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FAQ's About Injections and Vaccines at Birth, Refusal and Coercion, Child Abuse and Neglect

Updated March 05, 2024

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Q: I am pregnant and having my baby in a hospital or birthing center. Do I have the right to take my baby home without a hepatitis B, RSV, and Vitamin K shot? Can my newborn be taken from me if I refuse these shots?

Many hospitals and birthing centers, as a routine matter, administer the hepatitis b vaccine and vitamin K shots based on what is known as "standing orders," which are 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 specific circumstances arise. The recently approved RSV monoclonal antibody shot may also be subject to standing orders for your newborn. Pediatricians can 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, RSV monoclonal antibody shot, and/or the vitamin K shot after birth in a hospital or birthing center, you should discuss this with your health care facility where the birth will take place, as well as with your chosen birthing health care providers to ask that the "standing orders" for your baby be written accordingly.

NVIC has received reports that newborns have been given hepatitis B vaccinations in newborn nurseries without parental knowledge or 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 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.

Below is additional information that may be helpful.

If you do not want your newborn to receive one or more of these injections at birth, you should immediately evaluate the birthing options. Find out if the hospital or birthing center under consideration routinely gives newborns these injections.

Vaccination and injection policies may be hard to find and are often included under “Standard of Care” language in policy manuals. Flexibility around exceptions to a facility’s policy in this regard may vary. Request a copy of the facility’s policy governing these injections well in advance of the birth of your child. For more information, see General Information on Laws and Standing Orders below.

As you make informed decisions about where you will give birth to your child and the care your child receives at the birthing facility, it is also essential that you find a healthcare provider you trust. While NVIC does not provide medical advice, we provide resource information about organizations that provide physician information. These resources may assist you with finding a doctor who respects your right to make informed medical decisions for your newborn child. Visit NVIC’s FAQ - Physician referral, can NVIC help? for more information.

General Information on Laws, Policies, and Standing Orders

Below is general information that may be helpful in understanding standing orders and injections provided as a standard of care at birthing facilities.

State Laws May Not Apply to Hospitals - State public health laws, which require certain vaccinations for your child to go to school, do not apply to private hospitals or birthing centers. There may also be variability in state laws and their application to private hospitals and birthing centers regarding vitamin K shots. Private medical facilities may have their own internal policies in place regarding standing orders and 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. Request information on your health facility’s policies and standing orders governing hepatitis B vaccine and RSV monoclonal antibody and vitamin K shots well in advance of the birth of your child.

Ask for Changes in Standing Orders - Get a written agreement to your request for changes to standing orders relating to these injections. When admitted to the hospital or birthing center you have chosen, keep a copy with you and provide a copy to the admissions staff when admitted to give birth. Additionally, if you have a birthing plan, this preference should be noted in the written plan provided to the hospital or birthing center, and you should keep a copy of that plan with you when admitted to the birthing facility.

You may want to consult an attorney on existing state laws that govern birthing facilities, injections, and your rights so that you can call the attorney if you encounter any problems with being coerced against your wishes to give your newborn a vaccine or other injection (RSV and vitamin K) at the birthing facility where your baby is born.

If anyone is threatening you 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. See the next topic - Coercion and Child Medical Neglect or Child Abuse – for more information on legal resources.

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. Some are bullied and threatened with charges of child medical neglect or child abuse for vaccine refusal and 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.

A 2017 study published in the American Journal of Public Health on this topic noted that some states expressly prohibit terming vaccine refusal as the sole basis for child abuse or neglect, and most states provide no similar guidance to their Child Protective Services (CPS) division. The study additionally noted that the American Academy of Pediatrics didn’t support vaccine refusal as medical neglect.

In addition to seeking legal advice, you can best 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 decisions you will make as a parent.

Visit NVIC’s Disease and Vaccines webpages to learn more about risks and benefits to assist in decision-making. While NVIC doesn’t provide legal advice, below are legal resources that may help you identify an attorney if needed.

Findlaw provides a searchable directory of attorneys by location and legal experience;
Law Info provides a listing of Attorneys specializing in CPS Law:
Liberty Counsel provides pro bono legal assistance with vaccine exemptions;
Pacific Justice Institute works pro bono to defend religious freedom, parental rights, and other civil liberties;
First Liberty works to defend religious liberty;
Alliance Defending Freedom works to protect religious freedom, free speech, and parental rights;

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 the highest risk for hepatitis B infection, as are healthcare workers exposed to infected blood, persons requiring repeated blood transfusions, and residents and staff of crowded institutions like prisons.

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 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.

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. However, babies born to hepatitis B infected mothers are also at risk for hepatitis B infection. All pregnant women need to know if they are or are not infected with hepatitis B before they give birth. The CDC also recommends that all women during each pregnancy be screened for hepatitis B to prevent infant infections and estimates that 88% of pregnant women are screened.

Get screened to find out whether or not you are infected with hepatitis B, and if you do not want your baby to be vaccinated for hepatitis B right after birth, take your 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, ensure that your written birthing plan and newborn care plan include the understanding by staff that no hepatitis B vaccine will be given to your newborn before discharge.

To learn more about hepatitis B and hepatitis B vaccine, visit our hepatitis B web pages.

Respiratory Syncytial Virus (RSV) is a common respiratory virus with symptoms similar to a mild cold, and young infants are especially vulnerable to complications due to having small airways. It is estimated that between four and five million children become infected with RSV in the U.S. each year, with an estimated 58,000 to 80,000 resulting in hospitalization. However, most people who become infected with RSV will recover fully within a week or two without treatment.

On July 17, 2023, the FDA approved the drug nirsevimab under the trade name Beyfortus, a monoclonal antibody, to prevent RSV. The CDC treats this monoclonal antibody as a vaccine, although the FDA, American Medical Association, and the World Health Organization classify it as an injectable drug.

Unlike a vaccine that stimulates the body to produce an immune response against a particular antigen, a monoclonal antibody is given in an effort to stop an infection.

The CDC recommends that all infants under eight months of age born during or entering their first RSV season (late fall through early spring) receive a single dose of the monoclonal antibody nirsevimab. It is possible, depending on the date of an infant’s birth, that hospitals and birthing centers will include this injection as one to be given at birth, similar to the hepatitis B vaccine.

To learn more about RSV and nirsevimab, visit NVIC’s RSV web pages. To understand more about approval of the RSV vaccine in pregnant women and the approval of the monoclonal antibody shot nirsevimab, read the below articles:

Vote to Add Drug to Childhood Vaccination Schedule Opens Door to Daycare Mandates, Tracking, and Injury Liability Shield – Aug. 10, 2023.
ACIP Recommends RSV Vaccination for Pregnant Women – Sept. 28, 2023.

NVIC receives many questions about vitamin K shots. It is important to understand that vitamin K shots are not vaccines, and NVIC does not provide risk-benefit information on this procedure outside of what appears on this webpage.

According to the CDC, vitamin K is typically provided by the foods we eat and helps our body to form clots and stop bleeding. CDC additionally states that infants are born with low levels of this vitamin and that if there is a deficiency, bleeding into the intestines or brain is possible, leading to brain damage and possibly death. The bleeding condition is known as VKDB (Vitamin K Deficiency Bleeding) and is a rare but dangerous condition. Symptoms of VKDB may not be obvious and can occur in infants from about a week old to 6 months of age.

Because of the age range, VKDB is categorized as early, classical, and late onset. Below are the rates for each type published by the CDC as of July 2023.

Early and classical VKDB are more common, occurring in 1 in 60 to 1 in 250 newborns, although the risk is much higher for early VKDB among those infants whose mothers used certain medications during the pregnancy.
Late VKDB is rarer, occurring in 1 in 14,000 to 1 in 25,000 infants.
Infants who do not receive a vitamin K shot at birth are 81 times more likely to develop late VKDB than infants who receive a vitamin K shot at birth.

In 1961, the American Academy of Pediatrics recommended that vitamin K shots be given to infants to protect against VKDB. However, there have been concerns among parents about the large dosage of these shots and other ingredients, such as preservatives contained in the shots.

A Danish study on oral vitamin K drops (instead of an injectable shot) found that weekly administration of a drop of vitamin K until the infant reaches three months of age effectively prevented VKBD.

Below are a few resources to consider as you educate yourself on vitamin K. NVIC encourages readers to research and become informed on this topic. Below is a partial list; readers should undertake additional research to become better informed.