Q: I am pregnant and having my baby in a hospital. My pediatrician has told me that that my newborn must receive a hepatitis B vaccination shortly after birth before being discharged from the hospital. Do I have the right to take my baby home without a hepatitis B shot?
A: In 1991, the Centers for Disease Control (CDC) and American Academy of Pediatrics (AAP) recommended that all newborns be given a hepatitis B shot within 12 hours of birth. Newborns are not at risk for hepatitis B infection unless they are born to a mother infected with the hepatitis B virus or are given a blood transfusion that is contaminated with hepatitis B. The CDC’s 1991 universal use recommendation for newborns was based on a fear by public health officials that all hepatitis B infected women in the U.S. were not being screened and identified before giving birth. Below is information helpful in addressing concerns regarding hepatitis B vaccine and newborns.
- State Vaccine Laws Do Not Apply to Hospitals - State public health laws, which require certain vaccinations in order for your child to be able to go to school, do notapply to private hospitals or birthing centers. However, private medical facilities may have their own internal policies in place, which direct staff to routinely give newborn infants a hepatitis b shot before discharge. Private hospitals and birthing facilities have a legal right to refuse to allow you to give birth in their medical facility if you do not agree to abide by their policies in advance.
- You Can Be Tested for Hepatitis B - You may want to get a blood test to find out whether or not you are infected with hepatitis B and, if you test negative, you can bring the negative test results with you to the hospital or birthing facility you have chosen and request in writing that your newborn not receive a hepatitis B shot at birth. If the birthing facility agrees, make sure that your written birthing plan and newborn care plan includes the understanding by staff that no hepatitis B vaccine will be given to your newborn before discharge.
- Evaluate Your Birthing Options - If you do not want your newborn to get a hepatitis b shot at birth, you should immediately evaluate the birthing options you have in terms of where your baby will be born. Find out if the hospital or birthing center you have chosen routinely gives newborn infants hepatitis B shots. Newborn vaccination policies may be hard to find because it is often included under “Standard of Care” language in policy manuals. Some hospitals or birthing centers may be more or less flexible about allowing exceptions to hepatitis B vaccination policies for newborns.
Many hospitals and birthing centers, as a routine matter, administer hepatitis b vaccine on the basis of what is known as "standing orders", that is that they have written orders in place from the time of admission to check you and your baby's vital signs, administer certain medications and emergency treatments, and when to contact the doctor or nurse midwife if certain circumstances arise. Pediatricians have the ability to change one or more "standing orders" for a particular baby. Routinely administered care is not necessarily the most appropriate or best care for all mothers and babies. If you would prefer that your baby not be given the hepatitis b vaccine within 12 hours of birth as recommended by the CDC, you should discuss this with your baby's pediatrician and ask that the "standing orders" for your baby be written accordingly.
Some pediatricians will agree to delay vaccination until after hospital discharge. If possible, you should ask your pediatrician for something in writing that you can photocopy and share with the hospital or birthing center at the time of admission for labor and delivery. Additionally, if you have a birthing plan, this preference should be noted in your written plan provided to the hospital or birthing center.
Make sure you bring a copy of the written agreement and a copy of the negative hepatitis B vaccine test with you to the birthing center when you are in labor. You may want to consult an attorney so that you can call the attorney if you encounter any problems with being coerced to give your newborn a hepatitis B in shot at the hospital or birthing center, where your baby is born, against your wishes.
- Keep Your Newborn With You - NVIC has received reports that newborns have been given hepatitis B vaccinations in newborn nurseries without parental consent and in violation of written requests for no vaccination. It is a good idea to keep your newborn with you at all times in the hospital, or have a have a trusted family member stay with your infant while you are napping, to ensure that your baby is not vaccinated without your knowledge or consent before discharge.
- Find a Doctor to Trust - If your pediatrician insists that your baby get a hepatitis B shot in the newborn nursery and you do not agree, you can always look for another doctor, who respects your parental right to make an informed vaccination choice for your child.
Q: I have refused to consent to give my newborn a hepatitis B shot at birth and am being threatened that child protective services will be contacted and I will be charged with child medical neglect or child abuse if I don’t vaccinate my child. Is this legal? Am I in danger of having my child taken from me or going to jail?
A: NVIC receives many reports of harassment from new parents, who do not want to give their baby certain vaccines, including hepatitis B vaccine at birth, and are being bullied and threatened with charges of child medical neglect or child abuse. They are worried their child will be taken from them by state social services agencies.
There is no legal federal or state requirement in the U.S. that newborns receive a hepatitis B shot at birth. However, some individual doctors or medical workers in medical care facilities, who are ideologically committed to ensuring that every child receives every federally recommended vaccine on schedule, use threats and other types of coercion to intimidate parents into agreeing to give their baby a hepatitis B shot within 12 hours of birth. Below is information that you may find helpful if confronted with coercion.
- Find An Attorney - If you have are being threatened by anyone with charges of child medical neglect or child abuse for not giving your child a vaccine, such as hepatitis B vaccine, it is important to immediately find an attorney, who will advise you about whether or not your parental medical informed consent rights are being violated and evaluate your legal options.
- Become Educated and Make an Informed Decision - In addition to seeking legal advice, you are best able to defend your parental medical informed consent rights if you are knowledgeable about the hepatitis B infection and the vaccine. Deciding whether or not to vaccinate your newborn for hepatitis B is the first of many health care decisions you will make as a parent.
Unlike many other infectious diseases for which vaccines have been developed, hepatitis B is a blood-transmitted infection that is rare in childhood. Adults engaging in IV drug use and sex with multiple partners are at highest risk for hepatitis B infection, as are health care workers exposed to infected blood; persons requiring repeated blood transfusions and residents and staff of crowded institutions, like prisons.
However, babies born to hepatitis B infected mothers are also at risk for hepatitis B infection so it is important for all pregnant women to know if they are or are not infected with hepatitis B before they give birth. If you suspect you could be infected, it is a good idea to get a blood test before giving birth.
Learn More About Hepatitis B - To learn more, NVIC provides information here and the history of hepatitis B vaccine state school attendance mandates here. It is also important to find a health care professional you trust to discuss your concerns and answer your questions about the hepatitis B disease and the vaccine.
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