Changing rules, recommendations, and risks: COVID-19 vaccination decisions and emotions during pregnancy

As COVID-19 vaccinations rolled out globally from late 2020, rules and recommendations regarding vaccine use in pregnancy shifted rapidly. Pre-registration COVID-19 vaccine trials excluded those who were pregnant. Initial Australian medical advice did not routinely recommend COVID-19 vaccines in pregnancy, due to limited safety data and little perceived risk of local transmission. Advice from local medical authorities changed throughout 2021, however, with recommendations and priority access during pregnancy. In Western Australia (WA), recommendations became requirements as the State government mandated vaccines for some workers, with brief availability of pregnancy exemptions. Through an examination of 10 in-depth interviews with WA pregnant women, we explore their decision-making and complex emotions regarding COVID-19 vaccinations, and how they balanced mandates, recommendations, and shifting considerations and perceptions of risk. Changing recommendations and rules—and media and popular interpretation and communications of these—led to confusion, including for medical professionals. Expectant parents had to negotiate the risks of COVID-19 disease, potential benefits and risks of vaccination, professional and personal costs of vaccine refusal, and interpret mixed medical advice. Our findings can inform the development and communication of public health policies and medical advice, and contribute to our understanding of bodily autonomy, risk, and decision-making beyond the pandemic.