Kate Raess read the studies, talked to her obstetrician and consulted with her pediatrician.
After months of consideration, the Illinois mom, who is breastfeeding her newborn son, decided she would get a 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, arm ready for the shot.
Then, she was told she could not have one.
“I was so shocked,” Raess said. “To sit down in that metal chair and be told no, it’s like someone took a pin to a little kid’s balloon.”
An official told her, she said, the county decided pregnant and breastfeeding woman should not get a vaccine. In a statement, Kane County Health Department spokeswoman Susan Stack confirmed they do not provide the vaccine to pregnant or lactating women, citing the lack of data on breastfeeding or pregnancy for the Moderna vaccine, which the department is providing.
Because pregnant and lactating women were not included in initial vaccine trials, data is limited on how it might impact them. The Centers for Disease Control and Prevention (CDC) recommends they be offered the vaccine; maternal health groups such as the American College of Obstetricians and Gynecologists (ACOG) are urging data collection and conversations between patient and provider — and that the vaccine should not be withheld from pregnant women who are eligible for it.
All of this makes deciding whether to get a vaccine stressful for women who are pregnant, considering getting pregnant or breastfeeding. Pregnant women are more at risk of severe illness should they get COVID-19, especially Black and Latina women. Families are weighing factors like exposure risk, personal health factors and potential benefits.
“It was a really emotional decision,” Raess said. “My son’s safety and wellness and health is a priority to me. I don’t want a vaccine to do anything bad to him. I also don’t want COVID to do anything bad to my family.”
As a therapist, Raess will eventually be working in schools and is sometimes called to assist a 24-hour crisis line. She wanted to feel she was protecting herself and her family, which includes a 22-month-old daughter and 11-week-old son.
Like many, the decision was months in the making for Raess and her husband. Ultimately, she said, it feels like the difference between seeing her at-risk clients via telehealth, “versus me being fully vaccinated and being able to provide fully face-to-face services without me worrying.”
When she was denied, she said, “I actually burst into tears.”
She felt “this internalized sense of shame and judgment — that a county board felt that I couldn’t make this decision, and they would make it for me,” she said.
She told the official that the county should make information about restrictions available. The official, she recalled, told her, “I’ve been thinking about that. We’ve denied several women this morning.”
Raess has received several emails from the county health department with vaccine information; the most recent included language specifying pregnant or breastfeeding women could not schedule an appointment for a vaccine. An initial email about scheduling a vaccine did not include these restrictions.
Raess said she will be fine. She believes her regular medical practice can also give her the vaccine, although she has been monitoring appointments and unable to get one so far.
That means, she noted, that with maternity leave ending soon, “that window of being fully vaccinated before I return to work is gone.”
Raess wonders about people who do not have the time or ability to log on regularly to find appointments or advocate for themselves after being denied — people with child care complications, transportation issues or difficult work schedules.
“What about other breastfeeding and pregnant women, other marginalized groups that (officials) are saying, no, we’re picking and choosing who gets this vaccine?” she said. “To be frank, a politician is telling a woman what to do with their body.”
Denying women vaccines is concerning for multiple reasons, said Dr. Emily Miller, assistant professor in the Division of Maternal-Fetal Medicine at Northwestern Medicine’s Feinberg School of Medicine. It sends a message that women cannot make decisions about their own health and body. And for breastfeeding moms, it could add pressure to wean.
“That just creates a whole different risk balance that doesn’t need to be introduced,” she said. “That’s just not fair to put women in that scenario.”
Early conversations in the Society for Maternal-Fetal Medicine’s task force on COVID-19, which Miller is part of, included concerns that women could be denied a 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 nuanced medical decisions and carefully weigh risk and benefits to themselves and their offspring.”
These are regular conversations in maternal health, she added, because many medications aren’t tested on pregnant women. “We have to start protecting pregnant and lactating women through research, as opposed to from research.”
The Kane County Health Department’s statement noted that the CDC does not specify which vaccine pregnant or lactating women should get and that potential upcoming Johnson & Johnson and AstraZeneca vaccines will differ from Moderna’s mRNA technology. CDC guidance notes that experts believe the mRNA vaccines are unlikely to pose a specific risk for pregnant people, but that actual risks are unknown because they have not been studied.
Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said Wednesday that later trials have included more than 10,000 pregnant women. While monitoring those women, he said, “Thus far, no red flags.”
For pregnant women considering a vaccine, ACOG advised a conversation with their provider, and that patients who decide against a vaccine should be supported. People considering pregnancy should get a vaccine, ACOG advised.
And for women who are breastfeeding, patients should assess the risks and benefits. The Academy of Breastfeeding Medicine noted the limited data but that vaccines generally do not affect the safety of breastfeeding.
Raess said she didn’t realize the emotional toll the decision to get a vaccine had taken until she was denied.
“The decision was bigger than myself,” she said. “It was about my son, it was about my daughter, and it was about my clients, and to have that opportunity to be safe.”