After giving birth in May, Pip Lowdon and her husband decided on what they thought was a simple rule for visitors to protect their baby: family and close friends would be asked to get the whooping cough and flu vaccines.
“If they didn’t, we were happy for them to visit provided they were feeling well, but asked them to not get too close,” Ms Lowdon says.
“The obstetricians and nurses advised us that this was the best approach, particularly given the time of year.”
But a can of worms sprang open. While most loved ones have been accommodating, the 35-year-old Jan Juc mum says navigating the topic has been “difficult” and “confronting”, with her fear of how people will respond amplifying her anxiety.
The heaviest pushback has come from a close relative who pelted her with emails linking to anti-vaxxer spin.
“It made me feel belittled. I made the request to protect my daughter, and yet the response I received resulted in more than a few tears,” Ms Lowdon says.
“The emails continued even after I indicated … that how I protected my daughter is my choice, and that I would prefer not to receive anti-vaxx emails.”
The stand-off came to a head at the hospital maternity ward, days after baby Frankie's birth, when the relative arrived unvaccinated for the flu. An argument erupted.
“As we had done the research and were following the recommendations of medical specialists, we responded very shortly that we didn’t care about their view, it was our choice.”
Ms Lowdon was shaken up. At a time where she should have been savouring her new baby bubble, she instead felt “terrible”.
What's the best method of protecting a baby?
The question of how to deal with visitors has long been one parents agonise over. But the angst has only worsened as Australia’s anti-vaxx movement grows louder.
Worried mothers frequently turn to parenting groups on Facebook for advice. Should they be strict with all family and friends, no exemptions? How bad would it be to relax the rules a little with the occasional visitor? Should they offer to pay for other people’s vaccines? Perhaps it is easier to avoid the headaches and just endure isolation for a while?
Some parents have taken to posting an image that clearly commands ‘No Vax, No Visit’ when they announce their baby’s birth on social media – to avoid uncomfortable conversations.
Such images surged in use after the highly-publicised death of Perth baby Riley Hughes, who died at 32 days in 2015 after catching whooping cough.
The thinking behind it is similar to the once-popular cocooning strategy, which involves immunising those who will be closest to a new baby. Only this is far more rigorous.
But according to Associate Professor Margie Danchin, a Royal Children’s Hospital general paediatrician and Melbourne University researcher, this rule is not the answer, and it’s putting parents under undue stress.
“A new mum needs to see people and have visitors and it’s a normal celebratory time to share with family and friends. I’m very against hyper-vigilance … I don’t think it will achieve anything.”
Instead, she wants to reassure parents that the most effective way of protecting their new baby from whooping cough and the flu is within their control – and it comes in the form of maternal vaccination.
Australian health guidelines recommend women are vaccinated for the flu and whooping cough – both highly contagious respiratory illnesses – during pregnancy. The vaccines protect the mother but also her baby, as she will develop antibodies that transfer via the placenta. This is crucial because an infant cannot be vaccinated for whooping cough until at least six weeks of age, and the flu until they are six months old.
“If the mum has vaccinated herself in pregnancy I think she can feel much more reassured she has done the best thing to protect her infant,” Associate Professor Danchin says.
“[When a visitor has] no symptoms and the mum is vaccinated then the risk to the infant is exceedingly low. I think we’re creating hysteria.”
But despite both vaccines having proven to be very safe, uptake is lower than hoped.
A study published in April in the Medical Journal of Australia examined 153,980 pregnancies across 67 Victorian hospitals between July 2015 and June 2017. It found 39 per cent of women were vaccinated against the flu and 64 per cent against whooping cough.
Associate Professor Danchin says more work needs to be done to ensure private and public healthcare providers are recommending the vaccines.
“There are very few [medical] reasons a pregnant woman wouldn’t be able to get vaccinated.”
Paediatric infectious diseases physician Dr Archana Koirala, of the NSW Immunisation Specialist Service team, says the whooping cough vaccine should be done between 20 and 32 weeks' pregnancy, and it is 90 per cent effective at protecting newborns until they can be immunised themselves.
Meanwhile, the influenza vaccine should be administered at whatever stage of pregnancy a woman is in when the flu season starts. Dr Koirala says the reason is two-pronged – firstly because women are at higher risk of dangerous complications from the flu when they’re pregnant, and secondly to help protect their baby.
“It wanes, but there is protection for the baby until they are eligible to get the vaccine,” she says. “It is the best protection we can offer.”
The vaccine’s effectiveness varies season-to-season as its composition changes each year, but the Australian Immunisation Handbook cites US research finding it to be about 54-59 per cent effective. It also decreases the severity of the flu if you do catch the virus.
‘It felt like I was tearing my family apart’
Sydney mum-of-three Felicity Frankish welcomes the perspective from doctors on maternal vaccines, as it helps minimise the stress of new motherhood.
“There’s so much to worry about and you don’t want to feel bad if you’ve let people unvaccinated near your kids," Ms Frankish says.
But the 31-year-old says it doesn’t change her view that the ‘no vax, no visit’ rule gives a parent peace of mind and sends an important message to loved ones.
When she gave birth to her first child in 2016, she created a Facebook group for family and friends to request they didn’t visit unless vaccinated, particularly in the first six weeks.
“Before my first daughter we had three miscarriages,” Ms Frankish says. “We lacked so much control while trying to get pregnant ... so we wanted to take that back when they [the children] were born.”
Like both Ms Frankish and Ms Lowdon, Sydney parenting blogger Mel Watts was vaccinated during her pregnancies.
But the 32-year-old mum-of-four says she was also encouraged by health professionals to ask loved ones to only visit if they were vaccinated. The result, she says, was some people being “stand-offish” and thinking she was “overreacting” or being “rude”.
“My husband’s family is a lot older and they didn’t particularly like it. It took a bit to persuade them to agree to it," she says.
But she says for the most part, people got the vaccines once they understood their fears.
“We explained to them … that we were not forcing them but if they didn’t get it, we would prefer if they waited until our baby could get their first vaccination before visiting.”
Another mum, 32-year-old Stacey*, says her decision to not allow unvaccinated loved ones to visit her newborn son in 2016 caused a major rift in her family.
“It brought on many arguments, many, many tears and it felt like I was tearing my family apart,” she says.
The Queensland mum wasn’t vaccinated during pregnancy but was immunised immediately after. She says her parents, who had become anti-vaxxer, were horrified. So for the first months of her son's life, they were not present.
“When my little boy arrived … I had barely any visitors. One of the most exciting and happiest days of your life where you want your family, especially parents, with you, they were not there. Mentally I struggled from the day he was born.”
‘The anti-vaxxer movement has polarised our community’
High-profile Melbourne obstetrician Dr Joseph Sgroi says new parents, who are trying to do the best they can to protect their newborns, have become tangled in the conflict triggered by the swelling anti-vaxxer community.
“The anti-vaxxer movement has polarised our community. There are those that trust the medical profession in preventing illness through vaccination, whilst others believe there is harm created," Dr Sgroi says.
“Both sides are trying to protect their children. The concern is that those who wish to vaccinate and prevent harm to their newborn are caught in a tussle between the opposing values.”
For expectant parents, the shouting match between the two factions is confusing and distressing, leading many to resort to a blanket ‘no vax, no visit’ rule.
“It creates anxiety and stress when it should be a great time in a parent’s life," Dr Sgroi says.
Ms Lowdon says as a new mum, the anti-vaxxer sentiment is “scary” and she frequently finds herself trying to minimise risks when out with her 10-week-old daughter, such as by holding her close or covering her pram.
“Those people are selfish because they are putting others, who have vulnerable immune systems, at risk,” she says.
“It makes me second-guess whether I should go out to public places with my daughter and in some instances I stay home. But new motherhood is isolating and I need to do things.”
Dr Koirala believes there are a mixture of factors influencing parents’ hyper-vigilance, including the anti-vaxxer movement, greater public education of diseases and the relative novelty of the maternal vaccine recommendations.
“Before that it was all about cocooning and vaccinating people around you. It can take some years for understanding to occur.”
'Respecting a mother's wishes is important'
Of course, in an ideal world, everyone who is medically able would simply be vaccinated for their own health and for the good of the community and parents’ fears would be eliminated. But that can’t be controlled.
It’s why Dr Sgroi says maternal vaccines are the best safeguard.
“The stress of needing to tell people who are just coming in for an occasional visit, ‘hey listen, make sure you get the whooping cough vaccine’ is diminished. One thing I would say to women is you don’t need to be over the top about it,” he says.
He says he feels maternal vaccination is particularly pertinent this year, where the flu has so far killed 346 Australians.
Health department data shows the first six months of 2019 saw more than 121,800 laboratory-confirmed cases of the flu. This is seven times more than the same period last year.
Dr Sgroi’s position is to keep it simple: anyone caring for a newborn baby in close proximity in its first six months of life should be vaccinated, including parents, siblings and grandparents. Outside of those people, he recommends assigning a gatekeeper who can instruct visitors to stay away if they’re sick until they’re completely healthy.
“The standard advice I give to my patients is to say to people who are coming to visit, ‘if you’re sick or unwell, the most sensible thing is to not come to see the baby’, rather than say they must get vaccinated,” he says.
But he adds anyone who has a newborn in the family should consider vaccination not just for their own health but for the baby, whose immune system can be compromised easily.
“The joy a child brings into the world is immeasurable and that joy can be surpassed by the agony of any parent that sees their child sick. If you feel you contributed to that, you will in turn feel that agony.”
Ultimately, Dr Koirala says while maternal vaccination is the ideal solution, visitors shouldn’t deliberately disrespect the requests of new parents just because they don’t agree with their choices.
“A new mother has a lot to deal with and whether it’s the first, second or third child, I think respecting her wishes is important. It’s a hard time for parents.”
And with so much judgment directed at parents like her, Mel Watts hopes more people realise they aren’t being deliberately difficult, as they are only ever trying to do the very best for their new baby.
“We’re not doing it to be nasty or to hold control over people, it’s purely for the safety of our child.”
*Surname withheld on request