COVID-19 Vaccine
Effective Friday April 23, all pregnant folks are now eligible to receive the COVID-19 vaccine with the addition of pregnancy to the list of “highest risk” health conditions under Ontario’s Guidance for Prioritization of Phase 2 Populations for COVID-19 Vaccination.
The SOGC position statement supports the use of ALL AVAILABLE COVID-VACCINES approved in Canada in ANY TRIMESTER of pregnancy and during breastfeeding.
For those individuals residing in Thunder Bay and surrounding areas, please visit https://tbrhsc.net/vaccinations/ to book your vaccine appointment or call (807) 935-8100.
Vaccine Information & Research Articles
Society of Obstetricians and Gynaecologists of Canada: COVID-19 vaccination in pregnancy
Pandemic Pregnancy Guide on Instagram
This social media account is developed by physicians, obstetricians and residents at St. Michael’s Hospital to help pregnant people navigate their COVID concerns.
Conclusions:
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- 28% (almost 40,000) received at least 1 COVID-19 vaccine during their pregnancy (between December 2020-June 2021).
- Out of 13,000 pregnant people who received 2 doses of a COVID-19 vaccine during pregnant, 84% received 2 doses of the SAME vaccine and 63% received the 2nd dose within 4-8 weeks of dose 1.
- The percentage of pregnant people receiving COVID-19 vaccines increased from <1% in December 2020 to over 45% in June 2021.
- For those who have already given birth, the data from this report DO NOT suggest any pattern of increased risk of poor pregnancy or birth outcomes
Article: SARS-CoV-2 Antibodies in Breast Milk After Vaccination
Conclusions:
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- Antibodies in breast milk do not make it into the baby’s bloodstream, but rather coat the mouth, throat and gut and then eventually get digested.
- The antibodies on the mucosal surface work by fighting off infections at the body’s entrance. This is different and less effective than being vaccinated in pregnancy, which can transfer antibodies into the baby’s bloodstream
- Presence of antibodies against COVID-19 in breast milk was HIGHER in mothers who had been lactating for greater than 23 month.
- Antibody transfer through breastmilk confers only some level of immunity compared to a child being fully vaccinated or vaccination during pregnancy and there are many unanswered questions regarding the immunity conferred. More research is needed.
- Research Letter: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination in Pregnancy
Conclusions: COVID-19 vaccination in pregnancy is associated with a very good antibody response and does NOT damage the placenta. This provides evidence against the internet myth that the spike protein on COVID-19 (also encoded for by the COVID-19 vaccine) shares genetic similarities to syncytin-1 (an important protein for placental development), thus can damage the placenta. These findings dispute the false claim that our antibodies attack the spike protein, perhaps they can also attack syncytin-1 and damage the placenta. (Shanes et. al, 2021)
Conclusions: In this retrospective cohort study of pregnant women, BNT162b2 mRNA vaccination compared with no vaccination was associated with a significantly lower risk of SARS-CoV-2 infection (0.33% in the vaccinated vs 1.64% in unvaccinated group). (Goldshtein et. al, 2021)
Conclusions: Compared to the miscarriage rate across all pregnancies (12.5%-18.7%), receipt of the mRNA COVID-19 vaccine preconception or prior to 20 weeks’ gestation is NOT associated with increased risk of miscarriage. This adds to the growing body of evidence supporting the vaccine is safe & effective in pregnancy. (Zauche et. al, 2021)
Conclusions: The mRNA vaccine DOES NOT cross the placenta. The protective antibodies against COVID-19 your body makes after receiving the vaccine DO cross the placenta. It takes about 15 days after the first vaccine dose for fetal protection levels to match the birth parent’s. (Beharier et. al, 2021)
Article COVID-19 mRNA vaccine is not detected in human milk
Conclusions: The mRNA vaccine is not detected in human breast milk samples collected 4-48 hours after vaccination. These results strengthen the recommendation of ABM and WHO that lactating individuals who receive the anti-COVID-19 mRNA-based vaccine should continue to breastfeed their infants uninterrupted. Only the protective antibodies transfer through human milk.
Conclusions: Of pregnant women eligible for COVID-19 vaccination, less than one third accepted COVID-19 vaccination during pregnancy and they experienced similar pregnancy outcomes. There was lower uptake among younger women, non-white ethnicity, and lower socioeconomic background. This study contributes to the body of evidence that having COVID-19 vaccination in pregnancy does not alter perinatal outcomes. Clear communication to improve awareness among pregnant women and healthcare professionals on vaccine safety is needed, alongside strategies to address vaccine hesitancy. This includes post-vaccination surveillance to gather further data on pregnancy outcomes, particularly after first trimester vaccination, as well as long-term infant follow-up. (Blakeway et. al, 2021)
Conclusions: Preliminary findings did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines. However, more longitudinal follow-up, including follow-up of large numbers of women vaccinated earlier in pregnancy, is necessary to inform maternal, pregnancy, and infant outcomes. (Shimabukuro et. al, 2021)
Planning your Vaccine – BC Centre for Disease Control & Ministry of Health
CDC Information about COVID-19 Vaccines for People who are Pregnant or Breastfeeding
Sunnybrook Hospital COVID Vaccine FAQ for Pregnant, Breastfeeding or Trying to Conceive
Article “COVID vaccine in pregnancy triggers strong immune response in mom, babies”
Pause on AstraZeneca Vaccine Roll Out
As of May 11, 2021, Ontario has paused the rollout and administration of first doses of the AstraZeneca vaccine out of an abundance of caution due to an observed increase in the rare blood clotting condition, known as vaccine-induced immune thrombotic thrombocytopenia (VITT).
The decision to pause is also based on the increased and reliable supply of the Pfizer and Moderna vaccines and the downward trend in COVID-19 cases across Ontario. This allows for the province to pause administration of first doses of AstraZeneca to look at the data and information to be able to provide direction for second doses.
Read the full statement from the Ministry of Health here.
COVID-19 VACCINES AND BLOOD CLOTS FAQS – Thrombosis Canada
COVID Vaccine & False Link to Infertility
Health Canada will only approve vaccines if they are safe and effective, which includes impacts on fertility. There is no evidence that the COVID-19 vaccine decreases fertility or harms the placenta or fetus.
The mechanism of action of this mRNA vaccine and existing safety data provide reassurance regarding the safety of COVID-19 mRNA vaccines during pregnancy. The false theory that the COVID-19 vaccines cause infertility is based on the disproven idea that one of the spike proteins in COVID-19 and the Syncytin-1 protein (which help placenta development) are the same. They are not.
If you are trying to become pregnant now or want to get pregnant in the future, you may receive a COVID-19 vaccine when one is available to you. You do not need to avoid pregnancy after receiving a COVID-19 vaccine. You do not need to do a routine pregnancy test before getting vaccinated.
False Claim COVID Vaccine Shedding
Individuals who have received a COVID-19 vaccine cannot shed or release any of the vaccine components. Your menstrual cycle cannot be affected by being near someone who received a COVID-19 vaccine. None of the vaccines authorized for use in the Canada contain a live virus so it is not possible to shed it.
Many things can affect menstrual cycles, including stress, changes in monthly schedule, problems with sleep, and changes in diet or exercise. Infections may also affect menstrual cycles.
Clinic Policies
At Maternity Care Midwives, client safety is our top priority. We are currently implementing policies to keep our clients safe and reduce the spread of Coronavirus during this pandemic.
Clients must wear a mask (cloth or medical grade) and perform hand hygiene when entering the clinic. If you do not have a mask, one will be provided to you.
Clients may bring a single accompanying adult to appointments. The support person must wear a mask and pass the COVID-19 screening.
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- Our clinic is following the current Ministry of Health’s COVID-19 Guidelines for providing care in a community setting. In order to minimize the number of people in the office at one time and reduce the spread of COVID-19, clients are asked to attend their appointments alone.
- As midwives, we understand the importance providing family-friendly services and a positive social environment in our clinic. We miss seeing the smiling faces of your other littles! We are staying up to date with the changing COVID-19 guidelines and are looking forward to when it is safe to welcome an accompanying adult at appointments again.
- If you are experiencing exceptional circumstances, please contact our administrator or speak with your midwife prior to your scheduled appointment to discuss your individual situation.
Clients must pass through screening when entering the clinic.
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- In the past 3 days, have YOU or a MEMBER OF YOUR HOUSEHOLD experienced one or more of the following new or worsening symptoms: Fever, Cough, Difficulty breathing, Muscle aches, Fatigue, Headache, Sore throat, Runny nose, Nasal congestion, Hoarse voice, Difficulty swallowing, Chills, Change in sense of smell/taste, Gastrointestinal symptoms (e.g. nausea, vomiting and/or diarrhea)?
- Have you traveled outside of Canada in the last 14 days or outside of Northwestern Ontario (Manitouwadge to the Manitoba Border) in the last 7 days?
- Have you had close contact without personal protective equipment (PPE) with anyone with a confirmed or probable (being tested at present) case of COVID-19?
- In the last 14 days, have you tested positive for COVID-19 or are you waiting for test results because of symptoms?
- If you fail the COVID screening, please contact the clinic prior to your appointment and the midwife will arrange to do your appointment over the phone.
Changes to our prenatal visit schedule.
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- Midwives received an order from the Chief Medical Officer of Ontario to reduce non-essential visits on March 19, 2021. As per The World Health Organization recommended visits for a positive pregnancy outcome, we have received guidance on what is deemed an “essential visit.” The current recommended visit schedule is for in-person visits is: one visit in the first trimester, two visits in the second trimester (16-20, 28 weeks), and five contacts in the third trimester (31-32, 34-36, 38, 39, 40, 41 weeks).
- We will be following the routine prenatal care schedule, alternating between in-person and phone appointments.
- Your midwife team may discuss changing appointments to in-person if any clinical concerns arise (e.g., learning disabilities, concerns about fetal growth, high blood pressure, mental health concerns).
- Clients who are under shared care or are transfers of care to an obstetrician, will have the majority of their visits conducted by phone as in-person assessments will be done by their doctor.
| Gestational Age (Weeks) | Appointment Type |
| 8-10 | Phone |
| 12 | In Person |
| 16 | Phone |
| 20 | In Person |
| 24 | Phone |
| 28 | In Person |
| 30 | Phone |
| 32 | In Person |
| 35 | In Person |
| 36 | In Person |
| 37 | In Person |
| 38 | In Person |
| 39 | In Person |
| 40 | In Person |
| 41 | In Person |
Changes to our postpartum visit schedule.
- Providing postpartum care at home was established as a key part of the midwifery model. We are still offering home visits on a reduced schedule during the pandemic.
- We are currently offering 2 home visits to the parent-infant dyad in the postpartum period. A home visit will be offered within the first 48 hours of birth and at least one more additional time in the first week.
- Additional visits at 2 and 4 weeks postpartum will be conducted over the phone.
- The 6 week discharge visit will be in person at the clinic.
- Your midwife team may discuss changing the frequency or type of visit if clinical concerns arise (e.g., breastfeeding concerns, poor weight gain, mental health concerns).
Hospital COVID-19 Policies
- Labour and Delivery patients must enter through the Labour and Delivery Entrance (down to the right of the Emergency entrance).
- All patients and care partners are required to wear a mask when entering the hospital and will be asked to don a new procedure mask every time they enter after performing hand hygiene. The ECP must wear a mask while in hospital & while in contact with staff/professional staff.
- All individuals who enter our Hospital must call Labour and Delivery 684-6540 on arrival and pass through screening
- You are permitted an ECP for initial labour checks, routine NSTs, Biophysical Profile ultrasound, Rhogam injections, or other low risk obstetrical activity.
- Once admitted, the birthing parent may have 2 ECPs present.
- Caesarian Sections
- 1 ECP may be present in the OR during a Caesarian Section (subject to availability of PPE)
- ECPs of positive/presumptive patients will not be permitted in the OR
- After delivery (vaginal or C-section)
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- 2 ECP are allowed for immediate postpartum period (approximately 2h following the birth)
- Once the client has been transferred to the Maternal-Newborn Unit, 1 ECP must return their visitor badge and is not permitted to return. The other designated postpartum ECP can remain for the first 6 hours of life or until the end of that day’s visiting hours (8 pm), whichever is longer.
- The postpartum ECP must be the same individual throughout the hospitalization. You may NOT rotate between the 2 original ECPs.
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- Only 1 hospital access is allowed per day per ECP (no in’s and out’s).
- Designated ECPs who are on opioid replacement therapy will be allowed to leave if needed to access their medication or for medical appointments. Social Work may be able to support these ECPs.
- Smoking ECPs are encouraged to bring their own Nicotine Replacement Therapy for stays on any of the Women & Children’s Program areas. Leaves for cigarette breaks are not permitted. Alternatively, an alternate ECP who can remain with hospitalized patient should be considered.
- Meals will only be provided to the admitted patient. ECPs must bring any food/drink they will require for the duration of their time in hospital or may leave the room to go to the cafeteria or Robin’s Donuts in the hospital.
- Individuals who are experiencing symptoms of COVID-19 will not be eligible for entry to the hospital and will not be permitted to be an ECP in any Women & Children’s department
- If at any time an ECP becomes COVID symptomatic, they will be required to leave the premises and may not return until they have been medically cleared.
- Appeals regarding the ECP policy should be directed to Katie Forbes, the Department Manager for Labour and Delivery / Maternal Newborn by phone at 684-6548 or by e-mail at forbesk@tbh.net.
- The use of the tubs in the birthing suits is NOT permitted during the current outbreak.
COVID-19 Pandemic- Essential Care Partner (ECP) Guidelines- Women & Children’s Program
Additional Resources
PREGNANCY, CHILDBIRTH AND CARING FOR NEWBORNS: ADVICE FOR MOTHERS DURING COVID-19
WHO COVID-19: Pregnancy and Childbirth
TBDHU COVID-19 Pregnancy, Breastfeeding & Newborns
Public Health Agency of Canada: COVID-19 Being Prepared
COVID-19 (coronavirus) in Ontario
Government of Canada Travel Advice re: COVID-19
OMama: COVID-19 — Pregnancy, birth and the newborn
Disinfecting Your Home During COVID for planned Home Birth
Thunder Bay District Health Unit Informati
The Coronvirus While Pregnant or Giving Birth
National Perinatal Association
Talking to Your Children abut the Virus
Social Distancing Doesn’t Have to Mean Social Isolation