Specificity of the midwifery practice
Midwives are health professionals who provide care throughout pregnancy, labour, delivery and during the first six weeks following birth. Midwives are recognized as having a unique approach that considers health determinants and the uniqueness of each person in the context of discussions with their clientele. Their approach fosters trust and promotes autonomy.
The pregnant person and their family (as defined by the pregnant person) are at the center of the decision-making process and are part of a non-hierarchical relationship with their midwife. The role of midwives is to foster relationships based on trust, conducive to discussions. Midwives provide quality, adapted and accessible information to allow individuals and families to make informed decisions. The sovereignty of every person and community is also pivotal to midwifery practice.
Vaccination, a public health measure
In Canada, the federal government has given the National Advisory Committee on Immunization (NACI) and the Public Health Agency of Canada (PHAC) the mandate to promote best practices in terms of immunization and vaccination.
In Quebec, the Comité sur l’immunisation du Québec (CIQ) reports to the Institut national de santé publique du Québec (INSPQ). It identifies and reviews epidemiological research and voices recommendations and opinions on behalf of the ministère de la Santé et des Services sociaux du Québec (MSSS). In Quebec, there is a compensation program for victims of serious and permanent injury with a likely causal relationship to vaccination.
Public health is part of a population health approach as a whole and puts in place measures such as access to drinking water and vaccination. Vaccination is seen as an effective means in the prevention of transmissible diseases both at the individual and population level. When a sufficient proportion of the community is immunized (often around 85-90%), the principle of herd immunity then allows people who cannot receive the vaccine or who are immunosuppressed to be indirectly protected by others, reducing the chain of transmission from one person to another. Vaccination and herd immunity therefore protect the most vulnerable. However, historically, colonialist medicine. Many examples of violation, abuse of power and breach of trust have led to distrust measures such as vaccination. The history of medical experimentation, forced sterilization and current and past systemic racism are examples of such abuse of power that are still felt in some populations today.
Midwives in the pandemic context
During the pandemic, several midwives were instrumental for disseminating information on COVID-19. Time was scheduled to inform and discuss the recommendations, the issues related to vaccination as well as the psychosocial impacts of the pandemic with pregnant people in a context of constantly changing information.
Following the COVID-19 experiences, midwives observed a certain tension between the duty to communicate public health recommendations based on a population-based approach and the exercise of informed choice, a person-centered approach. This tension also stems from the presence of both personal and institutional biases. Some wondered if this role really fell to the midwives and wanted tools to be created for the purpose of these discussions.
Informed choice about vaccination
One of the professional standards in Quebec is that midwives provide people with the information available regarding the issues related to various choices, and their potential implications, during the perinatal period. In other words, people have the right to have access to available information about the decisions they can make. In the context of vaccination, midwives have the role of initiating a discussion to see what the person knows about the topic, and if they wish to know more. The information is transmitted in a relational approach, taking into account the life, values, experiences or access constraints. Such information is also intended to educate people on the benefits, risks, implications, current data and recommendations, and options. As professionals, it is crucial to adopt a reflective and sensitive practice that facilitates access and that is aware of personal biases with respect to vaccination.
Trying to convince a person is not in line with the midwifery approach to informed choice and is often counterproductive. It may even contribute to a distrust regarding vaccination. Giving too much information, too many statistics or relying on an authoritative message may have the same effect.
As with all care, the person will have the right to choose whether or not to get a vaccine. Vaccination is not mandatory in Canada and vaccination is not without risk, however, the benefits outweigh the risks, although this is all relative to the person and their context. Having access to information will allow each person to make their own choice and to understand the implications of that choice.
