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“I thought of her with each miscarriage I saw in COVID+ mothers, and during each delivery of premature rupture of membranes due to infection. I thought of her every time I gave steroids, increased the oxygen flow for someone struggling to breathe, or held the hand of someone before their emergency delivery. I saw her face when I was frantically calling a pulmonologist to help me manage oxygen on a deteriorating patient on the unit. She stayed with me through each obstetric emergency.
She probably never thought of me. I was the doctor who made her cry when she was most excited to tell me that she wanted children.
I don’t know if she’ll be back, and I don’t know if I am better or worse at explaining the urgency. All I know is that we all make choices. With COVID, some choices will save lives, whereas other choices might end with the unimaginable.”
Yuliya Malayev is an obstetrician-gynecologist.
She shares her story and discusses her KevinMD article, “What does it even mean to work through the unimaginable?”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Yuliya Malayev. She is an obstetrician-gynecologist, and she wrote the KevinMD article “What does it even mean to work through the unimaginable?” Yuliya, welcome to the show.
Yuliya Malayev: Thank you so much for having me, Kevin. It’s an honor.
Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?
Yuliya Malayev: So, yep, I mean, I’m an OB/GYN generalist in my sixth year of private practice. I work in a pretty busy metro Detroit suburb. I’m from Kiev, Ukraine, and I’ve been here since the ’90s, and I’ve been in Michigan basically since. I became really passionate about obstetrics and gynecology in med school, and I’ve been really lucky to work in my dream field. I’ve been happy to take care of patients from their very beginnings to later in their lives, when they’re done with their childbearing years.
Kevin Pho: So tell me about some of the challenges of practicing in a metropolitan area, in private practice gynecology.
Yuliya Malayev: I mean, you just get a lot of different patients. So we’re pretty lucky, because almost everyone’s got insurance, almost everyone’s got great access to health care, and almost everyone’s very compliant. But the one thing where we’ve had a very difficult time with compliance, despite our very educated and insured population, is COVID vaccination, which I’m sure is true everywhere in this country. And for women, that’s kind of a big deal, because the least vaccinated group is the 18- to 39-year-old women nationally. And maybe it wouldn’t be so bad if these weren’t the same people getting pregnant and then not passing on any immunity to their children, or not recognizing the adverse reproductive outcomes that could happen to their pregnancies.
Kevin Pho: Tell us some of the specific COVID-related complications that you see, especially for those who aren’t vaccinated.
Yuliya Malayev: So there’s a much higher rate of stillbirth or pregnancy loss. Originally, when COVID first started, it was maybe two times higher than the baseline, but by the time Delta came around, it’s something like four times higher than the baseline, which is really alarming. The hypertensive disorders in pregnancy are rising about 10 times with COVID at some point in the pregnancy, and sometimes preceding the pregnancy, which is making it even more complicated to care for and counsel these patients. And then, of course, if these people are becoming sick with any sort of respiratory distress, they’re almost 22 times more likely to be hospitalized.
Kevin Pho: All right. And I want to ask you about some of those interactions that you have with some of your patients, especially during the pandemic, but we’ll have you talk about it in the context of the article that you wrote in KevinMD, where you touch upon that. It’s titled “What does it even mean to work through the unimaginable?” Now, for those of you who get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Yuliya Malayev: So I wrote it as a follow-up to the first article I submitted to you. I came home from work one day, and I was just so frustrated. The ER had called, and they said, “You know, we’ve got an eight-hour wait until we can even triage this 18-week pregnant woman. She’s probably very sick and in respiratory distress. You’re an obstetrics ER. Can you manage this?”
So they send her over, and my nurses, they’re all freaking out. This is not what they normally do. This isn’t labor and delivery; this is 18 weeks in respiratory distress. And I have no support. I have no telemetry monitor. I have no way to properly care for her, except to stand at her bedside and watch her this entire time. So I’m just in and out of this room, donning, doffing, etc. I’m all sweaty, and it’s so frustrating, and I’m trying to call everybody and look everything up, and, you know, the stress.
At the end of the day, even though she ended up getting transferred to the ICU, she did well. She ended up discharged. I don’t know, because I don’t follow her. She doesn’t see my practice or anyone at my hospital, really. She was just a staff patient. I don’t know how the pregnancy ended, but hopefully well. It was just so hard to watch and so hard to see these complications. And then I just got so frustrated that I had nowhere else to put my thoughts except to grab the paper.
And then I coupled those with my personal story in the follow-up article, with the “unimaginable” thing, which is a Hamilton reference, of course. And I talk to my patients the same way that I would talk to my mother, to a sister if I had one, to any woman who’s close to me in my life. And I say to them, “This is why I’m talking to you about this. It’s not because I’m making money on this. It’s because I care about you, and I want you to be well, and I want you to know that this is only for your own benefit.” And they turn it into politics, they turn it into an argument, they turn it into whatever they want, anything but listening.
And even when I share the story of how I got sick with just the flu, which is what they all say COVID is, I was hospitalized. I had a problem with my placenta. My son didn’t grow. I ended up with six weeks of bed rest, which is a very hard thing to do in the world we live in, and with a private practice, and no one cares.
Kevin Pho: So when you talk to these pregnant patients and they give reasons about why they do not want to be immunized against COVID, what are some of the stories and reasons that you hear?
Yuliya Malayev: “I heard it on social media.” “I heard that you might have these other problems from the vaccine.” “I heard people are still getting hospitalized with the vaccine.” Yeah, they sure are. They’re also getting hospitalized at a much higher rate without the vaccine. “I heard that it’ll affect your baby, and there’s not enough long-term data.” That’s probably the best one that I hear, and it’s true: There’s not enough long-term data on what happens to women who get an mRNA vaccine while they are pregnant. But there’s enough data already to show what happens when you don’t get it and you get sick. And then it’s just a hard argument to have every single day, 20 times a day.
Kevin Pho: So tell me a success story. I know that in the vast majority of cases, it’s very difficult to convince people who are steadfast in their stance against the vaccine. But do you have a success story where you talked to one of your patients about the benefits of the vaccine and you actually changed their minds?
Yuliya Malayev: Yeah, actually, I do. I’ve had a couple, and I’ve been pretty lucky, because a lot of people really respect that I go through some of the same stuff that they go through, and so they kind of look at me as their peer and their doctor. So then they’ll say to me, “What do you think if I get this breastfeeding?” or “What do you think I should do if I’m going to be nursing and now it’s available to me?”
And so I tell all of them exactly what I did, which is the minute the vaccine became available to me was the minute that I got it. I U-turned on the main road as soon as I got the email notification that vaccines were available at my hospital. I was almost to my house, and I went right back to work, and I was like, “OK, I’m next.”
And then I was breastfeeding. I had a 10-month-old baby at home. I’d been nursing her since she was born, and I knew that I had a few more months left in me to do it. And so as soon as I got home after my inoculation, I started researching on ACOG’s website: Were there any studies enrolling nursing mothers who had just gotten vaccinated? Because there were none before that. There was barely even a statement from ACOG saying that you just shouldn’t exclude nursing or pregnant women who are interested in getting vaccinated from receiving it, and that was way back in December of 2020.
So I enrolled in a study. And then around the late fall of ’21, or maybe it was Christmas Day, I got the email, actually, from the researcher out in Massachusetts that the study had been published in the Green Journal, which is the most prestigious of all the obstetrics and gynecology journals, and that was really, really awesome. And then I’ve been able to tell that to all my patients, like, “Hey, I did this.” I actually collected milk, half an ounce per breast, per side, per day, labeled it, froze it, and submitted it with my blood and with my baby’s fecal matter, which was a little disgusting. But I mailed all of that to Massachusetts, and it showed that it was making a difference. She was getting antibodies. They found them in her poop, they found them in my blood, and they found them in the milk.
Kevin Pho: So I think that a lot of patients are concerned about, like you said, the long-term safety of the vaccine. So just so we can be clear, what is the data regarding breastfeeding and the vaccines in pregnant patients?
Yuliya Malayev: So they’re saying that the vaccine is not crossing into the placenta. It’s not crossing into the cord blood, nothing like that. They’re saying that the antibodies that the mom makes are crossing, and they are protecting these babies. The majority of transplacental antibody transfer will protect the baby for about six months after delivery if you’re getting vaccinated while you’re pregnant, and then you’re getting a booster while you’re breastfeeding. That’s really the ideal thing to do. Now, if you’ve already been immunized and now you’re boosted during your pregnancy, that’s awesome too. Either way, you’ll protect your baby about six months after you’ve delivered, and they’re saying that that’s about how long these antibodies are lasting. They’re not saying that natural infection is doing that.
In terms of breastfeeding, they’re noticing a spike, in some of the studies I’ve read, as early as one to two weeks after your first dose, of antibodies in the milk, which is really awesome and really powerful. You can’t mask your baby, so you have no other way to protect him or her.
Kevin Pho: And just to be clear, are there any side effects or complications from any of the COVID vaccines as it relates to pregnancy and breastfeeding?
Yuliya Malayev: I haven’t seen that yet in any of the literature. They’re saying that the complication rates are pretty similar to the regular women’s complication rates: mostly myalgia, some fever, some headache, nothing really that’s out of the ordinary, or what you wouldn’t expect from a vaccine.
Kevin Pho: We’re talking to Yuliya Malayev. She is an obstetrician-gynecologist, and she wrote the KevinMD article “What does it even mean to work through the unimaginable?” So we are entering the third year of the pandemic, and right now the numbers are going down, so hopefully we are coming out of this, and we have a lot of places where they are discontinuing mask mandates. But what have you learned as a physician in terms of communicating with patients over the past years? What will you do differently because of the pandemic, in terms of how you can communicate about the vaccine and COVID, and how you would change your interactions with patients in the exam room?
Yuliya Malayev: So, you know, at the beginning, I just thought, “I have to do everything perfect. I have to do it all myself.” I really just want them to respect me. And now, to be honest with you, I still want them to respect me, but I don’t care if they judge me, because I’m not doing this for me; I’m doing this for them. And when they realize that, that’s when they come around.
I had someone come in recently who was very against it. She was a reproductive-aged person with no actual plans to get pregnant in the near future, but a possibility always. But we broke down her fears. We talked it over. We were mutually respectful to one another. I said, “Teach me why you don’t want to do this. Please explain to me, in your own words, what it is that you believe. Show me where I can read this information so that I can understand how to counsel you and all other people that come after you.”
And what it really came down to with her specifically was that it was her politics. And I said, “OK, but if this is a political problem in the United States, is this a political problem in Germany, in France, in Australia, and every other country in this world?” And then she says, “Well, I guess it can’t really be a conspiracy in every country, because if every country has a conspiracy theorist, then maybe it’s just me.” So then when she came back a few weeks later for her follow-up, she said, “You know, actually, I got vaccinated. Nothing happened to me. My whole family got vaccinated. Nothing happened to any of them.” And I said, “This is wonderful.”
So, you know, I feel like you just have to be open-minded. You have to kind of put away some of your own feelings. I don’t want to resent these patients. I do a little bit, when this is all preventable and I don’t have to work as hard as I’ve been working, but I don’t want to resent them. I just ultimately want them to know that I respect them. I might not agree with them, but I still respect their choices and their autonomy. I always tell them, “I’m not going to your house. I’m not putting you in my car. We’re not driving to CVS to get this shot together. That’d be fun, but we’re not going to do that. I just want you to understand why I think this is important for you and for your family.”
And I just had somebody recently, actually, who told me the saddest thing. She came to see me for a follow-up, and she’s recently widowed. She and her husband had joked that if one of them got vaccinated and something happened and they both got COVID, it would be OK. Well, she’s vaccinated; he’s not. She got COVID, he got COVID, and their four-year-old got COVID. She and the four-year-old are OK, and her husband, you know, he passed away right before Christmas.
Kevin Pho: You mentioned earlier that you’re from Kiev, Ukraine. Tell me some of your thoughts during this war, and how difficult it is for you, both from a family standpoint and as a physician.
Yuliya Malayev: So I’m very lucky. I don’t have any immediate family in Ukraine. All of my family immigrated in the ’90s and afterwards, so at least no one I’m related to is directly in harm’s way. However, my parents lived there for a number of years before we left, and they have a lot of close family and friends who are suffering or trapped or whatever, people they grew up with, so that’s really hard.
And then you see these people who are crowded in these makeshift subway bomb shelters, and my mom says, “Oh my gosh, well, where we lived, the subway wasn’t even underground. So if we were still living there, we wouldn’t even have a bomb shelter. We’d just be screwed in our high-rise.” I was like, “Oh, that’s uplifting. That’ll be really helpful for my nightmares tonight. Awesome.”
So, you know, you hear that, you see that, and then you see all these people. They’re crowded. They’re not thinking about COVID; they’re thinking about where’s the water, where is the food, where is the bathroom. And then you think, what kind of awful infectious disease outbreak are they going to be dealing with? Is it going to be corona? Is it going to be one of the diarrheal illnesses, or one of the other illnesses of people crammed together in unsanitary conditions? And what’s going to be the outcome for that? Then you think, what’s going to be the psychology of these people who are now living through war in an industrialized country that’s very modern and very nice, or was very nice about three weeks ago?
And then you see more senseless and unimaginable loss, like these women being carried out of these maternity hospitals on stretchers, and these babies with makeshift NICUs and ventilators where somebody’s just bagging them, because you don’t know if there’s going to be power. You don’t know if you’re going to be able to save these lives. And then you read these stories of people who had Ukrainian surrogates, and they’re trying to get their babies out of there. You don’t know if that’s going to happen. You don’t know if the stress of all of this is going to cause some other additional poor pregnancy outcomes. And it’s hard, because you can’t help. You’re not going to go into active bombing, or I’m not going to go into active bombing. I’ve got a four-year-old and a two-year-old.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Yuliya Malayev: So never give up. I’m really sorry. That was kind of emotional.
Kevin Pho: Of course. Thank you for sharing.
Yuliya Malayev: So just never give up. Never underestimate the power of the truth and of being persistent. And then also, if people are being, don’t be afraid to kick them out of your practice. They don’t need to stay with you. You don’t need them. You don’t need that stress. I know that’s an awful thing to say, because people need doctors too, and people need doctors that are like them, that are going to understand them. You have to also protect yourself.
Kevin Pho: Yuliya, thank you so much for sharing your time and insight, and thanks again for being on the show.
Yuliya Malayev: Yep, thank you again.
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