Nakia Hubbard-Heard woke up in mid-April to the deafening sound of alarms, restrained to a hospital bed, breathing with the help of a ventilator and very afraid.
The alarms were from an array of medical monitors attached to Hubbard-Heard, 45, who is 28 weeks pregnant but has been hospitalized in the intensive care unit at Beaumont Health in Royal Oak for the past month.
She has COVID-19, and complications from the virus have prompted plenty of worries. Among them: Whether her unborn son will be strong enough to handle the trauma of birth. Whether she will be. Whether she can get enough oxygen during labor. And if mom and son leave the hospital, “Will I be strong enough after to care for the baby, the house and myself?” Hubbard-Heard wrote in an email to The Detroit News. She’s off the ventilator but cannot speak because she has a tracheostomy breathing tube inserted.
She said a persistent dry cough for two weeks led to a hospital visit on April 8, the scariest road of her life and regrets over not getting vaccinated. Her family hasn’t been allowed to visit her because they aren’t yet fully vaccinated.
Doctors say pregnant women who contract COVID-19 are more likely to be admitted to the hospital, face serious complications such as lack of oxygen, place their unborn baby at higher risk or die from the virus. And new research shows being vaccinated during pregnancy or while lactating has benefits for babies.
Hubbard-Heard’s physician, Dr. Karoline Puder, said pregnant women who contract COVID-19 are also more likely to end up on a ventilator or to have invasive procedures like extracorporeal membrane oxygenation, when blood is pumped outside the body to a heart-lung machine, to support their lungs.
“Babies of patients with COVID are more likely to be delivered early, some of it may be due to spontaneous preterm birth or changes that happened or how sick the moms are and the need to relieve the extra pressure in terms of their ability to oxygenate,” said Puder, a maternal-fetal medicine specialist at Beaumont. “We’re not seeing any risks of birth defects associated with COVID and most of the babies who are born to moms with COVID do not have infections.
“Those that have the infection after birth tend to be mild,” she said, adding there are rare instances of significant illness in babies.
A study published in late March in the American Journal of Obstetrics and Gynecology showed the Pfizer/BioNtech and Moderna vaccines were highly effective at producing antibodies in pregnant and lactating women and the antibodies were passed along to infants through the placenta or breast milk.
Researchers collected blood samples between December and March from 131 women including 84 who were pregnant, 31 who were lactating and 16 who were not pregnant.
The researchers found no evidence pregnant or lactating women had more reactions to the vaccine, or more severe reactions, than anyone else.
The American Journal study pulled reactions from the Centers for Disease Control and Prevention’s V-safe, a COVID-19 vaccine pregnancy registry, to better understand how vaccines affect pregnant women. So far, 4,622 pregnant women are currently enrolled in the registry and nearly 95,000 women have contributed results after receiving the vaccine.
Neither the Michigan Department of Health and Human Services or the Michigan Health & Hospital Association collect data on how many pregnant women are hospitalized with the virus or how many pregnant women in the state have been vaccinated, officials confirmed.
“The CDC has recommended that pregnant women and women planning to become pregnant may choose to receive a COVID-19 vaccine,” said Lynn Sutfin, spokeswoman for MDHHS, in a statement. “A conversation between patient and provider may assist with decisions to receive a vaccine, however, it is not required before vaccination.”
Beaumont Health treated 330 pregnant, COVID-19 positive patients who were positive with COVID-19 in the nine weeks since March 15, and 203 of those patients were admitted, said spokeswoman Maryanne MacLeod.
Last Friday, Beaumont had 18 COVID-19 positive patients who were still pregnant or who recently gave birth hospitalized, including one on an ECMO machine.
Elevated deaths from COVID-19 are not surprising, Puder said, as doctors similarly see influenza deaths are also disproportionately higher in pregnant patients.
“It’s the volume of patients that we’re seeing from the most recent outbreak that’s making this a much bigger deal,” said Puder, who is also a professor at Oakland University’s School of Medicine.
“Earlier, we were seeing more very, very sick people who were older and now we’re seeing an awful lot of very young, otherwise essentially well people who are getting COVID, and unfortunately, it’s using a lot of resources and then you add on pregnancy to that. … This third wave in Michigan has had a very large number of pregnant patients associated with it.”
Is there a right vaccine?
Puder said there is no theoretical reason why a vaccine would cause pregnancy-related problems or reproductive risk for people trying to get pregnant. But she knows there are myths circulating.
“People are worried that the (Pfizer and Moderna) mRNA vaccines are going to alter the DNA, but mRNA is given to make that viral protein which creates you to have an immune response but does not enter the nucleus, cannot be incorporated into your own DNA and is very quickly degraded,” she said.
“These rumors of infertility were circulating a week before the vaccine was even out. How anyone would identify infertility within a week after receiving anything, from a thought process, makes no sense.
“One of the things that tell it’s not true are all the people who have gotten pregnant since they’ve gotten the vaccine,” Puder said.
Some vaccines may be better suited for pregnant mothers than others, said Dr. Preeti Malani, chief health officer at the University of Michigan.
The American Journal study found that while the Moderna and Pfizer vaccines produced similar levels of antibodies in mothers, women who received the Moderna vaccine had more of a particular kind of antibody that passes more easily to babies.
The vaccine, however, had an 11-day pause last month spurred by rare blood clotting cases. U.S. health officials resumed its use after scientific advisers decided its benefits outweigh the rare risk of a blood clot.
“That said, for young healthy women with access to Pfizer and Moderna, there’s probably no reason to get the Johnson & Johnson, although the risk is so small, it’s not zero. I weigh it against the risk of COVID, which is also not zero.”
Hospitalizations at Beaumont for pregnant patients not admitted to the ICU are averaging 10 to 21 days, “meaning if they’re sick enough that they need to be admitted to the hospitals for any oxygen support, it’s taking a fair amount of time for them to recover and be able to be off of oxygen entirely and then they still don’t feel well for up to six weeks afterward,” Puder said.
Over the last year, physicians have been able to learn more about the disease and the good news is that practically all the medications used for the treatment of COVID-19, such as Remdesivir, can also be safely used during pregnancy, Puder said.
A plea from two mothers
Lilly Stotland, 42, was able to return to her Birmingham home on April 11 after being hospitalized for two weeks with a variant of COVID-19. She’s 36 weeks pregnant.
Stotland developed pneumonia in both lungs.
“My cough was so severe that I really couldn’t speak much,” said Stotland, who is expecting her third child.
The president and CEO of Southfield-based Vesco Oil Corp. initially declined the Moderna vaccine being offered doses at her father’s senior home because her doctors, at that point, weren’t advocating for it, she said.
She initially noticed a lack of appetite, was tired, developed a bad cough and had trouble breathing and talking. She began to lose awareness of her surroundings and her husband, Alex, used a pulse oximeter and saw that her oxygen levels were dropping from 99% to below 95%.
“I remember reading stories of doctors describing people walking into the hospital with a blood oxygen level of 90 and describing them as the walking dead. A year later, I remembered that expression and called her doctor immediately,” said Alex Stotland.
She went to the emergency room, was sent home with inhalers but returned the next day unable to breathe.
“I was so ill that I have very little recollection of a period of more than a week of my hospitalization,” she said. “I was in complete isolation because of COVID and while I received great care from the nursing and medical staff, it’s a very isolating and frightening experience, particularly being pregnant.
“For me, the COVID battle is a mental one as much as it is a physical one.”
Stotland can’t talk for long without a heavy cough and expects she’s facing a long recovery. The Birmingham couple is expecting a son in the next few weeks.
“There’s no question if I could go back in time, I would immediately get the vaccine because what I experienced with this illness taught me that you have no idea how the illness would progress if you contract it,” Stotland said. “You might be completely lucky and have no symptoms or very mild symptoms, or for me and for many other pregnant women, the symptoms can get extremely severe, very fast.”
It’s unclear when Hubbard-Heard will be able to return home, she wrote, but she plans to make a vaccination appointment when doctors clear her. People have raised more than $2,800 in 24 hours through GoFundMe to help with her medical bills.
Hubbard-Heard’s obstetrician sent her to the emergency room during a routine visit on April 8 because her oxygen levels were decreasing. She was transferred between COVID and intensive care units at Beaumont’s Wayne hospital, then intubated and airlifted to the Royal Oak hospital to be treated by a critical care team.
She spent nearly a week on a ventilator and “I honestly have no memory of those days,” she said.
Hubbard-Heard had to learn to breathe again on a machine, and she requested the tracheostomy breathing tube because she’s had trouble breathing, talking and swallowing due to her windpipe and vocal cords being damaged from intubation.
“Since I’ve had the trach surgery I’m breathing much better on my own, however, I’m still learning to eat as swallowing remains difficult as is speaking. I’m very weak still,” she wrote.
She believes she contracted the virus while working as an occupational therapist in a rehabilitation facility. Her husband, Janard Heard, and children, Rayne, 24, and Ryan, 19, have their first doses and the family has plans to get London, 12, Pfizer shots if they are authorized in the U.S.
“I believe had I been vaccinated I would have had avoided this traumatic hospitalization,” she wrote.
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“I also want to especially speak to African Americans who may be hesitant. Please get vaccinated, we have already lost many loved ones, please protect the ones we have left including yourself.”
In the meantime, she spends her days thinking of a name for her son that will reflect the journey.
“My husband and I can’t agree on a name yet but he told me today I can name him whatever I want after all I been through to save the baby,” she wrote. “Whatever his name is it will reflect the strength and will that God has blessed him with.”
Staff Writer Karen Bouffard contributed.
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