Evaluation of a Midwife-Led, Hospital-Based Vaccination Service for Pregnant Women

In 2012, England experienced a pertussis (whooping cough) outbreak, resulting in increased incidence and several infant deaths. To address this, a national maternal pertussis vaccination program was introduced, aimed at passively protecting infants by increasing levels of maternal antibody transferred during pregnancy. Vaccination during pregnancy has also been recommended for seasonal influenza to prevent severe illness in women and improve infant outcomes.

However, the uptake of vaccines during pregnancy, also known as maternal immunization, varies due to various barriers and influences on the decision to get vaccinated. Previous studies have shown that healthcare professionals and midwives play a crucial role in providing trusted advice for vaccine decisions. Additionally, midwife-delivered maternal vaccination clinics have been found to improve vaccine uptake.

Traditionally, pediatric and adult vaccines in England are delivered within primary care General Practices (GP). However, in recent years, some hospital-based antenatal clinics have started offering vaccines to pregnant women. Midwives, experienced in caring for women during pregnancy, are responsible for delivering vaccines in these clinics. This new model of care has presented challenges in accurately estimating maternal vaccine uptake, as data completeness issues and unknown recording accuracy in routine GP records make it difficult to assess.

To address these challenges, an evaluation was conducted on a midwife-led vaccination clinic, based in a hospital antenatal care setting in London. The evaluation aimed to describe the demographic characteristics of women who received or declined vaccination from the clinic and explore the decision-making process through qualitative interviews.

The findings of this evaluation will provide valuable insights into the effectiveness of the midwife-led vaccination service, particularly in improving maternal vaccine uptake. Understanding the factors that influence vaccine decisions and the role of midwives in providing trusted advice can help develop strategies to further enhance vaccine coverage among pregnant women. By increasing maternal vaccine uptake, there is also the potential to improve infant vaccine uptake, thus contributing to overall public health outcomes.

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Q: How effective is the maternal pertussis vaccination program in reducing cases of infant pertussis?

A: The maternal pertussis vaccination program has been shown to be safe and effective in reducing cases of infant pertussis and associated morbidity and mortality. By increasing levels of transplacentally transferred maternal antibody, vaccination during pregnancy provides passive protection to young infants, who are at higher risk of severe complications from pertussis.

Q: What are the barriers to maternal vaccine uptake?

A: Maternal vaccine uptake varies due to various barriers and influences on the decision to get vaccinated. Factors such as regional variations, deprivation, ethnicity, and lack of awareness can impact vaccine uptake. Strategies to improve maternal vaccine uptake include providing vaccine services through midwives, who are trusted sources of advice for women’s vaccine decisions.


The evaluation of a midwife-led vaccination clinic in a hospital antenatal care setting provides valuable insights into improving maternal vaccine uptake. By addressing data completeness issues and exploring the decision-making process of women who used the vaccine clinic, this evaluation aims to enhance vaccination coverage among pregnant women and contribute to better public health outcomes. Understanding the role of midwives as trusted advisors and implementing effective strategies can help increase vaccine uptake, ultimately protecting both mothers and infants.