This morning I was watching last nights news as per my usual routine, and one of the headlines had to do with the recent measles outbreaks. Some children in Toronto caught the virus because they had not been immunized against it. Unlike the recent outbreak that originated at Disneyland, these were all independent incidences with no connection. Except the fact that they had not been vaccinated.
I get very passionate about this subject, especially since I live in Canada, a country where health care is universal and we are not required to pay for things like provincially scheduled immunizations for children. Our healthcare system is usually in a sate of turmoil due to government funding (or lack of) and our hospitals are not always equipped with the best and newest equipment (or working equipment for that matter…three of our labour rooms have lights that will not turn on) so this makes prevention of diseases all that much more important. Third world countries cry for vaccinations and proper treatment for preventable diseases and would probably line their kids up for blocks and blocks to receive just one dose of the vaccinations that are given to our Canadian children at 2, 4, 6, 12, and 18 months. At 5 and 15 years old. So with this in mind, while watching the news this morning I posted on facebook my outrage that kids in Canada had measles because their parents chose not to vaccinate. What I didn’t expect was the debate it would spark. My privacy levels on facebook are set so only my friends can see what I post so I figured I was safe from sparking any huge debate by posting my feelings about vaccinations. I knew most of my friends were of the same mindset as I was and figured I would get the usual “likes” and random comments. I was wrong!
I love a good debate, and vaccination is a hot one right now. As a nurse I am required to not let my views show in the hospital room. The patients views are what matter, and like them or not my job is to make sure these values are respected and known to all the healthcare team. I must be accountable for my patients safety, advocate for them and maintain my continuing education to ensure I am providing them the best care. I don’t really know what happens after I take my patients up to the family newborn unit. There are children out there whose deliveries I was present for and I have no idea where they are or what they are doing now. I have no idea if they have been vaccinated or not, and it is not my place to care as a nurse.
As a person who has been through many illnesses and has actually had, or seen family members have some of the preventable viruses (even though we were vaccinated) I cannot understand how a parent would choose not to do everything possible to protect their child from preventable diseases.
When a patient decides to decline a treatment we are offering I tend to google it so I can get an idea of what they are learning by declining. I don’t tell them what I’ve learned from this search…that is not my place. I just like to know where they are coming from. Some of the most common things that are declined in my line of work are continuous fetal monitoring when it is indicated, antibiotics when they are indicated, induction of labour when it is indicated, and the vitamin K injection we give the baby to prevent hemorrhage.
Our policy on fetal monitoring is based on the Society of Obstetricians and Gynaecologists of Canada, or SOGC guidelines. They can be found here. These guidelines are there for the safety of a patients unborn child, plus the safety of the healthcare team caring for the labouring mother and fetus. It offers a solid communication that allows us to capture exactly how the fetus is responding to contractions and what interventions were taken to aid fetal wellbeing. We provide continuous monitoring for all patients who are receiving induction, are attempting a vaginal birth after having a c-section, when there is meconium present in the amniotic fluid. There are other examples as well. Fetal monitoring is not perfect. I have seen cases where it looked like we were capturing a perfectly healthy fetus, only to find it was the mothers heartbeat. I have also seen cases where we caught an issue on time because of the monitoring. I have seen people flat out refuse the monitoring and be lucky enough that nothing happened during the labour. A doppler can only tell us so much.
When a patient is positive for group b strep and their water breaks it is our policy to induce labour and start antibiotics so the baby does not get infected during delivery. You can read more about it here. Again, I have seen people come in as soon as their water breaks, receive the antibiotics and still develop a fever during labour. I have seen patients decline the antibiotics and the baby has done fine. I have also seen babies of patients who decline the antibiotics become sick and require antibiotic therapy after birth.
How does this relate to the vaccination debate? The point I’m trying to make is that as healthcare professionals we make decisions based on research, education and life experience. Sometimes things can happen that we can’t explain and might never be able to. They don’t follow the norm. There will always be a small percentage of people who do not react to a treatment the same way as most can. The same can be said about vaccinations. Lately people have been talking more and more about vaccine injury, which you can learn about here. People are using this as a reason not to vaccinate, along with fever, seizures and other known side effects. They are saying they do not want to subject their healthy child to something that does not have guaranteed safety. If you continue to read the above link to the CDC you will see that they even admit it is not known to be 100% safe. However, nothing in the medical field is. Chemotherapy is not 100% safe. Surgery is not 100% safe. The birth of a child is not 100% safe. We do the best we can based on what we know and what we have experienced.
No, we do not know how every single person will react to the vaccinations. We do not know how a pregnant woman and her baby will react to the flu shot. The flu shot is based on a guess. Experts try to determine what strains of influenza will be prevalent in the upcoming season based on the season that just past. Sometimes they get it wrong. They did this year. The reason we don’t know how pregnant women will react to certain medications until they are given them is that ethics prevents scientists from conducting tests on them. Testing for medications are conducted on healthy people of a certain age group. Ethics boards were created to avoid situations like this. Before we had any sense of ethics, a man named Edward Jenner discovered inoculations by scraping a spore of cowpox and injecting into a healthy young boy. He based this on his observation that milkmaids were not catching smallpox plus the observation that people who survived the disease never caught it again. You can read more about it here.
Some of the arguments surrounding when to vaccinate your child seem to have scientific background and could be legit, such as the fact that breast milk can help the child’s immune system. We know this is true for the first couple of months for sure. Maybe it’s true for longer, I don’t know. Again, who would want to do the study to find this out? Do you want to skip vaccination on the off chance that your milk will protect your child? When would you suggest starting vaccination if this is the case? And what about those parents who, for whatever reason, can’t breastfeed?
I am all for informed decisions, and if you have done your homework properly and still do not want to vaccinate your children that’s fine. But you could at least make sure there is not an immunocompromised child attending school with your child. You can make sure you are receiving the proper information. Google searches do not provide the proper information without some serious digging (I found all the above articles on Google after scrolling through blogs and obscure websites that are usually sponsored. And please don’t complain if your child develops and (heaven forbid) dies from an otherwise preventable disease.