Immunizations for Women: A Midwifery Responsibility

Abstract

This year, the American College of Nurse-Midwives (ACNM) joins the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Physicians in approving the 2012 recommended adult immunization schedule. The ACIP develops the US immunization schedules, which include recommended vaccines, number and timing of doses, and precautions and contraindications for specific vaccines. The 2012 adult immunization schedule appears in this issue and can also be obtained from the Centers for Disease Control and Prevention (CDC) Web site.1 Discussions about vaccination often focus on children and adolescents, but continuing vaccination throughout adulthood is important to minimize the risk of illness and death from vaccine-preventable diseases. The recent pertussis outbreaks that have occurred across the country are a tragic reminder of how dangerous vaccine-preventable diseases can be. Adults need vaccines not only to protect their own health, but also to prevent spreading illness to infants too young to be vaccinated. To that end, the priority adult populations for the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine are pregnant women, adults who have close contact with infants younger than 12 months of age, and health care providers. A one-time dose of the Tdap vaccine is recommended for those who have not previously received an adult Tdap dose. One change in the 2012 schedule is the new recommendation that pregnant women receive the Tdap vaccine during the second half of pregnancy (>20 weeks’ gestation) rather than waiting until they have given birth. The influenza vaccine is also recommended for all pregnant women. Other vaccines that may be recommended for adult women, depending on their age and other factors, include varicella; human papillomavirus (HPV); zoster; measles, mumps, and rubella; pneumococcal; meningococcal; and hepatitis A and B. As primary care providers, it is important for midwives to encourage women to receive recommended immunizations. In 2011, ACNM updated their position statement on immunizations (see Box 1 for key points).2 Midwives are responsible for assessing women's immunization status and providing education about vaccines. Ideally, midwives will offer the vaccines most frequently recommended for their client population. When that is not possible, midwives must facilitate access to immunizations by being knowledgeable about where vaccines are available in their communities. Many immunization resources are available for midwives. The CDC Web site has an entire section devoted to vaccines and immunizations (http://www.cdc.gov/vaccines). The childhood (birth to 6 years old), adolescent (7 to 18 years old), and adult (over 18 years old) immunization schedules are all available in formats appropriate for health care professionals as well as for the public. Midwives and other health care providers can download a screening questionnaire to identify precautions and contraindications to immunization, blank vaccine record forms, and full and pocket-sized versions of the schedules. The CDC Web site also contains extensive patient education information, including general information about immunization and specific content on individual vaccines. Encouraging women to receive immunizations is consistent with multiple hallmarks of midwifery including incorporation of scientific evidence into clinical practice; health promotion, disease prevention, and health education; and promotion of a public health care perspective. Receiving recommended vaccines benefits not only a woman's health, but also the health of her family and community. It is our hope that publishing the immunization schedule will remind midwives of the importance of adult vaccination and present the information needed for the provision of evidence-based care.