“Ultimately, the choice is theirs”: Informed choice vaccine conversations and Canadian midwives

Abstract

Background In Canada, vaccination that protects against pertussis and influenza is recommended in every pregnancy, but uptake remains low. Communicating the risks and benefits of vaccination is key to clinical conversations about vaccination, which may influence the uptake of pregnancy and subsequent infant vaccines. Canadian midwives use an informed choice model of care, which is distinct from informed consent and prioritizes client autonomy in decision‐making. Methods Using institutional ethnography, which treats lived experience as expertise, we aimed to understand how Canadian midwives, governed by intersecting professional standards and regulations, navigate vaccine discussions with their clients. We conducted interviews with individuals involved in midwifery training, regulation, and continuing education, as well as key public health professionals with expertise in immunization training. Following the phases of thematic analysis outlined by Braun and Clarke, data were analyzed holistically, emergent themes identified, and coding categories developed. Results Two types of confidence emerged as important to midwives' ability to conduct a thoroughly informed choice discussion about vaccines: confidence in vaccination itself (vaccine confidence), and confidence in vaccine knowledge and counseling skills (vaccine counseling confidence). A deferred or shortened vaccine discussion could be the result of either vaccine hesitancy or counseling hesitancy. Discussion Currently, available clinical communication tools and recommended techniques for addressing vaccine hesitancy do not always adapt well to the needs of midwives working to support clients' informed choice decisions. Our findings suggest that Canadian midwives require more and clearer resources on both the risks and benefits of vaccination in pregnancy.

Determinants of non-vaccination against seasonal influenza during pregnancy

“…Nevertheless, since midwives not addressing clients’ vaccine concerns might represent a missed opportunity to positively influence those views, it is vital to provide midwives with the knowledge and resources they need to offer a fully informed choice about vaccines. According to Pringle et al ( 2022 ), successful informed choice discussions involve clients gaining full knowledge of vaccination interventions and making decisions, regardless of whether they follow the midwife’s recommendation. However, the same study describes that Canadian midwives often face challenges due to limited confidence in vaccine knowledge and counselling skills, highlighting the need for additional support tailored to the midwifery model of care.…”