As Omicron surges, most pregnant people remain unvaccinated, often due to mixed messaging.
COVID-19 in pregnancy is linked to a higher risk of hospitalization, complications, and death.
Insider talked to unvaccinated pregnant women who got the illness about their decisions and experiences.
When the doctor told Sultana Ashiq that she would have to be put "down to sleep" to go on a respirator as her lungs struggled against COVID-19, all Ashiq understood was "sleep."
Ashiq, a 33-year-old in London, was almost 31 weeks pregnant with twin girls, and she was exhausted. In the nine days since she had tested positive on January 11, her condition had rapidly declined - from shortness of breath and fever to gasping for air and unbearable pain.
"I was shouting at the doctors: 'Please take the babies out. I cannot breathe. I cannot breathe,'" she said. She added, "Please protect them and protect me."
Ashiq's doctors decided to put her in a coma and deliver the babies by C-section. She stayed in a coma for 21 days, fighting off sepsis, a collapsed lung, and a flare-up of herpes simplex virus that also attacked her lungs. When she woke up, frail and 10 pounds lighter, her sepsis returned, and she developed delirium, thinking she'd been abducted and physically abused.
She wrote a note to her husband, Nayeem, who was, unbeknownst to her, experiencing suicidal ideation at the thought that she might not come home.
"I think I cannot make it. Please look after the family," Ashiq wrote. "Look after my son and my girls. Allah is preparing you for this."
One of her nurses later told Ashiq, who was unvaccinated because the shots weren't available for her age group at the time, her survival was "no less than a miracle.'"
Pregnant people and their babies are at increased risk of serious complications from COVID-19, and research shows the shots are safe and effective during pregnancy. For months, doctors and public-health organizations have issued urgent pleas in favor of the vaccine in pregnancy.
The Delta variant led to a "shocking" spike in COVID-19 deaths among pregnant people in August and September, Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, told ABC News. As the Omicron variant spreads rapidly, Walensky said she was "very concerned." "When I hear about a pregnant woman in the community who is not vaccinated, I personally pick up the phone and talk to them," Walensky said.
While the numbers are slowly ticking up, most pregnant people in the US and the UK remain unvaccinated. Some point to the absence of clinical trial data, concerns about putting something so new into their bodies, and anti-vaccine misinformation. Most didn't even know the shot was recommended by the CDC, one survey found.
Insider spoke with three unvaccinated women who survived COVID-19 in pregnancy. Their stories illustrate the range of factors behind vaccination decisions, and what people can experience when pregnant with COVID-19.
'This is not my time to go'
Brittany Campana said she wished she could go "back in time" to get the vaccine as soon as she was eligible, about 15 weeks into her pregnancy.
The 29-year-old labor and delivery nurse in Sarasota, Florida - young, healthy, and sensible about public-health measures - eschewed the shot, in part because, while it was offered by the CDC, it was not yet recommended by her obstetrician.
In March, she contracted the virus. Still, she wasn't too concerned. Her symptoms were mild. "I had no idea how sick I would actually get," Campana said.
As the weeks progressed, she was short of breath. She felt achy, feverish, tired, and she lost her sense of taste and smell. After eight days, at 26 weeks gestation, she was admitted to the ICU, struggling to breathe.
From that moment, physicians don't have many options, Dr. Joseph Austin, an OB-GYN in Mississippi who was not involved in Campana's care, told Insider. "It becomes a dangerous environment for the baby to stay inside. So you have to deliver the pregnancy prematurely," Austin said.
Within hours of Campana's admission, her fetus' pulse began to drop. Campana, who had developed pneumonia, was struggling to breathe, even on oxygen.
Sure enough, the hospital staff told Campana they recommended a C-section. At that point, she thought: "Oh my God, am I going to die from this?" "I was just thinking of all the moments I would miss with my kids. I was like, 'This is not my time to go!'" she said.
Campana refused to be induced, survived the night, and was eventually discharged. But for the next eight weeks, her unborn son's heart rate kept dropping randomly. At 33 weeks, doctors detected an infarction in her uterus, and ordered a C-section. She delivered baby Hudson at 33 weeks, six weeks before her due date.
Although Hudson had to go to the NICU for 14 days, he and Campana are now home and healthy, she said.
Still, she said no mom-to-be should experience what she did. "I wish I would have been vaccinated because I feel that I wouldn't have gotten as sick, but I can't go back in time now."
'Being sick and pregnant with 3 other little kids just felt really overwhelming'
Brooke Cavalla knows from experience that COVID-19 needs to be taken seriously in pregnancy - no matter how fit you are.
After experiencing a miscarriage in October 2020, she was terrified of contracting COVID-19. She worried that the disease, and whatever she'd have to take to fight it, could cause another loss.
"Putting anything in my body makes me really nervous," said the 37-year-old exercise specialist and mom of three in California. For that reason, along with her healthy lifestyle, she didn't get the COVID-19 vaccine - despite the fact that the virus, not the vaccine, may be linked to an increase in miscarriage risk.
In September, at 24 weeks pregnant with her fourth baby, Cavalla awoke at 3 a.m. with a 102-degree fever and chills. The next day, she tested positive for COVID-19.
"I just cried on the exam table," she said. "Being pregnant is one thing, being sick is another thing, but being sick and pregnant with three other little kids just felt really overwhelming."
For days, Cavalla experienced a terrible headache, body aches, and a fever that she could only manage with Tylenol. The fatigue, she said, was like nothing she'd felt before in her life.
Her eyelashes and hair started to fall out, and she lost her sense of taste and smell, which was "really a bummer" during pregnancy because her cravings couldn't be satisfied. "Even my coffee would just taste like cardboard," she said.
Cavalla made herself walk around every few hours, followed an extensive vitamin regimen, monitored her oxygen and blood pressure, and kept in contact with her OB-GYN. After two weeks, she regained her strength.
Now, at 32 weeks pregnant, Cavalla still has mixed feelings on vaccination, but she says she's proof that a healthy lifestyle isn't protection alone. "You just don't know how it's going to affect you," she said.
Pregnant patients with COVID-19 are more than 15 times as likely to die as healthy pregnant patients
As of September 27, more than 22,000 pregnant people have been hospitalized with cases of COVID-19, with 161 deaths, the CDC said.
A large 2020-2021 study, published in JAMA Network Open, found pregnant patients were more than five times as likely to be admitted to the ICU if they had COVID-19. They were also more than 14 times as likely to need intubation, and more than 15 times as likely to die.
Campana has treated some of these women. "For a lot of them, it's very similar to what my experience was. Some get sicker faster than I did as well, which is hard to see."
Not everyone gets horribly sick. Austin said that among his patients, "the most common presentation, fortunately, has been asymptomatic."
But experts say it's now clear that getting COVID-19 is a lot riskier than getting the vaccine in pregnancy.
Among the more than 150,000 people who've been vaccinated while pregnant, scientists have seen no red flags. And, the CDC's safety-monitoring systems have shown that, unlike the virus, the vaccine isn't linked to any increase in adverse pregnancy outcomes, such as miscarriage, preterm birth, or death.
But Dr. Jessica Shepherd, an OB-GYN in Dallas, Texas, told Insider a lot of patients don't fully trust that data until it's too late. By the time they get to the end stages of the disease progression, she said, "a lot of the time when they get to that point, they're like, 'Can I still get it?' and wish they had gotten it, and that's a hard conversation to have."
Cavalla and other women say they remain vaccine hesitant, in part because of mixed messaging. Prior to late July, the CDC and women's health organizations maintained that it was up to pregnant people and their providers to decide whether to get vaccinated.
Even though such organizations have now recommended the vaccine for months, moms-to-be are "still very much like, 'Are you sure?'" Shepherd said.
After all, false rumors have swirled on social media claiming that the COVID-19 vaccine leads to infertility, miscarriage, and other negative birth outcomes.
Cavalla said she has also struggled with mixed opinions from her own doctors - her previous OB-GYN encouraged the vaccine; her new one did not. "That's really hard for a hormonal pregnant mom," she said. "You feel that, either way, you're doing something wrong."
When AnneMarie Jenkins, a marketing professional in Utah who's due with her third child this month, talked to her doctors about getting vaccinated, they said: "If it makes you feel better, get it. If it makes you scared, don't." Meanwhile, her mom, who was dying from COVID-19, discouraged the shot.
Jenkins ended up getting vaccinated because she wanted to go on a cruise for her birthday where the shots were mandated.
But for Ashiq, who is now triple jabbed, there was no question that pregnant people should get vaccinated. Asked whether she would have taken the vaccine had it been available, Ashiq said, "Definitely." She added, "I wouldn't even give it a second thought."
On March 3, after 46 days in the hospital, Ashiq was discharged and allowed to meet her baby girls, Aizah and Amarah, for the first time. "I looked at them, and I started crying," she said. "I was like: 'This is my baby! This is my baby.'"