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

Figures & data

Figure 1. Consort diagram summarizing the final dataset creation for analysis

Table 1. Ethnicities of all women delivering at the hospital compared to all women recorded as using the midwife led maternal vaccine clinic

Ethnicity	All Hospital Deliveries April 2017- March 2018	Vaccine Clinic April 2017 – March 2018
Unknown	33%	33.0%
White	25%	28.8%
Black	11%	9.3%
Asian	13%	11.7%
Mixed	2%	2.7%
Other	16%	14.5%
Total Number of Women	3147	1501

Unknown = ‘Not Stated’ & ‘Not known’.

White = White British, White Irish and Other White Background.

Black = Black or Black British African, Caribbean and Any other Black Background.

Asian = Asian or Asian British Indian, Pakistani, Bangladeshi or any other Asian Background and Chinese.

Mixed = Mixed – White and Black Caribbean, Mixed – White and Black African, Mixed – White and Asian, Mixed – Any Other Mixed Background

Other = Any other ethnic group.

Figure 2. Pertussis vaccine receipt by ethnicity April 2017-March 2018

Percentage of women in each ethnic group who received maternal pertussis vaccine from the antenatal clinic April 2017- March 2018. Chi-Square Test of Independence of association between ethnicity and vaccine receipt, p = <0.05. Asian = Asian or Asian British Indian, Pakistani, Bangladeshi or any other Asian Background and Chinese (n = 176) Black = Black or Black British African, Caribbean and Any other Black Background, Mixed – White and Black Caribbean, Mixed – White and Black African. (n = 155).(Note mixed Black ethnicity included within Black ethnicity group) White = White British, White Irish and Other White Background. (n = 432) Mixed = Mixed – White and Asian, Mixed – Any Other Mixed Background (n = 24) Other = Any other ethnic group. (n = 218) Unknown = Other ‘Not Stated’ & Other ‘Not known’. (n = 496) Overall = 1501

Figure 3. Seasonal flu vaccine receipt by ethnicity October 2017-March 2018

Percentage of women in each ethnic group who received seasonal flu vaccine from the clinic October 2017-March 2018. Chi-Square Test of Independence of association between ethnicity and vaccine receipt, p = <0.05.Asian = Asian or Asian British Indian, Pakistani, Bangladeshi or any other Asian Background and Chinese (n = 69)Black = Black or Black British African, Caribbean and Any other Black Background, Mixed – White and Black Caribbean, Mixed – White and Black African. (n = 67)(Note mixed Black ethnicity included within Black ethnicity group)White = White British, White Irish and Other White Background. (n = 208)Mixed = Mixed – White and Asian, Mixed – Any Other Mixed Background (n = 18)Other = Any other ethnic group. (n = 97)Unknown = Other ‘Not Stated’ & Other ‘Not known’. (n = 254)Overall (n = 713)

Table 2. Reasons recorded for women who declined vaccination from the maternal vaccine clinic Oct 2017-March 2018

Reason for declining Vaccines	Number of women	% all women declining
Declined for personal reasons	36	22%
Declined as wants time to consider decision.	32	19%
Declined but no reason given.	28	17%
Declined as does not believe in vaccinations or does not believe in vaccinations in pregnancy.	26	16%
Declined as wanted to defer until after next app or until after scan or after anti-d injection.	8	5%
Declined as wanted more information on the vaccine and whether safe to have vaccine.	6	4%
Deferred today as felt unwell.	6	4%
Declined as family, friends or husband advised not to get vaccines in pregnancy.	4	2%
Declined – as thought they could not have vaccines as (for example ‘had allergies’).	4	2%
Declined due to language barrier	3	2%
Declined flu only.	3	2%
Declined pertussis only due to previous bad reaction to flu vaccine.	3	2%
Declined as would prefer to organize to have at their GP.	2	1%
Declined as scared of needles.	2	1%
Declined as felt unwell.	1	1%
Declined as chargeable overseas visitor.	1	1%
Total	167

Table

‘I could tell that the midwife had a lot of information and if there was anything that she didn’t know, she didn’t mind finding out and that gave me a great deal of reassurance. I had trust in the advice they gave me, reinforced by their competence” (vaccinated participant) ‘I didn’t know about it actually, so, I wasn’t thinking about it when I met the midwife at 14 weeks into my pregnancy. She told me all about it (the vaccine) and she was really excited about telling me. It was good,’ (vaccinated participant) ‘when I first met the midwife, they talked about the vaccine. I was given the materials and they asked me to do it that day. I think maybe I was about 16 or 17 weeks, but I didn’t do it immediately because I didn’t know about it … .i wanted to learn more about it’ (vaccinated participant) ‘I spoke to the midwife again and she explained things more clearly to me and made me feel confident about taking the vaccine.’ (vaccinated participant) “Women would really like to get straight answers from professionals so that they can make a truly informed decision” (vaccinated participant) “The quality of the doctor makes a massive difference. I have been seeing some junior doctors and I have been incredibly disappointed with how little they know and how very unwilling they are to go ‘off script’, for example, if I ask them a question about my previous illness, they just look at me like a damsel in distress and say well we can’t answer the question because we don’t know the side-effects. This has been a rather big factor in my decision not to have the vaccine”. (unvaccinated participant)

Table

“I knew that if I didn’t have the vaccine my baby would be at more risk, so, I felt the risk of the baby actually getting the whooping cough and the impact of that far outweighed any risk from the vaccine”. (vaccinated participant). “vaccines undermine parts of our immune system, so, if you don’t have them you are at less risk of catching infections as the immune system works better”. (unvaccinated participant) “Maybe one factor that would have taken away the fear of having the vaccine … .was when they gave me the leaflet. If they had said ‘here are the statistics … . last year X number of women had the vaccine and X number of women suffered side-effects as a consequence’ then, that sort of information might have encouraged me to take the vaccine … if I knew it was safe. If I had known that there were no real problems then that would have been helpful”. (unvaccinated participant) ‘I am not willing to take ‘the risk’ to do it.’ (unvaccinated participant)

Table

“I remember my mum had whooping cough years ago, it was awful and I know that it can be deadly for little ones, so, I just wouldn’t want to put my baby through that or myself … you know … . It’s like self-preservation and baby preservation … it just makes sense to me to have the vaccine”. (vaccinated participant) “we believe that you have the vaccinations because we have faith in the Public Health System acting in the best interests of the public” (vaccinated participant) “I believe in vaccines anyway as a scientist” (vaccinated participant) “A lot of people just don’t understand what whooping cough is” (vaccinated participant) “I believe very much about the holistic approach to everything”. (unvaccinated participant)

Table

“If the whole system of vaccination and the possible negative effects of vaccination were more transparent and the public were more aware about particular (although rare) results of vaccination then the doctors and the NHS and the drugs companies need to be more responsible with regards to the negative outcomes. The issue of transparency is huge it is creating a certain level of distrust which is having a huge impact on vaccine acceptance”. (unvaccinated participant) “we have faith in the Public Health System acting in the best interests of the public” (vaccinated participant)