Midwives

• Immunisation is an important public health strategy
• Information sharing, informed choice and consent are paramount during discussions with women about immunisation and prior to the administration of vaccines.
• Midwives as the main providers of maternity care are well placed to provide immunisation information to pregnant people and whānau during pregnancy and the postnatal period. 
• This includes the vaccines that are recommended during pregnancy, newborn immunisations and the national immunisation schedule.

Providing information, prescribing and administering specific vaccinations are within the midwifery scope of practice. 

To pregnant people

• Boostrix (Tdap)
• Influenza
• COVID-19 (as part of the Pandemic response – Midwives are able to offer COVID-19 vaccine to non-pregnant person.

Postnatal

• MMR
• Boostrix (Tdap)

Neonate

• Hepatitis B (alongside HBIG)
• National immunisation schedule vaccines to neo-nates
• Immunisation for the low birth weight and/or preterm infant

However, most midwives are not resourced to provide a full vaccination service, which requires adherence to standards for cold chain management, monitoring and appropriate support and equipment to treat anaphylaxis. 

Midwives may choose to provide vaccination as part of their maternity care/service. Support, information, and updates are available from Regional and Local Advisors.

The Immunisation Advisory Centre (IMAC) has an online immunisation course tailored specifically for midwives. It provides midwives with immunisation knowledge relevant to their practice including the National Immunisation Schedule changes, vaccine composition, safety of vaccines in pregnancy, administration of vaccines and talking with parents about vaccines.  

The course is approved as continuing midwifery education by the Midwifery Council.

The Midwife Vaccinator Course (online) is available here.

All adult vaccines are usually administered into the deltoid and neo-nates in the vastus lateralis.

For guidance on appropriate site and needle selection, see Chapter 2 of the Immunisation Handbook (Processes for safe immunisation).

Midwives Immunisation toolkit

Checklist pre-vaccination

Pre-vaccination screening tool

Recommended and funded vaccines during pregnancy (factsheet)

Vaccine and vaccine administration factsheets

COVID-19 vaccines during pregnancy and breastfeeding

Influenza and pregnancy

Vaccines are delicate biological substances and to maintain potency, must be stored in a temperature-controlled situation. The cold chain is the process that ensures vaccines are continuously stored at the required temperature between +2°C to +8°C. If exposed to temperatures above or below, vaccines may be damaged and may not provide the expected level of protection.

Maintenance of cold chain is required at all times, including while vaccines are stored in chilly bins for transport and during off-site vaccination clinics. Click here for more information.

Contact your local immunisation coordinator for support and guidance. 

• All vaccinators must be able to recognise and treat anaphylaxis. This includes having the appropriate training and equipment to handwhich will usually already be readily available to midwives. All vaccinators must maintain their current resuscitation certification, typically, this is required at least every two years.
• All vaccinators need to have a minimum of two people present, one of whom must be an approved vaccinator e.g. midwife; the other must be a competent adult who is able to call for emergency support and has a basic life support certificate.

For more information and list of minimum staff and emergency equipment requirements, see the Immunisation Handbook Appendix 4 

Resource: IMAC Management of Anaphylaxis

‍

Pregnant people need to be provided with recommendations for pregnancy. Vaccination during pregnancy stimulates the immune system to make antibodies, which will protect both the pregnant person and cross the placenta to protect their newborn.

Vaccines recommended during pregnancy are: 

• Influenza vaccine in pregnancy
• Pertussis vaccine in pregnancy
• COVID-19 Comirnaty (Pfizer) vaccine in pregnancy 

All three vaccines are currently recommended in NZ during pregnancy and can be given at the same time or separately into different sites in the deltoid.

• Maternal vaccination helps protect both mother and baby from diseases that can have serious implications for either the hapū mama/ pregnant women and/or their pepe/ babies. 
• Vaccines do not cross the placenta but stimulate the maternal immune response and antibody production (may not apply to all vaccines)
• Vaccinating the mother prompts the maternal immune system to produce high levels of corresponding antibody which are transferred across the placenta and provide passive protection to the baby after birth. 
• These maternal antibodies offer short term protection to the neonate until it starts making its own active immune response, stimulated by exposure to microbes and other antigens in the immediate environment, and infant vaccines. 

• Immunisation during pregnancy is recommended in an increasing number of countries aiming to protect pregnant women and infants from severe infectious disease, morbidity and mortality. 
• There are no safety concerns around giving non-live vaccines in pregnancy, including subunit vaccines and COVID-19 mRNA vaccine.
• Before a vaccine is approved for use, clinical trials are completed to determine safety, immunogenicity and efficacy and the results are assessed by Medsafe and other global regulatory organisations e.g., WHO. 
• These vaccines are used internationally during pregnancy with no evidence of harm for the course of the pregnancy, unborn baby or newborn.

From a biological perspective all non-live vaccines are expected to be safe for use during pregnancy and for live vaccines potential risks are theoretical only and have not been demonstrated in practice. For non-live vaccines the vaccine remains localised before being digested and does not pass to the fetus.

In the real world, vaccine safety is assessed in a number of ways allowing detection of a possible signal, verification of a signal and testing to see if there is an increased risk following a vaccine.

1. Clinical studies, usually randomised trials, both pre and post authorisation
2. Collecting reports of adverse events that occur after vaccination to national pharmacovigilance systems (safety signal detection)
3. Active surveillance using tools such as digital technologies like SMS messaging (safety signal detection)
4. Examining the normal (expected) background rates of adverse events and comparing them with the observed rates. (safety signal verification)
5. Observational studies that compare the risk of adverse events in vaccinated and unvaccinated people, in this case pregnant women. (causality assessment)

Whether or not a vaccine causes a particular type of adverse event is established using #5 comparing vaccine exposed and non-exposed in some way. All these approaches contribute different levels of information that together establish the safety profile of a vaccine, including in sub populations such as pregnant women. 

1. Studies show no increased risk of reactions to vaccines recommended for pregnant women or their unborn babies.
2. Side effects resulting from the immune response may include the expected local responses such as redness, swelling, pain at injection site and headache, muscle aches and fatigue. 
3. For all immunisations, as with medications and foods, an extremely rare allergic reaction called ‘anaphylaxis’ can occur. All vaccinators in New Zealand have training and equipment to deal with this situation if it occurs.

For further information on vaccine safety data, visit Global Vaccine Data Network.

IMAC fact sheets: Recommended and funded vaccines during pregnancy