At 9:45 a.m. in early November, I walk into the exam room to see my patient, Maria Smith (not her real name). She’s 32 years old, with a history of high blood pressure and thyroid problems, and she’s also 22 weeks pregnant. Ten minutes into her appointment, we’ve reviewed her medications and her weight; we’ve measured her belly and listened to the healthy bop-bop-bop of the fetal heartbeat. Now it’s time for me to ask The Question: “Can we give you a flu shot today?”
This is The Question for this time of year, because I have to ask it of every patient. Early fall is the beginning of flu season, and although the flu is often mild, we all know that sometimes it can be risky. What many pregnant women might not know is that for them, getting the flu is more dangerous than it is for the non-pregnant population. Many of the changes in the body that make carrying a pregnancy possible — changes in the heart, lungs, blood and immune system — also make infection with the influenza virus more likely to result in complications. Pregnant women who get the flu are much more likely to get very sick, to need hospitalization and even to die.
On the other hand, pregnant women are very cautious about what medications and treatments they’ll accept — as they should be. And no patient should accept an intervention she isn’t comfortable with. So when I ask The Question, I come prepared to have a longer discussion. If she wants, I’m ready with numbers about the safety profile of the vaccine we will offer her; I can review that it’s a vaccine made of dead virus, so there’s no way for it to cause an infection (but this also means she needs a shot, and can’t get the nifty inhaled nasal version with inactivated-but-live virus that her husband might have received). I’m ready with answers about our preservative-free quadrivalent vaccine, with the data that shows very few side effects and no increased risk to the fetus. I even give her a handout that explains getting the flu shot makes her pregnancy safer, both for her and the baby, and how it can even offer protection to her newborn (who can’t be vaccinated until six months of age).
I’m all ready to take the time to have this discussion, because the flu shot is important. I’ve taken care of a lot of pregnant women who got the flu, and though most had mild, short disease courses, I’ve also seen women in the ICU getting sicker and sicker — and I don’t want anyone I take care of to go through that.
And so, towards the end of our visit, I finally ask Ms. Smith The Question: “Can we give you a flu shot today?” I’m ready to pull out my stats and my handouts and work through her reservations.
But she surprises me: “The flu shot? Yes, that would be great! I was going to stop at a drugstore for it, but you’ll save me a trip.” Ms. Smith, it turns out, needs the flu shot for her job, where she works with people with chronic illness. She is well-educated and excited to have the opportunity to protect herself and her baby against the flu virus. I’m excited, too. I write the order and send her off to our nursing station for her important injection. Off I go to the next room, and to the next patient, ready to ask The Question again.
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The Big Question: Do Pregnant Women Need the Flu Shot? originally appeared on usnews.com
