Policies, politics, and medicine – hard to mix

Despite recommendations for vaccination from physicians, professional organizations and the Centers for Disease Control and Prevention (CDC), only 25% of pregnant women have received greater than or equal to 1 dose of a COVID vaccine.

Data from 3 CDC systems set up to evaluate for COVID-19 vaccine safety in pregnancy has been reassuring and the v-safe After Vaccination Health Checker pregnancy registry evaluating vaccination early in pregnancy did not find alterations in miscarriage rates.² With reports of increased severity of COVID infection in pregnancy with the delta variant,³ vaccination is an important strategy to optimize maternal health.

A number of groups, including hospitals, employers, and the federal government, have issued mandates to ensure vaccination of their employees with a goal to curb the pandemic. These mandates commonly include options for exemption to the mandate, due to a medical condition such as having an immediate or severe allergic reaction to any ingredient to the COVID-19 vaccine or a religious belief.

Some exemptions include pregnancy as a category for exemption. Having pregnancy as a choice for exemption puts health care providers in a bind as the vaccine is not contraindicated in pregnancy and may be life-saving.

Although an opportunity for education, this conflict has the potential for mistrust between the woman and her provider, especially given the available data that suggests the risks of COVID infection outweigh the risk of vaccination.

Similarly, recent legislation as highlighted in an article by R. Todd Ivey, MD,⁴, impacts our ability to provide the highest quality care to our patients. Beyond the many concerns of the legislation as Ivey outlines, the unintended consequence of the legislation not only puts the patients, but also the providers—all health care workers—at risk.

Legislation, policies, and external requirements obfuscates our ability to provide the highest quality care. Momentum is building among our medical societies to take a stand against such legislation, illustrated especially in the September 21 announcement by the American College of Obstetricians and Gynecologists (ACOG) that it is leading a groundbreaking coalition.

Joining 24 other medical organizations and leading the charge, ACOG filed an amicus brief to the US Supreme Court in the case of Dobbs vs. Jackson Women’s Health Organization. If you are not familiar with this case, it is one that challenges the Mississippi law that imposes a ban on the provision of abortion after 15 weeks of pregnancy for most individuals, according to ACOG.⁵

In its press release, ACOG explained that the brief asks the Court to recognize that Mississippi’s attempt to ban nearly all abortions after 15 weeks of pregnancy is fundamentally at odds with the provision of safe and essential health care, with scientific evidence, and with medical ethics. In part, the brief states, “The Ban dangerously limits the ability of women at or near 15 weeks’ gestation to obtain the health care they need: some will be forced to travel outside the State to obtain an abortion; others will attempt self-induced abortion; and others still will be forced to carry their pregnancy to term. Each of these outcomes increases the likelihood of negative consequences to a woman’s physical and psychological health that could be avoided if care were available.”⁵

Women’s health care is facing very challenging times. In this issue, we also address a collaborative care approach to reducing maternal morbidity and mortality in a piece by Larry Veltman, MD. To do this it is going to take a concerted effort among all practicing ob-gyns to address these issues. Do not stay silent. Our patients’ lives depend on it.

References

1. COVID Data Tracker. Centers for Disease Control and Prevention. Accessed September 23, 2021. https://covid.cdc.gov/covid-data-tracker/#vaccinations-pregnant-women

2. Adhikari EA, SoRelle JA, McIntire DD, Spong CY. Increasing severity of COVID-19 in pregnancy with Delta (B.1.617.2) variant surge. Am J Obstet Gynecol. 2021: S0002-9378(21)01005-X. Published online

September 13, 2021. doi: 10.1016/j.ajog.2021.09.008.

3. New CDC Data: COVID-19 vaccination safe for pregnant people. Accessed September 23, 2021. https://www.cdc.gov/media/releases/2021/s0811-vaccine-safe-pregnant.html

4. Ivey, RT. Texas Senate Bill 8 (SB8): Not just another anti-abortion bill. Contemporary OB/GYN. October 2021. Page 17.

5. ACOG leads groundbreaking coalition in Dobbs v. Jackson women’s health organization. News release. The American College of Obstetricians and Gynecologists. September 21, 2021. Accessed September 25, 2021. https://www.acog.org/news/news-releases/2021/09/acog-leads-coalition-in-dobbs-v-jackson-womens-health-organization