Midwives' perceptions and experiences of recommending and delivering vaccinations to pregnant women following the Covid-19 pandemic: a qualitative study

Background: Pregnant women and their unborn babies are at an increased risk of hospitalisation, morbidity, and mortality from illness. However, uptake of influenza, pertussis and Covid-19 vaccinations offered during pregnancy is below the desired rate. This research aims to explore UK midwives' experiences of approaching and discussing vaccinations with pregnant women, and their perceived role in pregnant women's vaccination decisions.

Methods: Midwives in the West Midlands, UK were recruited via participating hospitals and midwife specific social media groups. Interviews were conducted remotely from April to July 2023 and analysed with a deductive codebook coding strategy using thematic analysis.

Findings: Semi-structured interviews were conducted with 16 midwives identifying the following key themes: Recommendations to have vaccinations reported on the contents of recommendations and how they are communicated; Messages and guidance included the importance of up-to-date informational needs for midwives to administer vaccinations and the barriers caused by uncertainty and conflicting messages about the Covid-19 vaccine during pregnancy; Delivery of vaccinations included the convenience of offering vaccinations during standard antenatal appointments; and Midwives' barriers explored the pandemic specific and other barriers midwives face in the administering of vaccinations.

Discussion: These findings contribute to the understanding of how midwives discuss the topic of vaccinations with pregnant women. This research highlights the importance for midwives to receive clear and consistent information. A strong emphasis on why vaccines are important when recommending to pregnant women in addition to standard information on the availability and timing may have a bearing in helping women to make informed decisions about accepting vaccinations.