Health and Science News for Parents

I’m pregnant! (But there were too many hoops for my flu shot!)

written by Tara Haelle

I have some exciting news to share that also happens to be directly relevant to an evidence-based parenting topic: flu shots. First, let me warn you that this the first of several flu shot posts I’ll be writing in the week or two. I’m starting out easy by writing about my own recent experience first.

Now, the news: I’m expecting another baby boy who should be arriving in early April! At 16 weeks along, I’ve been to a handful of prenatal appointments already, and it’s been interesting to go through this pregnancy with far more evidence-based knowledge than I had while I was pregnant with my first son. Hence, I found myself on the phone a week or so ago calling my OB/midwife’s office to ask why I had not been offered the flu shot at my last prenatal visit, considering it’s already October. I had assumed that my care provider’s practice, like that of my OB in Austin, carried flu shots and included them as part of their standard prenatal care.

Pregnant? Don't forget your flu shot! Photo by Wong Mei Teng

I was wrong. The office did not carry flu shots, or even the Tdap, for that matter, even though the Tdap is now officially recommended during women’s second or third trimester to offer a bit of extra protection against pertussis to newborns. Still, the nurse was surprised that my provider had not recommended I get the flu shot. It’s not that my provider had recommended against it; it just never came up (and I did not think to ask about getting one until after I had left my appointment).

It’s possible that my provider didn’t mention the shot because she knows my line of work and that I would already have decided whether I was getting one or not, but I was still concerned that it hadn’t even come up and, especially, that the practice didn’t even have flu shots available for patients.

After all, pregnant women are far, far more likely to get their flu shot when their provider both recommends the shot and offers it there at the practice. In a CDC report on flu shots among pregnant women for the 2012-2013 season, 70.5% of women whose providers recommended and offered a flu shot got one. Unsurprisingly, only 16% of women whose providers didn’t recommend the shot ended up getting one.

And then there were the women whose providers recommended the flu shot — but didn’t offer one: only 46% of them ended up getting the shot. That makes sense. If you can get it right then during your prenatal visit, it’s easy. If you have to go out of your way to a drug store, grocery pharmacy or another provider to get your shot, you’re less likely to make the effort.

Then there are those who do make the effort but run into other obstacles. A couple of friends told me they have been turned down for flu shots while pregnant when they sought them at the pharmacy of several common drug store chains. This was in the past, and it’s only anecdotal, but it’s disturbing considering that pregnant women are among those considered “at risk for medical complications attributable to severe influenza,” and therefore among the high-risk, targeted groups for flu vaccination.

I, too, ran into a stumbling block of sorts, or at least it would have been if I had not known better. I showed up at CVS with my son, who was excited to watch mommy get a shot for a change. After filling out the form and checking the box that noted I was pregnant, the pharmacist apologetically said they didn’t have any of the preservative-free vaccines available that day.

The preservative she was referring to is the undeservedly much-maligned thimerosal, an ethylmercury compound that ensures the multi-dose vials of the influenza vaccine don’t transmit bacteria to patients receiving their shot. As I’ve written before, thimerosal is safe and ethylmercury is processed quickly and easily by the body, unlike its more potentially harmful cousin methylmercuy. And thimerosal is no more a problem for pregnant women than anyone else.

“That’s fine,” I told the pharmacist. “I can get the shot with the thimerosal.” I thought back, however, to my phone call with the nurse at my provider’s office. She, too, had said to get the preservative-free flu shot. I had corrected her at the time, gently letting her know that thimerosal poses no risk to pregnant women or their fetuses, but I marveled that two different medical professionals were suggesting that thimerosal-containing vaccines should be avoided.

Back at CVS, the pharmacist actually pulled out the vaccine insert to confirm its appropriateness for pregnant women and noted that it was a Pregnancy Category B medication, like most other vaccines and many medications that doctors prescribe to pregnant women. She said she wasn’t aware that it did have any concerns for pregnant women, just that they were typically discouraged from giving pregnant women the shot with thimerosal. I also confirmed with Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, that a flu shot with the preservative was completely fine for pregnant women. Yes, he said, it was.

And so I got my flu shot today (my son enjoyed being the one to put on the bandaid), and I thought it was important to share my experience because it’s so important that other pregnant women get immunized against the flu as well.

So, a quick list of what pregnant moms should know about the flu:



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9 Responses to “I’m pregnant! (But there were too many hoops for my flu shot!)”

  1. Cigal

    Tiny editing note, but it might make it clearer to patients (since I share your wonderful blog with my patients) in the last paragraph (great summary overall!):
    2nd to last bullet point: “pregnant” is probably meant to be “pregnancy”, and you might want to make it clearer that “flu” is getting the illness, not the flushot (I read it quickly the first time and thought you were saying the flu shot was associated with the bad stuff)

  2. Tara Haelle

    Thanks so much! I appreciate careful eyes for editing :) This is what I get for writing this at 2am! Fixes made. And I’m so excited to hear that you share this blog with your patients. I will be having quite a few flu posts coming up.

  3. Amy

    I was just talking about this today w my mom! My SIL is due next week and have got her flu shot yet, and the only reason we could come up w was that it wasn’t offered at the doctor’s and she just never got around to doing it.

    I live in the UK and just got my flu jab last week before coming back home to USA to visit family. I had to make a separate appointment for that and will have to make another appointment when I get back for my whooping cough vaccine, on top of regular prenatal visits. I feel like a person has to be especially motivated to do it all (simple, but time consuming to keep going back) when it should really just be available quickly and easily for all who need it.

    • Tara Haelle

      I agree that it should be made easier for women to have the vaccines built into the prenatal (antenatal) care regime. I understand that there are additional logistical challenges for practices to carry vaccines, but I also think taking on those challenges should be a responsibility of practices who aim to practice evidence-based medicine. Especially when a woman is pregnant, these vaccines are too important to be afterthoughts.

  4. Maria

    Thankfully all I had to do was go downstairs from my appointment to get my flu shot after my last OB appointment. Took me less than 5 minutes. If it wasn’t so convenient, though, I can easily see how you could forget to get around to getting the shot!

  5. Terrie

    Congratulations, Tara, on your pregnancy!

  6. Rachel

    This is still happening: this October I indicated to the CVS pharmacist on the form that I was trying to get pregnant, and she wouldn’t give me a flu shot unless I called my doctor and got permission, and told me I wouldn’t be able to try to conceive the month I got a flu shot. It turned out that I was pregnant: my doctor’s office gave me a flu shot as soon as it was confirmed.

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