Increased awareness and health care provider endorsement is required to encourage pregnant women to be vaccinated.

Maternal immunization is an important strategy recommended to protect both mothers and infants from serious infectious diseases; however uptake of maternal immunization is poor in Australia. This study aimed to gain an in-depth understanding of the decision making process and factors influencing a pregnant woman's decisions about recommended immunizations. This qualitative study used semi-structured interviews with open-ended questions to interview pregnant women. Data were analyzed using thematic analysis techniques and drew on the Health Belief Model. Pregnant women (n = 17) were asked about their attitudes toward immunization during pregnancy and their perceptions about risk during pregnancy. Women were also asked to detail their decision making process and factors influencing their decisions about immunizations in relation to pregnancy. Most of the participants were not aware of the immunizations recommended during pregnancy, in pregnancy planning or after delivery. In addition to endorsement by their health care provider (HCP), perception of risk and benefit, including risk of infection, previous vaccination experiences and assessing cost benefit play a vital role in women's decisions whether to be immunized while pregnant. Although the role of the healthcare provider in advising pregnant women about immunizations was identified as vitally important, the majority of women had not been advised of recommended vaccines by their healthcare provider. Healthcare providers are key to ensuring pregnant mothers are informed about recommended vaccines and these need to be more proactively supported and encouraged by healthcare providers. This is likely to have a positive effect on acceptance and uptake of immunization by pregnant women.