Vaccinations After Giving Birth

Anti-D, if you are D negative

This is the injection most people are given without much explanation. The NHS explains the underlying problem: haemolytic disease of the fetus and newborn "can happen when you have a certain blood type (D negative) that's different to your baby's blood type (D positive). This may mean you have antibodies that can break down your baby's red blood cells."

Sensitisation can occur when your blood and your baby's blood mix, which is most likely at birth. The antibodies you make would not usually affect that baby — they would affect a future pregnancy. That is why the injection after birth protects the next baby rather than this one, and why it feels counterintuitive at the time.

The NHS describes the pathway: screening happens at your first antenatal appointment at 8 to 12 weeks, and "If the results of the blood test show your blood type is D positive, there's no risk of HDFN. D negative, your baby's blood will be tested too." If your baby is D positive, the question of anti-D after birth arises. If your baby is D negative, "there's no risk of HDFN."

The NHS also notes that where there is a risk during pregnancy, "you'll usually be offered injections to stop you developing antibodies." Your cord blood is tested after birth to determine your baby's blood group, which is why the decision is often made a day or two later.

If you are D negative, check that this was actually done before you go home, and that it is written in your notes. It is a straightforward thing to confirm and an unfortunate thing to miss.

MMR, if you are not immune to rubella

Rubella immunity is checked in some antenatal pathways, and the vaccine cannot be given during pregnancy because it is a live vaccine. So the postnatal period is the designed opportunity.

The NHS explains what is at stake: if you are pregnant, "getting measles can cause premature birth, miscarriage or still birth. And getting rubella can cause serious problems for your baby such as damage to their sight and hearing."

It says the MMR vaccine "is recommended for adults and children born on or before 31 December 2019 who did not have the MMR vaccine when they were younger," and that it is especially important to be vaccinated if "you could become pregnant." It flags one group in particular: "you were born between 1970 and 1990 (as you may not have been vaccinated against all 3 infections)."

The NHS adds that "2 doses of the MMR vaccine gives you long-term protection," and that "Your GP surgery should be able to tell you which vaccinations you've already had."

If you are given MMR after birth, contraception advice usually accompanies it. Ask about that at the time, because it is easy to be handed the vaccine and not the conversation.

The question that catches everything else

The NHS 6-week postnatal check page includes this among the things to tell your doctor: "you're not sure you've had all of the current recommended adult vaccines, such as the MMR vaccine or COVID-19 vaccine."

That single sentence is the most useful thing on this page. Pregnancy is one of the few times an adult's vaccination status gets reviewed at all, and the postnatal check is the moment to close any gaps that were found and then forgotten.

Worth asking about specifically: MMR if your rubella status was unknown or non-immune; seasonal flu, if it is the season and you did not have it in pregnancy; COVID-19, per current adult recommendations; and whooping cough, which the NHS offers in pregnancy to protect the newborn — if you missed it, ask what the current advice is for you and for the people around your baby.

Vaccines and breastfeeding

Say you are breastfeeding when you are offered anything, so it is recorded, and ask directly. The routine adult vaccines discussed here are not generally a reason to interrupt feeding, but the question belongs with the clinician giving the vaccine rather than a website, and travel vaccines in particular need individual advice.

The NHS makes the related point about travel vaccines in pregnancy: "Most vaccines that use live bacteria or viruses aren't recommended during pregnancy," while "Non-live (inactivated) vaccines are safe to use in pregnancy." The live-versus-inactivated distinction is the one clinicians will be working from postnatally too. Ask which yours is.

Your baby's schedule is separate

Do not conflate the two. Your baby's first routine vaccinations come at around eight weeks, with further doses at 12 and 16 weeks and at 12 months. The NHS says a GP or health visitor "will discuss your baby's vaccinations with you" at the 6 to 8 week review, and vaccinations are recorded in the red book.

The NHS also notes that children are now offered the MMRV vaccine, which protects against measles, mumps, rubella and chickenpox, at 12 and 18 months — so the adult MMR page and your baby's schedule are genuinely different things.

What to do this week

Three checks. If you are D negative, confirm anti-D was given and recorded. If your rubella status was non-immune or unknown, ask whether MMR was offered before discharge and, if not, book it. And put "am I up to date with adult vaccines?" on the written list you take to your postnatal check — the NHS suggests making that list, and NICE NG194 expects the GP to respond to the concerns you raise there.