Addressing vaccination myths during prenatal visits

August 15, 2018 by Amanda Sams Bradshaw, The Conversation
Addressing vaccination myths during prenatal visits
Studies suggest that pregnant women might be influenced by medical myths on social media. Credit: Antonio Guillem/

During pregnancy, expectant parents spend countless hours sifting through online resources to make the "right" medical choices for their baby. In addition to decorating a nursery and playing baby shower games, pregnant women often are glued to their smartphones, seeking advice from friends and strangers.

A pregnant woman's Facebook news feed provides one window into motherhood, and the connections, articles and advice delivered by a Facebook news feed offer suggestions – both wanted and unwanted.

Despite expressing skepticism of the accuracy of digital resources and a pervasive fear of "fake news," pregnant women "Google it up" to gain information and health advice. Mothers-to-be have been found to rely on social media more frequently and with greater intensity at the transition to parenthood.

However, the internet has been dubbed a "postmodern Pandora's box." Misinformation and rumors abound on many health topics, but particularly in regards to vaccinations. False claims and widely perpetuated myths, such as the discredited assertion that vaccinations cause autism, have been declared a threat to modern society. According to the Centers for Disease Control and Prevention, community immunity requires that a certain percentage of the population be vaccinated to maintain coverage against dangerous diseases for all.

I study health communication, and I have analyzed some of these trends. I see problems when expectant parents accept medical myths. I also see opportunities to change the narrative to an accurate one.

Persistent falsehoods

Although overall vaccination rates in the United States remain high, social networks sometimes support grassroots mobilization of mothers against childhood vaccines. This allows personal narratives to take root and be shared more.

My recent study, not yet published, found that more than 30,000 members in the largest closed anti-vaccination Facebook group influence first-time, pregnant and new mothers in their decision-making process for their own children. In some instances, I found that a mother's expressed concern would transition from fear of protecting her child from measles to a more intense fear of more than 200 alleged side effects.

Another recent study analyzed 2.6 million Facebook users' interactions over more than seven years, identifying distinct, opposing pro- and anti-vaccination narratives. Users self-select the content they wish to view based on their own belief systems, ignoring all other content. Researchers found that posts from anti-vaccination advocates received more user comments. And anti-vaccination groups are growing more rapidly in comparison to pro-vaccination groups.

Similarly, another study identified that the majority of YouTube videos about infant vaccination showed babies in pain and distress. Videos that disapprove of vaccinations received the most likes, views and shares. In contrast, pro-vaccination YouTube videos received far fewer likes, shares and views.

Put simply, anti-vax videos are increasingly playing up the risks of vaccination, which mainly include redness and swelling where the shot is given and, in very rare cases, other side effects. These anti-vax videos consistently downplay the benefit of protection from life-threatening diseases.

A large study in New York state identified one in four students following an alternate, nonscientifically based vaccination schedule. An alternate schedule may include selectively vaccinating or delaying certain vaccines. Essentially, parents of these children are following their own schedule, or a schedule found in a book or magazine, but not the CDC recommended schedule. Students in private schools, or those who come from more affluent families with parents who have received higher levels of education, are more likely to opt out.

Physicians such as Robert Sears provide advice contrary to consensus by the medical community and use digital channels, including propaganda videos, to raise concerns about the safety of vaccinations. The Medical Board of California recently placed Sears on probation for allegedly writing inappropriate medical exemptions for vaccinations.

Causing a cluster

Parental refusal to vaccinate typically increases in geographic clusters, and when that happens, outbreaks of once-eliminated diseases, such as measles, occur. In 11 states, the number of kids not being vaccinated for nonmedical reasons has exceeded any point in the past five years. Infants, the elderly and immuno-compromised individuals are particularly vulnerable.

While women get a lot of information on birth plans and breastfeeding during standard prenatal care, my qualitative research suggests that they do not get much information about childhood vaccinations. In interviews and focus groups with more than 20 expectant mothers, some in their third trimester, all reported that providers had not initiated dialogue about childhood vaccinations. For first-time mothers, they reported our conversation was the first they had formally discussed this particular issue. Yet the American Academy of Pediatrics recommends that the first dose of the hepatitis B vaccination be administered within the first 24 hours of life.

The American College of Obstetricians and Gynecologists and the National Association of Certified Professional Midwives do not recommend that practitioners broach the subject of childhood vaccinations during pregnancy, focusing instead on maternal vaccinations during pregnancy and referring any childhood vaccination dialogue to the child's pediatrician.

But what might happen if this changed? Could this be a solution? I strongly believe it could.

A full-term medical press

Even though 90 percent of expectant mothers report making childhood vaccination decisions before the birth of the baby, a full one-third of expectant mothers expressed feeling uninformed, with first-time mothers identifying as more vaccine hesitant.

As one expectant mother in her third trimester in Gainesville, Florida recently said in an interview with me:

"I think that there's extreme lack of communication. I think that childhood vaccination information should be relayed. That way you have the information you need before something happens, and then it's too late to make an informed decision."

In a survey, 98 percent of OB-GYNs revealed they believe childhood vaccinations to be important, but less than half believed they could influence expectant mothers.

In an interview, a midwife in Gainesville stated childhood vaccination discussions are not in her "standard scope of practice," explaining that beyond a basic handout, she typically refers questioning mothers-to-be to a pediatrician.

Although the American Academy of Pediatrics recommends finding a pediatrician during the third trimester of pregnancy, a 2018 survey showed that only 5 to 39 percent of first-time parents actually attend a prenatal visit with their baby's chosen pediatrician. Urban poor and pregnant women in rural areas are less likely to attend a prenatal pediatric visit.

In the absence of comprehensive information about childhood vaccinations, Dr. Google may take over.

I believe the following things would help to get the truth out:

  • A more active physician voice on social networking sites, connecting patients with evidence-based sources as opposed to anti-vaccination propaganda.
  • Standard policy by the American College of Obstetricians and Gynecologists recommending childhood vaccination discussions to occur during the third trimester of pregnancy, particularly surrounding the first . Research has suggested that this could help educate parents.
  • Standard policy by National Association of Certified Professional Midwives to include more information about childhood vaccinations during prenatal care.
  • Increased efforts to orchestrate prenatal pediatrician's visits to connect mothers-to-be with their child's future doctor to discuss vaccination, with a special emphasis on connecting first-time mothers with a pediatrician during the third trimester.

Explore further: Expectant first-time mothers uncertain about vaccinating their children

Related Stories

Expectant first-time mothers uncertain about vaccinating their children

September 11, 2017
First-time mums are more hesitant and undecided about childhood vaccinations compared to mothers with children and only two thirds of all mothers believe they receive enough information on vaccines during pregnancy.

Study finds 75 percent of first-time moms plan to follow vaccine schedule

November 5, 2015
First-time expectant mothers who do not plan to follow the recommended childhood immunization schedule differ in a number of ways from mothers who do, according to a recent study led by the Centers for Disease Control and ...

For school kids, vaccines are key

August 7, 2018
(HealthDay)—Be sure to put vaccinations on your children's back-to-school lists, whether they're just starting school or heading off to college, experts say.

Addressing parents' HPV vaccine hesitancy ups vaccination rates

May 22, 2018
(HealthDay)—Providers engaging parents hesitant about human papillomavirus (HPV) vaccination and addressing their concerns can lead to same-day vaccinations, according to a study published online May 15 in Pediatrics.

Parents' reasons for not vaccinating children influence public attitudes toward them

May 23, 2017
Mothers are viewed negatively if their child hasn't been vaccinated, no matter the reason. But mothers who outright refuse to vaccinate their children are viewed in a harsher light compared to those who delay vaccines because ...

No association between mother flu in pregnancy and increased child autism risk

November 28, 2016
A study of more than 196,000 children found no association between a mother having an influenza infection anytime during pregnancy and an increased risk of autism spectrum disorders (ASDs) in children, according to a new ...

Recommended for you

Study shows changes in histone methylation patterns in nutritionally stunted children

November 13, 2018
An international team of researchers has found changes in histone methylation patterns in nutritionally stunted children. In their paper published in Proceedings of the National Academy of Sciences, the group describes their ...

Your 6-month-old isn't sleeping through the night? Relax

November 12, 2018
(HealthDay)—If your 6-month-old still wakes up at 2 a.m., a new study suggests you don't lose any additional sleep worrying about it.

New exercise guidelines: Move more, sit less, start younger

November 12, 2018
Move more, sit less and get kids active as young as age 3, say new federal guidelines that stress that any amount and any type of exercise helps health.

Some activity fine for kids recovering from concussions, docs say

November 12, 2018
(HealthDay)—Children and teens who suffer a sports-related concussion should reduce, but not eliminate, physical and mental activity in the days after their injury, an American Academy of Pediatrics report says.

Soy formula feeding during infancy associated with severe menstrual pain in adulthood

November 9, 2018
New research suggests that infant girls fed soy formula are more likely to develop severe menstrual pain as young adults. The finding adds to the growing body of literature that suggests exposure to soy formula during early ...

A major role for a small organ in the immune response during pregnancy

November 9, 2018
The immune system of a pregnant woman is altered during pregnancy, but not in the way previously believed, according to results from a study at Linköping University, Sweden. This study, published in the Journal of Allergy ...

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

not rated yet Aug 15, 2018
People rightfully grow more and more suspicious about vax because 'the industy', 'official' approach is to 'stick to guns' and 'insist' or 'act' like there is literally NO risk whatsover, and that the growing number and combination of vaxes represent no risk of reactions that may affect immunes systems even premantly for a very very few unfortunate individuals. The industry seems to feel compelled to COMPLETLY 'white wash' the complex of issues. If 'the industry' instead took a more sophisticated approach of fairly representing the risk and nuances, even though this takes time, people would be more comfortable and more trusting. The industry is 'afraid' to 'fairly represent' it in what they perceive as a 'threat to society' environment, but the 'reaction' to the 'threat' can backfire if it seems like a whitewash. Don't be afraid to explain 'accurately'. Most people can handle it better than the preachy whitewash.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.