Evaluation of a midwife-led, hospital based vaccination service for pregnant women

Abstract

Background: Vaccines against whooping cough (pertussis) and seasonal-influenza are recommended for pregnant women in England. Uptake however varies regionally and by ethnicity. Pregnant women are traditionally vaccinated in primary care, though some hospitals now offer vaccines through antenatal clinics. This mixed-methods evaluation describes the demographic characteristics of women seen in a hospital midwife-led antenatal vaccine clinic and explores vaccine decision making. Methods: Descriptive statistics of women seen in a London hospital's midwife-led vaccine clinic were generated from electronic routine maternity records, including data on ethnicity, parity, age and deprivation indices. Reasons for vaccine decline given by women to midwives were categorized by themes. Qualitative interviews of women seen in the clinic were also undertaken. Results: Between 1st April 2017 and 31st March 2018 the vaccine clinic saw 1501 pregnant women. Of these, 83% received pertussis vaccine and (during flu season) 51% received influenza vaccine, from the clinic. Fewer Black Afro-Caribbean women seen by the clinic were vaccinated, compared to other ethnicities with only 68% receiving pertussis and 34% flu vaccines respectively (p < .05). Among all women delivering at the hospital over the year, 42%, (1334/3147) were vaccinated by the clinic. Qualitative interviews found that reassurance from healthcare professionals, particularly midwives, was the most important factor influencing maternal vaccine decisions. Conclusions: Midwife-led hospital clinics can offer an effective alternative to primary care provision for vaccines in pregnancy. Consistent with previous work, vaccine uptake varied by ethnicity. Midwives play a key role in the provision of vaccine services and influence women's vaccine decisions.

Women’s views on accepting COVID-19 vaccination during and after pregnancy, and for their babies: A multi-methods study in the UK

“…For example, initial analysis of the UK's COVID-19 vaccine program for adults aged over 80 years found lower uptake among Black Afro-Caribbean ethnicities (17). We have previously shown that acceptance of pertussis and influenza vaccines in pregnancy is also lower in this group (18,19).…”

“…Of the 1,181 respondents to the COVID-19 vaccine acceptance question in the survey, 19.7% (n=233) of respondents left a response in the subsequent free-text box. The number of responses to each theme by survey respondent is shown in Table 2 including how often themes were mentioned by the women surveyed.…”

“…Routine vaccination in pregnancy is now established worldwide with pregnant women in the United Kingdom offered vaccination against pertussis and seasonal influenza and there are more vaccines on the horizon (31). Uptake of existing maternal vaccines can be affected by both access and vaccine confidence (32) and in the UK women living in poorer areas or belonging to a minority ethnicity group are less likely to be vaccinated in pregnancy (19,33,34). This is mirrored in uptake of childhood vaccines in the UK, with children also living in poorer areas or belonging to a minority ethnicity group being less likely to receive their routine vaccinations (33,35,36).…”

“…Here we present one aspect of the survey, specifically regarding the acceptability of a 'future' COVID-19 vaccination. The COVID-19 vaccine section asked respondents: 'Please select how much you agree or disagree with the following statements about a future vaccine to protect against COVID-19: i) If a vaccine against coronavirus (COVID- 19) becomes available, I would get vaccinated whilst pregnant, ii) If a vaccine against coronavirus (COVID-19) becomes available, I would get vaccinated whilst not pregnant and iii) If a vaccine against coronavirus (COVID-19) becomes available, I would vaccinate my baby.' Responses were scored on a Likert scale: 'Yes definitely', 'Unsure but leaning towards yes', 'Unsure but leaning towards no', 'No, definitely not'.…”

Women’s views and experiences of accessing vaccination in pregnancy during the COVID-19 pandemic: A multi-methods study in the United Kingdom

“…Traditionally, vaccinations are delivered in primary care via general practices (GPs) in the UK; however some hospital-based antenatal clinics also offer vaccines to pregnant women (15). During the first national lockdown the public were advised to ‘stay at home’ and avoid attending healthcare settings unless necessary.…”