TRANSCRIPT EPISODE 53 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #53: What You Need To Know About Getting Vaccinated Before And During Your Pregnancy

Transcript

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(00:00)

In today's episode of the podcast, you will learn all about immunizations and pregnancy.

(00:12)

Welcome to the All About & Birth podcast. I'm your host, Dr. Nicole Calloway Rankins, a board certified Ob Gyn physician, certified integrative health coach and creator of The Birth Preparation Course, an online childbirth education class that will leave you feeling knowledgeable, prepared, confident, and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

(00:44)

Hello, welcome to another episode of the podcast. This is episode number 53 and I so appreciate you spending some of your time with me today. Now in today's episode of the podcast, I'm talking about immunizations and how they are an important part of pregnancy. And immunizations and vaccines are basically the same thing. So you'll hear me use those words interchangeably throughout the podcast. And immunizations are really important because they help prevent moms and babies from getting certain infections. So in today's episode you're going to learn how immunizations work, and the safety of immunizations. I'll give you a big picture view of how immunizations relate to pregnancy. You'll learn about the immunizations that are recommended for pregnancy. There are only two, and then what immunizations or vaccines are not safe for pregnancy.

(01:48)

Now before we get into today's episode, let me do a listener shout out. This is to Miranda Ochoa and she left me this review in Apple podcast and it says best podcast for expecting mamas. That's the title and the review says, "I started binge listening to these podcasts from Dr. Nicole Rankins a few months ago when we first found out we were pregnant. I really go out of my way to find women of color podcast and even my doctors because they usually give you advice that is extremely relatable like no other. All of her advice is science backed and if not she points it out like if it's her opinion and brings on tons of experts from various fields. I really can't wait to begin her birth course in the next few months. Thank you so much Dr. Rankins. You've helped me prepare for what to expect throughout my pregnancy, birth wishes for delivery and a healthy postpartum."

(02:45)

Well, thank you for that lovely review Miranda. That just so truly warms my heart to the core. I really appreciate it. I'm also super excited that you would like to be a part of my childbirth education class. For those of you who don't know, Miranda's talking about my online childbirth education class called The Birth Preparation Course and if I do say so myself, this course is pretty amazing. It ensures you are knowledgeable, prepared, confident and empowered for your birth. Over eight hours of content covers everything from mindset to what labor's like, to how to push and not get tears, to some not so commonly covered things like the risk and benefits of circumcision as well as how to do placenta encapsulation safely. And of course you get lifetime access and it's really super affordable. It's especially affordable if you go through my free class on how to make a birth plan and so you can get access to a big discount on the course through that free class as well.

(03:46)

And that free class is great too, packed with tons of useful information. Women really like that class as well. So check out The Birth Preparation Course at www.ncrcoaching.com/enroll or check out my free online class on how to make a birth plan that works at www.ncrcoaching.com/register and as always, I will link those up in the show notes.

(04:10)

Okay, so let's get into today's episode on vaccines or immunizations and pregnancy. So let's start off with how exactly do vaccines work. And it's really pretty simple. So what it is, is that vaccines introduce a weakened form of a virus or bacteria into your system so that it can't make you sick because it's weakened. However, your body recognizes it as foreign and makes something called antibodies to it. And antibodies and different types of cells are ways that our immune system fights off infection.

(04:50)

So what happens is that later down the road, if your body gets exposed to that actual virus or bacteria that was in the vaccine, then your body is already prepared to aggressively attack it so you don't get sick or you don't get as sick as if you didn't have the vaccine. Okay? So that's really the principle of how vaccines work. You get a weakened version that doesn't make you sick. Sometimes it may make you feel a little tiny bit sick, depending on the vaccine, like the flu vaccine sometimes makes people feel a little bit icky, but you get a weakened version of the bacteria or virus. Your body builds up a fight against it, and if you get exposed to it again, then you're ready to go and you can attack it right away.

(05:44)

Now, vaccines in general are very, very safe. And by safe, I mean that the chances of you having any problems are low and the benefits far, far, far outweigh the risk. Now of course, that does not mean that vaccines are risk free. Nothing is really risk-free. Adverse events do happen from vaccines, from things as minor and simple as a headache or a fever or a little bit of a muscle ache, but there are also rare but serious events like seizures. Now again, the benefits far, far, far outweigh the risk and the chances of having a serious complication are very, very rare. Immunizations in fact are actually very similar to childbirth in that regard in the sense that most of the time everything is super duper safe, but sometimes unfortunate or bad outcomes do occur.

(06:49)

Now as far as the safety of vaccines and pregnancy, we have to break it down in the types of vaccine and whether or not it's an inactivated vaccine or a live vaccine. So there's no evidence of harm to pregnant women or the babies that they're carrying if a pregnant woman gets an inactivated vaccine. However, live vaccines, meaning the bacteria or the virus is actually live in the vaccine, those are considered safe in children and adults, but they may be harmful to a developing baby while baby is still in utero, still inside mom. So we generally really, really, really avoid live vaccines during pregnancy. And I'll talk about what those live vaccines are to avoid towards the end of the podcast.

(07:45)

Now a couple other things that folks often wonder about in regards to the safety of vaccines. I know there's tons and tons of tons of talk about vaccines or immunizations and autism and the overwhelming majority of research and studies that we have do not support an association between immunizations and autism. There's just not research there and there's been a ton of research done. The other thing that people get concerned about that has been thought maybe to contribute to the autism issue is thimerosal containing vaccines. Thimerosal is a mercury preservative that is used in order to preserve the vaccine. And there was maybe some concern that that's a component that's the issue. Some vaccines have thimerosal, some vaccines do not. There has never been any evidence that showed that thimerosal containing vaccines cause any issues in women during pregnancy. And it's not recommended by the CDC that women avoid those types of vaccines during pregnancy or avoids them really. But you can if you're interested and you want to look and if it's a concern to you, you can get a list of vaccines by brand name and whether or not they have thimerosal in them that is available from the FDA, so the US food and drug administration.

(09:12)

All right, so when we step back and take a big picture, look at vaccines and how they relate to pregnancy. Actually the vast majority of vaccines, and there are lots of vaccines available, the vast majority are not given or recommended during pregnancy. In fact, there are only two that are recommended during pregnancy. The flu vaccine and TDAP, and I'll talk about those in a minute. There are also some vaccines that aren't recommended during pregnancy, but they can be given in special circumstances during pregnancy under certain things. I'm not going to talk a lot about those in detail because they're things that are pretty uncommon and that you're unlikely to encounter like the meningitis vaccine or yellow fever vaccine or rabies vaccine. Those things, again aren't recommended during pregnancy routinely, but in special circumstances may be warranted. And then there are some vaccines that cannot be given safely during pregnancy because there are lot of vaccines. And I'll talk about those as well.

(10:19)

All right. Now even though there are only two vaccines that are recommended during pregnancies, immunizations still play a really important role in having a healthy pregnancy because there's some vaccine preventable diseases that can be quite devastating for a baby who's developing inside of mom. So really the first step and a very important step in relation to vaccines and pregnancy is to be up to date on your vaccines before you get pregnant. And two vaccines in particular, MMR, which is measles, mumps, and rubella, and then the varicella vaccine. And varicella is chicken pox. And the reason that it's important that you have these vaccines before pregnancy is because these vaccines cannot be given during pregnancy. They're not considered safe. And measles, rubella and varicella can all have really devastating effects in pregnancy.

(11:27)

So let me tell you what those infections can cause in pregnancy. So measles that's contracted during pregnancy. So if a pregnant woman gets measles, it can have serious consequences both for mom and for baby. It can cause diarrhea. It can cause pneumonia. This is for mom. It can cause encephalitis, which is an inflammation around the brain. Essentially, most women who get infected with measles during pregnancy, about 60% will have some sort of bad outcome, whether it's for mom or for baby or for shortly after baby is born. And up to 12% of women who get measles in pregnancy have actually died according to one study. And there's also a risk for babies. Babies can be born with low birth weight, a miscarriage is a possibility. Intrauterine death or stillbirth is a possibility. Premature birth is also a possibility. So measles in pregnancy can have really bad outcomes both for mom and for baby.

(12:36)

Now rubella, rubella can also have pretty catastrophic effects on a developing baby. It can result in miscarriage and infection. And I'll talk about some of the things that can come with if a baby is infected with rubella. Still birth or the baby doesn't grow well. Now, the good thing, I guess if there's a good thing about rubella and pregnancy is that it's a limited period of time during pregnancy that the infection really causes problems, so it's really within the first 16 weeks of life. If mom gets infected with rubella after 20 weeks or after 16 to 20 weeks, then there is really very little bad things that happen for a baby.

(13:22)

The biggest thing that we may see after 20 weeks is that baby isn't growing well. However, if mom is infected in that first trimester or before 16 weeks, then there can be some pretty serious issues, particularly something called congenital rubella infection and that can lead to preterm delivery, stillbirth. And once baby is born, it can also lead to deafness or be a cause of deafness, a cause of cataracts, a cause of heart disease, but it can really actually affect all of the organ systems in a baby. It's just that those are the most common, the cataracts, the deafness and the heart problems and these issues can last for a long time. Also the other thing is that if mom gets rubella early in pregnancy, it's almost certain that there's going to be an issue, that they're going to be some concerns. Up to 80 to 85% of women will have some serious defects if they get rubella during the first trimester of pregnancy. Again after 20 weeks not so much, but in the first trimester there's a high risk of things happening. So again the way to help prevent that is to get that MMR vaccine before pregnancy.

(14:45)

Now the last one is varicella, and varicella is chicken pox. And varicella acquired during pregnancy, if mom gets infected during pregnancy it can also be associated with some serious complications for mom and can also cause something called congenital varicella syndrome for babies. Now some of the things that can be an issue for mom, in severe instances varicella can be associated with a terrible pneumonia. And then for babies with that varicella syndrome it can cause scars on the baby's skin in a particular type of pattern. It can cause neurologic problems like mental retardation, hydrocephalus, which is literally water on the brain. Hydro is water. Cephalus is brain seizures. It can cause the head to actually be too small. There can be issues with the optic nerve. That's the nerve that feeds the eye. It can be cataracts. Some limb abnormalities like the arms, legs being too small and not growing well, low birth weight is an issue. Sometimes there are issues with the way the intestine develops. So again, varicella can be very serious if it is acquired during pregnancy. It's not common that it happens for any of these actually because the good news is that most of us are vaccinated against these prior to pregnancy.

(16:10)

So the MMR vaccine is given in childhood, it's given in two shots, I believe. I can't remember the timing off the top of my head. So most of us will have had the MMR vaccine as a child. And then varicella vaccine, which is a new vaccine. When I was growing up, varicella vaccine did not exist. But the varicella vaccine has been given in elementary school since roughly the late nineties or so. Or you may have been exposed to chicken pox naturally. Like for me, I was exposed to it. My sister got it. I didn't get it terribly, but blood work shows that I was exposed to it. Now, speaking of blood work, we check all pregnant women at their initial prenatal visit for immunity to rubella. That's part of the routine prenatal labs, and if you're immune to rubella, then you're most likely immune to measles as well. Now, we don't do blood test for immunity to varicella, but we do ask if you have had that chicken pox vaccine or if you have been exposed to chicken pox throughout your childhood. If for sure you don't recall that you have, then you very well may get tested for it so that you can get the vaccine after you deliver.

(17:20)

Again, those two vaccines, the MMR, measles, mumps, and rubella vaccine and mumps, coincidentally does not seem to cause issues of pregnant women if they get infected with mumps, but the measles and the rubella do. So you can't give the MMR vaccine during pregnancy. You can't give the varicella vaccine during pregnancy because they are both live virus vaccines. So if you're not immune to them, then we give them right after birth before you leave the hospital.

(17:49)

Okay. All right. So let's move on and talk about the vaccines that are recommended during pregnancy. And as I said, there are only two. One is the flu vaccine or the influenza vaccine. And I talked all about the influenza vaccine and pregnancy and why it's important and why you should get it and the bad things that can happen with the flu. With pregnancy, I've seen some pretty sick pregnant women with the flu. I talked about that in episode number 43 of the podcast. So that's www.ncrcoaching.com/episode43, episode spelled out, and we will link that up in the show notes. So do go back and listen to that episode. If you did not, there is still time for you to get your flu vaccine. The flu has been a little bit serious this particular season.

(18:38)

And then the second vaccine that is recommended during pregnancy is the TDAP vaccine, and TDAP stands for tetanus diptheria and acellular pertussis. And the reason that we recommend the TDAP vaccine is for protection against pertussis. That's the main thing for here in the United States. Pertussis is also known as whooping cough and pertussis has been on the rise in the U S we think because immunity to pertussis from the vaccine or even getting the disease as a child, it kind of wanes over time, like your immune system sort of forgets how to, how to fight it. We don't completely understand why that is, but that seems to be the case. However, pertussis is quite contagious and adults who develop pertussis can transmit it to susceptible babies in the household. And this is really a concern because babies under the age of about three months are at the highest risk of having problems from pertussis, but the pertussis vaccine is not recommended until about age two months. So young babies are at risk from having those more severe complications, yet they themselves cannot get that pertussis vaccine until they're two months of age. This is why we recommend that mom gets the vaccine.

(20:09)

Now, let me take a second and tell you what pertussis does and why it can be such an issue. So pertussis or whooping cough causes this very distinct cough and you can Google it or YouTube video it to see what it sounds like. And it can be a very violent cough. There can be gagging associated with it. Folks can turn blue, look like they're struggling to breathe, and this cough can last for anywhere from two to eight weeks. At its worst, there could also be vomiting associated it. So you can have this cough for anywhere from two to eight weeks and then the recovery or the wind down from having the cough will take an additional several weeks. So that is why pertussis is sometimes called the cough of a hundred days because it lasts for quite some time. Now those young babies in particular are at risk for the more severe complications. In addition to that cough, they can have serious complications like poor weight gain, pneumonia, respiratory failure, where they can't breathe, seizures. And in the very worst case, death. Of course that is rare, but those issues do arise.

(21:33)

Now, the reason that we recommend the vaccine for parents as well as anyone who's going to be in close contact with the baby is because over 50% of babies who get pertussis get it from a family member, usually the mom. So vaccines help prevent that from happening. And the way vaccines work during pregnancy is that mom gets the vaccine and then she builds up those antibodies, those antibodies cross the placenta and get into the baby's system. And that provides what we call a passive protection system against pertussis. And that passive protection works for the first few months of life. So again, mom gets the vaccine, she builds up those antibodies, they get transferred to the placenta and then they're in babies system. Now because it takes some time for mom to build up those antibodies and then for them to get transferred through the placenta, that's why we recommend, or the CDC, the advisory committee on immunization practices, recommends that mom get the TDAP vaccine between 27 and 36 weeks. So you have some time, several weeks to build up those antibodies and for them to get into your baby's system.

(23:02)

And preferably we want to do it closer to that earlier part to really maximize that response and get the most antibodies to baby as possible. Okay. So that is why we recommend the TDAP vaccine. Now the other thing about TDAP is that it does offer some protection against tetanus as well. This is more of an issue in developing countries. In industrialized countries like the US neonatal tetanus is very rare. However, in developing countries neonatal tetanus is actually a leading cause of death and that's because a lot of people aren't immunized and there aren't safe practices for things like cutting the cord and delivery practices. So in other parts of the world, vaccination from mom helps protect baby, but in the US that's not necessarily the case. TDAP again should be administered during pregnancy, preferably 27 to 36 weeks.

(24:01)

However, let me say one more thing. Why isn't it given earlier? It's because it's thought that the immunity may wane. Like when they look at studies of the optimal time and when mom gets it and when the antibodies get to baby and the antibody levels that baby has at birth. Really that 27 to 37 weeks is the ideal time and not before that, not after that. All right. Now if for some reason it's not given during pregnancy then it should be given immediately postpartum. So while still in the hospital, this will provide some protection indirectly to the baby, especially through breastfeeding because those antibodies will get transferred through breast milk. However it takes about two weeks we think for that immunity to build up. So for those first two weeks baby is still susceptible to any issues if they get exposed to pertussis.

(25:00)

Now TDAP is also recommended for family members and childcare providers who are expected to have close contact with newborns or babies younger than 12 months old and they haven't received it previously. So really anybody who's going to be around the baby should have the vaccine as well. That's the same for the flu vaccine too. Now, I couldn't find the rationale for why exactly pregnant women need TDAP every single pregnancy. We do recommend that it's done every single pregnancy. Doing it every single pregnancy is not recommended for non-pregnant household contacts. So you know, grandparents or childcare providers don't have to get it every single time you get pregnant. But it is recommended that every pregnancy you get the TDAP vaccine.

(25:51)

Now, unfortunately we're not doing so great with the TDAP vaccine rates in the US. Only about 54% of women received the TDAP vaccine during pregnancy. But I know that all of you out there are going to help increase that now that you understand why it's needed for the health of your baby in particular to protect against pertussis.

(26:14)

Now the last thing I'll talk about is the vaccines that are not safe during pregnancy, and mostly these are live vaccines except for HPV. HPV isn't recommended during pregnancy. It's not a live vaccine, but it's not something that's considered like crucial or essential to mom's or baby's health for pregnancy. And if you happen to get it while pregnant, there are no known harms to it and you can just finish the series after you give birth. But HPV vaccine is not recommended during pregnancy. Also, MMR, that's a live vaccine, not recommended during pregnancy. Again, live vaccines have the potential for actually causing an infection in a baby who's a developing baby, whose immune system is not there yet and all those kinds of things.

(27:03)

There haven't been reports of harm that we're aware of. But again, we stay away from live vaccines, so can't do MMR, can't do varicella and can't do tuberculosis. Yes, there is a tuberculosis, a BCG vaccine. It's not offered in the United States because tuberculosis isn't that common, but it is in some other parts of the world.

(27:25)

Okay, so just to recap, vaccines work by giving you a little piece, a weakened piece of a bacteria or virus, your immune system builds up a response to it and then if you're exposed to it later, you are ready to aggressively fight it and not get sick or get less sick. Vaccines are very, very safe. They're not risk-free. Everything has risk involved with it. They're not risk-free, but they are very, very safe and the benefits far outweigh the risk. If you have not had the MMR or varicella vaccine, you definitely want to get those before pregnancy in order to prevent measles, rubella and varicella.

(28:04)

All three of those can have very devastating effects on in some cases mom and all three on a developing baby can be quite terrible. Flu and TDAP are recommended during every single pregnancy. And then finally live vaccines are not safe during pregnancy. All right, so that is it for this episode of the podcast. Be sure to subscribe to the All About Pregnancy & Birth podcast in Apple podcasts or Spotify. I have lots of folks who listen in Spotify or wherever you listen to podcast and you know, I would love it if you leave a review in Apple podcast. It's really, I love to see what you guys think about the show and it just really truly, truly warms my heart to read those comments. It also helps other women find the show and helps the show to grow. So I appreciate it. Even if you listen on other platforms, if you want to take a second and leave a review in Apple podcast, I would so, so, so appreciate it.

(29:06)

The other thing I would love for you to do is join my free Facebook group, All About Pregnancy and Birth community on Facebook. This is really a community supported group and women supporting other women in a really positive way. I'm in the group as well and the community manager, Keisha who is a doula is in the group, but again, the members of the group really support each other. I jump in, I mean I post in the group and I jump in where I see as necessary, but the ladies in there are giving some excellent supportive advice. So if you want to check that out, go to Facebook and search for All About Pregnancy and Birth and just request to join and we will look at that right away.

(29:51)

Now, next week on the podcast I have Kristen Pascucci coming on. She is the founder of an organization called Birth Monopoly, and we had a really insightful conversation about women's rights during pregnancy and childbirth as well as obstetric violence. I think you will find this a really, really informative conversation. So as always, I would love for you to come on back next week, but until then, I wish you a healthy and happy pregnancy and birth.

(30:33)

Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan as well as my comprehensive online childbirth education class, The Birth Preparation Course, with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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