At MIGA’s recent webinar on the COVID-19 vaccination roll-out, one of the insured Eligible Midwives asked the panel a series of questions to assist her with providing care and advice to women during the roll-out. The complexities of the vaccination and the evolving nature of information has created a whirlwind of uncertainty.

Here is a summary of the questions posed and the answers provided by the panel, supported by the Australian Government’s COVID-19 Vaccination Guide.

What are the current recommendations for pregnant and breastfeeding women, including with health conditions that make them more vulnerable to more serious COVID-19 disease?
Although the available data does not indicate any safety concern or harm to pregnancy, there is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy. However, it may be considered if the potential benefits of vaccination outweigh any potential risks. So, if a woman has medical risk factors for severe COVID-19 or is at high risk of exposure the decision to vaccinate should be made in consultation with the health team.

RANZCOG Guidelines are that the most likely relevant groups of medical conditions are:

  • Significant pre-existing medical conditions e.g. diabetes
  • Solid organ transplant recipients
  • Those with chronic respiratory conditions including cystic fibrosis and severe asthma
  • Those who have homozygous sickle cell disease
  • Those receiving immunosuppression therapies sufficient to significantly increase risk of infection
  • Those receiving dialysis or with advanced chronic kidney disease
  • Those with significant congenital or acquired heart disease.

Will it be safe for baby and will it provide protection to baby as well as mother?
This is still unknown and there is currently no advice on this.

Is the vaccination recommended for Breastfeeding women and is it safe and potentially beneficial for the breastfed babies?
Breastfeeding women can safely receive almost all other vaccines. Comirnaty (Pfizer, Australia) is not a live vaccine. Although it has not been specifically tested in breastfeeding, there are no concerns about its safety to women or their babies. There is no need to stop breastfeeding before or after vaccination. The mRNA in Comirnaty is rapidly broken down in the body and not thought to pass into breastmilk. However, even if it did, it would be quickly destroyed in the baby’s gut and is therefore extremely unlikely to have any effect.

When do you expect pregnant women to be included in vaccination programs?
This is still unknown. While the risk of community transmission is so low in Australia, the recommendation of no routine vaccination will remain.

All health advice should be patient-centred and consider each individual’s personal considerations and preferences. In the absence of evidence on the safety or efficacy of the COVID-19 vaccines in pregnant women, the decision to receive vaccination rests solely with the pregnant woman following informed consultation with her midwife and/or doctor.

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