Patients, pregnancy and COVID: A GP’s story of working during the pandemic

Pregnancy is normally a time of excitement for future parents, but quite understandably, it also comes with anxiety of the unknown.
 
Add a pandemic into the mix and that anxiety reaches a whole new level.
 
As a GP working during this unprecedented healthcare crisis, when I found out I was pregnant with my second child, I knew I was about to board an emotional rollercoaster. And what a ride it has been.
 
We know pregnancy already comes with its own risks, so when I started bleeding at eight weeks after a previous miscarriage, I prepared myself for the worst. Thankfully it turned out to be a small subchorionic haematoma which self-resolved – but the stress didn’t end there.
 
Next was the onslaught of pandemic-specific pregnancy concerns.
 
Higher risks of complications. More severe disease. A greater chance of landing in ICU on a ventilator. Vaccination challenges. Two lives at risk. Death.
 
Pair that with working full-time across multiple clinical and non-clinical roles, a toddler in day care, autoimmune thyroiditis, Haemophilus influenzae and parainfluenza infections in second trimester, gastroenteritis, reflux, sciatica, glossopharyngeal neuralgia, severe iron deficiency, a hospital admission isolated from family, and eventually difficulties in actually getting vaccinated – it feels somewhat of a miracle that I made it through in one piece.
 
And this coming from someone already armed with knowledge and experience to navigate medical conditions and uncertainty. It really makes me empathise with non-medical expectant parents simply trying to survive pregnancy, let alone a pandemic and infodemic.
 
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) made it clear early on in the pandemic that pregnant women are a vulnerable group.
 
So as a pregnant GP working part-time clinically in the first half of this year, I knew I was at greater risk of COVID-19 infection, but nonetheless continued face-to-face consultations up until the end of June.
 
This was despite the reported personal protective equipment shortages because thankfully local community transmission was low in Sydney at the time. However, by July, I decided to step back from clinical practice as a way to mitigate the risk to myself and my unborn child given I was also an unvaccinated pregnant healthcare worker and a local outbreak was beginning.
 
What followed was a hot mess of vaccination hesitancy and confusion. Even as a doctor, I changed my mind about if and when to get vaccinated about a dozen times, particularly with the lack of safety data and guidance from peak bodies early on.
 
I was therefore relieved to hear in June 2021 that RANZCOG and ATAGI had issued a joint statement recommending routine Pfizer vaccination at any stage of pregnancy in light of mounting safety and efficacy data.
 
By the third trimester which was not long after I ceased working clinically, I made the decision to protect myself and my unborn child through vaccination. The trouble was, I couldn’t book an appointment – and I was not alone.
 
Even in September, pregnant women were still struggling to book vaccination appointments. In my case, it took the privilege of being a doctor, support from my local GP and pulling some strings to book in my two doses of Pfizer just prior to my due date, which happened to be at the peak of Sydney’s last COVID outbreak.
 
More broadly, the ongoing danger of COVID-19 infection throughout my pregnancy was equally exhausting. This was made worse by the uncertainty of not knowing what effects COVID-19 could potentially have on me or my unborn child if I contracted it.
 
To this day, researchers around the world are still trying to gain a better understanding of the effects of COVID-19 infection on pregnant women and newborns.
 
The latest data shows that in addition to high rates of mortality, intubation, ICU admission and preterm birth, pregnant women with COVID-19 face an increased risk of stillbirth. They also face additional health risks and are more likely to experience gestational diabetes, low lymphocyte count and post-partum haemorrhage in third trimester.
 
Further still, pregnant women who contract COVID-19 are more likely to be older, have obesity, be carrying more than one foetus, and have a history of hypertension, which adds to their risk profile.
 
Sadly, vaccination rates for pregnant women in Australia still lag behind the general population, while during the UK’s summer COVID wave one in six COVID-positive patients in ICU were unvaccinated pregnant women.
 
Thankfully, according to RANZCOG, ‘global surveillance data from large numbers of pregnant women have not identified any significant safety concerns with mRNA COVID-19 vaccines given at any stage of pregnancy’.
 
What my experience has taught me is that pregnancy is a wild ride at the best of times, notwithstanding a global pandemic. The most useful tools I had in protecting myself and my child were vaccination, a good GP and evidence-based information.
 
I encourage all GPs to continue listening to the concerns of their pregnant patients, and to keep the conversation, and the door, open.
 
Pregnant women already face the many challenges of pregnancy and need our ongoing support and guidance in these uncertain times.
 
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COVID-19 general practice pandemic pregnancy