PREGNANT — AND WORRIED
South Florida’s Zika scare has expectant mothers and their caregivers on edge
Giving birth is stressful enough. Having a baby in South Florida, the nation’s Zika ground zero, at a time when so much remains unknown about the virus and the news changes daily? “I have to admit, I have had my freak-out moments. I have called my husband crying,” said Annemarie Johnston, 28, a Tamarac resident who is 10 weeks’ pregnant with her first child. “I feel like I am a bad mom sometimes. What am I getting my child into?” Moms-to-be and their partners have a lot more options to weigh these days than what to name the baby or what color to paint the nursery. Should they get tested for Zika, a mosquito-virus that can cause fetal abnormalities? Move out of state until delivery? Wear repellent with DEET, when women have been told for decades to avoid the insecticide during pregnancy? Stop having sex, as Zika can be sexually transmitted — and 80 percent of those infected don’t knowthey are a carrier because they have no symptoms? “Of all times, there is a health issue affecting unborn children and it’s right inmy backyard,” said Marielle Kunhardt, 32, a communications executive who lives in Fort Lauderdale and is due in November. As of Friday, 75 pregnant women in Florida have tested positive for the virus. State health officials will not say where they live. There are 529 pregnant women among the more than 2,500 confirmed Zika cases
nationwide.
This month, officials with the federal Centers for Disease Control and Prevention have issued advisories recommending pregnant women and their partners not travel to two areas with the only confirmed active Zika transmission in the country: a 1-square mile area north of downtown Miami that includes the trendy Wynwood neighborhood, and a slightly larger area in south Miami Beach.
On Aug. 19, the CDC raised the stakes by suggesting expectant couples “consider” not traveling anywhere in MiamiCounty.
That news is particularly alarming to Johnston, a teacher at a private school just outside Wynwood. She thought about taking a leave of absence but gained confidence when her boss was extra supportive.
The school arranged Johnston’s schedule and gave her a new parking spot so that she will spend as little time outside as possible. Her supervisor also bought Johnston indoor bug zappers and fumigated her classroom.
“I have to stay protected to keep myself safe,” Johnston said. “I cover myself with DEET every single day.”
The CDC is continually updating its pregnancy guidelines as scientists learn more and advise pregnant women to consult their doctors about Zika. Yet often, physicians can say only: We’re not sure.
“There are a lot of unknowns. I give them the facts that we know and let them decide,” said Dr. Rachel Bernstein, a obstetrician-gynecologist at Holy Cross Hospital in Fort Lauderdale who is Kunhardt’s doctor. She said she receives Zika updates from the CDC and her medical specialty association almost daily.
Things haven’t gotten any easier since state health officials announced the first locally transmitted cases of the virus, which can cause fetal birth defects if the mother is infected, on July 29.
Hoping to ease fears, Gov. Rick Scott on Aug. 3 authorized free Zika screenings at county health departments for all Florida pregnant women. Previously, expectant mothers struggled to get tests authorized unless they were showing symptoms — which few people with Zika do — or they or their partners had traveled to countries with Zika outbreaks.
The Florida Department of Health has screened 1,118 pregnant women at no cost since free testing was started, said spokeswoman Mara Gambineri. Either a viral test, which would determine if the virus is active in the bloodstream, or an antibody test, which can tell if someone ever has been exposed to Zika, are used
depending on what’s appropriate for the patient, Gambineri said.
Wait time for results is about two weeks, she said. “The county health departments are keeping up with the demand and we are in constant communication with them should we need to provide additional personnel,” Gambineri said.
Both Kunhardt and Johnston opted to be tested. Kunhardt, who went in about a week ago, is still waiting for results. Johnston, whose doctor had encouraged her to be tested because she works so close to Wynwood, got a call from the health department Thursday: Her test was negative.
Johnston, who still has seven months until delivery, was worried she couldn’t be tested again. Gambineri, however, said there is no limit on the number of tests a person can receive.
The spectre of Zika-induced microcephaly — where babies are born with abnormally small heads and often have severe brain damage or developmental problems — drives many women to be tested. The CDC also recommends additional ultrasounds, which can detect the disorder in the womb, for women with Zika symptoms or risky travel history.
News photos of severely deformed, sobbing microcephalic infants in Brazil, where there have been thousands of cases possibly tied to Zika, are etched in the minds of pregnant women worldwide. Kunhardt remembers seeing such pictures in February, shortly before discovering shewas pregnant.
“At that point, I figured it was isolated in the forests of Brazil and in poor countries,” she said. A month later, a pregnant friend out of state told Kunhardt she didn’t want to come visit during mosquito season because of Zika.
Researchers have estimated an infected pregnant woman has a 1 percent to 13 percent chance of giving birth to a microcephalic child. And evidence is emerging that the virus also may cause other initially hidden prenatal central nervous deformities, such as vision problems.
Although Kunhardt is comforted that fetal problems
due to Zika usually occur in the first and early second trimesters, she wonders if she’ll always worry as her child grows older.
“Even if my baby comes out normal, what about 10 years down the road? What concerns me is the virus is so new, there are no studies out there about the longterm affects,” Kunhardt said.
Three babies in the U.S. have been born with microcephaly due to Zika, according to federal statistics. One was an infected pregnant woman who came to Broward County from Haiti in May, and gave birth a month later to the first microcephalic Zika baby in Florida.
Dr. Adolfo Gonzalez-Garcia, who practices maternal and fetal medicine at Broward Health Medical Center, was the Haitian mother’s physician. She is no longer his patient but he said he has heard the infant is “not doing well.”
Like Bernstein and other obstetricians, Gonzalez-Garcia does his best to reassure his patients while urging them to stay safe. He goes over the CDC guidelines that advise expectant couples not to travel to areas with Zika outbreaks, to in some cases abstain from sex or use protection during the length of the pregnancy, to always wear repellent and stay indoors as much as possible.
“I thinkwhat’s important to convey is to keep calm,” Gonzalez- Garcia said. “This is not Brazil. Our health department is set up to control this kind of thing.”
Still, he agrees that Zika probably will permanently change the way obstetricians practice medicine. “I think that we will get to the point that we automatically order Zika tests, the way we do for syphilis or HIV,” he said.
In the meantime, many moms-to-be are taking control of their baby’s future. Terri Brevda, a registered nurse and perinatal educator with the Memorial Healthcare System, which has 5,000 births annually, saids ome of her patients are mall-walking instead of going outdoors.
“A lot of them come up with clever alternatives,” Brevda said.
Kunhardt now exercises
on her parents’ treadmill that they moved into her house. Others are staying with family members in other states until they deliver.
Lisa Raynor, a Coral Springs doula who coaches women from pregnancy through childbirth and postpartum care, recently worked with a pregnant Brazilian woman who had moved to Broward to escape Zika in her country. Many of Raynor’s clients also have canceled their “babymoons,” a honeymoon-trip couples take late in pregnancy to celebrate their final childless months together.
“Life certainly has changed a lot for me,” said Sasha Shulman, 36, a former prosecutor with the Broward County State Attorney’s Office who opened her own law firm in January. Two weeks later, she discovered she was pregnant.
Now she carries bug spray with her everywhere, including into the Broward County courthouse. “When I went through security, I told them I had my Zika protection inmy purse,” she said.
Shulman, however, is like many pregnant women here — discouraged by the lack of information as they juggle their jobs, their worries and the natural stress of pregnancy. They also wish that the public would realize that Zika is a threat to everyone, not just couples having a child, and that anyone can spread the virus if they don’t take precautions.
“My biggest frustration is ... that we keep getting handed the same pamphlets. The information hasn’t changed,” said Ted Kunhardt, 31, Marielle Kunhardt’s husband. “When are we going to see a vaccine?”
He hopes that Zika will end up like polio — a rampant disease that terrified and devastated young parents 60 years ago but today has vanished.
Ted Kunhardt said he imagines telling his child one day: “‘We were scared and just stayed inside until you were born. Your mom walked on a treadmill.’ Hopefully, I can say to my child that Zika doesn’t even exist any more.”