Quote from mAGGI315
My problem with this new recommendations is that hospitals tend to pick and choose, if we are going to follow the recommendations and make a "campaign", then do so to the fullest.
This means that
-ALL health workers need to be up to date with the Tdap and MMR, otherwise, you and your facility could be exposing babies.
-ALL family members should be up to date. Is your facility giving out information stressing the importance to other family members? If our goal is to really make a dent and prevent it, why do it half way? Why not make up some handouts and show the importance for all family members. That's the recommendation, not just new moms.
And as an FYI, the current statistic is 30 deaths in the neonatal period PER YEAR...so statistically, giving the shot is not going to make a huge difference if you look at how many babies are born, how many die from other causes.
If you look at how many women get infections, if you look at the fact we are somewhere like 18th on mortality in mothers, then anything that could potentially hide an infection (such as fever, chills, pain, etc) is a huge risk factor that should be eliminated.
Sometimes I think we do things to make ourselves feel better, but we don't really take the time to look at all the evidence and really stop to look at it from a common sense approach. We'd save more than 30 lives a year doing so many other common sense things, and if we're doing to do the vaccination promotion, then just giving the moms the shots without following the FULL RECOMMENDATIONS is really just fooling ourselves and giving ourselves a pat on the back. If the health care workers are walking around not up to date and we aren't pushing the other family members who are in the home, then we aren't making a difference. We're just making mom's uncomfortable and possibly could see more than 30 moms get sick or die over a year's time from masked infection (we've already had 2 in our facility, so I'm sure the numbers will be there over the whole country).
And giving a mom the VIS while she's recovering from birth, on narcotics, hasn't slept, and often giving it to her right as we're prepping the shot is a joke as far as informed consent. Informed consent should never be given when mom is under the influence of narcotics. We do it all the time in ob, especially with such short stays. These are moms who have been given huge packets of information, bombarded with all kinds of educational materials, and we hand them some information about vaccines, and then give them the shot a few minutes later, and think we gave them informed consent. I find that we should at least be embarassed by that and at worst should be thinking about malpractice if there's a reaction and mom can't even remember it and you find out she just had percocet 2 hours ago.
I don't work OB, never have, and I really have no desire to, so this is based on my own personal experience. I had c-sections with both of my children. On the day I was discharged from the hospital, on both occasion, I was more than lucid enough to read a paper and make an informed decision about whether I wanted a vaccine or not.
And if those 30 something deaths per year could be prevented? Why not? I mean seriously... I give Tdap vaccine to patients ALL the time, I have yet to even have 1 single person who had reactions bad enough to even call the office afterward. I don't think its going to mask any underlying infection in a post partum mom. Obviously if mom starts running a fever and having s/s of infection, whether she got Tdap or not, she should be evaluated by a Dr.
I do agree with you in the regards to complying with the full recommendations of the vaccine. Every 11 or 12 year old should be boostered with a Tdap and anyone older than that who has had a Td >2 yrs ago should be boostered with a Tdap. For instance, if I see a new parent in my clinic with their 2 month old child for immunizations, I should check her Tdap status while she is here with child and fathers status and the status of any sibling. BUT I work in a Native American clinic, so if one parent is not native then all I can do is advise them of the importance of being vaccinated and following up with their own private physician.
Obviously, I'm very pro-vaccine. Its what I do every single day. For me, the benefits far outweigh the risks. On another personal note, I have been administering vaccines for 8 years now and I have yet to have a patient have any serious side effects to any of them *knock on wood* I pray that it never happens. As medical professionals it is our obligation to make sure that our patients are informed of the risks/benefits of anything we do. I would say that if you feel a mother is not in the right state of mind to make that decision when she is leaving the hospital, then by all means, wait until her follow up appt. and do it at that time.