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While challenges surrounding vaccine acceptance in pregnancy have long been prevalent in Canada, the COVID-19 pandemic introduced a new context for perinatal vaccine decision-making. Pregnant people had to weigh concerns about SARS-CoV-2 infection during pregnancy and the introduction of the new mRNA pandemic vaccines, with less access to in-person perinatal care and social support than usual. This qualitative analysis sought to understand how trust influenced the decision-making of pregnant people during the early COVID-19 pandemic regarding both routine and SARS-CoV-2 vaccinations.

This qualitative study, as part of a larger mixed-methods study, analyzed interviews with 73 participants who gave birth in Ontario or British Columbia, Canada from May 1st, 2020, to December 1st, 2021 via reflexive thematic analysis.

Three types of trust were influential to pandemic vaccination decisions during pregnancy: 1) trust in prenatal care providers, shaped by goals of alleviating mental load, cultural norms, and perceived transparency, 2) trust in institutions, focused on the government, healthcare system, and pharmaceutical industry, and 3) trust in networks, encompassing (dis)trust in social media, valuation of lived experiences, and views of vaccination as a reciprocal obligation to the broader community.

Several dimensions of trust played vital roles in the experiences of pregnant people navigating vaccine decisions amid high uncertainty. Trust in providers was composed of both honesty and transparency, with the latter enabling a new approach to the patient-provider relationship. Avenues to increase trust include social media moderation and discussion of original research by prenatal care providers.