Pregnant women try to do the best for their baby’s health and development, yet, when something is new – such as Covid-19 vaccinations – it can be hard to make decisions for yourself, let alone for your unborn child. In this time of rapidly changing public health announcements, it’s not surprising that some pregnant women are hesitant when it comes to Covid-19 vaccinations.
The negative consequences of not getting vaccinated were starkly displayed in recent figures from England, showing that one in six critically ill patients are unvaccinated pregnant women with Covid. Of the 20 women requiring high-level and invasive intensive care treatment, 19 were unvaccinated and one had received one dose.
This is an urgent reminder of the advice that pregnant women should get vaccinated. And it’s not just an overseas problem; pregnant women with Covid are also in intensive care in Melbourne. Our city may be looking forward to emerging from the world’s longest lockdown but those of us in the healthcare system are bracing for a flood of seriously ill patients, sadly, including pregnant women.
After more than 30 years as an obstetrician, this pandemic has made me reassess how I explain what I believe is the best care for those who trust me to safely see them though their pregnancy. Usually known for my no-nonsense attitude and forthright opinions, I have altered my approach to spend the time needed to understand my patients’ fears, unpack the information they’re bringing to their appointment and respect their opinions.
As an obstetrician, I’ve observed that women rightly question what they see as unnecessary medical intervention in a supposed natural process. From both professional and personal experience, however, I also know that, though the evolutionary concept of “nature knows best” might work for the species, it can be cruel to the individual. Women are often told to “make up their own minds” about medical advice but that’s hard to do when the memory of the thalidomide tragedy and the false claims of vaccinations causing autism can understandably lead to a mistrust of anything that seems too new.
As a mother, I understand how emotion, personal preference and the desire to assume an uncomplicated outcome will influence the taking of advice. Even now my sons are adults, it wasn’t easy to weigh up the risks posed to them being in the known risk group for heart side-effects versus those of contracting Covid. I momentarily wondered how I would feel if one of them became seriously unwell from a rare vaccine complication after I had pushed them to get the jab. Weighing this against the alternative that if they did get a Covid infection, it would most likely only be a minor inconvenience, we discussed it together and decided the benefit to the community overrode the slight personal risk.
These pandemic times have been characterised by developing science and rapidly changing advice. A simple statement by a doctor or midwife about an ideal course of action is no longer enough, particularly when this advice is counteracted by lay opinions among friends, family and espoused through traditional and social media.
The dissemination of information through social media has been one of the biggest changes I’ve witnessed during my medical career. This can be beneficial but, unfortunately, the size of an influencer’s following is sometimes seen as the equivalent of scientific peer review.
This has combined with an endless volume of ever-changing official recommendations that, at times, are interpreted to suit political purposes to create an environment of suspicion of officialdom and allows popular opinions to be seen as valid alternatives.
I am seeing far more nuance to pregnant women’s decisions about Covid vaccination than a simplistic case of pro- versus anti-vaccination. In fact, many women begin a discussion with the opening statement: “I’m not an anti-vaxxer but …” Many of these women are happy to have influenza and whooping cough vaccines but are unsure about those for Covid.
I have been spending time in appointments suggesting alternative sources of information, offering to continue the discussion in an open way, and emphasising it is ultimately the individual’s decision.
This approach seems to be working. My colleagues and I are noticing that, despite being available and open to discussions about Covid vaccinations, we’re now seeing more women proudly announcing they’ve had their first and, increasingly, their second jabs.
The balance of risk versus benefit is swinging in favour of reason and I am happy to report that most pregnant women I’m seeing across public and private practices are now rolling up their sleeves to protect themselves, their babies and the community.