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BLOG: Turning the oil tanker - approval of mandatory e-learning vaccination and immunisation modules for midwives in North Wales

MPH student, Kailey Ben-Sassi, discusses a midwifery e-learning initiative in North Wales that addresses maternal vaccination hesitancy by enhancing midwives' education and confidence, promoting better healthcare outcomes.

Kailey Ben-Sassi | Masters in Public Health student

Concern around a decrease in the uptake of the recommended maternal vaccines and anecdotal reports of midwifery hesitancy prompted my Student-Led, Individually-Created Course (SLICC), which aims to identify any barriers to the recommendation of vaccines by a midwife during routine antenatal appointments.

Most pregnant women anticipated to have an uncomplicated pregnancy and normal delivery may solely be under midwife-led care during pregnancy, birth, and in the acute post- natal period.  A search of the literature identified that recommendation by a midwife is indeed the greatest influence on a pregnant woman in deciding to accept a vaccine during pregnancy.

Whilst our pregnant women have confidence in our midwives, our midwives, however, are less confident in recommending vaccination. This lack of confidence stems partly from a lack of education and training on the importance of vaccinations during pregnancy, both at undergraduate and postgraduate levels. A lack of clinical knowledge means that midwives are simply becoming providers of information, either in the form of printed material or links to a website, rather than engaging proactively with pregnant patients and recommending vaccination.

As a result of my SLICC, a health board-wide vaccination in pregnancy meeting has been established with key stakeholder engagement and cross-sector representation from the School of Midwifery in North Wales.

Since the meeting convened in September 2023, I have highlighted my concern regarding the gap identified in midwifery knowledge on vaccination and immunisation and have recommended the available resources accessible via the health board e-learning platform pertinent to vaccination and immunisation, and the Public Health Wales vaccination in pregnancy webinar accessible via their resources for health care professionals to support the development and understanding of the public health principles of vaccination and immunisation to midwifery colleagues.

At one particular meeting, the matron for midwifery announced that their practice development nurse had approved and mandated the resources to form part of the 30-hour annual training programme for all 465 health board-employed vaccines with immediate effect. ‘It takes time to turn the oil tanker’ I thought.

Photograph of an oil tanker

Interestingly and coincidentally ‘turning the oil tanker’ is the title of a publication describing the inherent resistance to change within many healthcare systems (Ranasinghe, Dor and Herbert, 2019). Reading the article reinforced the need for me to ‘continue striving’ and that change implementation can be a long, arduous process of small steps, analogous to ‘turning the oil tanker’.  

The article recommends a ‘three pronged’ approach to support successful change implementation, which I both identified and recognised as methodology I have unconsciously adopted during my SLICC progress.

  1. Determined opinion leader with a network of like- minded opinion leaders: Within my health board, as the clinical lead for vaccination and immunisations, I perceive myself to be in this role. I am supported by like-minded clinical colleagues who are keen to see change in maternal vaccination and immunisation implemented.
  2. Presentation of hard evidence with adequate praise for current practice and the generation of clearly worded, specific guidance: The evidence to support the education and knowledge skill of midwives on the subject of vaccination and immunisation is supported in published literature. I believe that the midwives I work with have begun to recognise that the purpose of my SLICC is supportive rather than critical.
  3. Use of simple reminders and continuous analysis of outcomes: Regular contact through the established maternal pregnancy meetings and regular review of national published vaccination data will support and allow change to be evaluated.

Completion of mandated e-learning in isolation will not upskill our midwives to enable them to engage with confidence with their pregnant mum’s to be. It is, however, a massive leap forward and recognition of what can be achieved through effective collaboration and investment in building trust and relationships. From a personal perspective, it’s been a huge confidence boost and the momentum needed to continue embedding the principles and values instilled through the completion of the SLICC to support and represent midwifery colleagues to adapt and prepare for future maternal vaccination campaigns with confidence.


Ranasinghe, L., Dor, F.J. and Herbert, P. (2019) ‘Turning the oil tanker: a novel approach to shifting perspectives in medical practice’, Advances in Medical Education and Practice, Volume 10, pp. 507-511. Available at

Further information

Read a previous blog: An MPH student's thoughts on the Year 3 SLICC option

Find out more at Student-Led, Individually-Created Courses