• Barbara K. Hackley CNM, MS

    Corresponding authorSearch for more papers by this author
    • Please refer to Hackley B. Immunizations in pregnancy: a public health perspective. J. Nurse Midwif 1999;44(2):106–17 for coverage on the epidemiology of VPDs, current recommendations for adult vaccination by the Advisory Committee on Immunization Practices and pregnancy-related vaccine issues.

    • Barbara Hackley is an Assistant Professor in the Nurse Midwifery Program at Yale University School of Nursing. She received a Bachelor of Science degree in Nursing from the University of Michigan and a Master of Science degree in Nurse-Midwifery from Columbia University. Currently, she practices in a community health center in the South Bronx where she was instrumental in incorporating immunizations into women's health services.

Yale University School of Nursing, Nurse-Midwifery Specialization, 100 Church Street South, P.O. Box 9740, New Haven, CT 06526-0740.


Adverse events occur only rarely after vaccine exposure. Yet, given the high vaccine coverage rates in the United States, the public is increasingly becoming concerned that vaccines may be causing immediate or long-term health problems and less concerned about the possibility of becoming infected. More than 10,000 reports of possible vaccine-related adverse events are reported every year to VAERS, the passive surveillance system that monitors vaccine safety after licensure. As providers of primary health care services to women, midwives are ideally positioned to answer women's questions about vaccine safety. This article provides the background midwives need to be able to help their clients make informed vaccine decisions. It discusses the incidence and risks of infection, the efficacy and risks of vaccines, issues complicating the evaluation of vaccine safety, the state of vaccine safety monitoring systems, and approaches consumers use in vaccine decision making.