Although pregnant people are currently eligible to receive the COVID-19 vaccines in all 50 states, many expectant moms in the U.S. have had to deal with unexpected roadblocks that often don't align with state or local policy before actually getting their shot. Some have been turned away completely.
The guidance from the Centers for Disease Control and Prevention and leading obstetrical care groups, including the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal and Fetal Medicine (SMFM), is clear: Pregnant individuals should have access to COVID-19 vaccines, given their increased risk of severe illness from the virus.
"If you look at the recommendation from (ACOG), although they don't specifically recommend vaccination of pregnant women, they make a very important statement that all pregnant individuals who choose to receive the vaccine must be allowed to do so in alignment with state and local vaccination allocation plans," Dr. Anthony Fauci, chief medical adviser to the president, said at a press briefing earlier this week.
He added that the CDC is currently enrolling and has received almost 70,000 pregnant participants in its V-safe program, which tracks the effects of the vaccines.
'I felt pretty discriminated against'
Chelsea Gottschling, 30, of Orange County, California, told TODAY that she scheduled her appointment to get her COVID-19 vaccine at a local Walgreens after the state opened up immunizations to those with underlying conditions, including pregnancy, on March 15. But when Gottschling, who is expecting her second child, arrived, two pharmacy workers refused to vaccinate her unless she provided a doctor's note, she said.
Gottschling said she questioned what the pharmacists told her, explaining, "Nowhere do I recall seeing anywhere that says I need to bring with me a note. When did this come up?"
In California, no documentation is required to receive a vaccine if you have an underlying condition, but those meeting eligibility requirements must sign a form attesting that they meet the criteria, according to the state's department of health. In Orange County, the only required documents to bring to a vaccine appointment are a photo ID and a form to verify date of birth, per the county's health care agency.
In the U.S., four states — California, New York, Florida and Indiana — require an additional step for those with underlying conditions to get vaccinated, the National Academy for State Health Policy told TODAY. California requires a self-attestation form; New York and Florida require documentation from a doctor (though the requirement does not explicitly address pregnancy); and in Indiana, a physician must register them for a vaccination.
Gottschling said she showed the pharmacists messages from her secure medical portal in which her OB-GYN was encouraging her to take the first COVID-19 vaccine that was available. But she said they told her it was Walgreens' policy to have a note to attach to her file and that they had the right to refuse her if they weren't comfortable administering the vaccination.
In a statement to TODAY, a Walgreens spokesperson shared the following, in part: "We’re working closely with our clinical and safety teams to continuously review the latest guidance from the CDC and other health officials with our pharmacy team members to serve as a resource and help address any patient questions and concerns. Walgreens is following guidance from the CDC and offering to administer any of the currently authorized COVID-19 vaccines among people who are pregnant or breastfeeding, once they’re eligible to receive the vaccines."
The company added that they "will be accelerating our existing education and training across all of our stores nationwide to ensure our team members are following the latest CDC guidance regarding pregnant patients."
Gottschling said she waited in the pharmacy for almost 90 minutes, crying, until her OB-GYN faxed over a note and she got her first shot.
"I just felt pretty discriminated against," she recalled. "It was hard enough to make the decision to get vaccinated and go through the process, and I felt like I had done the research for myself and my family and determined this was definitely the right thing to do. To just have that all questioned was tough."
'Making up their own rules'
Dr. Shannon Clark, ACOG member and professor of maternal-fetal medicine at University of Texas Medical Branch-Galveston, who runs popular Instagram account @BabiesAfter35, told TODAY she's received more than 100 reports from pregnant and breastfeeding people around the country saying they've been denied a COVID-19 vaccine at government-run sites and pharmacies, including Walgreens and CVS. The most frequently mentioned states to her are Texas, Florida and Indiana.
In response, CVS Health shared the following statement with TODAY:
"Of the millions of COVID-19 vaccines we’ve administered, there’s been a total of one complaint related to vaccine access for a pregnant woman. That isolated incident has been addressed, and should never have occurred in the first place as our policies are crystal clear. In fact, we have information on our website encouraging pregnant women to get vaccinated in consultation with their health care provider, and those guidelines are regularly shared with our health care professionals administering vaccines."
Clark added that she's also heard from breastfeeding women that they've been told to get rid of their milk for two weeks after the vaccination. "Where are they getting that recommendation? That has not been said anywhere to anyone," Clark stressed. "It seems to me from what I'm hearing they're just making up their own rules."
A representative from ACOG told TODAY that the group was first made aware of reports of pregnant women being denied the vaccine several months ago and has worked with state and county health departments, including New York and Illinois, to issue clearer guidance.
'I ... was offered no explanation'
Amaya Mendizabal, 36, of Miami, who's pregnant with her second child, told TODAY that two weeks ago, she showed up to her drive-thru vaccine appointment at the state-run site at Hard Rock Stadium, but left without receiving a vaccination. She said she brought the state-required form filled out by her doctor and an additional note, which she shared with TODAY, from the practice stating the ACOG and CDC guidance and that she was cleared by her doctor to receive it.
She said at the site she was "immediately (told), 'We're not vaccinating pregnant people at this location.' I asked them why and they couldn't give me an answer. They just said 'Nope, that's just the protocol, we're just not doing it here.'"
Mendizabal and her partner, who was in the car to get his own shot, proceeded to the station where the vaccine was being administered. He got vaccinated, but she was told no again. She said she asked to speak to someone who could give her a reason for the denial but once more was told, "We're just not doing it here."
"I left in tears because after this super stressful year of uncertainty, I really thought this was it. Knowing that I was at risk, I was really looking forward to getting it and was offered no explanation," she said. "It was disheartening for someone else to make that decision for me."
The soon-to-be mother of two was later able to get her first shot at a local grocery store's pharmacy.
The Florida Health Department did not immediately respond to TODAY's multiple requests for comment.
Another woman in Salem, Virginia, told NBC 4 Washington that her vaccine appointment was canceled a few days beforehand because, the pharmacist told her, the Pfizer shot "wasn't recommended" for pregnant women. The Virginia Department of Health includes pregnancy in the qualifying underlying conditions for the vaccine. She says the company running the pharmacy has since apologized.
What can pregnant and lactating women do in this situation?
Dr. Judette Louis, a member of SMFM's COVID-19 task force and chair of the University of South Florida's department of obstetrics and gynecology in Tampa, told TODAY she's also received numerous stories from pregnant people "meeting some additional barriers" when trying to get vaccinated.
Asked how pregnant and lactating individuals should respond if they're facing denial, she said she thinks the onus is on health care providers to contact locations where this is happening and make sure workers are aware of CDC and other groups' guidance that vaccines should not be withheld from pregnant or lactating people.
For individual patients, she recommended "trying to speak to whoever is the most senior in leadership there and asking for a specific reason why you're being denied ... really challenging them and saying that the guidance is that if you're pregnant, you should be allowed to make your own autonomous decision."
"(Try) to get them to acknowledge that they're going against recommendations and to really provide a solid reason why that could be," she added.
Clark said that when she's suggested patients show people at the site the guidance from the CDC, ACOG and SMFM, that's occasionally been successful. She said she's also heard of patients lying and saying they're not pregnant or lactating to get the vaccine, but "they shouldn't have to do that either."
Mendizabal added that when she was denied, she let her doctor know right away so he could warn other patients. You can also notify your state or local health department to make them aware if you were denied or asked to provide documentation that's not required.
"The guidance is clear that if you're pregnant, the outcomes are worse," Louis said. "By denying them the opportunity to receive the vaccine, it really puts the lives of these mothers in danger."