Protection during pregnancy
on 15 July 2024
As midwives, we do all we can to ensure that mother and baby are as healthy as possible during pregnancy and postnatally. One of the best parts of our armoury for doing that – and for setting baby up for life - is vaccination. RCM Professional Policy Advisor Clare Livingstone talks here about the current challenges, and opportunities, in public health.
The dictionary definition of public health is the science and practice of preventing disease. As midwives, we are fully on the frontline when it comes to protecting health and promoting wellbeing. We are often the first point of contact for information and advice to women and birthing people, on a range of health issues.
Vaccinating in pregnancy has huge benefits, conferring immunity through the placenta, providing vital protection to babies during the early weeks of life, until routine vaccination can be given at eight weeks. Midwives and maternity support workers have a hugely important role in counselling women so that they can make an informed choice.
Never has this been more important. For many of us, pertussis or whooping cough is something we vaguely remember from childhood, but thanks to vaccination has been consigned to the past. Sadly, that is no longer the case. Uptake of the vaccination has fallen significantly; in December 2023, coverage was just 59.3% in England and 36.8% in London. Rather than being eradicated, pertussis is back and, tragically, this entirely preventable disease has claimed the lives of eight infants in England in the first four months of 2024 alone.
Also on the rise is parvovirus, commonly called ‘slapped cheek syndrome’. This is usually a minor illness in children, but can cause pregnant women, especially before 20 weeks, to have an increased risk of miscarriage and other complications, including hydrops fetalis and fetal loss, and it’s therefore important we’re aware and ready for questions.
Anyone presenting with a rash illness, or reporting contact with someone affected by a rash illness, should be referred for immediate review by clinicians. The UK Health Security Agency (UKHSA) has just issued guidance on the latest outbreak and there’s specific advice on diagnosis and management of this and other viral rash illnesses in pregnancy.
Currently, pertussis, flu and COVID-19 vaccinations are recommended in each and every pregnancy. These vaccines are not live and are therefore safe for pregnant women.
However, pregnancy is often a time of heightened anxiety when women need access to reliable information, reassurance and support. Tommy’s resources include an excellent guide to vaccinations in pregnancy and this is well worth promoting as a trusted source of information.
As ever, midwives stand ready to meet the next public health challenge. The RCM is aware of a rise in respiratory syncytial virus (RSV), a form of bronchiolitis, which is currently having a serious impact on young children leading to distressing respiratory symptoms and, sometimes, hospital admission.
The NHS across the UK is putting plans in place to offer pregnant women a vaccination for RSV at 28 weeks, adding to an already crowded schedule of antenatal care interventions. The RCM continues to raise concerns about the impact this will undoubtedly have on maternity services and midwives, taking up clinical time to deal with concerns, questions and counselling. This is such an important part of empowering women to make informed choices about their, and their child’s, health, which cannot and should not be rushed.
Lessons must be learned from the rollout of the COVID-19 vaccine. We’ve seen the inequalities and cracks in the system that appear without very careful implementation of vaccination programmes. Healthcare professionals, like midwives, must be supported to provide sound, evidence-based advice and information.
In terms of public health, pregnancy is a clear window of opportunity. Midwives are the first to see new life enter the world and know the importance of promoting and protecting health. But we can only do this effectively with the right staff, in the right place with the right education and training.