Promoting prenatal vaccinations through partnered vaccine counseling: a midwifery-led approach

Full Description: This original case study is part of my dissertation which seeks to understand how prenatal care may be used to improve prenatal and infant vaccination uptake. This study explores how Certified Nurse Midwives (CNM) approach vaccine counseling with pregnant women during prenatal care. We conducted in-depth-interviews to understand prenatal vaccine delivery and counseling experiences with the Clinical Director and several CNM who oversee and provide prenatal care at a Free-Standing Birth Center.

Our results showed that vaccine counseling initiates early in the prenatal care trajectory, relative to expected administration. Midwives either administer vaccines (accepting clients) or initiate a cyclical discussion process (hesitant or declining clients). For hesitant or declining clients, they 1) assess client knowledge, 2) engage directly with client concerns by tailoring education to clients’ personal rationales, empathizing as appropriate, and 3) guide and encourage independent client research and discuss findings at follow-up. The process continues until clients accept or refuse prenatal vaccines and midwives’ provide support regardless of the outcome. In sum, midwives’ cyclical discussion process of client assessment and tailored education supports shared decision making around prenatal vaccine uptake, with an overarching goal of preserving the overall clinical relationship and respecting client decisions.

This work addresses several needs in research and practice. First, it is the first study, to our knowledge, to focus on US midwives within the prenatal vaccine context. Second, it contributes to scant knowledge regarding organizational and interpersonal processes that support effective prenatal vaccine counseling. This research is key for informing prenatal care provider communication strategies. Transferrable aspects of our research include 1) introducing vaccines early and engaging in ongoing shared-decision making dialogue, 2) engaging all clinician types in addressing client vaccine concerns and parrying misinformation at collaborative staff meetings and 3) aligning prenatal vaccine indicators and financial reimbursement codes to support prenatal care vaccine counseling regardless of vaccine receipt.

This work supports the AMCHP conference theme as it reflects on the widely-used traditional medical model of prenatal care and draws on the under-researched midwifery model to illuminate prenatal vaccine counseling practices. These evidence-informed strategies can be used to develop future research and programs to improve prenatal vaccine uptake.

Through this project I have honed research skills including: research conceptualization, proposal and grant development, qualitative data collection and analysis, research synthesis, and technical writing. This project has highlighted the value of the midwifery model in creating an empowered, relationship-focused approach toward vaccine decision making to improve quality of clinical care.

Abbreviated Description: This is the first study of midwife-led prenatal care that details the organizational and interpersonal processes of vaccine counseling in the US. Through midwives’ cyclical discussion process of client assessment and tailored education, they support shared decision-making around prenatal vaccine uptake, with an overarching goal of preserving the overall clinical relationship and respecting client decisions. This study informs how a partnered approach to prenatal vaccine counseling can improve vaccine uptake with intergenerational benefit. This work supports the AMCHP conference theme as it reflects on the widely-used traditional medical model of prenatal care and draws on the under-researched midwifery model of care to illuminate effective prenatal vaccine counseling practices.