Increase In Pregnant Women In Intensive Care Linked To “Inevitable” Vaccine Hesitancy

New data published today found that 122 pregnant or recently pregnant women were admitted to intensive care in England with COVID-19 in August 2021. This comes following last week’s report from Public Health England that found that only 81,532 pregnant women have received at least one dose of the vaccine, only 10% of the 800,000 pregnancies expected each year.

In a quote given with the data, Clare Murphy, Chief Executive of the British Pregnancy Advisory Service (BPAS) says that vaccine hesitancy is inevitable in a culture that encourages pregnant women to avoid absolutely any hypothetical risk to their pregnancy, even at the risk of their own health. 

“Messages regularly go out to women about the dangers of particular behaviours – a cup of coffee or a glass of wine – in the absence of any good evidence of harm. Doing so is not however harmless… We need to really re-evaluate how we communicate risk to women in pregnancy – and ensure women’s own health needs are deemed as important – and indeed not mutually exclusive – from those of her fetus.”

Caitlin Dean, chairperson for Pregnancy Sickness Support also reports that they are hearing from women who have been explicitly advised by health care professionals to wait and have the vaccine post partum.

BPAS, Pregnancy Sickness Support and Birthrights are calling for the Government to urgently rethink how risk in pregnancy is communicated. In the meantime, they emphasise that a pregnant person and their foetus are at more risk of COVID-19 than they are of the vaccine, as shown by the numbers admitted to ICU.

As Professor Catherine Nelson-Piercy, consultant obstetric physician at Imperial College Healthcare NHS Trust and Guy's and St. Thomas' Hospitals Trust, says: “If you are pregnant, the best thing you can do to protect yourself and your baby is to have your COVID-19 vaccine.”

Imogen, 29, is in the second trimester of her first pregnancy in Brighton. Having done her research, she was satisfied that she felt safe to get her COVID vaccine but a combination of pregnancy-induced brain fog and confusing messaging resulted in her fighting off panic while queuing for the jab. One comment from the registering nurse at the front of the queue about the need to be in her second trimester was enough to induce a barrage of anxious thoughts about whether she really was far enough into her pregnancy.

Luckily, when she reached the front of the queue the volunteers recognised her worry. 

"I finally reached the front and the man said, 'It says here you’re pregnant?' I did my best not to sound hysterical and quickly replied, 'Yes and I’m starting to freak out about doing this.' Suddenly, I felt enveloped by a comforting embrace of people who have probably had to deal with this a thousand times already." They gave Imogen a seat and talked to her about how these things are always so nerve-wracking anyway, without the added pressure of a baby on the way, while another person went to get her a pamphlet. "I felt bad for holding up the line," Imogen continues, "but I knew I needed this minute to be comforted. The woman with the pamphlet helpfully pointed out the bits of info that I’d already found online myself, where it says how safe it is to get vaccinated. They asked if I wanted to go ahead and I said I absolutely did, but I really needed their help. I was so grateful."

The experience, she says, has emphasised how important it is for clear messaging about the vaccine and pregnancy.

"This showed me that in my current state I am in need of people in positions of trust and authority to be really fucking clear about what they’re saying to me. The nurse who checked me in was just doing her due diligence and making sure I had all the facts but what she said made me question what I was doing to the point where I nearly walked out of there. I don’t like to waste the NHS’s time or my own, and in the end that’s all that kept me queuing and got me jabbed."

Anxiety and confusion surrounding the vaccine’s distribution and efficacy for pregnant people has meant that even those like Imogen, who were otherwise happy to be vaccinated, have doubted or queried their decision. Mixed advice about the COVID vaccine has recently been shown to be driving hesitancy among pregnant women. The campaign group Pregnant Then Screwed conducted a survey of about 9,000 pregnant women and found that 40% have not had their first dose, with only 21% fully vaccinated. This has led to health chiefs from Public Health England actively encouraging more pregnant people to take up the vaccine.

With a proliferation of rumours about the effect of the vaccine on pregnant people bumping up against increasing calls for vaccine uptake, how are you meant to make an informed decision?

To help, we spoke to the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives to sort the most up-to-date facts from fiction when it comes to the vaccine and pregnancy.

RCOG: We recommend the COVID-19 vaccine in pregnancy, as it is the best way to protect both mother and their baby against the known risks of COVID-19 in pregnancy, including admission to intensive care and premature birth.

We now have data of nearly 200,000 pregnant women in the UK and the US receiving a COVID-19 vaccine (using Pfizer/BioNTech or Moderna vaccines) with no safety concerns.

RCM: The RCM along with the Royal College of Obstetricians and Gynaecologists and other health leaders are recommending having the COVID-19 vaccination if you are pregnant.

Vaccination remains the best way to protect yourself and your baby against COVID-19. No pregnant women who received both doses of vaccine were admitted to hospital, and only five women who were admitted to hospital over the past month had received just one dose.

By contrast, in the past few weeks alone, over 100 unvaccinated pregnant women have been admitted to hospital with COVID-19.

RCOG: There has unfortunately been a lot of misinformation about the vaccine, causing concern about the impact on pregnancy and fertility, despite there being no evidence to suggest that the vaccine causes harm to the pregnancy or fertility.

We have seen that some people believe that you can catch COVID-19 from the vaccine. The vaccines that are being used in the UK are not ‘live’ vaccines so cannot cause COVID-19 infection in the woman or their baby.

RCM: The important thing is that there is strong and growing evidence that the vaccine is safe for you and your baby. The myths are just that – myths, based on misinformation, often designed to scare people out of doing the right thing.

RCM: All the evidence shows that the vaccine is safe. There are some common side effects which are the same for anybody having the vaccine, including tenderness in the injected arm, headache, nausea, and flu-like symptoms. However, these are normally mild and short lasting for most people including pregnant women.

RCOG:There is no evidence to suggest that the vaccine during pregnancy causes any harm. Some women may choose to delay their vaccine until after the first 12 weeks of pregnancy as this period is the most important for the baby’s development. There is no evidence that delaying is necessary but women may choose to have the first dose from 13 weeks onwards.

The Joint Committee on Vaccination and Immunisation (JCVI) will continue to closely monitor the evidence on COVID-19 vaccination in pregnancy and will update its advice as required.

RCOG: Pregnant women are no more likely to catch COVID-19 than anyone else. More than half of the pregnant women who test positive for COVID-19 have no symptoms at all.

We do know, however, that particularly in the later stages of pregnancy, women are at increased risk of becoming seriously unwell with COVID-19. Pregnant women who do have symptoms of COVID-19 are twice as likely to give birth to their baby prematurely.

Figures suggest that roughly one in 10 pregnant women admitted to hospital with symptoms of COVID-19 need intensive care.

A recent study also found that women who do test positive for COVID-19 at the time of birth are more likely to develop pre-eclampsia, are more likely to need an emergency caesarean and are at increased risk of stillbirth, though the number of stillbirths remains low.

We have seen that the number of pregnant women being admitted to hospital has risen recently. With social distancing restrictions now over, and the high daily number of COVID-19 [cases], we are concerned that pregnant women are more at risk of infection.

Data from hospital admissions throughout July show that around 95% of pregnant women admitted were unvaccinated. No pregnant women who had received both doses of the vaccine were admitted since the vaccination programme began.

RCM: If you are unsure about this do speak to your midwife or doctor who will be able to give you the advice and support to make your decision. Only trust official websites such as the NHS website that you know have the right evidence-based information on them, and the same applies to social media also. The RCM’s website also has a range of information on COVID-19, pregnancy, and the vaccine, see Advice for pregnant women - RCM.

It is worth stressing that even if you have been vaccinated, we do recommend continuing social distancing, mask wearing and hand washing to carry on protecting yourself, your baby, and others from the virus.

RCOG: We recommend that any pregnant woman who is unvaccinated or partially vaccinated takes steps to avoid catching COVID-19, such as practising good hand hygiene, social distancing and avoiding indoor spaces with poor ventilation – particularly in the third trimester.

Women with concerns should speak to their GP or midwife. We have also developed a decision aid to help women make an informed decision about COVID-19 vaccination. Further information, Q&As and our decision aid can be found on our website.