When Angela started looking for a COVID-19 vaccine in mid-September, she couldn’t find one. Her local pharmacies in Freeport, Maine, did not have them in stock yet, a scenario that played out across the country amid confusion over how broadly the federal government would approve the vaccine’s use.

Two weeks later, Angela — who is set to have a baby around Thanksgiving — contracted COVID. Soon she was battling a 101-degree fever.

Angela worried about the consequences of a fever in the third trimester of her pregnancy, including preterm labor or neurological defects in the fetus. Emerging research indicates contracting COVID so late in a pregnancy may increase the risk of maternal ICU care and ventilation. 

Angela took the anti-viral medication Paxlovid. For fever relief, she relied on an over-the-counter medication that she knew was safe for her and her pregnancy: acetaminophen.

A week later, Health and Human Services Secretary Robert F. Kennedy Jr. announced the government would warn the drug may be unsafe to use in pregnancy, claiming without clear evidence that it could cause autism. At the same news conference, President Donald Trump suggested that pregnant people with pain or fever should “tough it out,”  despite evidence showing that not treating a fever in pregnancy can endanger both the pregnant person and the fetus.

The timing felt almost poetic, Angela said.

“I had taken Tylenol for the fever from COVID, for which I was discouraged from getting a vaccine,” said Angela, who asked that her last name be withheld because she has not widely discussed her pregnancy. “Fever is way worse than the not-even-proven risk of taking Tylenol.”

Bethany — a pregnant woman in Boise, Idaho, who asked that her last name be withheld because she also has not discussed her pregnancy widely — read about the government’s announcement and felt alarmed. She briefly considered “panic buying” acetaminophen just in case stores stopped selling it to pregnant people. She’s used the drug only a few times in her pregnancy, but like Angela, she worried about the threat of an uncontrolled fever. Already, she said, there are few options for pregnant people — and she worries about the risks her own illness could pose not only to herself, but to the developing fetus.

“Obviously being a mother is about making sacrifices, and if there’s something I believe is harmful I’m not going to do it. But I’m already so nervous about getting sick, because there’s so many things I can’t take,” she said.

This is the reality of being pregnant in America right now. Trump and his administration are transforming not only how the government talks about pregnancy, but the health policy around it. A series of actions in recent months by federal officials, including Kennedy, is putting pregnant people’s medical options under heightened scrutiny and creating new challenges for the health professionals who treat them.

“There’s this sort of stoking of anxiety and worry and fear that happens during pregnancy anyway — that adds a lot of stress to the pregnancy that we don’t advise,” said Dr. Margot Savoy, chief medical officer for the American Academy of Family Physicians. “It’s a really unfortunate time for pregnant women and pregnant people in general to have to struggle with already the challenges of pregnancy, with new questions that they weren’t sure were even questions before.”

The administration’s charged rhetoric comes as Trump seeks to establish his bona fides with the pronatalist movement, which supports policies that would boost the U.S. birth rate and has ties to Christian nationalist and conservative Catholic communities. This month he announced steps that he said would make fertility care more affordable. Dr. Mehmet Oz, who oversees Medicare and Medicaid, predicted a wave of “Trump babies” because of the two initiatives: a negotiated discount for one of the drugs used in in vitro fertilization, and guidance for employers to offer standalone fertility insurance, though employers wouldn’t receive any incentive to actually provide that coverage.

Trump used his Truth Social account over the weekend to continue spreading inaccurate and misleading information about not just pregnancy but childhood vaccines — ideas that could disproportionately affect working mothers.  

Meanwhile, because of recent federal actions, physicians say they are spending more time dispelling pregnant patients’ concerns about what care is safe for them.

“We see patients who not only feel blame but also patients who question what is an evidence-based decision, like getting a vaccine or treating a fever,” said Dr. Lynn Yee, a maternal-fetal medicine specialist at Northwestern University. “It leads to patients feeling uncertain when they need to reconcile what the public-facing message versus what their doctor says in the exam room.”

Already, some health care providers are nervous about treating pregnant people because research on their best medical care is limited. The new government guidance and rhetoric has heightened that sense of fear.

“At baseline people are scared to treat [pregnant people], and patients are scared to take treatment. Now all that has happened is all these things we have found evidence to improve outcomes — they are now questioning and declining them because of the information they are seeing,” said Dr. Judette Louis, a maternal-fetal medicine specialist and dean of the medical school at Old Dominion University in Virginia.

Over the summer, the Food and Drug Administration held a hearing that featured speakers who questioned the use of selective serotonin reuptake inhibitors — a class of antidepressant known as SSRIs — in pregnancy. The medical consensus holds that taking SSRIs can benefit a pregnancy if taking them will protect the pregnant person’s mental health, and that those benefits often outweigh medical risks. 

Medications generally aren’t tested for use in pregnancy. For many drugs, such as acetaminophen and SSRIs, it’s impossible to ethically conduct a randomized controlled trial — the gold standard of research — comparing health outcomes for pregnant people who use medications versus those who don’t. But a combination of federally led research efforts, drug company reporting, and pregnancy data registries are used to ensure the safety of drugs for pregnant people.

Research suggests particular drugs may increase a risk to a pregnancy. But untreated conditions pose their own dangers to the pregnant person and the fetus, meaning pateints and health providers must strike a delicate balance.

All of this was top of mind when Bethany in January, in consultation with her doctor, stopped taking medication for obsessive compulsive disorder as she considered having a baby. Then things picked up at work. She had trouble sleeping, counting herself lucky to get between four and six hours a night. She tried meditation and melatonin, watching her diet and making sure to exercise regularly. Nothing worked. 

So she went back to her doctor. After several tries, they landed on the SSRI escitalopram, which is sold under the brand name Lexapro. The difference was “night and day.” She could sleep again, and work no longer felt all-consuming. 

“If I didn’t feel like I needed to be on it, I probably wouldn’t be, but the amount of stress, that would be way more harmful to a baby,” Bethany said. “It was such a tumultuous time, and I was so miserable.”

Bethany was able to find a medication that worked for her in consultation with a doctor she trusted. But that doctor-patient trust is being tested right now, said Dr. Emily Briggs, who owns a family medicine practice in New Braunfels, Texas, just northeast of San Antonio. Briggs said while many of her pregnant patients are repeat visitors to her practice, the work of establishing that relationship is harder with new patients.

“Definitely in the last few months, my patient conversations have been far more ginger,” she said. “We’re more cautious about how we talk about medications and interventions that were previously just trusted to be OK because their doctor is recommending it.”

The administration’s actions have prompted swift backlash from major medication organizations. The American College of Obstetrics and Gynecology has issued its own recommendations for pregnant people, including advice that they continue to receive COVID-19 vaccines and to take SSRIs and acetaminophen when appropriate. The Society for Maternal-Fetal Medicine, which represents doctors who treat high-risk pregnancies, has released similar guidelines. 

Public opinion data suggests a brewing uncertainty. A recent poll from the University of Southern California found that 38 percent of adults said they would recommend a pregnant person take a COVID-19 vaccine. Another poll from KFF, a nonpartisan health policy research, polling and journalism organization, found that 35 percent of adults said it’s “definitely false” that taking acetaminophen in pregnancy causes autism, and 4 percent said it’s “definitely true.”  In that poll, another 30 percent said that claim is “probably true” — the same share as said it is “probably false.” 

Yee said she worries about government rhetoric translating into heightened barriers for pregnant patients seeking care, whether that is lack of insurance coverage, or new difficulties getting appropriate treatments. 

“I’ve had patients coming to me, saying, ‘No one would give me a COVID vaccine at my local pharmacy,’” Yee said. “I’ve had patients saying, ‘I went to pick up an evidence-based medication and being told it was no longer accessible.”

That concern was acute this summer for Ruth Morrison, who was several months pregnant when Kennedy reversed the government recommendation on COVID-19 vaccines for pregnant people. COVID vaccines can not only protect the pregnant person from the virus — some research suggests that they can pass antibodies to the fetus that then protect them as newborns.

Morrison, a 35-year-old writer living in New York City, couldn’t find a vaccine at any of the pharmacies near her unless she had a prescription from her doctor. So instead, she and her crossed the Hudson River to New Jersey. Vaccines have since become available to pregnant people in New York.

“It’s partially for us, but again, we were really thinking, once the baby is here, what if our families can’t get vaccinated? What if our friends can’t get vaccinated? Will it be like lockdown all over again?” she said. “I had friends who did have babies in 2020, and it was really scary.”

For Bethany — who scheduled her COVID-19 vaccine in September, still in her first trimester — the calculus was similar, and so were the concerns. She knew that pregnancy meant she was at higher risk for complications if she contracted the virus. She worried that falling ill could threaten her pregnancy. 

The change in federal policy meant she wasn’t sure if her health insurance would pay for a vaccine. She hoped it wouldn’t be one more expense in a growing list of bills — doctors’ visits, baby supplies, child care — that she would have to budget for. A major trade group for private insurance companies has since stated that its health plans will continue to cover COVID-19 shots.

All of these calculations, whether it’s justification for or against these vaccines and medicines, are rooted in one thing: mom guilt. 
“Mom guilt is pervasive, and when you have something that is internal, it takes very little to have that magnified,” Briggs said. “So something as little as, ‘Did you just eat that thing? Did you just take that medication to make yourself feel better, when you could have been harming your child?’ The ripple effect from a tiny little comment — mom guilt is real.”