Airlifted, intubated, and pregnant: COVID is landing pregnant women in the ICU
At first, Nakia Hubbard Heard just thought she was tired. In March, the occupational therapist was 23 weeks pregnant with her fourth child, so tired seemed like a good bet.
But then came the on-and-off fever. The shortness of breath. She lost all interest in food. After about a week, she broke down crying to her husband, saying she was “tired of being sick all the time.” The COVID vaccine had recently become available to her, but little was known about its safety in pregnant women. Worried, she and her husband drove around the Inkster area where they lived, looking for a COVID-19 test. But everything was closed, she says. So the next day, Hubbard Heard went to the Emergency Department at Beaumont Hospital, Wayne, where she tested positive for the virus.
That’s when she started getting worse, fast. Her fever spiked. Doctors couldn’t get her oxygen levels to stop dropping. They moved her from the obstetrics floor to the COVID unit and eventually, the ICU. Eventually, they said she needed to go on a ventilator.
And this is where her memory goes blank for about a week. The last thing Hubbard Heard remembers is her husband coming in to be with her for the intubation. But she has no memory of being airlifted that same day to the high-risk pregnancy unit at Beaumont Hospital, Royal Oak.
“When I woke up I was restrained, [there was] beeping, I had a tube in my throat, and IVs in my neck. It was a bright room. I was scared, by myself. I just really didn’t know what happened,” she says. “...I felt like I was breathing through a straw.”
How COVID can pit the medical needs of mom and baby against each other
As COVID cases and hospitalizations surge in Michigan, doctors in the state say they are seeing more pregnant women become seriously ill from the virus.
“Pregnant women are probably the group with the lowest vaccination rate: only about 30% in the United States,” says Dr. Karoline Puder, a maternal fetal medicine specialist at Beaumont, Royal Oak. “Unfortunately, pregnant women who get COVID are at higher risk of both pregnancy complications, as well as higher risk of adverse outcomes. So [they’re] more likely to be hospitalized, more likely to be in an ICU, more likely to require early delivery because of the illness severity, and almost twice as likely to die as non-pregnant women of similar age.”
Currently, some 20 pregnant women are hospitalized with COVID at Beaumont alone, Puder says. About half of those patients are in the ICU.
“We have tragically lost mothers,” Puder says. “They have primarily been postpartum. So often the setting is that it's clear that the mom is deteriorating rapidly, despite all of the interventions. Sometimes there are indicators that the baby is no longer tolerating the environment inside mom at that point [and there is an emergency delivery.] …But there are babies, primarily premature babies, who are left without mothers because of this pandemic.”
Unlike other COVID cases, doctors treating pregnant patients must try to balance the interconnected - and sometimes competing - medical needs of both the fetus and the mother. If both mom and baby are doing well, great. But if one of the two starts to suffer, the situation can spiral quickly.
For instance, if mom’s oxygen levels start dropping, that can put the baby at risk. But an emergency delivery via c-section could, in turn, put a critically-ill mom at greater risk for complications from a major surgery.
On the other hand, it’s much simpler to treat a woman for COVID once she’s delivered the baby, Puder says. But that needs to be weighed against the risks of premature delivery for the baby, especially earlier in pregnancy, when “every single day that the baby stays inside makes a difference in survival, as well as survival without significant disability,”
“So in all of the care, it's balancing this risk of prematurity and this desire to get the baby out of the equation, which frequently comes up in [medical] discussions. In other words, if mom is delivered, then the ICU team no longer has to worry about baby in terms of medications, in terms of oxygenation, in terms of other issues that come up in caring for a critically ill mom.
“And from the other perspective, is delivering the baby potentially going to harm mom and not help the baby, or harm the baby by adding additional prematurity? And we want to try to work together to try to prolong the pregnancy as long as both mom and baby are tolerating that.”
“I was afraid I would die trying to deliver the baby”
Five days after being intubated, doctors were able to take Hubbard Heard off the ventilator. But small areas of inflammation called granulomas had developed on her lungs and were blocking her airway. Hubbard Heard had a tracheotomy, where doctors put a tube in her neck to make it easier to breathe. Over the next three months, she had three surgeries and relearned how to walk, all the while worrying about her baby and the upcoming delivery.
“I was afraid I wouldn’t be able to push,” Hubbard Heard said. “I was also afraid I’d go into respiratory failure. The trach was in place, but I thought I might have to go back on the vent, or die trying to deliver the baby.”
On July 8, Saint Dalton Rocco Heard was born three weeks early via emergency C-section. Today, he’s five months old with big brown eyes and a head of dark curls, babbling and smiling on his mom’s lap. He's healthy and happy.
“He was always doing great,” Hubbard Heard says. “He never had any issues. That’s why we named him Saint, we felt he was just covered by God the whole time.”
But she’s still struggling to fully recover. The scars from her tracheotomy are still visible, she says.
“Just sometimes reading him stories, I get winded. I can’t talk and carry him in his carrier at the same time. I can only do so much laundry before I get winded going up and down the stairs. I can’t bathe him in the tub, because I’m not able to go from the floor holding him to come back up. I still have a lot of memory issues that I didn’t have before. I wake up with a lot of body aches I can’t explain. Even though things are getting better, I still have a ways to go.”
Today, she’s vaccinated. “They have a lot of good data now that they didn’t have at the time I was pregnant initially that proves there is no issue with the vaccination...I don't think women realize when you're pregnant, just how immunocompromised you are. It’s very easy to catch COVID or anything else. And it just doesn’t make sense to take a chance on you or your baby when there’s something out there that can prevent it.”
Despite the severity of her illness, Hubbard Heard says she still considers herself “one of the lucky ones.”
“I’m here at home, with my son. But some women don’t make it.”