Deciding whether you want to receive a COVID-19 vaccine can feel like a very monumental and stressful decision. If you’re struggling to land on a comfortable answer for yourself, here are some decision-making frameworks, factors, and evidence-based information sources that might help:

Not Sure How You Feel About COVID-19 Vaccination?

As a doula, it is my mandate NOT to tell you what to do. Not about the vaccine. Not about breastfeeding. Not about an epidural. Not anything.

I'm the librarian of birth: I know where to find high quality, evidence-based information. I have zero interest in convincing or selling you on a specific answer. A doula exists to help you come to an informed decision, but whatever that decision is, I support you and I honor that it was the right one for YOU and your family.

First, I want to share two thoughts that may shift your perspective when considering whether or not to receive a COVID-19 vaccine.

#1. The oxygen mask mentality. Parents - moms especially - are self-sacrificial. Just ask me. As a parent, I've obviously had those moments myself. And I watch my clients go through them every day. In any situation where there is an issue that affects both mom and baby, mom will undoubtedly prioritize the health/wellness/safety/attention of baby. If we have to go to an emergency c-section, mom says "it doesn't matter as long as baby is OK." If that brand new baby goes to the NICU while mom hasn't even been stitched up yet, she sends dad with baby and gives up her key support person.

Yet on the flip side, we are all very quick to cheer on people in our lives who post things on social media like "you can't pour from an empty cup" and "you wouldn't let your phone battery stay at 0% Recharge yourself." So I'm going to challenge you: if your automatic response when considering whether to vaccinate is "whatever is best for baby...." or "whatever has the lowest risk for baby...." that's a totally VALID feeling. But also, it's OK to want to protect yourself. It's OK to put on your oxygen mask first.

That's not something to feel guilty about. You're a person and your life and health and longevity has value too, both to yourself and your current family, and your future or unborn family. We worry so much about how our children will be affected by every move we make as parents, even before they are born. But in the words of Dr. Judette Louis, Florida OBGYN has said, the status quo has been that "we won't offer a vaccine or certain medications for fear that it may cross the placenta or fear it may harm the baby. But in the meantime, we have clear evidence that those conditions increase the risk [ for mom ]. Well, I've got news for you: ... Maternal death crosses the placenta." If the need to ignore your own wellness needs, or a feeling of guilt or shame around prioritizing your own healthcare wants is a feeling that has been holding you back, I want you to think about that, and maybe even talk it out with your partner, your family, your doctor, or your mental health professional.

#2. We often talk about RISK vs. BENEFIT in decision making. We all know how to make a pros vs. cons list. But that's not exactly a fair way to look at this...or anything else, frankly. If you think about the idea of vaccination through that lens, you can come up with a very short [ albeit strong ] list of "pros": 1) I get antibodies for myself. 2) I contribute towards herd immunity and stopping transmission. 3) I get to leave my house for a field trip to the pharmacy. But your cons list...that could go on forever, amiright? CON...I don'texactly know the effects this could have on me. CON...I don't know the effects this could have on myfuture children. CON...what if it doesn't actually work? CON...what if it wears off within 6 months CON...CON...CON.

So I want you instead to think about RISK vs. RISK. And this is a list that is individualized to you. It's going to be different for every single person. But if you draw up your columns on paper - and I encourage you to do so - you're going to put on one side "risks of GETTING a vaccine"...and on the other side "risks of NOT GETTING a vaccine."

Some obvious answers for the "if I get it" camp would be "we don't have long term data," "it could affect my fetus," etc. etc. And at this stage, go ahead and put down things you're not sure the answers to yet. If you're worried about miscarriages or fertility problems or the vaccine causing you to turn purple...put WHATEVER feels like a risk to you. We will validate or disprove those later. And for the other side, not getting the vaccine, you can put "I might get covid" "I might have a more severe outcome because I'm pregnant," "my parents refuse to visit me if I don't get the vaccine," "the government isn't going to let me travel." Whatever seems like a possible risk of NOT getting it. And I encourage you to think BEYOND the physical of "I will or I won't get covid." Consider the mental health impacts of getting it. Is it going to cause you anxiety if you get it, because every sneeze or stomach ache is now a possible side effect? Or is it going to cause you anxiety if you DON'T get it, because you work a high exposure job or you want to see your grandma who lives in long term care? What are the risks to your job, your livelihood? Think about the potential impacts to travel, to childcare arrangements. Look at it from every angle you can think of. Write down all the risks you come up with. Real or imaginary. We will validate or disprove them later.

And now let's take that risk vs. risk list...and we're going to make a new list. A 5-part list. And we're going to use the acronym BRAIN: Benefits, Risks, Alternatives, Intuition, Now/Never? And our question to ourselves becomes "What are the Benefits, Risks, Alternatives...etc. to GETTING a vaccine?"

I encourage you to go through these questions with a healthcare authority that you trust, because searching the internet for answers is just going to be a negative experience that leaves you confused. So book a chat with your family doctor, your OBGYN, your midwife, your pharmacist. Someone you trust AND someone who knows YOUR personalized factors, like your health history, and your underlying conditions. When you sit down with that person, you're going to ask them:

1. "So what are the benefits?" I think we're pretty clear on what the benefits COULD BE: immunity for you, reducing community transmission, “permission” to do certain things like visit a family member in hospital or long term care, travel more freely, etc. But ask this person what their educated opinion is of the benefits.

2. “What are the risks?” When you get to risks...look at your own risk vs. risk list and ask them the hard questions that are stressing you out: "Is this going to impact my fertility?" "Is this going to impact my fetus?" " If I don't get vaccinated am I going to die if I catch COVID?" Ask them to help you understand which risks are real and true, and which are not. Maybe all of them are literally "real"...but we moreso want to understand the LIKLIHOOD of any of those things occuring. Because that's going to tell you if it's a risk that you are willing to tolerate or not. For example: there's an implicit risk to driving a car or riding in an airplane. But you still do it. You accept that small level of risk in exchange for the convenience benefit it provides. And THAT’S what we really want to assess through this conversation. Certainly risks to receiving a COVID vaccine exist…but how significant are they, and is that a liklihood that you are personally willing to tolerate? Your answer may be yes where someone else’s may be no.

3. “What are my alternatives?” You may want to discuss the different choices of vaccine. There are many articles that propose that the "best" COVID vaccine is the one that is offered to you. Ask your care provider if they agree with that. Or maybe you have specific risk factors like a clotting disorder, etc. that make one of the brands a better or worse choice for you.

And after these 3 questions...you're going to stop, and rinse and repeat with another care professional. Because I don't want you to get your information from only one source. So now you're going to ask those same questions to another primary care professional, or at least do some informed research from the evidence-based accounts tagged below.

Once you have done that with two or three more sources...

You're going to go back and ask yourself the next two questions:

4. “What does my intuition say?” I want you to imagine both scenarios. Imagine that you got the vaccine. Mentally, how do you feel afterwards? Free? Relieved? Optimistic? Scared? Now imagine that you DON'T get the vaccine. How does that feel? Confident? Anxious?

5. “Now? Later? Or Never?” Just because you're not ready to get a vaccine now doesn't mean you will never get one. What kind of time factors are at play for you, and how might that affect your decision? Would you be more confident receiving a vaccine before or after baby is born? How does breastfeeding factor in? Would you be more confident if you knew you were totally done having kids? Would you be more confident after X months of research data? How does delaying for different time factors affect your decision?

And then comes the hard part. Or maybe it's easy by this point. Maybe the answer becomes obvious. But you have to weigh all the data you have compiled - real facts, real outcomes, real risks, real feelings, real mental health impacts - and decide what will make you most comfortable moving forward.

Credible Research Sources

If you like bite-sized information from Instagram [ I sure do! ] check out some of these accounts for excellent evidence-based discussions about the mechanisms of the COVID-19 vaccine, the safety data we have available thus far, and the implications to babies and birthing people:

• @mamadoctorjones

• @science.sam [ a Canadian scientist! ]

• @babiesafter35

• @alirodmd

• @dr.martaperez

• @taz.science

• @virus.vs.labcoat

Lindsey Bowns is a professional Calgary doula. adora birth + wellness provides DONA International certified birth doula services, working alongside your local midwife or OB, in hospital or at home.