MANAGING HEPATITIS B POSITIVE MOTHERS AND
OUT-OF-HOSPITAL BIRTH

Hepatitis B virus (HBV) infection in a pregnant woman poses a serious risk to her infant at birth. Without postexposure immunoprophylaxis, approximately 40% of infants born to HBV-infected mothers in the United States will develop chronic HBV infection. Of that 40%, approximately one-fourth will eventually die from chronic liver disease or liver cancer.

Perinatal HBV transmission can be prevented by identifying HBV-infected (i.e., hepatitis B surface antigen [HBsAg]-positive) pregnant women and providing hepatitis B immune globulin and hepatitis B vaccine to their infants within 12 hours of birth.

Arranging post exposure prophylaxis can be challenging for women giving birth in a non-hospital setting. Often families are encouraged to take their infant to the emergency department for HBIG and vaccine. But this defeats the intention of avoiding hospital care and disrupts a very important bonding time for a new family -- not to mention exposing a new baby to ill people in the ER waiting room.

We would like to hear about your experiences in working with hepatitis B positive women and facilitating post exposure prophylaxis for their infants. What has worked, what didn’t work? Do you routinely screen women for hepatitis B? Do you accept hepatitis B positive women into your practice? The goal of starting this dialogue is to produce a protocol or guidelines for ensuring that infants get the care that they need, maintain out of hospital birth as an option for hepatitis B positive mothers, and streamline the process of obtaining postexposure prophylaxis for midwives and families. Please offer your answers, thoughts, or feedback via Melissa Denmark.

All pregnant women should be screened for HBsAg during every pregnancy. In Washington State hepatitis B in pregnant women is a legally notifiable condition and should be reported within 3 work days to the health department. All pregnant women who are HBsAg-positive should be reported to the health department as early in pregnancy as possible. For links to local health departments, click here.

Perinatal hepatitis B resources can be found at: Public Health Seattle-King County

Washington State Department of Health
Centers for Disease Control and Prevention