HEALTH AUTHORITIES ARE being criticised by maternity campaigners, politicians and healthcare professionals for failing to effectively communicate with pregnant women about the Covid-19 vaccine.
The health service says it is advising women at any stage of pregnancy to get vaccinated but vaccination rates have remained “lower than expected”, at between 25-40%.
The chair of the Institute of Obstetricians and Gynecologists, Dr Cliona Murphy, said in recent days that the number of women who have been admitted to intensive care units for Covid-19 treatment is “striking”.
One maternity care campaigner told The Journal that pregnant women were finding it difficult to get information from the HSE.
The jab first became available to pregnant people in Ireland in April when the National Immunisation Advisory Committee (NIAC) recommended that they be offered a vaccine between 14 and 36 weeks’ gestation only.
In September, the vaccine was opened up to women at any stage of pregnancy after NIAC updated its advice.
Critics say health authorities failed to reassure pregnant people about the safety of the vaccine following these updates.
Sinn Féin health spokesperson David Cullinane said Health Minister Stephen Donnelly, the Department of Health and the HSE have “failed to reassure pregnant people after positive recommendations were made.”
Responding to these concerns, the HSE says it has run campaigns aimed at encouraging pregnant people to get vaccinated across radio and social media platforms. Pop-up vaccination clinics have also been run at maternity hospitals.
The Department of Health says it regularly focussed on the matter at press briefings and in statements and social media posts.
Dr Murphy said 20 pregnant and postpartum women have been admitted to intensive care units for Covid-19 treatment since June.
She added that three women were transferred from maternity hospitals in Dublin to intensive care units last weekend alone.
Looking outside Ireland, one sixth of the most critically ill Covid patients in England in recent months have been unvaccinated pregnant women. Health officials in the UK have urged expectant mothers to get their jabs as an urgent priority.
Research from Israel has also shown that the illness can cause serious problems for the mother-to-be and her baby in the later stages of pregnancy.
The Irish stats show that at least 83% of pregnant women in ICU were in the third trimester.
‘Lack of communication’
Maternity care campaigner Linda Kelly said the HSE is not doing enough to provide pregnant women with the information they need to compel them to get the vaccine.
“There has been a lack of communication from the HSE centrally around what’s to be advised,” Kelly said.
“Women are reporting to us in the ‘Better Maternity Care’ campaign that they’re just finding it really hard to get the information in the first instance.
“There’s no communications plan. There doesn’t seem to be any plan for a national roll-out of an information campaign for pregnant people, and this is months after they first made the vaccine available,” she added.
The ‘Better Maternity Care’ movement arose last September in response to restrictions on partner visits in maternity wards.
After more than a year of campaigning, fresh guidance was issued last week to allow access to partners from 8am to 9pm each day. The change will come into effect on 1 November.
‘Do it yourselves’
Kelly’s comments were echoed by a midwife working in a Dublin hospital who said that the HSE has given them very little instruction on how to handle vaccine-hesitant women and largely left them to research the matter themselves.
The midwife, who asked not to be named, said that staff in the hospital where they work have been proactive in promoting the Covid-19 vaccine since NIAC first recommended the jab to pregnant women in April.
However, they said that the same level of proactivity has not been forthcoming from the HSE.
“With each appointment you make sure you ask, ‘do you have your whooping cough vaccine? Do you have your flu vaccine? Do you have your Covid vaccine?’ And if they say no, then we’d always say ‘okay why? What’s holding you back?’” the midwife explained.
The healthcare professional said that the patients’ concerns are usually assuaged by giving them information on the risks posed by getting Covid during pregnancy and detailing scientific research – which has found that the benefits of receiving the vaccine outweigh any known or potential risks.
The midwife added that many women are also reassured to learn that the vaccine is broken down by the body and does not cross the placenta.
However, they were not provided with the information for patients by their employers and had to learn it of their own accord. “It was very much, ‘go off and do it yourselves’,” they explained.
“We would refer women to go on the HSE website, and there’s information for pregnant women there. But from our point of view, we were never briefed on ‘this is what you say if they ask this’ or ‘this is what you say is they ask that’”
The HSE has an online learning and development portal called HSeLanD (sic), which features educational information for staff regarding subjects such as hand hygiene, domestic abuse or smoking cessation during pregnancy.
“Interestingly, we never got a Covid one, because we were all waiting for that,” the midwife said.
“Something to help you navigate when women asked questions about X, Y, Z… you would have thought that would have been rolled out to make sure we were all on the same page,” they said.
The midwife added that one effective resource they and their colleagues refer concerned people to is the Instagram account of obstetrician Dr Sarah J Murphy who publishes posts explaining common misconceptions about the Covid jab.
Kelly said vaccine hesitancy in pregnant women stems from deep concern for their baby and is not due to misinformation or anti-vaccine sentiments.
Generally pregnant women are told not to put anything at all into their body, not even caffeine, so it’s a very genuine vaccine hesitancy.
“But a lot of people are reporting to us, ‘if I could just get the information’, or ‘if I could just sit down with somebody and talk to them about my concerns’, then I could make a decision,” the campaigner said.
‘Early uncertainty’
Sinn Féin’s Cullinane said the “early uncertainty” on vaccination during pregnancy caused a lot of anxiety among pregnant people.
The Waterford TD said that unvaccinated pregnant people and their children are “especially vulnerable in hospital settings where, despite the best efforts of staff because of poor infrastructure, and the nature of hospitals, there have been continuous outbreaks among patients and staff.
It is particularly disappointing that midwifery staff are reporting that they have not been properly briefed or provided with materials to reassure pregnant people of the safety of vaccines and ensure uptake in this key cohort.
“Clear and effective communication is essential to counteract vaccine hesitancy, especially where that hesitancy is a result of mixed messaging,” the Sinn Féin health spokesperson concluded.
The HSE says it encourages all women to read the information on Covid-19 and pregnancy on its website and to discuss vaccination with their obstetric caregiver.
“Most maternity hospitals/units are also having the vaccine discussion with women at their booking visit (12 to 14 weeks gestation),” the HSE added.
The health service says it has run a number of communication programmes across radio and social media platforms which were aimed at raising awareness, and encouraging uptake of the vaccine.
In response to the lower than anticipated uptake rates, vaccination clinics have also been set up in a number of the larger maternity hospitals, where women attending the hospital for routine clinics, can have a consultation with the obstetric care-giver and can then receive the vaccine on site.
The Department of Health said Ireland’s Covid-19 vaccination programme is “one of the largest and most intensive projects ever undertaken in Ireland.”
ℹ️ Are you pregnant or considering becoming pregnant? You might have questions about the #COVID9 vaccine.
— Department of Health (@roinnslainte) August 26, 2021
▶️ This is Ita’s story, where she talks honestly about how she decided that getting the #COVID19vaccine was the right choice for her.#ForUsAll
pic.twitter.com/Bv9b6NOXmC
“From the outset, it was well understood that effective communications would be a critical success factor to the programme. Together with the HSE, the Department of Health have approached communications with principles of transparency, objectivity, and accessibility,” it said.
The department added that it has focussed on the topic of Covid-19 vaccines and pregnancy since the vaccine was made available to this cohort.
The department said there have been updates at NPHET press briefings, statements and social media posts and videos focussing on the “genuine concerns pregnant people have relating to the Covid-19 vaccine”.
It added that there has been a series of social media posts encouraging pregnant people to make an informed choice.
The Royal College of Physicians in Ireland has also collated a suite of information on vaccination for pregnant people on its website.
The latest statistics from the Health Protection Surveillance Centre show that 11% of women who were admitted to intensive care with the coronavirus disease were pregnant.
The figures published by the HSE’s disease monitoring centre show that 12 pregnant women were admitted to ICU with the illness between 27 June and 2 October.
Only one of the women had received a Covid-19 vaccine. A further five women were admitted to intensive care with Covid within six weeks of giving birth.
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