In the weeks after Katelyn Bailey took her second pregnancy test — positive — in late January, she said she felt two sentiments: “Yay! But, oh no!”

Bailey, who was 23 at the time, was finishing up her final semester at Texas A&M University-Commerce. This would be her first pregnancy. She also worked as an administrative assistant at a doctor’s office in Keller that treated COVID-19 patients.

Navigating pregnancy as a first-time mom is difficult as-is, she said, but the pandemic compounded her anxiety. Her husband couldn’t come to any of her prenatal appointments because of COVID-19 restrictions. “It was hard on me,” she said, “but it was especially hard on him.” 

In the early months of the vaccine rollout, the uncertainty about how the vaccine would affect pregnant women gave her pause. Her husband chose to get vaccinated. She decided to wait. The Centers for Disease Control and Prevention didn’t formally recommend pregnant women for the vaccine until mid-August, about three weeks before her son was born. 

Bailey never caught COVID-19. She masked, social-distanced and quit working at the doctor’s office in May. She and her son are healthy and well and, in mid-December, Bailey received her second dose of the Pfizer shot. 

In the months since she found out she was pregnant, some of the uncertainty she observed about COVID-19, vaccines and pregnancy has dissipated. Early data suggest the Pfizer and Moderna vaccines pose no safety concerns for pregnant women. For pregnant women who contract COVID-19, however, the disease can complicate not only their own health, but their baby’s. And, since the delta variant became dominant in the U.S., if a mom has COVID-19 during her delivery, her risk of stillbirth quadruples. The overall risk is still low.

“For people who are immunocompromised, COVID is a bad actor,” said Dr. Cindy Robbins, an obstetrician-gynecologist at the Eighth Avenue Obstetrics and Gynecology office in Fort Worth. “And when you’re pregnant, you are considered immunocompromised.”

Changes during pregnancy put women at risk for respiratory issues

When a person is pregnant, her immune system becomes “downregulated,” said Dr. Jay Herd, an obstetrics and gynecology surgeon and the chief medical officer at Baylor Scott & White All Saints Medical Center – Fort Worth. 

Her hormone production increases, as does her blood volume, which can make it harder for her to breathe, he said. That’s why he recommends pregnant women get the flu vaccine; the flu can cause pneumonia and then sepsis, a leading cause of death in pregnant women. 

“We’ve had experience with other viruses causing more lung problems with pregnant ladies than non-pregnant ladies,” he said. Herd works at Andrews Women’s Hospital, part of Baylor Scott & White All Saints Medical Center – Fort Worth, which experienced a baby boom over the summer. 

Pregnant women who contract COVID-19 are more likely to need intensive care than women who aren’t pregnant, according to the CDC. They’re also more likely to die. 

A specialized team at the Baylor Scott & White hospital has treated pregnant women so sick with COVID-19 they’ve needed help breathing through ventilators and extracorporeal membrane oxygenation, or ECMO, a heart-lung machine that provides oxygen to the body. 

ECMO can be “life-saving,” Herd said, but it can also increase the risk of placental abruption, where the placenta detaches from the uterus before delivery. The separation can endanger both the mom and baby, according to the Mayo Clinic. 

‘Almost unrecognizable as a placenta’

The placenta serves as the baby’s lifeline, Robbins said. It provides oxygen and nutrients to the baby as she develops. “The placenta is a whole lot of what keeps the baby healthy.”

A placenta is normally purple and fleshy, but in a recent delivery overseen by one of Robbins’ partners, it was yellow and shriveled. The mother had had COVID-19 during her pregnancy. 

“Her placenta, to be honest with you, was almost unrecognizable as a placenta,” Robbins said. The woman’s only risk factor was COVID-19. Her baby survived, but not all of them do. 

Women who have COVID-19 while giving birth have significantly increased chances of delivering a stillborn baby, according to a robust study released by the CDC in November. 

Although the risk was present before the delta variant became the dominant wave in the U.S., it has further increased since then.  

Researchers aren’t yet certain why the association exists. Herd thinks it stems from a baby’s lack of oxygen, either because the mom can’t breathe as a result of her COVID-19 disease, or because the mom’s disease has caused trauma to the placenta. 

Babies who survive may be at higher risk for mental and physical delays, Robbins said. 

Although pregnant women with COVID-19 can receive monoclonal antibody treatment, both Herd and Robbins recommend they get vaccinated before contracting COVID-19 and, if they’re already vaccinated, boosted. 

Robbins understands why pregnant women were reluctant to get vaccinated this year. 

“They’re very hesitant about certain chemicals on their skin, perfumes, teas, what they eat,” she said. “When you’re pregnant, you’re just very careful about everything you put into your system.”

Bailey tried to be “as careful as you can be without driving yourself crazy,” she said. After she stopped working, she didn’t go out much during her pregnancy. When she did, she wore a mask. 

It took her a few months of post-birth healing before she felt well enough to get the COVID-19 vaccine. She, her husband and her newborn live in Euless, and she’s looking forward to spending the holidays with family.

Still, she’s lamented the lack of new mom support groups because of the pandemic. She could use camaraderie around stitches and breastfeeding. If she were to share wisdom with other pregnant women, it would be to “control what you can and just know that there are some things that you can’t control.”

“We were very lucky,” she said. “I didn’t get sick. He didn’t get sick. And we were both very healthy. But I know that’s not the case for everybody.”

Katelyn Bailey’s husband was allowed to be with her as she delivered. (Courtesy photo | Katelyn Bailey)

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....

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