding. But I know you can pass on immunities to most everything mom is exposed to during nursing. I don’t know but what I DO know is I loathe the year 2020 lol. 

yellingbanana

@brynn_mamaof4 we also do a delayed schedule (only 2 vaccines at a time), but ready by kindergarten. And this was the first year I’ve ever gotten a flu shot! I feel like we are living similar lives in an alternate universe! 

brynn_mamaof4

@yellingbanana seriously lmao! Are we separated at birth 😳😳😆😆😆

mkc3888

I was offered the vaccine through my employer today.  My OBGYN said it is recommended, so I'll be getting my vaccine this week.  

ec1212

@mkc3888 hope it brings you some peace and comfort about going to work!! I kind of want to see if there are any observational studies being conducted locally to see if I can sign up...they'll be starting those for pregnant women soon! 

Let us know how you feel after if you're open to sharing.

ckmb_1250

@mkc3888 awesome! Do you work in healthcare? I’d also love to hear about your experience if you want to share.

spartan4life

@mkc3888 I would love to hear your experience too if you're willing to share! I will likely be offered the vaccine in the next few weeks since I also work in healthcare (not front lines, but handling lab specimens). Still undecided...DH doesn't want me to get it but I'm still torn.

ckmb_1250

https://abm.memberclicks.net/abm-statement-considerations-for-covid-19-vaccination-in-lactation

I just read this article specifically about the vaccine while breastfeeding and thought it did a great job explaining why there really should be no risk to baby.

mkc3888

I’ll certainly share after I get my injection. It’s the 2 part vaccine. So I’ll get my first shot this week and another in 3 weeks. A friend of mine who is a geriatrician posted a long post on Facebook last night and I shared it along with why I’m getting the vaccine. 

@ckmb_1250 I work for a small local hospital, but I work in an outpatient clinic providing mental health therapy. I worked from home from March-August and then again starting in November. I don’t know if my boss will want me to return to work in office after getting the vaccine. We’ll see. 

Here’s my friends post on the vaccine. It’s long but provides a lot of info. She shared it publicly so I feel it’s ok to share here. 

Here it is: our way out of this mess. 

A vaccine. 

Here’s my take. 

Please take a brief moment to appreciate that this is a modern marvel, a triumph of science, and the beginning of us fighting back against COVID. 

It’s ok to be skittish, suspicious or scared of this development. That’s human nature. The best response to that feeling is information and understanding. 

It’s a lot. But here we go:

_________________________________

Vaccines 101

_________________________________

1,  What are we trying to do?  We want you to be immune but not have to take the full risk of infection to get there.  We’ll take smaller risks. Different risks. But overall we must expose you to much much less risk with a vaccine than with the disease. That’s the whole point. 

2, How do we do it?  We fake out your immune system. We show it weakened virus, dead virus, portions of virus and then let it do exactly what it was designed to do:  Fight that fake virus. Make a memory of it. Be ready to fight it better when it sees the real thing. 

3,’ But vaccines make me sick’ : vaccines make your immune system *think* you’re sick. So it activates its foot soldiers: fever, aches (cytokines), and fatigue (so you rest). But it quickly realizes there’s no threat and retreats. A very few people’s immune systems attack hard and they can feel horrible after vaccines. But as bad as some may feel, the risk of having a serious or life threatening complication from a vaccine is 1 in a million or less. There are however many millions of people in the world so yes you will hear of people who are hurt by vaccines. But the disease it’s preventing would hurt 1000, 10,000, 100,000 times more people. 

***** A vaccine is not a risk free choice. It is the choice to take a different, much smaller risk compared to the disease ****

_________________________________

What makes this vaccine different?  

What does mRNA even mean?

_________________________________

Everyone knows about DNA. It’s our motherboard. The blueprint to who we are. Every cell in our body has a copy. It’s own original.  mRNA is how it translates the blueprint into action. 

If DNA is the blueprint, then mRNA is a tracing of a small section, on tissue paper. The mRNA is then used to make something, do something, stop something and then it’s destroyed. Every normal cell does this on repeat trillions upon trillions of times in your life. We’re talking galaxy level number of times. Your body is good at this. 

While vaccines up until now have been weakened virus, dead virus or bits of virus this one is different. Because it doesn’t contain virus at all. 

The Pfizer vaccine (and moderna but we’ll focus on Pfizer for now) contains a strand of mRNA surrounded by a very fragile bubble of lipids (this bubble is why it needs the crazy freezer care). That’s it. It contains no virus. No proteins. No toxins. Just one piece of tissue paper with a small section of copied blueprint for a spike protein. THE spike protein common to all SARSCoV2 / COVID  strains. The little red bits sticking out on all the COVID cartoons you’ve been seeing. That’s THE protein that allows the virus to attach to you and then the rest of that ball of virus does all the bad stuff. But that spike?  All it does is attach. 

And that vaccine?  It can only make a spike. Nothing else.  

Beautifully simple. 

So it’s injected. That lipid bubble slides into your cells releasing this bit of mRNA inside. Your cell knows exactly what to do with mRNA. It reads it and builds what it says: a spike protein. And destroys the mRNA after (Are you amazed yet?  You should be. But it gets better)

Your body’s so smart. It knows right away: this spike protein isn’t you. It’s other. It’s bad. It needs to be attacked. Here come the foot soldiers: fever, aches, fatigue. And then memory.  Protein destroyed and immunity made. 

**** An mRNA vaccine contains a small bit of instructions directing your cells to make one small, key morsel of the virus shell. The instructions are naturally destroyed.  Your immune system uses the protein to gain immunity. ****

_________________________________

But does it work?

_________________________________

A resounding yes!  

The results from the Pfizer phase three (and moderna phase three) have gone so far above and beyond the hopes we had for an initial vaccine. 

We were hoping for 60% protection. 

We got 95%!

_________________________________

But is it safe?

_________________________________

It is safer than COVID.  By far. 

95% of vaccine related side effects and adverse effects occur within the first 6 weeks after vaccination. We have over 2 months of data. 

All we see are the work of foot soldiers (fever, arm soreness, fatigue, aches). And this is exactly what we should see for an effective vaccine. 

Of the 18,860 vaccine recipients, 4 ‘severe’ events were noted:

Arm injury from injection x1, swelling of lymph nodes in the arm x1, 1 arrhythmia (funny rhythm to the heart), right leg numbness. None were judged to be due to the vaccine. 

During roll out, allergic reactions have been noted and the official stance of Pfizer is that anyone who has been told to carry an Epipen for history of severe allergies should not receive the vaccine for now. All vaccination locations must be prepared to treat anaphylaxis on site as well. 

But what about long term effects?  

We won’t know for a while. Generally these are considered to be rare when found but until “long term” time passes we won’t have this data. 

But we also don’t know the full scope of long term effects for covid itself. We do know the risk of long term damage from this virus is real, happening now and measurable already. 

The vaccine has already proven itself to be the lower risk option with room to spare. 

_________________________________

FAQs

_________________________________

-1- Can I get COVID from the vaccine: No. It doesn’t contain the virus at all. It is 100% impossible to get Covid from the Pfizer vaccine. 

-2- Can it change your DNA? No. mRNA cannot change DNA by itself. There is an enzyme that can do this, called reverse transcriptase. It’s found in one class of viruses but NOT in coronaviruses. You don’t have this enzyme and neither does the vaccine. Your DNA will stay untouched in this process. 

-3 - Can the vaccine cause infertility? Highly unlikely.  IF we find that COVID can cause infertility then maybe, maybe not. Depends on how COVID would do that if it does. The chances that this one protein would cause a downstream immune response that could cause infertility is unlikely. But if it does, getting Covid will do the same and more. Again: the vaccine is the lower risk option even with the remaining unknowns 

-4- Does this vaccine use fetal cell lines?  While early animal studies and basic science research did use fetal cell lines, the production and manufacturing of the Pfizer vaccine does NOT use fetal cell lines. Use of this vaccine is supported by the National Catholic Bioethics Center. 

-5- What if I’ve already had covid?  While previously swab positive Covid people were excluded, baseline antibodies showed that some had been infected prior to vaccination. Numbers were small but reinfections were noted and were 7 times higher in the UNvaccinated group. Vaccination after infection is recommended. In times of shortage it is reasonable to wait until 90 days after infection to vaccinate. 

-6- When will it be available for children?  Enough data for approval may be available by late spring for children down to 12 years of age. Down to 5 years old may be ready by next school year. 

-7- What about pregnancy?  Pregnancy was excluded from the trial, though a handful of participants did become pregnant during. Most societies are recommending that the vaccine be offered in pregnancy due to the much higher risk for covid complications during this time (double the death rate of nonpregnant people). The risk of the vaccine to pregnancy and child are theorized to be extremely low in comparison. 

-8- What about breastfeeding?  All societies and experts recommend vaccination for breastfeeding mothers. 

-9- But it was rushed!? No. mRNA technology was first introduced in the 1990s. This is not the first vaccine of its kind, it’s just the first that’s worked. Zero safety steps were skipped.  There is a critical difference between rushing and expediting. Normally very few people are working on vaccines, maybe a handful for any given disease at a given time. They have to wait in line at every step for approval, for design, for product. Then they have to wait for enough volunteers to care about their one vaccine to get enough data. And then for those volunteers to come across the disease naturally to test the vaccine. That is what takes years normally. Rarely do we have the entire world working on the same thing, pushing it to the front of the line, giving it all the funding, all the scientists, and unfortunately plenty of disease going around to test quickly. THIS is what we can do when that happens. And it’s awesome. 

I hope this information helps. Lord knows not everyone has been on the same page on many things COVID related. But we are all on the same page that we desperately want to start getting back to normal. We should also be on the same page that THIS is the off ramp from the roundabout of surge-shutdown-surge-shutdown. My blinker’s on. I’m excitedly in the exit lane, ready for my vaccine. 

Which lane will you choose?

Dr Britni Hebert

Internal Medicine / Geriatric Medicine

December 14, 2020

alexandraseattle

@ec1212 I signed up for a study through the university of Washington! It’s not vaccine specific but pregnancy and covid observational study. I’m excited to be a part of science!! 

yellingbanana

@mkc3888

mkc3888

My boss got back to me and I’m getting my first injection Friday. I’m most nervous about how cold this thing is kept and how it’s gonna feel going in. But overall I’m excited and hopeful to get immunity and hopefully some of it will pass to baby. I know we don’t know anything about that but I’m hopeful. 

spartan4life

@mkc3888 they have to bring it to room temp before the injection so it shouldn't be any different from the flu shot I wouldn't think. I think it's good at room temp like 24 hours or something and then 6 hours after it is mixed with saline (that's what I remember from the news anyways 🤣)

mkc3888

@spartan4life thanks. Now I feel better. 

mkc3888

Least painful shot I have ever gotten. I got it 2 hours ago and my arm is a little sore, but that’s it. I can update later if y’all want. 

ec1212

@mkc3888 YAYYYYYY! At least one of us is on her way to immunity! Yes, would love updates. I understand that everyone is different, and your experience isn't necessarily going to be the same as someone else's but would love hearing as many real-life firsthand accounts as I can get from pregnant women. 

mkc3888

They had me wait 30 minutes before leaving to make sure everything was ok. They said that the recommendation for that changed at 10am this morning. Overall it was good. I barely felt the injection. I noticed the cold from the alcohol swab more than the actual poke. 

I have to go back for the second shot in the series in 3 weeks. Then 1 week after that I’ll have the full effect. 

yellingbanana

@mkc3888 sweet!!! That is so exciting! And good to hear!

spartan4life

@mkc3888 yay!! I'm so excited for you, please do update with what you're comfortable! I talked to my medical director today and he called our head of OB for our hospital system, and he is highly recommending it for pregnant women. I have my next OB appointment January 4th so I will ask her again then. I think I have about 2-3 weeks before I will need to decide so I'm really hoping I don't get called before I can talk to her. DH doesn't want me to get it because we don't know the risks, but I'm so torn! I feel like the risks are higher if you actually get COVID but everyone is so different.

ckmb_1250

So stressed about this decision 😩 I halfway wanted to think I wouldn’t even be offered it since I’m not in any type of priority group, but my Dr said today he hopes everyone would have access within a few months. I don’t even think I’m worried about short term side effects, more like some issue discovered 10 years down the road about how it affects the baby, like has happened a handful of times with other medications. I stress about taking Tylenol during pregnancy, so 🤷🏻‍♀️

mkc3888

@spartan4life I definitely this the risks of getting covid are much higher than the risks of getting the vaccine. Pregnant women are twice as likely to have severe symptoms and outcomes compared to not pregnant people of similar health. It’s personal decision for everyone though. If I didn’t get it this week I wouldn’t know when I’d get another chance, so I went for it. I’ll update with anything out of the norm. 

mkc3888

@ckmb_1250 you could just wait until the baby is born if it gives you that much stress. For me I’m more hopeful that it will give some immunity to the baby. It’s not a live virus so that makes me feel good about it and smfm and acog both don’t recommend against it, but there wasn’t a study done on pregnant women. If it makes you feel better, wait until may or June. 

I’m 1 day post vaccine and my only symptom has been soreness at the injection site. 

ckmb_1250

@mkc3888 you’re right, I think I’m just worried now that I’m going to be offered it in like March or something, and then I’d feel like I was risking my health for two full months not getting it. But maybe that’s not realistic. & I wouldn’t have gotten pregnant during a pandemic if I didn’t feel like I could stay isolated if needed. I’m trying not to really think about it until I need to, but the thinking is happening 😩

glad your symptoms are mild! 👏🏻👏🏻

mkc3888

https://youtu.be/v1bpe7vKigw

another updated video on the covid vaccine and pregnancy. 

mkc3888

2 day update. Only symptom is injection site is still a little sore, but I had to poke it to check 😝

spartan4life

@mkc3888 that's great to hear!

JessKo08

Just got mine today! I’m an ER RN and have seen too many sick people recently. I’m also scared of the higher risk COVID is to pregnant people, more likely to end up hospitalized and intubated than nonpregnant counterparts. I had a great conversation with my OB who recently went to a conference at the Mayo Clinic (the hospital where I work and doctor are affiliated) who said the chair of the Mayo OB department is also a virologist and said if she was pregnant she’d get it. He supports my decision and agrees the benefits outweigh the risks for me. But I do agree it’s ok to worry about it, there hasn’t been any official trials with pregnant women, so you have to do what’s best for you. 

ckmb_1250

@JessKo08 awesome! Glad you were able to get it. I’d likely be doing the same if I worked in the ER.

mkc3888

@JessKo08 that’s good to hear! I’m high risk, even not pregnant, so I would have gotten the vaccine either way. It’s good to hear the officials who know more about it than I do would make the same decision.