Provider Attitudes and Practices Regarding Maternal Vaccination Among Obstetrician-Gynecologists: A National Survey

Abstract

Background. Obstetrician-gynecologists (ob-gyns) play a crucial role as vaccinators of pregnant women, yet little is known about their attitudes and practices in this role. Our objectives were to describe, among a nationally representative sample of ob-gyns: 1) practices and attitudes regarding vaccination of pregnant women; and 2) barriers to the use of standing orders. Methods. An e-mail and mail survey among ob-gyns conducted March-June 2016. Results. The response rate was 69% (331/477). Overall, 90% reported administering ≥1 vaccines to pregnant women. Almost all (97% and 95%, respectively), strongly recommend influenza (flu) and tetanus-diphtheria-acellular pertussis (Tdap) vaccines; 60% use standing orders for flu vaccination and 56% for Tdap vaccination. More (68%) always recommend Tdap vaccines to household contacts of pregnant women than flu vaccines (53%). Physician attitudes are shown in the figure. The most significant barriers to the use of standing orders included provider concern that patients prefer to speak to them first (12% major barrier, 25% somewhat), provider belief that they should be the one to recommend vaccines (11% major, 12% somewhat), and staff discomfort because of having to answer vaccine-related questions (7% major, 17% somewhat). Conclusion. Ob-gyn attitudinal barriers to maternal vaccination are rare, whereas barriers to use of standing orders, a highly effective strategy for increasing vaccination uptake, are common, and less than 2/3 of providers currently use them.