By Sheila Kaufman, MSN, CNM, WHNP-BC, Certified Nurse Midwife, Virtua Midwifery – Camden 

As parents, we're the protectors of our children. Our profound need to safeguard our kids has led to important questions and discussions about the safety and effectiveness of the COVID-19 vaccine, especially for people who are pregnant, trying to get pregnant, or who are breastfeeding.

What's clear is that the Centers for Disease Control and Prevention (CDC), the American College of Nurse Midwives, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine, recommend that people who are pregnant, planning a pregnancy, or who are breastfeeding get the COVID-19 vaccine. And that includes getting a booster shot when they're eligible.

The reasoning and the science are clear: the CDC cites consistent and growing evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy, suggesting that the benefits of receiving the vaccine far outweigh any known or potential risks. And now, the benefits of COVID-19 vaccination during pregnancy have been shown to extend to newborns, providing protection in their first six months and helping prevent severe illness and hospitalization.

This is a critical discussion we have with our patients every day, and we want to provide answers to some of the most pressing questions we've received about the COVID-19 vaccine. As always, we encourage you to have a conversation with your pregnancy care provider if you have questions or concerns.

Will the COVID-19 vaccine affect my fertility or ability to get pregnant?

Currently, there's no evidence that the vaccine affects fertility in either partner or the ability to become pregnant. However, there is evidence that COVID-19 infection in male partners may affect sperm motility and sperm count for up to 60 days after infection.

Why should I get the COVID-19 vaccine while pregnant, or if I'm trying to get pregnant?

If you're pregnant, you're taking other steps to have a safe and healthy pregnancy, like eating a well-balanced, nourishing diet, exercising, taking a daily prenatal vitamin with folic acid, and seeing your provider for regular prenatal care.

Given all that you're doing, it's understandable if you have questions or are worried about the safety of something new like the COVID-19 vaccine. We honor that concern but ask you to trust your provider's advice.

As pregnancy care providers, we are clear: vaccination is the best tool we currently have to protect you and your baby from COVID-19 infection and illness. And for us, this isn't a new recommendation: getting vaccinated against COVID-19, just like getting your flu shot and Tdap (tetanus, diphtheria, and pertussis) booster, is a way to protect yourself so you can have a healthy pregnancy. And that protection extends to your newborn. You can even get all three vaccines at one time.

Talk with your provider to determine the best time in your pregnancy to get these vaccines.

What are the risks of getting infected with COVID-19 while pregnant?

Research shows that being pregnant puts you at an increased risk of getting sicker if you get COVID-19. In addition, having other health problems can also increase your risk. These conditions include:

• High blood pressure
• Diabetes
• Obesity
• Heart disease
• Having a lower immunity because of cancer or advanced disease 

If you get infected with COVID-19 while you're pregnant, you have a higher risk of being hospitalized and needing respiratory support. It also puts you at risk for preterm birth or having a low birth-weight baby and may increase your chance of developing blood pressure problems during your pregnancy. There also has been a small but significant increase in stillbirth seen in pregnant people infected with COVID-19 during pregnancy.

Should I take a pregnancy test before I get vaccinated?

No. A positive pregnancy test wouldn't change the recommendation to get vaccinated or boosted.

What should I do if I get pregnant after my first vaccination?

You should be proud of yourself for prioritizing your health and the health of your baby and reassured that you're setting yourself up for a healthy pregnancy. And don't forget to schedule your follow-up vaccinations and booster!

What are the vaccine side effects for those who are pregnant?

A pregnant person who gets the COVID-19 vaccine may experience one or more common reactions over the coming days. Not to worry: this is a reminder that the vaccine is working. These symptoms are usually minor and improve quickly. Some people report feeling fatigue, fever, headache, or pain/soreness in the arm—particularly after the second dose of a two-dose vaccine. Some people have no symptoms at all.

If you develop a fever, take acetaminophen as directed to reduce your temperature. If you're allergic to acetaminophen, talk to your provider about treatment options.

I'm in my third trimester of pregnancy. Should I wait until after I deliver to get vaccinated?

Don't wait! If you haven't gotten your COVID-19 vaccine yet, schedule it now to protect yourself and your baby.

Think of it this way—after birth, you're going to want to spend as much time as you can with your newborn. If you're sick with COVID-19, you may not be able to spend as much time enjoying your baby in those early days.

Also, your partner and any other family or friends who will be around your newborn should get vaccinated as well – for COVID-19, flu, and whooping cough (pertussis).

If I'm pregnant and get the COVID-19 vaccine, will it protect my baby?

The short answer is: probably. Exciting information and studies are emerging that benefits of COVID-19 vaccination during pregnancy have been shown to extend to newborns, providing protection in their first six months and helping prevent severe illness and hospitalization.

Can I get the COVID-19 vaccine if I'm breastfeeding?

Yes, we absolutely recommend getting the vaccine if you're breastfeeding. According to the American Academy of Pediatrics, "COVID-19 vaccines are considered safe for breastfeeding mothers and babies. Many lactating people have received the COVID-19 vaccine. Recent studies demonstrated COVID-19 mRNA vaccine antibodies in the breastmilk of vaccinated lactating mothers, which can potentially pass along protection to the breastfed infant."

I don't want to get the COVID-19 vaccine while I'm pregnant. What else can I do to protect myself?

The best protection from COVID-19 infection is vaccination. If you decide against it, take steps to "cocoon" yourself throughout your pregnancy. This includes:

• Wearing a well-fitting mask, such as an N-95 or KN-95, that covers your mouth and nose
• Encouraging your household to get fully vaccinated/boosted to reduce the risk that they bring COVID-19 home to you
• Avoiding large gatherings and unnecessary travel
• Asking your partner, family, and friends to help with errands so you can avoid stores and crowded public areas

If you test positive for COVID-19 while you're pregnant, contact your provider to create a plan for monitoring and managing your symptoms.

If you have additional questions or concerns, talk to your midwife or OB provider. Getting vaccinated during pregnancy can feel scary, but doing it will help protect you, your baby, your family, and your community.

Get to Know Midwife Sheila Kaufman, MSN, CNM, WHNP-BC

Sheila has spent the past decade providing midwifery care within immigrant and under-resourced communities. She loves that within the midwifery model of care, she has time to get to know her patients and offer them tools to be leaders in their health and their family's wellness. In addition to her health care degrees and midwifery training at the University of Pennsylvania, Sheila holds a degree in Spanish literature. She is fluent in Spanish, having lived in Chile and Spain and trained with a professional midwife in Mexico. Sheila is also a classically trained Pilates teacher who incorporates movement awareness into pregnancy and health maintenance care. Sheila is thrilled to bring the full range of midwifery care to Virtua Midwifery – Camden.