Children whose mothers received most of their perinatal care from midwives were less likely to be fully vaccinated on schedule and more likely to have delayed or refused routine immunizations than those cared for primarily by physicians, according to an observational study published this week in Vaccine.
The study, led by researchers from the British Columbia Centre for Disease Control in Canada, examined whether provider type—either obstetrician/family physician or midwife—was associated with receipt of routine infant vaccines in British Columbia (BC). Midwives provide care for roughly one in four pregnancies in the province.
Vaccine-hesitant parents may prefer midwives
Using data from BC’s perinatal and immunization registries and provincial billing records, the researchers analyzed the link between perinatal care provider type and vaccination through age two years in children born from January 2010 to December 2015. The analysis included 180,087 children, 16.6% of whose parents opted for majority-midwife care during the perinatal period.
Children whose mothers received majority-midwife care were more likely to experience delays in receiving recommended vaccines and had lower overall vaccination coverage than those receiving majority-physician care.
Midwife care was linked to lower completion of all recommended vaccinations by age two years (adjusted risk ratio [aRR] up to date for age, 0.81), greater refusals of any vaccine (aRR, 2.50), and longer vaccination delays, especially for the third dose of the vaccine against diphtheria, tetanus, and pertussis (DTaP), hepatitis B, polio, and Haemophilus influenzae type b (Hib) at the six-month health care visit (aRR, 0.76).
Because it was an observational study, and parents who are inclined to delay or refuse vaccination may be more likely to use midwives for perinatal care, the authors write, the study can’t establish causation, but the findings suggest that the type of provider families engage with during pregnancy and childbirth may influence early attitudes toward immunization.
Midwives may be less confident talking about vaccines
The authors point to several potential explanations for the observed differences.
Midwifery care models often emphasize shared decision-making, which tends to balance vaccine advocacy with patient agency. Midwives in Canada, Australia, and France also report feeling less equipped to talk about vaccination with patients, especially those who are vaccine-skeptical, due to limited training and confidence in counseling.
In contrast, physicians may be more likely to take a strong stance on the benefits of vaccines and feel comfortable making firm recommendations for vaccination.
Midwife education could boost uptake
Given that vaccine hesitancy remains a persistent challenge in many countries, understanding how perinatal care experiences influence parental decision-making could help public health officials design more effective outreach strategies, including enhanced vaccine education resources, training, and support for midwives.
“Many parents prefer to start learning about infant health during pregnancy. In particular, vaccine-hesitant parents may want additional details about the risks and benefits of vaccination, and it may be important to use the prenatal period with a trusted care provider to address their concerns,” the authors write.
Insights from these studies suggest that supporting midwives in strengthening vaccination counseling confidence could positively influence parental decisions about subsequent infant vaccination
“Insights from these studies suggest that supporting midwives in strengthening vaccination counseling confidence could positively influence parental decisions about subsequent infant vaccination,” they add.
Improving collaboration among midwives, physicians, and public health systems could also help ensure higher levels of vaccine acceptance. “As midwifery grows in accessibility and popularity, it is imperative that the public health and primary care communities consider the features of midwife-associated care and identify opportunities to improve uptake of early childhood vaccination,” the authors write.
