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In anticipation of a possible swine-flu pandemic, the CDC and the Washington State Department of Health have released recommendations for maternity care providers regarding the H1N1 vaccine and antiviral medication for pregnant women who develop influenza-like illness. Those recommendations are included below.

Because licensed midwives do not have prescriptive authority, the DOH's Perinatal Advisory Committee has issued additional recommendations so that our clients can obtain vaccinations, if desired, and antiviral medications, if indicated.  

Many midwifery clients may be disinclined to get the vaccine because of concerns about safety. Licensed midwives should let their clients know that the H1N1 vaccine will be available in single-dose, thimerosol-free vials for pregnant women and children under the age of 3; however, it's possible that there will be a shortage of this thimerosol-free supply.  

Pregnant women who choose to get vaccinated should request the thimerosol-free vaccine, although the DOH is still recommending the H1N1 vaccine for pregnant women, even if the thimerosol-free supply runs out.

It is also important for pregnant women to know that some of the first vaccine available may be the nasal spray which contains the active virus. Pregnant women should only receive the injectable vaccine--NOT the nasal spray.

MAWS would also like to offer a helpful list of recommendations for all of us to best maintain optimal immune health during the flu season.

RECOMMENDATIONS FROM THE CDC AND THE WA STATE DEPARTMENT OF HEALTH

Background

Pregnant women with influenza are at high risk for severe complications.  It is imperative that pregnant women with influenza get treated with antiviral medications and acetaminophen for fever as early as possible, preferably within 48 hours of influenza-like illness onset. If influenza is suspected, do not wait for test results to start treatment. Sick women should be monitored closely to see if they develop breathing problems or pneumonia. Due to the rapid progression that has been observed in the pregnant women who have died from H1N1 complications, all women with influenza-like illness should be closely monitored to determine the need for hospitalization.

References

CDC guidance

CDC guidance use of antivirals

CDC clinician call summary

Suggestions for obtaining antiviral medications for midwifery clients within the first 48 hours of symptom onset:

• Refer her to her primary care provider if she has a medical home or to an urgent care facility for evaluation and treatment.
• Refer her to an obstetric provider with prescriptive authority for evaluation, treatment, and follow up.
• Contact local health agency for list of alternative care sites where she can be safely evaluated and treated  To locate a local health agency, visit this site.
• If unsuccessful using the list above, send to emergency room for initial evaluation.

Women with severe symptoms such as breathing problems or symptoms of pneumonia should be directly referred to the appropriate hospital.  All women with symptoms should receive follow up phone calls from their licensed midwife to be sure they were seen and evaluated.

For assisting women in obtaining vaccinations:

• Refer her to her primary care provider, if she has a medical home
• Contact local health agency to locate the vaccines sites
• Refer to pediatrician for children
• Check with local hospital to see if they are operating a vaccination clinic

For Washington State H1N1 information visit this DOH page.