Decision-making about early childhood vaccination often starts during pregnancy. Recommendation from a trusted healthcare provider is a key determinant of parental decisions. Physicians and midwives can hold differing views on what and how to communicate about vaccination and can serve different parent populations. We sought to understand whether pregnancy care provider type in British Columbia (BC), where more than a quarter of pregnancies involve care by a registered midwife, was associated with receipt of routine infant vaccines. Using data from BC's perinatal and immunization registries linked with provider services from the provincial insurance billing database, we used a Poisson regression model to analyse the association between perinatal care provider type and vaccination up to age 2 years for a cohort of children born Jan 1, 2010 through Dec 31, 2015. Binary outcomes included up-to-date status for recommended vaccinations, refusals, and delays of 30 days or more from the provincial vaccination schedule. The analysis included 180,087 children, 16.6% of whose mothers had majority-midwife perinatal care. Majority-midwife care during pregnancy was associated with lower completion of all recommended vaccinations by 2 years of age (aRR up to date for age = 0.81 95%CI 0.80–0.82), greater refusals (aRR refusal to any vaccinations = 2.50, 95%CI 2.37–2.64) and higher vaccination delays, especially for the third dose of DTaP-HB-IPV-Hib vaccine at the 6-month milestone (aRR = 0.76 95%CI 0.75–0.77). Majority-midwife perinatal care was associated with vaccination delays, lower overall vaccination rates, and higher refusal rates than majority-physician care. A causal association between provider type and infant vaccination cannot be concluded from our study, as parents inclined to delay or refuse vaccines may preferentially seek midwifery care. However, strengthening midwife resources for vaccination counseling and improving the transition from midwifery care in pregnancy to public health and/or primary care postnatally may improve vaccine uptake. • Midwives provide care to one in four pregnancies in British Columbia, Canada. • Midwife care was associated with lower vaccination rates compared to physician care. • Targeted strategies based on findings may improve vaccine uptake.
Twohig et al. (Wed,) studied this question.