Beard FH. Pertussis immunisation in pregnancy: a summary of funded Australian state and territory programs. Commun Dis Intell Q Rep. 2015; 39:(3)E329-36

Blanchard-Rohner G, Siegrist C-A. Vaccination during pregnancy to protect infants against influenza: why and why not?. Vaccine. 2011; 29:(43)7542-50

Blanchard-Rohner G, Meier S, Ryser J Acceptability of maternal immunization against influenza: the critical role of obstetricians. J Matern Fetal Neonatal Med. 2012; 25:(9)1800-9

Castagnini LA, Healy CM, Rench MA, Wootton SH, Munoz FM, Baker CJ. Impact of maternal postpartum tetanus and diphtheria toxoids and acellular pertussis immunization on infant pertussis infection. Clin Infect Dis. 2012; 54:(1)78-84

Eppes C, Wu A, Cameron KA, Garcia P, Grobman W. Does obstetrician knowledge regarding influenza increase HINI vaccine acceptance among their pregnant patients?. Vaccine. 2012; 30:(39)5782-4

Eppes C, Wu A, You W, Cameron KA, Garcia P, Grobman W. Barriers to influenza vaccination among pregnant women. Vaccine. 2013; 31:(27)2874-8

Health Education And Training Institute. Organisational structure. 2018. (accessed 11 July 2018)

Healy CM. Pertussis vaccination in pregnancy. Hum Vaccin Immunother. 2016; 12:(8)1972-81

Kfouri RÁ, Richtmann R. Influenza vaccine in pregnant women: immunization coverage and associated factors. Einstein (Sao Paulo). 2013; 11:(1)53-7

Kharbanda EO, Vazquez-Benitez G, Lipkind HS Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomes. JAMA. 2014; 312:(18)1897-904

Knapp TR. Why Is the one-group pretest–posttest design still used?. Clin Nurs Res. 2016; 25:(5)467-72

Leask J, Quinn HE, Macartney K, Trent M, Massey P, Carr C, Turahui J. Immunisation attitudes, knowledge and practices of health professionals in regional NSW. Aust N Z J Public Health. 2008; 32:(3)224-9

Maertens K, Hoang TT, Nguyen TD The effect of maternal pertussis immunization on infant vaccine responses to a booster pertussis-containing vaccine in Vietnam. Clin Infect Dis. 2016a; 63:S197-204

Maertens K, Braeckman T, Top G, Van Damme P, Leuridan E. Maternal pertussis and influenza immunization coverage and attitude of health care workers towards these recommendations in Flanders, Belgium. Vaccine. 2016b; 34:(47)5785-91

Meharry PM, Colson ER, Grizas AP, Stiller R, Vázquez M. Reasons why women accept or reject the trivalent inactivated influenza vaccine (TIV) during pregnancy. Matern Child Health J. 2013; 17:(1)156-64

Healthy Communities: immunisation rates for children in 2012–13.Sydney: NHPA; 2014

Nicholl S, Seale H, Saul N, Campbell-Lloyd S. The importance of involving midwives before and during the implementation of an antenatal pertussis vaccination programme in New South Wales, Australia. Women Birth. 2018; S1871-5192:(17)30127-0

Nursing and Midwifery Board of Australia. Accreditation. 2017. aspx (accessed 9 July 2018)

Omer SB. Maternal immunization. N Engl J Med. 2017; 376:(13)1256-67

Petousis-Harris H, Turner N, Kerse N. New Zealand mothers' knowledge of and attitudes towards immunisation. New Zealand Family Physician. 2002; 29:240-6

Robbins SC, Leask J, Hayles EH, Sinn JK. Midwife attitudes: an important determinant of maternal postpartum pertussis booster vaccination. Vaccine. 2011; 29:(34)5591-4

Tong A, Biringer A, Ofner-Agostini M, Upshur R, McGeer A. A cross-sectional study of maternity care providers' and women's knowledge, attitudes, and behaviours towards influenza vaccination during pregnancy. J Obstet Gynaecol Can. 2008; 30:(5)404-10

Webb H, Street J, Marshall H. Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations. Hum Vaccin Immunother. 2014; 10:(4)1114-21

Wiley KE, Massey PD, Cooper SC, Wood N, Quinn HE, Leask J. Pregnant women's intention to take up a post-partum pertussis vaccine, and their willingness to take up the vaccine while pregnant: a cross sectional survey. Vaccine. 2013a; 31:(37)3972-8

Wiley KE, Massey PD, Cooper SC Uptake of influenza vaccine by pregnant women: a cross-sectional survey. Med J Aust. 2013b; 198:(7)373-5

Wiley KE, Cooper SC, Wood N, Leask J. Understanding pregnant women's attitudes and behavior toward influenza and pertussis vaccination. Qual Health Res. 2015; 25:(3)360-70

The effectiveness of an online module for midwives conducting antenatal pertussis vaccinations

02 August 2018
Volume 26 · Issue 8



An online education programme was developed to support midwives and maternity staff to implement the New South Wales antenatal pertussis vaccination programme from March 2015.


To determine if an educational programme met the needs of midwives and maternity staff to conduct an immunisation appointment confidently with a pregnant woman.


Pre- and post-surveys were conducted with learners completing the programme.


Before completing the programme, 57% of respondents reported feeling ‘confident’ or ‘very confident’ in conducting a vaccination encounter with a pregnant woman. This increased to 94.1% after completion of the programme.


The education programme met the needs of midwives and maternity staff in New South Wales. An informed and confident maternity workforce will increase vaccine uptake in pregnant women and ensure that pertussis vaccination is incorporated consistently into routine antenatal care, to protect vulnerable infants from life-threatening diseases such as pertussis and influenza.

There has been a resurgence in pertussis, with the highest incidence and complication rates in young infants, and deaths occurring mainly before 3 months of age (Healy, 2016). The most effective way to protect young infants, who are disproportionately burdened by pertussis, is through maternal vaccination (Omer, 2017). In response to increasing pertussis incidence in infants in New South Wales (NSW), Australia (Nicholl et al, 2018), NSW Health implemented a maternal pertussis vaccination scheme, offering diphtheria, tetanus and pertussis vaccines to all women in their third trimester of pregnancy.

Previous studies have reported on the importance of educating health professionals to improve maternal vaccination rates (Eppes et al, 2012; 2013; Kfouri and Richtmann, 2013), which is vital to the success of a vaccination programme (Wiley et al, 2013a). The decision of a pregnant woman to consent to vaccination relies on how much importance the midwife places on the vaccine, which also determines the midwife's level of engagement in programme implementation (Robbins et al, 2011). An Australian study found that midwives' perceived self-efficacy regarding vaccination was the most important factor in the vaccination of postpartum mothers (Robbins et al, 2011). When discussing immunisation with pregnant women, it is important to state that it offers protection for both the infant and the woman, as this may increase vaccine uptake (Wiley et al, 2015). Midwives therefore need to be well informed and prepared to address women's concerns as well as increasing women's confidence and trust.

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