Getting the flu is miserable for most people, but if you’re pregnant it can be dangerous.

The number of pregnant women who choose to get the flu vaccine is on the rise, with about 52 percent opting in during the 2013-14 flu season, according to the Centers for Disease Control and Prevention (CDC). Yet since this year’s vaccine shot is only 23 percent effective against the dominant viruses in circulation, you may not be protected.

Whether you receive the shot or not, the truth is that all pregnant moms are at risk.

Even doctors.

Take Dr. Tanya Altmann, a pediatrician in Los Angeles.

Pregnant with her third child, Altmann started to feel like she was coming down with a cold. It was New Year’s Day, just last month, and she was due to give birth at any time.

It didn’t make sense, especially since she makes a habit of washing her hands, avoids touching her face, and gets the flu vaccine every year.

“I rarely get sick because I think I know all the right things to do,” she said.

Yet within two days, her symptoms intensified.

“I was lying in bed feeling horrible. Everything hurt, even my teeth,” she said.

Altmann remembered she had been treating siblings— a toddler and a 5-month-old—both with the flu just a few days earlier that week. So on Monday, she returned to her office and a quick swab test confirmed her suspicions.

She not only worried that the flu could harm her baby, but that she would still be sick when he was born. She feared having to be separated from him or not being able to nurse him.

Altmann’s doctor prescribed bed rest, plenty of fluids and acetaminophen for the pain.  She also took Tamiflu and had her entire family take it as well to prevent getting sick.

Her lungs stayed clear and her doctor monitored her baby’s heartbeat, oxygen levels and movement. Five days after she recovered, her baby was born healthy.

Flu and pregnancy: a dangerous combination
Since your immune system is weaker during pregnancy, you’re more susceptible to— and affected more seriously by— the flu, said Dr. Alane Park, an OB/GYN at Good Samaritan Hospital in Los Angeles. Since your heart and lungs are working harder, it can also put stress on your body which makes you vulnerable to the virus.

The flu increases your chances for miscarriage, particularly in the first trimester, as well as preterm labor and premature birth. During pregnancy and up to two weeks postpartum, there’s also an increased risk for hospitalization and even death.

It’s not necessarily just the flu itself that can affect pregnant women– it’s what the flu has the potential to cause that is problematic.

For example, if a pregnant mother is having trouble breathing she won’t have enough oxygen for her baby, which could lead to birth defects and brain damage. Doctors can actually see that the baby is not getting enough oxygen by watching his movements on an ultrasound.

“All the complications that it causes the mom… in turn then affect the pregnancy and the baby,” Park said.

How to prevent the flu
The good news is that there are several ways to prevent the flu so you can stay healthy through your pregnancy. Here are nine.

1. Get the flu vaccine.
Even if this season’s flu vaccine is not 100 percent effective, it’s still better than nothing and you may even have milder symptoms if you do get sick, Altmann said.

The antibodies you make from the vaccine are also passed onto your baby, protecting him until he’s six months old, at which point he can receive the vaccine himself. In fact, according to a study in the journal Clinical Infectious Disease, the flu vaccine during pregnancy was 92 percent effective at preventing infants from being hospitalized. Those same antibodies are also passed through breast milk.

2. Wash your hands.
Be sure to wash your hands frequently to avoid picking up the virus. Use warm water and soap, scrub the front and back of your hands, in between your fingers and under your fingernails for at least 20 seconds. When soap and water isn’t available, use an alcohol-based hand sanitizer.

3. Don’t touch your face.
The flu virus can easily spread into the mouth, nose and eyes so do your best to keep your hands away until you’ve washed them.

4. Kill the germs.
Disinfect all surfaces you frequently touch at home and work, especially if someone has been sick.

5. Eat healthy.
Plenty of fruits and vegetables, ideally five to nine servings a day, will give you  the antioxidants to help strengthen your immune system.

6. Avoid crowds.
You might want to re-think that baby expo because coming into close contact with other people can increase your chances of catching the flu. If you’ll be traveling, wash your hands frequently and wipe down all surfaces on the plane with disinfectant wipes.

7. Consider supplements.
Vitamin C, D3, and other supplements may help you to fend off the flu. Be sure to talk with your doctor first about which ones are safe during pregnancy.

8. Rest and relax.
You’re probably a restless sleeper these days, but make it a point to get enough rest because it can strengthen your immunity. Also, activities that reduce stress like a prenatal yoga class, meditation, a day at the spa, and sex can help too.

9. Get checked.
If you have a high, persistent fever, call your physician immediately. The swab test for the flu will give you results fast but it isn’t 100 percent accurate. Nevertheless, your physician may prescribe Tamiflu anyway.

“It can’t hurt and it may help you get better sooner and decrease complications,” Altmann said.