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Dr. Jones: Your period is late and you got the test and you're pretty sure it says that it's positive, but this pregnancy wasn't planned. What are you thinking about and how do you feel?

Well, it turns out that in the United States and around the world, about half of pregnancies are unplanned. Unplanned meaning you weren't thinking about having a baby next month, it wasn't exactly on time, but unplanned usually means that you weren't planning on having a baby any time in the immediate future.

In the unplanned category, of these 50% of pregnancies that are unplanned, about half of them are mistimed. You might say that. A woman would say that she was planning on having a baby sometime, but just not right now.

And about half of those unplanned pregnancies are unwanted, meaning the woman when asked in interviews . . . And these interviews are done nationally about every five to six years through the National Survey of Family Growth and many other organizations who try to get a better understanding of this issue. In that spectrum of unplanned pregnancies comes a spectrum of different emotions.

In the virtual Scope studio today is Jamie Hales. And Jamie is a clinical manager at the Huntsman Mental Health Institute. She's here as a social worker to help us kind of think about what are the emotional responses to an unplanned pregnancy. So thank you for being in the studio, the virtual studio with us, Jamie.

Jamie: Thank you. I appreciate you having me.

Dr. Jones: So I'll give you a little bit of my background. I'm a reproductive endocrinologist and an infertility specialist. So, clearly, the unplanned pregnancy among my infertility patients is one that's met with often surprise and joy. But I'm also a family planning specialist and I've been an abortion provider for pregnancy termination.

And the spectrum of emotions is huge in terms of people who come and are faced with a pregnancy that they either didn't want now or didn't want ever. Can you tell me a little bit about your experience and what you've seen?

Jamie: I would completely echo that experience. What I most often see in my practice is more when somebody has had an unexpected pregnancy, it's a happy thing. They're excited about it. But I 100% see people where that is the exact opposite experience.

Sometimes our society, the idea is that, as a woman, you're supposed to be extremely excited about this new journey and chapter in your life. It isn't always that way for everybody, and that's not a bad thing.

And I think something that's really important when you're working with people who are childbearing age is to be as open-minded as possible about this because not everybody's pregnancy journey is the same. There is variation all over the place, and I think it can be hard sometimes for people to admit that, "Yeah, this is something that I'm really struggling with."

Dr. Jones: We go down this pathway of healthy baby, healthy mommy, and we don't spend a little time and say, "Why don't you tell me how you're feeling about this?"

Quite frankly, I'm a mother and a grandmother, and I planned my pregnancy down to the minute, but I was ambivalent. Even though it was highly planned, I was ambivalent thinking, "My life will never be the same." And there was a little bit of worry and grieving about that, even in a very planned pregnancy.

I think it's a matter of recognizing that it's an emotional rollercoaster. First of all, your hormones are different. You are now in a potentially new social domain going forward. You will now be a new person, if you choose to continue the pregnancy, called a mother. And then there's your own emotional makeup and you don't want to do that.

Listen with an open heart. I don't know how to put that in any other way. It's rare to have someone who's so neutral that they've got nothing going on. I worry if I see that.

Jamie: That's a very good point. I think being completely neutral about your pregnancy probably is more of a red flag than having some strong feelings about it either direction.

And those feelings can change, right? One day you may be feeling absolutely fantastic about it, and then there may be other days where that is not the case. And ultimately, it isn't up to the people around you to decide what the normal range of emotion is. That's up to you.

It can be a very fraught topic, but it's also one that I think is very important for us to discuss because this is another one of those situations where you might be out there experiencing some of these thoughts and feelings and think, "Wow, I'm the only one that's dealing with this right now," or, "I don't want to say anything because nobody is going to understand." And it is much more common than I think people realize. 

Dr. Jones: So how do we begin to help women negotiate how they're feeling and what they're planning on doing, figure out what are the resources available to them?

Jamie: Resource-wise, there are a couple of groups that are done online through Postpartum Support International. They have a virtual group for medical termination and also one for post-termination support, even if it wasn't for medical reasons.

So there are really good resources out there, and I think it's important to speak up if it's something that you're struggling with.

Ultimately, at the end of the day, we're not the ones that have to make really tough choices around this. And what the person wants and how they're feeling about it absolutely comes ahead of what any of the rest of us may or may not think about that pregnancy.

If you're going to therapy, that's a really great safe space, I think, a lot of the time to bring up complicated feelings about stuff because it's confidential.

And not everybody in your life may agree one way or the other with your choice whether to continue, not continue, the fact that it happened in the first place.

There are a lot of factors that go into unplanned pregnancies. There's a change in identity. Everyone, I think, comes at it with a different background, a different degree of support and resources.

Dr. Jones: Right. And most women struggle in the sense that they are making a decision thoughtfully, and when they finally make their decision, they're usually pretty sure. But on the way, it's giving them the information that they need so that they can feel that the next 60 years of their life one way or the other is written in a way that they can feel comfortable and move ahead.

I want to thank you so much for joining us. And for everyone who's been listening, thank you for joining us on the "7 Domains."

You are pregnant and trying to do the right thing to keep yourself healthy and provide a safe place for your growing pregnancy. Is it time to get a COVID vaccine?

I have tragic memory of being part of a team that cared for a wonderful young woman who was pregnant and got influenza. Influenza isn't usually lethal to healthy young people, but it's dangerous in pregnancy. We knew this young woman. She worked in our unit, and she and her baby died of influenza. This was before my hospital required all employees to be vaccinated for the flu each year. Now we have over a decade of information about the influenza vaccine in pregnancy and safety, and we encourage every one of our patients to get the flu vaccine. It saves lives.

Now we have this other virus, COVID-19. COVID isn't new to us as humans. We've seen several other COVID viruses that were quite deadly in the past 20 years, but they didn't go that far and we see coronaviruses, the COVID family, make up some of the virus that caused the common cold. But COVID-19 is very contagious and causes severe illnesses and death all too frequently and lingering illnesses in many of those who weren't even really sick.

So when we first offered the COVID-19 vaccine, we had little information about COVID vaccine in pregnancy, but we had almost nine months of data on the COVID-19 virus infection and how it affected pregnant women. Here at the University of Utah, Dr. Torri Metz, a specialist in high-risk pregnancy, helped lead a national team to collect information about pregnant women who were infected with COVID-19. We talked with her, and she said it was sobering to see that young, healthy women who were pregnant had much more serious courses of the infection than women of the same age who weren't pregnant. They were more likely to get hospitalized, they were more likely to be admitted to the intensive care unit, they were more likely to be put on a ventilator, and if their oxygen levels became too low, they were more likely to lose their babies and sometimes they lost their lives.

But it took us another nine months to collect information about women who were pregnant and were vaccinated and compare outcomes to women who were pregnant and were not vaccinated. And the news is good and compelling about the safety of the COVID-19 vaccine in pregnancy.

So what is true? One, the Moderna and Pfizer vaccines had no adverse effects on fertility, pregnancy, and offspring in lab animals. Two, in 35,000 women who were pregnant and received the COVID-19 vaccine, headache, muscle aches, chills, and fever were less frequent in pregnant women than in non-pregnant patients. Three, injection site pain, where you got the shot, was more frequent in pregnant women, but it wasn't really all that bad. Four, the safety data following 4,000 pregnancies in women who were vaccinated showed no higher rates of miscarriage, no higher rates of preterm birth, no higher rate of newborn birth defects, or deaths compared to what we normally experience in pregnancy. I'm going to say that again. There were no higher rates of miscarriage, preterm births, or birth defects in women who were vaccinated compared to women who aren't vaccinated. Number five, women who are infected with COVID-19 have an increased risk of harmful abnormalities in the placenta. Women who are vaccinated don't have these harmful changes. Six, women who are vaccinated are five times less likely to get COVID-19 compared to pregnant women who are not vaccinated, one-fifth the rate of getting COVID compared to non-vaccinated pregnant women. Seven, women who are vaccinated give good antibodies to COVID-19 to their newborn babies. So there are seven true things.

What's not true? One, the COVID-19 vaccine causes infertility. It doesn't. Two, the Moderna and Pfizer vaccines have DNA in them and will alter the DNA of the fetus. Nope. These vaccines have mRNA in them, and these molecules are very short-lived and act mostly in the muscle around the shot. They don't change the DNA of the fetus or the mom. Three, the COVID vaccine has a microchip in it to track you. Really? I don't know where that ever came from, but it's one of the silliest of the vaccine myths.

Women who are pregnant are at high risk if they become infected with COVID-19. Pregnancy may lower women's immune responses, but the vaccine is still very protective against women developing complications from COVID-19.

With the information about the risks of COVID-19 infection to the pregnant mother and now the efficacy data from the vaccine outcome data collection and the safety information from more than thousands of women who were vaccinated while pregnant, the Centers for Disease Control and Prevention, the American College of Obstetrics and Gynecology, and the Society of Maternal-Fetal Medicine have strongly recommended that women who are considering pregnancy, trying to get pregnant, who are pregnant, or who are breastfeeding get vaccinated with the COVID-19 vaccine.

I think back to the day when I saw a young woman die of influenza and how much the flu vaccine is part of our counseling to pregnant women during flu season. So if it's flu season and you're pregnant or breastfeeding, don't forget to get your flu vaccine. And no matter what season it is, if you are pregnant, trying to get pregnant, or breastfeeding, please talk to your clinician and get vaccinated against COVID-19. And because no vaccine is perfect, please wear a mask that covers your nose and mouth when you're indoors in groups of people and practice social distancing if you're with people who aren't vaccinated.

And thanks for doing what you can to protect yourself, your baby, and those around you. And thanks for joining us on The Scope.