Ep. 47 Pregnancy, COVID, And Vaccines With Dr. Lauren Sylwanowicz

Updated: Nov 18



The topic around vaccines has been very sensitive nowadays, especially because of the pandemic. Dr. Lauren Sylwanowicz is a board-certified emergency medicine physician in Southern California and also happens to be 38 weeks pregnant. She has experienced the pandemic as a physician, patient, and soon-to-be mom, and understands the stresses that new parents face. In this episode, she discusses some of the risks and benefits of getting vaccinated before, during, and after pregnancy and provide resources to help patients make the safest decisions. As a soon-to-be mom, she can now share and understand her patients more and sympathize with them better.

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Pregnancy, COVID, And Vaccines With Dr. Lauren Sylwanowicz


This episode was supported by the National Geographic Society Emergency Fund for Journalists. We’re talking to Dr. Lauren Sylwanowicz. Dr. Sylwanowicz is an Emergency Physician in Southern California and we’re going to talk about COVID, pregnancy and vaccination. Dr. Sylwanowicz is an Emergency Medicine Physician who lives and works in Long Beach, California.


She also sees patients from home via Telemedicine with TelaDoc Urgent Care and works for mobile health as a consultant for product development with a focus on preventative medicine. Her undergraduate degree is in Biology and Physiology with a minor in Chemistry from California State University, Long Beach, where she was also Captain of the Division 1 Women’s Basketball Team and an Academic All-American.


She went on to medical school at the University of California Irvine and stayed there to continue her training, completing a Residency in Emergency Medicine in 2019. Medicine has been her passion for many years and will remain a key aspect of her life as she enters a new chapter in her life as a mother. She’s pregnant upon recording this interview and has been pregnant for a good portion of the pandemic.


She and her husband, a local dentist, are expecting their first child, who is a boy and they’re looking forward to him joining them for their many hobbies, which includes spending active time outdoors, on the beach, exploring Long Beach and adventuring in the United States and all over the world. Welcome, Lauren.


Thanks for having me. I’m glad we were able to fit this in before I delivered.


Me too. If you need to go, let me know.


I’ll keep you posted.


Tell me a little bit about your background. Where’d you grow up?


I grew up in Southern California, Fullerton, which is North Orange County. As you mentioned, it was very fortunate for all of my training to be able to stay local. You’ve mentioned Long Beach and the University of California Irvine, where we met years ago. I stayed local but I love to travel and get out and see the world.


When did you know you wanted to be a Doctor?

When you’re a mom, you want to protect your baby more than wanting to protect yourself.

I thought I wanted to be a Veterinarian. When I entered college thinking I was going to be a veterinarian. I was interested in the sciences and started going down that route and realized I only liked dogs and puppies. When you think of the big picture of being a veterinarian, there’s a lot of other animals in the world, so I switched course. My parents are both in healthcare, neither are physicians, but I always had a background in healthcare from that aspect. I started volunteering at a hospital in college and realized very quickly that I wanted to be a Physician. Partly because I do like all people versus only liking dogs in the animal world. It worked out well.


What made you choose Emergency Medicine?


After college, I was a scribe in the ER and that was my first introduction to emergency medicine. My mom always teased me because, as a child, I didn’t want to go to the doctor. I nearly passed out for every shot. My mom was an ER Nurse and my dad was a Respiratory Therapist. They had medical conversations all the time that I did not want anything to do with it, but here I am, an ER doctor years later. It was that introduction to emergency medicine as a scribe that pushed me down that route. As you know, experiences in medical school lead you one way or another and here we are.


I find that in medical school, emergency medicine physicians tend to be the people who are like, “I like everything.”


I think the one other thing I thought about ironically with this topic is OB-GYN. I realized I didn’t love the OR as much. I loved procedures but not the OR. That led me away from it. We see a lot of pregnant patients in the ER, so it’s been right. As you said, we get the variety.


What is your favorite thing about Emergency Medicine?


The fact that we can see anyone and everyone who walks in the door. There’s not a front office filtering which insurance the patient has, where they’re coming from, where they referred, were they not referred. To me, that aspect of medicine is it’s frustrating even as a patient. I liked the fact that I go to work and whoever comes to see me, I can see and I can provide the best care for and use the best supplies and use all the skills I have at my fingertips. I don’t have to filter through. Are they going to pay or not pay? That is ultimately what I enjoy most about it.


I am so with you on that. Not having to worry about insurance is a major benefit of working in the emergency department. We still have to worry about it and there are still times where we have to transfer patients and do other things, but for the most part, that’s not going into my decision-making at all.


The initial care, which is nice.


What is your least favorite thing about Emergency Medicine?


Going into being a mom or a mother, the schedule can be tough. It has its pros and cons. It’s nice that we work different hours. We work days and nights but even still at a young age and still early in the career, the switching back and forth to nights gets very hard very quickly. I do think I’m probably well prepared for a newborn because of that. I’d say the lack of stability in the schedule is probably the biggest con, but I also think that it’s on the pro list. The fact that we work nights and weekends, so we’re not a Monday through Friday, 8:00 to 5:00 and we get to spend a lot more time at home. We don’t have calls, so there are definitely pros and cons there.

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Not being on call is a huge benefit.


It allows us to do other things like you do or, for me, consulting and doing some telemedicine. There’s more variety in the career than some other specialties.


That’s one of my personal favorite things about emergency medicine because you’re well-versed in a lot of different things. There’s a lot of opportunities to do non-traditional types of medicine like wilderness medicine or any of the non-traditional fields.


You have the time to dive into it a little more, too.


There are always patients waiting, but you don’t own the patient panel that you’re responsible for.


One of your colleagues is there holding down.


We’re discussing COVID, vaccines and pregnancy and you are pregnant, so you’ve definitely experienced all of this firsthand. For me, vaccines weren’t available until I was nursing. I think one month after I delivered was when I got my first dose, the second I was able to get it. Getting the vaccine while nursing is still a concern for many women. We’re going to discuss the risks and benefits associated with vaccines and pregnancy. You chose to get vaccinated while pregnant. Tell us a little bit about your thought process and what data, if there is any, that helped convince you that was the right thing to do.


I got the booster while pregnant. I was vaccinated barely prior to conception, but it was something I thought about. My husband and I talked about wanting to have kids towards the end of 2020. As you know, as all the public knows, November and December here in Southern California were when the pandemic was at its worst and we were on the frontlines.


I was seeing COVID patients my entire shift. The patient side of me was also concerned about getting pregnant and getting COVID right away. We have a lot to think about. I knew if I got pregnant, I was going to get vaccinated. Part of me also wanted to try to get vaccinated before getting pregnant because I knew being on the frontline how high risk I would have been to get it early in pregnancy.


There are many risks that come with getting it while being pregnant. To answer your question, I got both doses of vaccination and months later, I conceived. I chose, though, to get the booster while pregnant and have a lot of reasons behind that as well. One is that here towards the end of the pregnancy, this is when I’m at higher risk for a more severe course. I was working in the ER. I finished my shifts, but I was concerned that if I got it this late in pregnancy, as you remember, we don’t breathe as well when our bellies are these big. I know if I got pneumonia of any kind, I wouldn’t have as much strength to fight it as I would not be pregnant.


I got the vaccine on the first day I could last December 2020 and got the booster. Part of my reasoning for getting the booster as well as to pass antibodies to the baby, so we pass the antibodies through the placenta then, as soon as I deliver, want to breastfeed. Especially those first few days, there’s a lot of antibody passage. I’m hoping that I also am giving him protection.


I remember vaccination wasn’t an option for me while I was still pregnant but especially toward the end of pregnancy, I was so nervous, even with hospital protocols. If I were to get infected at the time of delivery, my husband probably wouldn’t have been allowed in the room. My doctor and nursing staff wouldn’t have been able to be present as much, potentially. I could have ended up delivering in a coma, which has happened to pregnant women.


Very scary cases. Ventilators. Delivering while on a ventilator, on ECMO. They’re sad cases at the end of pregnancy.


There’s a ton of evidence out there that supports women getting vaccinated while pregnant or before pregnancy. I know you have done a ton of research to talk about this. We know that pregnant women are a high-risk group and they’re at risk of having the severe disease if they can track COVID during pregnancy. What were some of the most standout statistics or facts that influenced your decision?

Vaccines give protection that reassures you as well.

Overall, they rate the pregnant women group as an overall low risk, but if you do get pregnant, you’re at a much greater risk of more severe disease. That’s going to be typically later in the third trimester. Statistically, you’re at a much higher risk to be admitted to an ICU, a much higher risk to die from the illness and a much higher risk to have a severe illness.


I know that CDC put out a report where they looked at all the women who had to be hospitalized or died from COVID-19 during their pregnancy and 97% of those were unvaccinated. In that severe illness group, the hospitalized and those who unfortunately passed, the not vaccinating part was a huge part of why they had a more severe course.


As pregnant women, we’re generally young, healthy people, but those who do have obesity and have diabetes prior to the pregnancy or those who develop gestational diabetes while pregnant, just like if you weren’t pregnant with diabetes and obesity, are at higher risk. There are groups even within the pregnant population, even though overall, a pregnant population is a healthy population for the most part. There is a much higher risk for a severe course.


That’s a great point too. If a pregnant woman is or has pre-existing conditions like hypertension or diabetes or obesity, those are things that can increase your risk for severe illness from COVID. Being pregnant adds to that chance of having more severe symptoms from COVID. An important consideration for women to think about is what their risk group is. If they’re in one of those high-risk groups before being pregnant and adding the pregnancy, they probably should consider the vaccine even more seriously.


You bring blood pressure and even those without high blood pressure prior to pregnancy, gestational diabetes can become something during pregnancy. Preeclampsia is something that all OBs are talking to their patients about and that’s why you go pee at every visit. They’re checking that protein in the urine. There are studies that are showing that those who suffered from COVID-19 at any point during their pregnancy are at higher risk for preeclampsia, which puts both mom and baby at risk. The other thing you’re at higher risk for with COVID, not even as part of the conversation, is getting blood clots in pregnancy.


There are studies that are coming out that when you compound pregnancy, increased risk of a blood clot with getting COVID, which we hear in the news all the time, that’s part of the risk of having COVID independent of being pregnant. When you combine those two, there are studies out there that are showing a higher risk which is going to, again, be dangerous for you and the baby. More reasons to get vaccinated.


We’ve talked about preeclampsia in our pregnancy series. To review, preeclampsia is a disease that happens in pregnancy where women will start to have a protein in urine and elevated blood pressure and this can progress to seizures and other risks to both mom and baby. It’s something we want to avoid and we have to treat it very aggressively when it happens.


There’s a lot of rumors out there swirling about the vaccine. I think I’ve heard people say that the vaccine affects fertility. There are microchips in the vaccine. There are all things out there on social media. What are some of these that you’ve heard and we’d like to lay to rest what is true and not true? I can’t say obviously, but there are no microchips in the vaccine. It does not affect fertility. You had a study that you found to support this.


As far as fertility, what went around and circled on social media was that there was a protein in the vaccine that was similar to that protein that helps your placenta stick to your uterus. The placenta is your passageway to your baby and it’s what nourishes the baby. You would not be able to make it through a 40-week gestation without the placenta. The placenta is for sure important. This rumor passed on social media that some interaction with this protein or this protein is similar. There are lots of different versions of it, but basically, that was what was going to cause you to have fertility issues if you got vaccinated. None of it was true.


The other thing was, if I got vaccinated, would I get COVID? A lot of people were scared of that or by getting vaccinated, would I give the baby COVID? The vaccines are not live viruses. It’s not possible in any way for that to happen. Those are two big things I would see pop up on social media and on news sources that weren’t reliable that were scaring a lot of people. If you go back to December 2020, when the vaccine came out, the wording that CDC, even the big OB-GYN groups and organizations, weren’t pushing the vaccine early on when that came out and probably for the right reasons. There wasn’t enough data.


Even back then, I knew I would get vaccinated and I felt like I had enough information, but I could easily see how anyone in the general public would be scared, as they should be. I was scared, which led up to this nine-month period since the vaccine came out where many pregnant women were not vaccinated. I think at one point, the death rate for pregnancy hit its highest in August of 2021.


At that point, there were only about 20% and it was 21% to 23% of pregnant women were vaccinated and the death rate was skyrocketing in August 2021. All of this campaigning came out on behalf of the CDC and ACOG to get pregnant women vaccinated and get the right information out there so that they would be interested and feel comfortable getting vaccinated.

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Those are all important points. As physicians and as patients, it’s always important to consider risks versus benefits. For you and me, we’re literally on the frontline treating COVID patients day in and day out. For us in particular, the benefit of getting vaccinated even early before thousands of other people had been vaccinated made sense.


I understand the hesitancy to a point for people to want to wait a little longer and wait for the vaccine to be fully approved. Everyone has to do a risk versus benefit analysis. At this stage, we know the COVID vaccines, in general, are very safe and very effective. The risk, particularly for women who are pregnant and may have underlying conditions as well, is high enough that I think it’s important to get vaccinated.


The risk benefits there. Now with all these big organizations, the CDC, ACOG, which is the American College of Obstetrics and Gynecology, the Society for Maternal-Fetal Medicine, they’re all very strongly supporting and promoting getting vaccinated. We’ve talked a lot about what benefit it has to the mom. I think as a mom, even not yet a mom, I haven’t delivered, part of me is more wanting to protect the baby than I even want to protect myself.


Those risks that come with mothers who get COVID during pregnancy, particularly in the third trimester, your baby’s much higher chance of being in the NICU. Unfortunately, there are studies showing that higher risk of stillbirth and earlier in pregnancy high risk of miscarriage for those who aren’t vaccinated and get COVID. Not only are you helping and protecting yourself, but you’re also very quickly switching into mom’s brain and helping your baby, which these big organizations are trying to get more data and more studies to support those claims too.


As a pregnant woman, it’s not only your health. Everything that happens to you also happens to the baby. I think that’s another important thing to think about if there is any benefit of passing some of those antibodies to the baby that gives them an additional level of protection. Also, if you were to get infected with any illness that causes high fevers, that can affect the fetus as well and lead to some of those bad outcomes that you talked about.


You want to avoid getting sick at all when pregnant because the SARS-CoV-2 virus has been prevalent during this time. It’s been increased risk, but in general, women who are pregnant should try to avoid getting sick as much as possible. Is there any difference in all the different vaccines for pregnant women or can women have whatever?


They’re all now approved for pregnant women. I think the only thing is if you were under the age of eighteen, you still have to go towards Pfizer as far as what’s approved. Otherwise, they’re all approved and boosters are approved as well. As I mentioned, I got the booster and I’m hoping that if I go to the full 40 weeks, I’ll have had about five weeks to pass antibodies through the placenta after my booster. Also, we’ll be passing antibodies through the breast milk.


In addition, I feel much more comfortable going into having a newborn baby and knowing that I’m less likely to get COVID from someone else and give COVID to my baby. Not only are you passing antibodies when you’re breastfeeding, but you’re also very close to your baby. When you’re caring for your baby, you’re very close to your baby. If you get COVID during that time, even shortly after postpartum, when your baby’s high risk to get worse infections, whether it’s COVID or not, having that protection gives me some reassurance as well.


That’s one thing we haven’t talked about yet. The data suggest that after getting the COVID vaccine that antibodies can be passed to the baby and breast milk. There are no known risks to the baby for this, but there’s a lot of potential benefits. How do you counsel your patients on this?


Throughout the whole pandemic, I saw a lot of pregnant women with COVID. I saw a lot of women coming in, asking questions like, “If I get the vaccine, can I get pregnant?” Especially early on. I always tell them that, as we already discussed, weigh the risks and benefits. Risks are going to be the same as those if you were not pregnant. The allergic reaction that we see is very rare, but it can happen. You could possibly experience some symptoms, flu-like symptoms after, as well as pain in the arm.

Encourage people not to be afraid of vaccines.

Those are the big ones we hear about, with allergic reactions being the most severe ones we hear about. There has been no data or no information out there to support that because you’re pregnant, you’re going to have this other set of risks or these other lists of things you need to be concerned about. It’s adding more information that you should get vaccinated. The benefits of vaccination are even more than someone who is not pregnant.


As far as breastfeeding goes, what are some of the benefits and risks associated with getting the vaccine while breastfeeding?


There’s been a study that came out. It’s still only a small group of women. They studied about 131 women. There was a group that was pregnant, a group that was lactating and a group that were non-pregnant. They looked at what response they had while after getting the vaccine, particularly after getting the second dose. All of the markers became much more significant statistics.


To compare because a lot of women didn’t want to get vaccinated because they had COVID-19, which they’re very much correct. They’ve had an antibody response. The antibody response from the vaccine and what antibodies we pass to the baby from the vaccine were much stronger than if you had the disease itself. That’s something to keep in mind. A question I got asked a lot throughout 2020 as well is, “I had COVID, so I did not need to get vaccinated.”


Basically, this study broke it down and they looked at different types of immunoglobulins, which are antibodies that we’re going to pass to the fetus. As we’ve already covered, the two main ways as a mom, we give protection to our fetus through the placenta and through the breast milk. This study showed that we are passing those antibodies through the placenta because, at birth, they took blood from the umbilical cord, which is our connection to the baby and the antibodies were there. They were there much more so for those who got two doses of the vaccine than those who didn’t, much more so for those who got two doses of the vaccine than those who had COVID.


That’s the first way. Throughout your gestation, passing through the placenta. Specifically, for breastfeeding, right after you deliver, for the first few days before your milk comes in. You have a product you’re producing for your baby called colostrum. That is very high enriched and antibodies. That is where they also saw a good amount of passage of the antibodies in this study. It’s a small study, but if we think about the science of how we pass all of our other antibodies onto our baby, this is the same process. It’s encouraging and a big benefit.


I don’t know any mom who doesn’t want to give their child the best health or the best benefit that they can. It’s interesting that there’s a much stronger antibody passage to the baby, particularly after vaccination, compared to having the illness. That’s cool. Let’s say a mom does have COVID and so has the baby. Fortunately, it doesn’t have any complications. Now, it’s still recommended that the mom continues breastfeeding, as far as I know. Can we talk a little bit about the risks and benefits of breastfeeding versus not breastfeeding for moms who have COVID and don’t want to pass it to their baby?


I’ve read the same thing. If you are in the unfortunate circumstance where you’re breastfeeding and have COVID, they recommend the same measures as they do to the whole public, wearing a mask and washing your hands. There’s still doing those two things despite your baby being very close to you, which can prevent the risk and significantly decrease the risk of exposing your baby to COVID-19. It seems to be that the benefits of continuing breastfeeding and not separating yourself from your baby if you do develop COVID during that period. The benefits of continuing breastfeeding outweigh the risks of passing COVID to your baby. You should continue to breastfeed, from what I’ve been reading.


As far as I know, I haven’t read any studies that have found SARS-CoV-2, the actual virus, in breast milk. It’s unlikely that the virus passes through breast milk to the baby, even though antibodies against the virus to protect the baby do pass through breast milk. I want to clarify that. Another approach that I think I’ve read has moms who have COVID, depending on how bad their illness is, pump and have another non-infected family member feed the baby with a bottle. That can also increase the distance between mom and baby while she’s still infectious but still maintains the breast milk for the baby, which, as we’ve discussed, has tons of benefits.


That’s also a great plan.


What is one thing you wish everyone knew about COVID?


It is sad and scary for someone to be in an ER room with a doctor that is covered head to toe in protective gear, not able to communicate with you, not able to give the best care possible by being pulled so many different directions during this pandemic and so much information being flooded at us as care providers. I want people to know you don’t want to be in that situation. You don’t want any of your loved ones to be in that situation. You don’t want your baby to be in that situation. Whether it is taking measures to prevent from getting the virus or getting vaccinated, whatever it is, you can do to prevent getting into that situation.


It’s terrible to be going through what you and I have gone through in caring for patients. There’s a lot of morale that has dropped within the healthcare system between nurses and doctors. It’s not a great place to work now, but I do think, in general, we’re going to come out stronger. Meaning the healthcare system should come out stronger by going through this, but I would want to stress to the general population that you don’t want to put yourself in that situation.

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What are some of the best ways for pregnant and breastfeeding women to stay safe? What are the best ways for them to prevent getting sick?


Wearing a mask and physical distancing. Those are the two things that have been proven throughout the entire pandemic, pregnant and non-pregnant, to prevent your risk of getting the virus. Being socially aware of who’s going to be around you, particularly late in the pregnancy and around your baby, that’s something I’ve had to think about. If I don’t feel like it’s a comfortable situation or I think I’m putting myself at risk, that mom’s brain is starting to kick in where I want to be around those who are being safe and being careful as well and those who are vaccinated. I know how much that decreases my risk and how much less risk it will be to my baby too.


I know everybody is tired, like you and I, all the physicians, the nurses. Everybody in healthcare is tired. The patients are tired. The general public is tired and I get that. I get that as a human being who wants to get back out there and live life like normal. I also want to see this pandemic end in a safe way. It’s important, particularly if you’re a new parent, to continue to try to stay as cautious as you can so that you don’t end up hanging out with Dr. Sylwanowicz or I in the ER.


It’s great to see, even daily, more studies come out about protecting kids. If we protect kids, we protect babies. They’re all playing together. They’re spreading the virus-like in the non-COVID pandemic world. This time of year, especially out come all these germs that are passed around in schools. It’s super exciting to see more of the pediatric population going to have access to vaccination as well.


I can’t wait until my child can get vaccinated. It is something where our life hasn’t changed that much and we still need to protect them. It is rare for kids to have severe side effects. We did do an episode on Long COVID and children and that happens. You can have debilitating long-term side effects and there have been 550 kids or so who have died. Nobody expects it’s going to be their child, but you never know.

It is sad and scary for someone to be in an ER room with a doctor that is covered head to toe in protective gear.

It’s continuing to be a long process to recover from, but we are very much looking forward to hopefully seeing things improve and continuing to improve. You mentioned or alluded to how difficult 2020 has been. How have you been able to maintain balance for yourself between everything that we’ve seen and faced in the emergency department, your pregnancy, having family and friends? How have you managed that?


Pregnancy made going to work much harder. It made it physically harder. It made, again, my concerns about COVID even more so being pregnant but also, in a way, the pregnancy has been a distraction, a good one. All the little things are learning from you or from other friends and colleagues about what things I need as a mom. It’s funny, as a doctor, people expect you also know how to be a mom. No, we learn all these things in medical school, yes, but we don’t learn a lot of the practical things.


It’s been fun reading and educating myself more about being pregnant and being a mom in a way. Putting myself in the patient’s perspective and not being the doctor has helped me step away and helped be a good distraction. The little things like putting together the nursery, getting clothes for him. These are all such happy moments in our lives that, despite a pandemic, I’m still much enjoying. In a way, although the pregnancy has made work harder, it has also been a good distraction.


I felt the same way. I knew what was happening as far as anatomy and physiology were concerned. Being a mom, being a parent and going through the changes to your body it’s all very different from what we learned in a textbook.


Even throughout my pregnancy, I realized how much better care I was providing to my pregnant patients by further educating myself, going through things more myself and now entering the newborn stage here. I think, when babies come in, I’m going to be a better doctor to babies too. That’s exciting to me and has been a fun part for sure.


I continue to learn new things every day and that’s so important for everyone, whether you’re a physician, a parent or living your life. It’s important to continue learning every day. Do you have any advice for anyone who’s struggling going through the pandemic or pregnancy or any number of life changes?


Pregnancy is a rollercoaster within nine months. In a way, in the bigger picture, our lives are also rollercoasters over the course of many years. There are going to be highs and lows. It’s crazy. We’re out of residency. We’ve already, even within our careers, experienced this rollercoaster of getting out of residency and everything was so new. We start to feel a little more comfortable being on our own and practicing and here comes the pandemic and down go then back up we come because we’re vaccinated.


We’re pregnant and having babies. You have a baby. Our babies are going to be about a year apart. There are so many exciting things happening in our lives. Many crazy things are happening, but leaning on others for support has been something I’ve done very much so, my husband, my family, my friends. In a way, the pandemic has allowed me to connect with people more in some ways, despite not being able to see everyone. Knowing that there’s a rollercoaster of pregnancy and of your lif