What should happen if a non-immune (not previously exposed or vaccinated) new mom contracts rubella?

Management of Non-Immune Postpartum Women

A non-immune new mother should receive MMR vaccination immediately postpartum before hospital discharge, with counseling to avoid pregnancy for 3 months following vaccination. 1

Immediate Postpartum Vaccination

• Administer MMR vaccine in the immediate postpartum period before the mother leaves the hospital or birthing facility. 1
• This is the critical window to protect against future rubella exposure and prevent congenital rubella syndrome in subsequent pregnancies. 2
• Breastfeeding is NOT a contraindication to rubella vaccination—the vaccine can be safely administered to nursing mothers. 1

Essential Patient Counseling

• Counsel the patient to avoid pregnancy for 3 months (28 days minimum) following vaccination. 1
• Explain that approximately 10-20% of women of childbearing age remain susceptible to rubella despite childhood vaccination programs, making postpartum vaccination crucial. 2
• Emphasize that rubella infection during early pregnancy carries up to an 85% risk of fetal defects if infection occurs in the first trimester, including deafness, cardiac defects, cataracts, and mental retardation. 2

Why This Matters

• The primary objective of rubella immunization programs is preventing congenital rubella syndrome in future pregnancies. 2
• Without vaccination, this mother remains at risk for rubella infection during any future pregnancy, with devastating consequences including miscarriage, stillbirth, and severe fetal anomalies. 2
• Postinfection immunity from natural rubella is long-lasting, and vaccine-induced immunity provides similar protection. 2

Common Pitfalls to Avoid

• Do NOT delay vaccination until a postpartum visit weeks later—many women will not return, missing this critical prevention opportunity. 1
• Do NOT withhold vaccination due to breastfeeding concerns—this is a common misconception that leaves women unnecessarily vulnerable. 1
• Do NOT assume the patient understands the severity of rubella in pregnancy—explicit counseling about the 85% risk of fetal defects in first-trimester infection is essential. 2

Documentation and Follow-Up

• Document vaccination in the patient's permanent medical record and provide a vaccination card. 1
• Ensure the patient understands the 3-month pregnancy avoidance period and has appropriate contraception if desired. 1
• If the patient declines vaccination, document refusal and counsel about risks to future pregnancies. 1