For nine months, the life of an expectant mother is filled with decisions. Very important decisions. Who will be your obstetrician? What will your birth plan be? How long will you go on maternity leave? One crucial decision we don’t discuss enough is the one pregnant women have to make regarding getting prenatal vaccinations.
Deciding to get recommended vaccines during pregnancy can help a mother’s body create protective antibodies that can be shared with her child, according to U.S. Centers for Disease Control and Prevention (CDC). These recommended vaccines include Tdap to protect against tetanus, diphtheria, and whooping cough (pertussis); hepatitis B, and a flu (influenza) shot; as well as newly recommended respiratory syncytial virus (RSV) and COVID-19 vaccines. In the first few months of a child’s life, these vaccines can make a huge difference in preventing or lessening the impact of certain illnesses, when babies are too young to be vaccinated themselves. Still, statistics show that a number of mothers, especially Black mothers, are going without them.
According to recent CDC data, during the 2022-23 flu season, coverage estimates indicate only 39.5% of Black pregnant women received a flu vaccine during pregnancy and 31.4% of Black pregnant women received a Tdap vaccine during pregnancy; as of Jan. 2024, only 10.4% of Black pregnant women received an RSV vaccine, and as of March 2024, only 5.7% of Black pregnant women received an updated 2023-24 COVID-19 vaccine during pregnancy.
Reasons for these rates may run the gamut, from concerns about safety, lack of information about vaccines’ benefits, misunderstanding and misinformation, not having the vaccines recommended to them, and increased feelings of concern and vulnerability when it comes to navigating the healthcare system for Black pregnant women in general.
“I find the biggest barriers to be access, education, and accurate information. Especially in under-resourced settings or clinics, access to prenatal vaccinations can vary greatly,” says Haben Debessai, M.D., CDC Foundation Gilstrap OBGYN Fellow. “Lack of education on vaccinations, given in lay terms to the general population, in addition to inaccurate information being spread on vaccinations, are also barriers for pregnant people.”
For Black pregnant women, in particular, identifying trusted providers can also be a barrier. “There is, understandably, lingering distrust of the medical community in the Black community. This has been validated by examples like the ‘Study of Untreated Syphilis at Tuskegee and Macon County, AL’ and the origin of many medical practices in the U.S.,” Dr. Debessai says. “However, it is up to us— the medical and public health community— to gain this trust, which can lead to increased uptake of vaccinations in these communities.”
Raising awareness of how vaccines work within the body, for both mother and child, may also persuade more people to obtain them.
“These vaccinations benefit both the pregnant person and their baby. Due to the way pregnancy affects the immune system, pregnant patients are at higher risk for severe illness from infections like COVID-19 and flu if contracted” says Dr. Debessai. “The outcomes can be dire for both the pregnant person and their baby, which is why getting vaccinated is the best option.”
“Some vaccines are especially for the baby’s benefit,” says Dr. Debessai. “RSV and Tdap are recommended at a certain time during pregnancy so the pregnant person’s immune system can develop antibodies that will then be shared with their baby,” she says. “This helps protect them during their early months of life — when they are highly susceptible to these illnesses that can be severe.”
This protection for baby was top of mind for 43-year-old Kimberly Mapp of Burke, Va., who just welcomed her fourth child (her third biological one) on February 1, 2024. She says being vaccinated for flu and Tdap, and receiving COVID-19 vaccines before she was pregnant, kept her and her newborn son healthy.
“There were several people who I had been in close proximity with at work and at home while pregnant that had either the flu or COVID-19 without me even knowing and I never got sick,” she says. “I believe that being vaccinated protected me from getting sick and I believe that even if I did get sick, the symptoms would be very mild and harmless to my unborn baby. The understanding that these vaccines reduce the risk of serious illness alleviated a lot of stress for me once I was aware that I had been in close contact with people who were sick.”
It’s also important to note that vaccination needs during pregnancy vary from person to person and the season in which they’re expecting. “I would say every pregnant person should be counseled on receiving flu, COVID-19, Tdap (whooping cough), and the maternal RSV vaccines,” says Dr. Debessai. “Some of these vaccines vary in recommendation depending on seasonal trends of viral illness and the time of the year when the person is pregnant.”
For Marisa Price, a 40-year-old mother of two based in Tampa, Fl., when she prepared to give birth in the summer of 2021, the world was in the thick fog of the COVID-19 pandemic. Because she wasn’t new to pregnancy, she was familiar with most of the vaccinations offered and considered them safe. However, she initially had some reservations about the COVID-19 vaccine since it had been developed so recently.
Having honest conversations with her providers (a primary obstetrician and high-risk OB), doing her research about the vaccine, including following updates on it, and asking questions helped Price to make the best decision for herself and her baby; she received a COVID-19 vaccine. She says that she experienced minimal side effects. Her initial shot came with no symptoms aside from a sore arm, but she dealt with some strong fatigue after the second dose. It lasted a day.
Price says making that choice helped her baby recover well from a bout of COVID-19 at nine months old. “She did not have to go to the hospital, nor did she have to take any prescribed medication. She was able to fight off the sickness from her built up immunity plus any additional immunity passed through nursing. Having the vaccine also helped to protect me from contracting COVID while I cared for her as well,” Price says.
Dr. Debessai drives home the fact that, despite the side effects that can occur, which are generally mild, the recommended vaccines are safe for expectant people and their babies. With that said, she is happy to answer any questions and address whatever concerns may come from her patients, and encourages expectant people to ask questions to their healthcare providers. A doctor’s recommendation and insight can be a gamechanger.
“I encourage patients to ask their healthcare provider questions and talk with their own trusted community,” Dr. Debessai says, including family members, faith leaders and more. “My goal as a clinician is to provide the education my patients need to help them make the most informed and best decision they can for their families.”
Both Mapp and Price say that pregnant people shouldn’t allow what they don’t know to keep them from protecting themselves and their unborn babies.
“You are your child’s first and best advocate,” Price states emphatically. “If you do not have the information needed, seek it out. This information can be found on advocacy groups’ websites, government sites and from your doctor.”
“I would say to moms-to-be to read literature about these vaccinations to get a better understanding about the protections they provide to the mom and baby,” adds Mapp. “There is a lot of research that goes into the safety of vaccines before they are released to the public. I think that the consequences of getting RSV, the flu, or COVID-19 on the mother and unborn child far outweigh the potential side effects from getting vaccinated.”
For more information on prenatal vaccinations and what to know about them, visit CDC’s From Me, To You website.