Midwife Connection: Should Pregnant Women Take the H1N1 Vaccine?

October 4-10 is National Midwifery Week! Each year during National Midwifery Week, midwives across the US raise
awareness of the midwifery profession and the services provided to women. RH Reality Check will be publishing a series of posts this week from the American College of Nurse-Midwives blog, Midwife Connection, to recognize this week – and the care midwives, Certified Nurse-Midwives and Certified Professional Midwives, provide. Need a quick Midwife 101? Read more.  

This week, the first doses of H1N1 (swine flu) vaccine will begin
arriving at midwifery practices around the country. Although government
agencies and health care providers are urging pregnant women to get the
seasonal flu vaccine as well as the H1N1 flu vaccine, some women remain
hesitant. Pregnancy is a time to avoid caffeine, alcohol, and
unnecessary medications. So, why make an exception for a new vaccine?

As a certified nurse-midwife
and mom of five (plus five step daughters!), I am typically cautious
about new products. When it comes to H1N1 flu, however, I am absolutely
convinced that vaccination is a must.

Because of the normal
changes of pregnancy (for example, decreased ability to fight off
infections), pregnant women are especially susceptible to the harmful
effects of H1N1 flu. Research consistently shows that pregnant women
are at increased risk for serious illness and even death from H1N1
infection and are four times more likely to be hospitalized.

you’re still on the fence about vaccination, consider this: for the
first time ever, a national coalition of eight organizations (including
ACNM, March of Dimes, ACOG, and AWHONN) has come together to develop a clear statement about the seriousness of H1N1 flu
and the importance of receiving the vaccination. This sends a pretty
clear message in favor of heading to your midwife to receive that

If one of your worries is thimerosal, a controversial
component of vaccines, about half the doses of H1N1 flu vaccine to be
released this fall are thimerosal-free and will be prioritized for
children and pregnant women. Ultimately, only you can decide what is
best for you and your family. I encourage you to give this issue
serious consideration and make a decision as an informed health care

Need more information to make your decision? Check out these helpful resources:

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  • hlm

    Get ALL The Facts: H1N1 and seasonal flu vaccines not proven safe for pregnant women, nursing mothers and there is little evidence it is safe for those with compromised immune systems by Heather L. Maurer There is shear panic being created around the Seasonal Flu and Swine Flu and billions of dollars being poured into the pharmaceutical companies to create a new vaccine for the Swine Flu. The FDA placed the Swine flu vaccine on the fast track for approval. And millions of doses have been given to individuals across the world. According to the CDC’s website, the number of deaths reported this week relating to pneumonia and influenza is low and within the bounds of what is expected at this time of year. This year the CDC is recommending flu shots are for pregnant women, infants and children. The 2009/20010 lot of approved flu vaccines may contain over 10 times the federal safe limit for mercury exposure in infants and 3 to 4 times over the safe limit for young children. Thimerosal is a dangerous and scientifically documented neurotoxin that has never been tested using modern safety standards. (2003 Congressional Report Mercury in Medicine) All manufactures inserts for the swine flu vaccine state, “Safety and effectiveness of Influenza A (H1N1) 2009 Monovalent Vaccine have not been established in pregnant women and nursing mothers.” This particular lot of swine flu vaccines does not contain the adjuvant squalene; however, several pharmaceutical companies are currently manufacturing H1N1 vaccine with the adjuvant and these may be released later this flu season. Rats injected with squalene develop the animal version of rheumatoid arthritis (adjuvant arthritis) and multiple sclerosis (experimental allergic encephalomyelitis or EAE. Injecting squalene into mice induces autoantibodies (antibodies against self) that are specific to systemic lupus erythematosus. There are over medical 30 studies that show these links. All seasonal influenza vaccines are classified by the FDA as a Category C, including all swine flu vaccines. Category C means Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women or no animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women. "In 1976 the U.S. recommended nationwide vaccination against a suspected swine flu, with less than successful results, to say the least. Under orders from President Gerald Ford, a vaccine was rushed into production and administered to 45 million Americans, at a cost of $135 million. But within weeks, people started developing Guillain-Barré syndrome, a paralyzing immune-system disorder that can result from the vaccine. Some experts estimated the risk of Guillain-Barré as being seven times higher in those who were immunized vs. those who were not. After the immunization program was terminated nine months after it began, government officials paid $90 million in damages to patients who were injured by the vaccine. And the widely feared swine flu epidemic never emerged,“ Time Magazine April 29, 2009. The FDA released on October 1, 2009, the lot of H1N1 vaccines. Manufactures include sanofi pasteur, CSL Limted, MedImmune and Novaritis. Some of the H1N1 vaccines contain as much as 25 mcg’s of mercury per dose. The specific brands that do not contain thimerosal are the MedImmune, LLC, intranasal spray, CSL Limted’s .5 ml single dose pre-filled syringe, and sanofi pasteur’s .25 ml, .50 ml, and the single dose .5 ml syringes. (Manufactures insert details as shown on the FDA’s website, http://www.fda.gov) Contradictions to receive the Influenza A (H1N1) vaccine include hypersensitivity to eggs, egg proteins, gelatin and concomitant aspirin therapy in children and adolescents. Immunocompromised persons should carefully way out the benefits and risks of the H1N1 vaccine according to the manufactures inserts. On April 26, 2009 the Secretary of the Department of Health and Human Services determined that there was a public health emergency because of the swine influenza A (H1N1). Because the government made this a public health emergency, if you or your child are injured from receiving the swine flu vaccine, you will not be able to receive compensation nor sue the government, the pharmaceutical manufactures and the pharmaceutical companies. Congress passed a law that protects the vaccine manufactures and any person giving swine flu shots from lawsuits relating to the H1N1 vaccine. To date no funded government vaccine injury compensation program has been established for the swine flu. Studies show that fetus being exposed to thimerosal run a risk of mitochondrial dysfunction, degeneration and death. (D.A. Geier, P.G. King and M.R. Geier, Toxicological & Environmental Chemistry, Vol. 91, No.4, June 2009, 732-749) "Exposure to high levels of metallic, inorganic, or organic mercury can permanently damage the brain, kidneys, and developing fetus," (Agency for Toxic Substances & Disease Registry states, ToxFAQ for Mercury, April 1999). FDA toxicologist, Dr. Mike Bolger, stated that "Methyl mercury easily crosses the placenta, and the mercury concentration rises to 30 percent higher in fetal red blood cells than in those of the mother. (FDA Consumer, September 1994). The adverse health effects of mercury on unborn children were observed in cases of accidental poisonings and in studies of individuals who ate large amounts of seafood, a common source of mercury.” A 50 pound child receiving two flu vaccines this season could be potentially receiving 20 times the EPA’s limit for ingested methyl-mercury if you are vaccinating with mercury containing vaccines. The EPA’s recommended maximum daily consumption of methyl-mercury from fish is 0.1mcg/kg/day to prevent health effects in the woman. As of September 18th, 2009, the FDA’s website lists the following vaccines as still containing full amounts of thimerosal (typically either 25mcg/.5ml dose or 12.5mcg/.25ml dose): • DT (Diphtheria/Tetanus) from Sanofi Pasteur • TT (Tetanus Toxoid) from Sanofi Pasteur • JE-VAX (Japanese Encephalitis) from Research Foundation for Microbial Diseases of Osaka University • Menomune (Meningitis) from Sanofi Pasteur in the multi-dose vials A recent primate study published in NeuroToxicology shows significant harm from a single dose of mercury containing vaccine to newborns. A research team led by scientists from the University of Pittsburgh and Thoughtful House conducted a primate study which showed significant damage to newborns receiving at birth the hepatitis B vaccine that included an ethyl mercury preservative. It caused significant delays in the development of several survival reflexes in male rhesus macaque monkeys. (NeuroToxicology, 2 October 2009, Laura Hewitson, Lisa A. Houser, Carol Stott, Gene Sackett, Jaime L. Tomko, David Atwood, Lisa Blue, E. Railey White and Andrew J. Wakefield) The new swine influenza is mild for most people even though a small number have developed complications and died. Yes, pregnant women are more at risk of getting this flu. I would suggest getting your Vitamin D levels tested and increase your Vitamin D intake to help protect you from the swine flu. Of the 28 women who died of complications relating to the swine flu we have no other information about their health. Where they immune compromised? Did they have other related illnesses? These facts haven’t been released. The swine flu vaccine has been tested for only a few weeks on a few thousand healthy children and adults, including very few pregnant women. We don’t know how safe it really is for pregnant women or children and adults with chronic illness even though they are being specially targeted for vaccination by government health officials. There is very little information about how safe it is to combine the swine flu vaccine with other vaccines, including seasonal influenza vaccine. Find out the facts, educate yourself and make an informed decision.

  • amytuteurmd

    Many illnesses are more severe during pregnancy, but the H1N1 influenza has had an unexpectedly devastating impact among pregnant women. According to the CDC, there have been approximately 700 reported cases of H1N1 in pregnant women since April. Of these, 100 women have required admission to an intensive care unit and 28 have died. In other words, 1 out of every 25 pregnant women who contracted H1N1 died of it. By any standard, that is an appalling death rate.


    There seem to be two reasons for the dramatically increased death toll. The first is the altered immune status of pregnant women making them particularly vulnerable to the virus. The second is that pregnancy compromises lung function. If a pregnant woman gets pneumonia as a complication of the flu, it is particularly difficult to insure that she gets enough oxygen.


    How should pregnant women decide what to do? The best place to start is with what we know for sure. We have a great deal of evidence that H1N1 influenza is particularly lethal in pregnant women. To put it in perspective, the chance of a pregnant woman dying from H1N1 is greater than the chance of a heart patient dying during triple bypass surgery. That is not a trivial risk.


    We have no evidence that the vaccine will cause any harm to pregnant women or their unborn children beyond the side effects associated with other flu vaccines, such as local irritation at the vaccine site, or the rare complication of Gullain Barre Syndrome. We have no reason to expect that the H1N1 vaccine will be any different.


    Given the dramatic threat and the fact that we know of no unusual complications of vaccination, the decision seems clear. Every pregnant woman should get vaccinated as soon as possible.

  • hlm

    For all the Health Care Professionals that are recommending the swine flu and the seasonal flu vaccine:
    It is a fact that the swine flu proposes a higher threat to pregnant women. Nobody wants anyone to die from this flu. Nobody wants any pregnant woman to die nor have their unborn child hurt by this disease. However, how do we know the swine flu shot won’t hurt these unborn babies? Publish the studies that show it is safe if you believe this to be the case. SHOW US THE SCIENCE! Your words and your MD, RN status are not enough. We have heard this before and we want to see the facts.

    How in the world could you recommend an vaccine that manufacture’s inserts state the safety hasn’t been proven? Since when did your word get to ride above their warnings? Are you going to be there for the women when they miscarry or their child is born damaged b/c of this vaccine? And because it is now declared a public emergency there is no compensation for these women.

  • hlm

    We know for a fact that during the winter months our Vitamin D levels go down. We also know that low levels makes us more suseptible to the flu. Why not first start testing women to see if their levels are low and begin with nutrition and vitamins to help build a health immune system before relying on an untested vaccine. YOu state, “We have no evidence that the vaccine will cause any harm to pregnant women or their unborn children beyond the side effects associated with other flu vaccines, such as local irritation at the vaccine site, or the rare complication of Gullain Barre Syndrome. We have no reason to expect that the H1N1 vaccine will be any different.” But you also have no evidence showing it is safe. We are no longer going to be your lab rats!

  • amytuteurmd

    "how do we know the swine flu shot won’t hurt these unborn babies?"


    We don’t.


    It would be much easier to make the decision if we knew more, if we had some idea of how extensive the fall outbreak will be, if we had longer experience with the specific vaccine. Unfortunately, that information is not available to us and by the time it becomes available many more pregnant women may sicken and die unnecessarily.


    Given the dramatically high death rate and the fact that we know of no unusual complications of vaccination, the decision seems clear. Every pregnant woman should get vaccinated as soon as possible.

  • crowepps

    There isn’t any ‘science’ that can provide a 100% safety guarantee for anything whatsoever and the fact that you think that should be possible seems to indicate that you seriously overestimate the current state of medical research. WITHOUT a flu shot 15 to 20% of pregnant women are going to miscarry and a minimum of 2% of children are going to be born with some sort of birth defect. Blaming those things on the flu shot even though they would have happened anyway is irrational.

  • crowepps

    We are no longer going to be your lab rats!

    Did I miss some news that getting a flu shot is going to be mandatory? If you don’t want to get a flu shot, I’m not aware that anybody is forcing you to do so. Feel free to take vitamins, cross your fingers and carry around a ‘posy’ to repel miasmas. So far as I know you have every right to get sick, suffer complications, refuse medical care and die in agony if that’s what your paranoia demands.

  • hlm

    What I still find so interesting is you can’t site one study that says it is safe? I am asking for the science. Isn’t your entire practice based on science? What ever happened to first do no harm?

    And yet you, the CDC and the government are running and spending billions of dollars to get everyone to line up for an untested vaccine. How in the world can you advocate something with no science to back it up? How can you say the factually swine flu vaccine it is safe for pregnant women and their unborn fetus? Where are your studies to prove this? Why in the world should we blindly believe you, the government and the biggest money making industry in the world, with no science to back this up? Nobody is disputing the fact that this disease may have negative impact on pregnant women. But what is so safe about a live vaccine on a pregnant woman? What about the thimerosal? How many women will receive the vaccine with it and not know they had a choice?

    Did you read the manufactures insert? Did you see in their own words they say the vaccine hasn’t been proven safe for pregnant women? I don’t get the medical establishment. Do you all own stock in GSK?

    I am shocked at the irresponsiblity of the medical establishment. Shame on you!

  • outsidethebox

    According to the 3 Vaccine inserts provided by the FDA’s website, there have been NO trials on pregnant women, there is no evidence of the effect this will have on the mother or baby. PLEASE go read them for yourself. It is unfathomable that they would push this vaccine for pregnant woman with no data. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm181971.htm

  • maria19

    The main point is that we should take all the information about the vaccine,then only think of taking the vaccine.Do not take the Vaccine without proper knowledge of it. It May harm you and your baby.


  • crowepps

    Every single medical intervention, vaccine, prescription or over-the-counter medication, bite of food, choice of activity, person or item in the environment of a pregnant woman could “potentially be harmful”. The more useful way of gauging that harm is to weigh it in the balance against the known potential harm of NOT intervening.

    While there is a potential harm in the vaccine, at this point based on past cases with this particular virus and the pattern of previous patient deaths, having the flu seems to carry MORE potential harm. Each woman, of course, will make up her own mind.

    Pregnant women, even ones who are healthy, can have medical complications from the flu. A large study of influenza-related illness during pregnancy was reported in 1998(1). This study examined the effect of the flu on pregnant women during 17 previous influenza seasons.

    The study found that during the flu season, pregnant women in the third trimester were just as likely to be hospitalized for heart or lung problems as women with serious, chronic medical conditions who were not pregnant. The risk increased the farther along they were in their pregnancies. Healthy women at 37 to 42 weeks of gestation were almost five times as likely to be admitted to the hospital during the flu season for heart or lung problems as women who were one to six months postpartum. Pregnant women with asthma are at particularly high risk for hospitalization during the flu season(2). The pandemic H1N1 flu virus that appeared in spring 2009 also appears to affect pregnant women disproportionately, perhaps even more so than the seasonal flu(3).


    (1) Neuzil, K.M., Reed, G.W., Mitchel, E.F., Simonsen, L., Griffin , M.R. 1998. “Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women.” American Journal of Epidemiology, 148:1094-102.

    (2) Hartert, T., Neuzil, K., Shintani, A., Mitchel, E., Snowden, M., Wood, L., Dittus, R., Griffin , M. 2003. “Maternal morbidity and perinatal outcomes among pregnant women with respiratory hospitalizations during influenza season.” American Journal of Obstetric Gynecology, 189:1705-12.

    (3) Jamieson, D.J., Honein, M.A., Rasmussen, S.A., et al. 2009. “H1N1 2009 influenza virus infection during pregnancy in the USA.” Lancet , 374:451-458.