Pressing the point

By Sarah Campbell on 24 November 2017 Midwives Magazine Flu Vaccination

Midwives can help mothers understand the benefits and safety of vaccination against pertussis and influenza.

The peak season for flu in the UK falls between November and April, so midwives across the country are now working hard to ensure pregnant women have all the information they need to make informed decisions about the vaccination that can protect them and their babies. Midwives will also be advising women on the vaccination for pertussis (whooping cough), which is a vital part of antenatal care all year round. Pregnant women can safely have both vaccinations at the same time.

Last year at the RCM leadership forum, members discussed the need for midwives to understand more about vaccinations and help pregnant women make more informed choices. As part of this, the RCM and its Alliance partner Emma’s Diary carried out an online survey in June, asking pregnant women and those who had given birth in the past 12 months about their experience of vaccinations. More than 2600 women responded. 

The results showed that their main sources of information on vaccinations were midwives – more so than the internet or friends and family. The survey also threw light on why some women hadn’t had the vaccinations, emphasising the importance of them getting the right information at the right time.

Flu vaccination

Catching flu carries risks. Vaccination helps to reduce these risks. Potential complications include pneumonia, sepsis, meningitis and encephalitis. Compared with the general population, pregnant women have a much higher risk of developing a serious illness as a result of flu (Vaccine Knowledge Project, 2017a).

Between 2009 and 2012, one in 11 of the UK women who died during pregnancy or shortly afterwards died from flu. It is estimated that the vaccine could have prevented more than half of these deaths (MBRRACE-UK, 2014). 

What’s more, babies born to women who have had flu are up to four times more likely to be born prematurely and to have a low birthweight (Vaccine Knowledge Project, 2017a). Flu can even lead to stillbirth or death in the first week of life. The vaccination also protects against this and, as the antibodies are transferred through the placenta, gives the baby some protection against flu for the first few months of life (Vaccine Knowledge Project, 2017a). 

Pertussis vaccination

A nationwide outbreak of pertussis in 2012 led to more than 9300 cases of the highly infectious disease in England alone – more than 10 times the normal number of cases. 

Babies under three months old are most vulnerable to the disease. In 2012, 14 died, and between 2013 and 2016 another 18 died (Vaccine Knowledge Project, 2017b). 

The vaccination can protect babies from pertussis, and women are advised to have the pertussis vaccine during each pregnancy. 


Supporting informed choice

The RCM will be working with Emma’s Diary to develop new resources to boost awareness of vaccinations in pregnancy.
 
Nick Watts, managing director at Emma’s Diary, says: ‘Working with the RCM on the pregnancy vaccination research has been hugely beneficial and insightful. We were able to tap into our engaged audience to better understand pregnant women’s perceptions and the factors that encouraged and discouraged them from taking whooping cough and flu vaccinations during pregnancy. We are using our research findings to help shape resources to support pregnant women in making an informed choice on vaccinations now and in the future.’

Email any suggestions to highlight the importance of vaccinations in pregnancy to [email protected]


What midwives say

One of the most important findings of the survey was that pregnant women said they would like more time to talk about vaccinations with their midwives before making a decision.

Consultant midwives Claire Homeyard, Clara Haken, Fiona Greig and Denise Lightfoot, all experts in public health or antenatal care, talked about their experience of what helps and hinders this process, and what support midwives need to help women make informed choices: 

‘Some services think midwives should take professional responsibility for understanding the information they offer women and don’t have particular competencies for midwives as they don’t administer vaccinations,’ said one. ‘But my service makes sure midwives working in antenatal care have vaccinations as part of their mandatory training. We do refresher on-site updates with staff when the flu season is coming up.’

Another said: ‘We do all we can to offer women a one-stop-shop process and have made vaccinations part of normal antenatal care. When a midwife first sees a woman, vaccination is part of her booking discussion, and also when she’s seen at the appointment with her midwife. Even if she’s on a high-risk pathway and sees an obstetrician, they check what her wishes are and check her consent then. Once she decides she wants the vaccinations, she can have them there and then at the clinic.’

And another said: ‘We felt it was important that a woman has a discussion with her midwife about vaccination as early as possible in her pregnancy. We also found that by reorganising clinics so that women don’t have to make another appointment to get vaccinated elsewhere – it used to be at their GP – the take-up increased from 40% to 68%. We want to get it higher this year!’

One of the consultant midwives said the approach had worked even better when they offered vaccinations when women came for their anomaly scan. ‘MSWs vaccinate women in our clinics after a midwife or obstetrician has had the discussion with the woman and confirms her consent. This works well. We’ve asked women what they feel about it and they like that they get everything done at once. Making a separate appointment is a barrier to having vaccinations.’

All said that having enough time to talk with a woman about the benefits and her concerns was essential but could be hard to do. ‘If there’s a shortage of staff on the ward and the MSW allocated to support vaccinations is taken away from the antenatal clinic, that means there will be a group of women who will have to “roll on” and have their vaccinations next time they’re at antenatal clinic or book an appointment at their GPs. The risk is always that a woman will miss out when that happens because she hasn’t time or it’s not straightforward to get to her GP. We need to make it as easy as possible.’

As one consultant said: ‘Women can think whooping cough is more about protecting the baby and so it’s more worthwhile than the flu vaccination. That’s why it’s so important to have the time to explain that her baby benefits from flu vaccination too. There’s nothing like having a conversation to talk it through.’


References

MBRRACE-UK. (2014) Saving lives, improving mothers’ care: lay summary. See: https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/Saving%20Lives%20Improving%20Mothers%20Care%20report%202014%20Full.pdf (accessed 3 November 2017).

Vaccine Knowledge Project. (2017a) Flu vaccine in pregnancy. See: http://vk.ovg.ox.ac.uk/flu-vaccine-pregnancy(accessed 3 November 2017).

Vaccine Knowledge Project. (2017b) Pertussis (whooping cough) vaccine in pregnancy. See: http://vk.ovg.ox.ac.uk/pertussis-vaccine-in-pregnancy (accessed 3 November 2017).

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