Hawaii doctors are urging pregnant women to get vaccinated against COVID-19 to protect themselves and their babies from the coronavirus.

“We’re just pleading with everybody that’s pregnant — please, please get vaccinated,” said Dr. Keith Ogasawara, a veteran obstetrician-gynecologist at Kaiser Permanente Hawaii. “The vaccine is safe, and everybody is strongly encouraging pregnant women, breastfeeding moms and women thinking about getting pregnant to get vaccinated to protect themselves and their kids.”

Although daily average case counts in Hawaii are declining, COVID-19 still poses a great risk for those in this demographic.

Women who are pregnant and recently pregnant are at an increased risk for severe illness from COVID-19, according to the Centers for Disease Control and Prevention. Additionally, pregnant women who contract the virus are at increased risk for preterm birth and other adverse pregnancy outcomes, including stillbirth.

The CDC recently issued an urgent health advisory on the need to increase vaccination rates among pregnant and recently pregnant women, saying the benefits outweigh known or potential risks. Further, doctors advise that pregnant women qualify for, and should receive, a booster COVID-19 shot if it’s at least six months since they became fully vaccinated.

As of Monday, more than 128,000 lab-confirmed COVID cases have been reported among pregnant women nationwide, CDC said, including more than 22,000 that required hospitalization, and 180 deaths. About 97% of the hospitalized patients were unvaccinated.

“When you look at the data,” Ogasawara said, “COVID has now become the leading cause of maternal death in the U.S. this year.” Some long-standing risks, such postpartum hemorrhaging or preeclampsia, are now overshadowed by those tied to contracting COVID-19, he said.

To date, two maternal deaths due to COVID-19 have been confirmed in Hawaii during September, according to the Hawaii State Maternal Mortality Review Committee. In both cases, the women contracted the disease while pregnant and died after giving birth to babies that survived.

What’s significant, said Dr. Stacy Tsai, chair of the state Maternal Mortality Review Committee, is that such maternal deaths are preventable. In a written statement Tsai said young women who are vaccinated have a lower chance of dying from COVID. She added, “We also know pregnancy increases risk of worsening COVID disease, ICU admission, being on a ventilator, and death.”’

During the recent delta variant surge hospitals reported an uptick in pregnant women hospitalized with COVID requiring intensive care, and delivering prematurely. Even so, national vaccination rates for pregnant women remain low. Only about 33% of women ages 18 to 49 who are pregnant in the U.S. have been vaccinated, according to statistics released in early October — a slight increase from about 25% in August.

The Hawaii Department of Health said it does not have a breakdown of how many COVID cases involve pregnancy, or the percentage of vaccinated pregnant women.

In August, the CDC shared new data showing COVID-19 vaccines to be safe during pregnancy, citing an analysis that found no increased risk of miscarriage among nearly 2,500 pregnant women who had received an mRNA COVID-19 vaccine before 20 weeks of pregnancy.

Also in August, the state Health Department issued a Facebook message advising: “We recommend all people who are pregnant, breastfeeding or thinking about becoming pregnant get vaccinated against COVID-19. Protect your child and yourself by getting vaccinated. Increased risk of severe illness and pregnancy complications related to COVID-19 infection make vaccination more urgent than ever.”

Ogasawara said obstetricians having one-on-one conversations with patients are finding many hesitant about getting vaccinated. “We ask them what their hesitancy is and we try to redirect them to reliable information,” he said, noting there’s a lot of misinformation that spreads rapidly on social media.

Among the misinformation heath officials are rebutting are rumors that vaccines cause infertility, that the mRNA vaccine may affect someone’s DNA and that there is a risk of contracting COVID from the vaccine itself. Ogasawara pointed out that while the body mounts an immune response to the vaccine, which can result in side effects such as low-grade fever and fatigue, this is not due to having contracted COVID.

Also recommending COVID-19 vaccine shots for pregnant women are the American College of Obstetricians and Gynecologists and the Society for Maternal-­Fetal Medicine.

The PATH Clinic — a women’s health clinic run by the nonprofit Waikiki Health Center — is also pursuing one-on-one conversations with patients, according to clinic director Jacque Tellei. Due to current COVID protocols, patients are asked whether they’re vaccinated, which is where the conversation starts. Tellei said initially, many patients harbored vaccine hesitancy in part because they were afraid of unknowns.

Tellei said she shares her own stories, including her own experience as a mother getting vaccinated as well as the experiences of colleagues, and examples of how COVID-19 has affected the community as a whole in Hawaii. She also points them to pertinent CDC guidance. With an emphasis placed on sharing with compassion and empathy, Tellei said, the clinic in Kaimuki offers a home-like setting for conversations.

To assist those in need of transportation to get a shot, PATH has offered cab rides. Also, as an incentive, the clinic recently began offering a $50 Target gift card to patients who get vaccinated. “At the end of the day it is their choice,” Tellei said. “Our role is to provide correct information and then help them filter through what they’re hearing, and what makes sense. Then they make their choice.”

Papa Ola Lokahi, a nonprofit, held a webinar last month with local obstetricians Dr. Reni Soon and Dr. Ronnie Texeira about vaccination, with recommending that pregnant women get vaccinated against COVID-19.

Soon said over the summer she saw more pregnant women on ventilators than in the total of her 20 years of practicing. Texeira, who recently gave birth, shared that she herself had gotten the vaccine at 16 weeks of pregnancy, and based on studies, felt confident in its safety.

On Tuesday, the number of new coronavirus cases reported in Hawaii fell to 49 for the first time since early July. The seven-day average of daily cases statewide was at 162 and the average positivity rate was 2.7%, according to the Department of Health’s dashboard. No new fatalities were reported. Nearly 70% of Hawaii’s population — 69.6% — is fully COVID-19 vaccinated.

Still, Ogasawara said it’s important for pregnant women to get vaccinated and remain vigilant of the ongoing COVID-19 threat. “If a mom dies from COVID it was a potentially preventable death, which is tragic,” he said. “The untold story is a kid that’s going to grow up without a mother. It’s multiple tragedies.”