An exploration of women's decision-making processes around accepting or declining vaccinations in pregnancy: A qualitative descriptive study

Objective: To explore women's perceptions and experiences of accepting or declining vaccinations in pregnancy, and to identify factors that influence vaccination uptake. Design: A qualitative descriptive interview-based study. Setting: The maternity unit of a rural hospital in the Republic of Ireland. Participants: A purposive sample of eight women who were pregnant, aged 18 and over, who were receiving antenatal care through the public healthcare system. Half of the participants accepted vaccinations, while the other half declined, reflecting varying levels of vaccine hesitancy. Methods: Semi structured interviews (n=8) were conducted between July 2022 and August 2022 and analysed using thematic analysis. Findings: The study offers insight into women's decision-making processes on vaccinations in pregnancy. Five main themes were identified (1). Maternal Instincts in the Shadow of Uncertainty, (2). Lack of Balanced Information, (3). Misinformation: Difficult to Ignore, (4). Navigating Fear and Social Pressures, (5). Perceived Benefits Outweighing Risk. Key conclusions: The decision-making process around vaccination in pregnancy is complex and multifaceted, influenced by various factors that can either hinder or promote uptake rates. Participants expressed complex emotions, associated fears and anxieties, and highlighted the necessity for more balanced and transparent dialogues with healthcare professionals. They emphasised the need for the dissemination of high-quality objective evidence from health authorities. This, they felt, would help facilitate genuine informed decision making, and ease the burden of feelings of uncertainty. Implications for practice: The provision of balanced, reliable, evidence-based information made available through multiple sources, alongside open and non-judgemental conversations with healthcare professionals is essential to support women in making informed decisions. Consequently, healthcare professionals require education and training to effectively communicate vaccination information clearly, empathetically, and in a way that is tailored to individual needs.