The doctor is running late, and five women sit quietly in his waiting room. Four are obviously pregnant. Would anyone mind talking about Zika?

A 23-year-old woman holding her young daughter on her lap rolls her eyes and says there's always a new virus to worry about.

Across from her sits a woman in her 40s. Pulling a bottle of bug spray out of her purse, she mists her arm. "It's hard to avoid mosquito bites in south Florida or wear long sleeves when it's this hot." Looking exasperated, she says this will be her third and last baby.

Dr. Aaron Elkin arrives from an emergency delivery and starts seeing patients right away. He talks fast and walks even faster.

His patient Taylor Wiest is in her third trimester. "All right, let's listen to the baby," says the doctor. One move of the Doppler wand creates a loud whooshing and then what sounds like a galloping horse. The baby has a strong heartbeat, the doctor says.

The baby responds with a little kick, much to mom's delight. Now it's time to talk Zika.

Severe birth defect

Zika infections in pregnant women have been shown to cause microcephaly, a severe birth defect in which the head and brain are undersized, as well as other brain abnormalities. The connection between Zika and microcephaly came to light last autumn in Brazil, which has since confirmed more than 1,800 cases of microcephaly.



In adults, Zika infections have also been linked to a rare neurological syndrome known as Guillain-Barre, as well as other neurological disorders.

Elkin peppers the women with information and questions. Have you or your partner travelled to Zika-affected areas such as Miami's Wynwood neighbourhood? Experienced any rash, fever, redness in the eyes? Are you using bug spray and a condom? Would you like to do a Zika test?

Dr. Aaron Elkin talks to Unique Robinson about Zika risks in pregnancy. (CBC)

"Probably 100 per cent of the patients that we see are all getting bitten by mosquitoes. One mosquito can change everything, one mosquito bite can change everything," he says.

You can feel Lauren Book's excitement and fear about being pregnant.

After two years of trying to conceive, she and her husband tried in vitro fertilization. Book is now 13 weeks pregnant with twins.

"Being pregnant is scary. Being pregnant with one is scary. But then all of these other things that you have absolutely no control over is really terrifying," she said.

Haunting images

Images of babies born with small heads, brain damage and life-altering disabilities haunt Book.

"You cover yourself in DEET, and you wear mosquito bands, and you get your house sprayed and yet that's still not a for-sure thing."

The World Health Organization has said the response to the Zika outbreak has been hurt by a severe lack of research.

'What's next?'

Women in Miami, including Amanda George, are figuring that out. Now in her third trimester, she was reluctant to return to Miami following a summer trip to Philadelphia.

"When the news first came out, they didn't think it could affect you throughout the pregnancy. Now they say it can. What's next?" she asks.

It's almost like the recommendations we're writing now are in pencil, so we have to change them in a month or we change them again in a month. — Dr. Aaron Elkin

Initially, doctors thought women infected early in pregnancy were at greatest risk. They now say the virus can harm babies in the second and third trimester. Babies can also contract the virus after they're born, by being bitten by a mosquito.

In his over 30 years of practice, Elkin says, he's never seen a virus like Zika. "I think we're learning with patients now. It's almost like the recommendations we're writing now are in pencil, so we have to change them in a month or we change them again in a month."

Johanna Mikkola, who lived in Miami for part of her pregnancy, says there is still a lot of uncertainty about how the Zika virus may affect women like her. (CBC) What's more, new research in mice suggests certain adult brain cells may also be vulnerable to the damaging effects of Zika. Scientists still aren`t sure how long the virus survives in the body.

Couples were told to wait six weeks before trying to have a baby after travelling to a Zika-affected area. The recommendation is now six months. A case in Utah has health providers worrying how Zika virus may be passed on through bodily fluids such as tears and urine, as well as semen.

In Florida, Zika testing is available. So far, more than 80 pregnant women have tested positive. Thousands of others must wait up to six weeks for results. Book says women need this information to make life-altering decisions such as whether to have an abortion.

'Really devastating choices'

"It's too late in the pregnancy. You have to make really devastating choices. As a first-time mom, I couldn't imagine what it's like."

Book's test comes back negative. She's relieved, but she knows there are many more tests to come. She's not planning to move farther away from Miami, but others have.

"You don't ever think it's going to affect you ever so closely," says Johanna Mikkola. She's 35 weeks pregnant. Originally from Toronto, she and her husband run a business in what's now a Miami Zika danger zone.

"I'm not even living in Miami anymore, I barely go outside, I do all my Zika checks, it's a bit surreal." Mikkola is now staying with relatives 50 kilometres north in Fort Lauderdale.

Elkin insists the risk of contracting Zika and having a baby with microcephaly is low. But there is a risk.

At the end of every visit he tells expectant mothers, "Fear isn't going to change anything. The most important thing you can do is protect yourself."