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 neonates
• 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. 

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Expanded opportunities within the midwifery scope of practice

Colleague-to-colleague vaccination

From April 2025, the Midwifery Council approved colleague-to-colleague* vaccination as expanded practice within the Midwifery Scope of Practice.

Please note the following:

• It is not an expectation of midwives to expand their scope - they are free to make this choice
• *Colleagues are healthcare staff within the maternity setting where their care impacts on whānau
• Midwives providing colleague-to-colleague vaccinations must declare this as expanded practice when they apply for their Annual Practicing Certificate

For those wishing to expand their practicee, in addition to completing the Maternal immunisation essentials for midwives course, the following is recommended:

• View IMAC's 2025 flu webinar
• View IMAC's 'Pertussis - a reminder of the basics' webinar‍
• Those working in hospital setting delivering flu vaccines may also be recommended to complete IMAC's Influenza peer vaccinator course. (Please contact Health New Zealand's Occupational Health team for guidance on process.)

For further information, please contact your local Immunisation Coordinator or email immunisation@tewhatuora.govt.nz.

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Further opportunities to expand practice from 1 February 2026

To better meet whānau needs, a midwife may offer additional immunisation as an expanded practice activity with appropriate education, and continuing competency. For those wishing to expand their scope practice, in addition to completing the Maternal immunisation essentials for midwives course, the following is recommended:

Vaccination for pēpē (birth to 12 months)

Midwives may choose to expand their practice within the Midwifery Scope of Practice to provide vaccination for pēpē for up to 12 months after birth.

Before expanding your practice within the Midwifery Scope of Practice, make sure you are already offering maternal vaccinations and feel confident with everyday processes such as using AIR, ordering vaccines, and managing routine workflows.

The Midwives immunisation expanded practice 3-hour online course provides the essential knowledge, skills, and support needed to deliver safe, effective vaccination care within the expanded practice.

Midwives immunisation skills log

The Midwives immunisation skills log supports practical competency development in the workplace for this expanded vaccination practice. It is designed to complement the online education programmes, enabling midwives to develop, evidence and reflect on the practical skills required for safe immunisation delivery.

Vaccination for pēpē and whānau

For midwives who wish to expand their practice further, this pathway supports vaccination not only for pēpē (birth to 12 months), but also for their whānau during baby’s first year. In addition to completing the Midwives immunisation expanded practice online course and the Midwives immunisation skills log, midwives are recommended to complete the following funded IMAC education to support the additional expanded practice.

• Human papillomavirus (HPV) online course

• Shingrix vaccine webpage

• Adolescence and vaccination webinar

• FAQs and vaccines at 65 and beyond webinar

• Improving immunisation catchup outcomes webinar

Working alongside an experienced vaccinator mentor is recommended to build confidence and capability across all aspects of the role.

For further information, please contact your local Immunisation Coordinator or email immunisation@tewhatuora.govt.nz.

NOTE: Midwives who meet the criteria can claim administration fees for eligible vaccine events. Click here for more information.

‍IMAC midwife vaccinator courses

The Immunisation Advisory Centre (IMAC) has online immunisation courses tailored specifically for midwives. They provide 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 courses are approved as continuing midwifery education by the Midwifery Council.

Maternal immunisation essentials for midwives course (online)

Midwives immunisation expanded practice course (online)

Note: The Maternal immunisation essentials for midwives course is a prerequisite for enrolling in the Midwives immunisation expanded practice course, as it provides the foundational immunisation knowledge required for expanded practice.

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

Pre-vaccination screening for consumers

Recommended and funded vaccines during pregnancy (factsheet)

Immunisation in pregnancy - resources to support positive conversations

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

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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 factsheets: Recommended and funded vaccines during pregnancy