As of September 2024, pregnant women in the United Kingdom are offered four vaccinations: the whooping cough (pertussis) vaccine, the RSV vaccine, a flu shot during flu season, and the COVID-19 vaccine. The whooping cough vaccine you are offered is a combination vaccine that also protects against diphtheria and tetanus. Depending on the form you are given, this particular vaccination may also prevent polio. You may also be offered a separate hepatitis B vaccination if you are considered at high risk of developing the condition. You have the right to decline all vaccinations you are offered, but given how vulnerable your baby’s immune system is at birth and how swiftly you’ll want to recover from pregnancy, accepting them is highly recommended by national health organisations, as well as the WHO. You can also feel good about reducing the number of parents who wind up at A&E units across the country with their babies, which was a key motivation for the RSV rollout. As with all decisions you make about your health in pregnancy, labour, and birth, you can analyse your options for vaccination using the mnemonic tool BRAIN, considering the benefits, risks, alternatives, your intuition, and what could happen if you do nothing. Let’s try that now.

What are the benefits of getting these vaccinations in pregnancy?

It takes a lot of research, thought, and discussion from both medical experts and public health officials before pregnant women are offered routine vaccinations. Firstly, it’s widely considered unethical to test medication on them, so there either needs to be evidence that administration is safe or that the benefits outweigh any risks considerably. If an antenatal vaccine is offered, you can be confident that it is generally considered better than going without by a large community of medical professionals experienced with pregnancy. Secondly, it is extremely expensive to administer any vaccination countrywide, yet most nations will endeavour to take this step for pregnant women regardless. You can be confident that receiving these vaccinations is what’s considered best for society by generations of public officials. Finally, and perhaps most importantly for you and your family, the chief benefit is that you will be protecting yourself and your newborn from conditions that can be life-threatening in infancy and potentially complicate and lengthen your own postpartum recovery.

What are the risks of getting these vaccinations in pregnancy?

These are not live vaccines, so while you may have a mild reaction yourself (e.g., pain at the injection site, nausea), you won’t get sick with any of the illnesses the medicine is formulated to protect, and neither will your baby. The risks pertain to lack of efficacy and strongly adverse reactions, and both of these are quite small. It’s important to be completely transparent with your healthcare providers about any underlying conditions you may have or that are part of your medical and family history, so they can respond to any unexpected outcomes as promptly and safely as possible.

You may read or hear negative information about vaccinations from public figures or online advocates who are against their widespread use. We would urge you to look at the wide variety of credible sources in favour of pregnancy vaccines, as well as to listen to all the information your doctor or midwife gives you about them, before making a decision.

What are the alternatives to getting vaccinated in pregnancy?

There are no equivalent preventative measures to vaccinations you can take, aside from perhaps having a home birth and isolating yourself and your newborn from the outside world for the first twelve months (during which time they will need healthcare, including other routine vaccinations). This isn’t a realistic option for many parents.

What is my intuition about getting vaccinated in pregnancy?

We can’t know your gut feelings! However, we advise you to trust your parental instincts even before the birth of your baby. These are real and very valuable, whatever they may be.

What happens when I do nothing?

Doing nothing will have the same effect as declining vaccinations. You and your unborn baby will be more vulnerable to COVID-19, the flu, RSV, pertussis, diphtheria, tetanus, and potentially polio and hepatitis B in their first year of life.

Why isn’t the chickenpox vaccine offered during pregnancy? Can’t chicken pox kill newborns too?

Yes, it can. However, there is widespread immunity to the chickenpox virus as a result of so many pregnant women having had it as children or adults. If you haven’t had chickenpox, you should let your doctor know. If you aren’t sure, your doctor or midwife can easily check with a blood test. You won’t be offered a chickenpox vaccination but you may be more closely monitored. An injection that will make chickenpox shorter and milder can help you if you are exposed to the virus while you are pregnant. You can be treated with different medications if you develop Ramsay-Hunt syndrome or shingles (two other complications of the chickenpox virus) during pregnancy. You won’t be offered a chickenpox vaccine if you’re pregnant because it is a live vaccine. You should still ask about having one before conception or after pregnancy.

Vaccinations can be scary for small children. Why don’t pregnant women receive all the vaccines their babies will need in the future—MMR, etc.?

The immune systems of their unborn babies are considered too underdeveloped for the live vaccines they will receive after birth, including the MMR vaccine. While the risk of them getting live vaccinations may be small, based on what little information there is available, it tells you a lot about the high bar governments and medicine have for what is safe in pregnancy that they don’t give women all these shots while they are expecting.

Why have I been offered the hepatitis B vaccine during pregnancy?

Vaccination against hepatitis B is not routine; it is only given to pregnant women considered at high risk of developing the condition. If you have hepatitis B, you can pass it on to your baby in the first 12 hours after birth, at which point it is highly likely they will get very sick, and sometimes fatally so. You are considered high-risk if you are living with someone who has Hepatitis B, if you are a healthcare worker working with sufferers, or if you are a member of certain ethnic groups. You are also at high risk if you:

Have been diagnosed with hepatitis B for the first time during pregnancy.
Have a high maternal HBsAg titer
Have a high maternal HBeAg positivity.
Have high maternal HBV-DNA levels
Have a specific genotype of HBV
Have specific polymorphisms in certain genes

You should be screened for hepatitis B at your first midwife appointment, but please ask your doctor or midwife if you have any concerns.

Why aren’t women in the UK offered tDAP shots in pregnancy?

They are; don’t worry, we just call them a different name in the UK. The whooping cough vaccination you are offered in pregnancy is a combination shot. It is the same or similar medication to the tDAP vaccine offered to an American mum-to-be.

For more advice on taking care of yourself in pregnancy, labour, and birth, check out Unii’s Antenatal Classes, with prenatal video episodes taught by senior NHS midwives, an award-winning obstetrician and gynaecologist, and six other leading healthcare experts. Now exclusive to unii.com.

Antenatal Class Questions: What antenatal vaccines will I be offered?