MADELEINE BRAND, host:

As we just heard, the CDC committee says pregnant women should be some of the first people to get the swine flu vaccine. But as NPR's Richard Knox reports, it will not be so simple to convince pregnant women, or their doctors for that matter, to agree to the vaccine.

RICHARD KNOX: Dr. Iffath Hoskins saw firsthand this spring what the new pandemic virus can do to healthy pregnant women who start out with ordinary flu symptoms.

Dr. IFFATH HOSKINS (Chief, Department of Obstetrics and Gynecology, Lutheran Medical Center, Brooklyn): We've seen them come in with these symptoms. We've seen them get very sick very quickly.

KNOX: Hoskins is chief of obstetrics and gynecology at Lutheran Medical Center in Brooklyn. One case haunts her: A woman in her 20s, who came in with a high fever, went into labor, delivered a severely premature baby, then had to be put on a ventilator without knowing her baby died. It took two months to wean her off the ventilator.

Dr. HOSKINS: As we were weaning her off, I didn't want her to be told until we were sure she's actually awake. It was hard.

KNOX: Hoskins says most of her pregnant patients are pretty casual about getting the flu.

Dr. HOSKINS: See, normally we say, oh, it's only the flu. We know it's the season. You know, two or three days of aches and pains, chicken soup. But in pregnancy, we should take it very seriously because, in general, pregnant women get sicker for longer.

KNOX: New data from the Centers for Disease Control and Prevention paint a picture of what the first wave of swine flu meant for pregnant women. It's published online today by The Lancet, a British journal. Dr. Denise Jamieson is an author.

Dr. DENISE JAMIESON (Author, Centers for Disease Control and Prevention): Pregnant women who've been infected with pandemic H1N1 influenza virus have had a higher rate of hospitalization in the general population, a fourfold increased risk. And of the 45 deaths reported to CDC during the first two months of the outbreak, six were in pregnant women.

KNOX: Six deaths out of 45 doesn't sound like much, but it's 13 times higher than the proportion of pregnant women in the total population. And if there's lots more of the new flu virus going around this fall and winter, as expected, keep in mind, there are 3.4 million pregnant women in the country at any given time. They've been hard to persuade to get vaccinated against the flu. The CDC has been trying for five years, yet fewer than 15 percent get seasonal flu shots.

Dr. JAMIESON: There's a real hesitancy on the part of pregnant women to do anything or take anything during pregnancy. And a lot of women want to avoid all medications and all exposures.

KNOX: Dr. Hoskins, the Brooklyn obstetrician sees that all the time. And it's not just pregnant women, their doctors are reluctant, too, both to vaccinate and, according to the new CDC report, even to prescribe antiviral medicine to pregnant patients with the flu.

Dr. HOSKINS: We are fighting an uphill battle to tell the obstetricians across the country, be wary of the flu and then, yes, jump on them and treat them. Many of obstetricians and family practice people and midwives who care for pregnant women don't get it. They really don't.

KNOX: Health officials have to convince pregnant women and their caregivers that flu vaccines are safe in general. There won't be much, if any, specific data on the new swine flu vaccine. No tests are currently in the works with pregnant women, and even if they're eventually done, they won't be big enough or long enough to mean much. But Dr. John Treanor, a vaccine expert at the University of Rochester, says experience with past flu vaccines is reassuring.

Dr. JOHN TREANOR (Vaccine Expert, University of Rochester): I think there is accumulated evidence that the vaccine is safe in pregnancy.

KNOX: Treanor says many obstetricians may worry that a pregnant woman who gets a flu shot may have a common event like miscarriage and it will be blamed on the vaccine.

Dr. TREANOR: It will be. And it will be hard to know for sure that that wasn't it.

KNOX: The trick, he says, will be to convince women and their doctors that this year in particular, the risk of a flu shot is much lower than the risk of doing nothing.

Richard Knox, NPR News.

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