Vaccination in pregnancy — structured oral station (12 minutes)

Opening prompt — "She asks whether she really needs the injections. How do you respond?"

Model response — lead with rapport, then the four vaccines: ^[4]

• "I would thank her for raising it and acknowledge that it is a reasonable question to think through. I would not pressure her — I would explain what is recommended and why, and support her to decide."
• "There are four vaccines routinely recommended in pregnancy: influenza at any stage, pertussis around 20 to 32 weeks, COVID-19 per current guidance, and RSV around 28 to 36 weeks. Each protects both her and her baby — the antibodies she makes cross the placenta so her newborn is born already protected."^[4]
• "I would offer the influenza vaccine today if she is agreeable, and plan the others for the right visit."

Probe 1 — "Why pertussis in particular? Is it not a childhood disease?"

• "Pertussis kills infants, and the deaths are concentrated in babies under three months — too young to have received their own vaccines. The maternal dose closes that gap. The Dabrera study found maternal pertussis vaccination was 93% effective in protecting infants under eight weeks."^[2]
• "That is why it is given in every pregnancy — the antibody wanes between pregnancies, and each baby needs its own fresh protection."^[4]

Probe 2 — "She has heard vaccines are unsafe in pregnancy. What do you say?"

This is a scored communication domain. Demonstrate it out loud: ^[4]

• "I would ask what specifically she has heard, and address it directly. The recommended vaccines in pregnancy are inactivated or recombinant — they cannot cause the infection. The live vaccines, like MMR and varicella, are genuinely not given in pregnancy, but the recommended ones are safe across all trimesters."^[4]
• "I would share the evidence: the COVID-19 mRNA studies show vaccination is associated with fewer, not more, pregnancy complications. Influenza vaccination has been used in pregnancy for decades."^[5]
• "I would offer her written information and time to decide, and record her decision either way."

Probe 3 — "Her booking serology comes back rubella IgG negative. What do you do?"

• "I would not give MMR during pregnancy — it is a live vaccine and contraindicated. The reflex error is to vaccinate; the correct action is to defer."^[4]
• "I would plan MMR for the postpartum period, given before discharge. It is safe in breastfeeding. I would counsel her to avoid pregnancy for one month after the dose, and I would document the seronegative result and the plan."
• "Rubella matters because primary infection in early pregnancy causes congenital rubella syndrome — so the postpartum catch-up is essential, not optional."^[4]

Probe 4 — "She also tells you her GP gave her the MMR vaccine two weeks ago, before she knew she was pregnant. She is very anxious."

• "I would reassure her. There is no documented link between inadvertent MMR in pregnancy and fetal harm, and termination is not recommended for the vaccine alone."^[4]
• "I would document the exposure, continue routine antenatal care, and make sure she understands this does not change her pregnancy management. The anxiety is the main thing to address here — with empathy and the evidence."^[4]

Probe 5 — "Summarise your approach to vaccination in this pregnancy."

• "Offer the four recommended vaccines at the right visits — influenza now, pertussis at 20 to 32 weeks, RSV at 28 to 36 weeks, COVID-19 per guidance. Defer MMR to postpartum given her seronegative status. Address her hesitancy with the evidence and the trusted-provider relationship. Document every vaccine given or declined, and report to the immunisation register."^[4]