Re: [ozmidwifery] Hep B Vaccine at Birth

[Jo Slamen]

From a "consumer's" point of view - this vaccine 
has me stumped!  It was introduced "between" my two babies' births and 
since I couldn't see the point of it, and could only see disadvantages in it, I 
refused it.  No drams at all in hospital, but I have had comment from 
a GP since, but was water off a duck's back as far as I'm concerned.  It 
utterly beats me as to why it was introduced at such an early age.  I guess 
if there are identifiable risk factors then perhaps there's a point, but those 
factors would surely, even in this day and age, be present in the vast minority 
of newborns' lives.  From what I can gather this disease is as "hard" to 
get as AIDS.  And it's probably a fair bet that when that vaccine is 
perfected it will be stuck straight into everyone as soon as they see daylight 
too.  How ridiculous!
 
My brother and SIL has had their 1st bub last 
November, and have also had comment from the local council vaccination mob about 
their daughter "missing" the newborn Hep B jab.  I don't think they want to 
let anyone that "gets away" go unscathed...
 
Jo

Re: [ozmidwifery] Hep B Vaccine at Birth

[Sandra J. Eales]

Thank you Robin.  There are references ( 
I thought I had included them but they obviously got left off in all the cutting 
and pasting).  I am currently working on a discussion paper which I will 
hope to get published.
Sandra

  - Original Message - 
  From: 
  Robin 
  Moon 
  To: [EMAIL PROTECTED] 
  Sent: Wednesday, March 12, 2003 6:45 
  AM
  Subject: Re: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  Wow, at last someone has eloquently described 
  something that has been bothering me for ages. Well Done, Sandra.
   
  Does anyone have references to support this 
  argument? Because, we're gonna need them if we can effect any 
  change.
   
  Robin
  
- Original Message - 
From: 
Mary 
Murphy 
To: [EMAIL PROTECTED] 

Sent: Tuesday, March 11, 2003 11:37 
AM
Subject: Re: [ozmidwifery] Hep B 
Vaccine at Birth

Marilyn wrote: "Sandra you are so 
brave." A long time agoe some ancient philosopher wrote something 
like this:  "In order for evil to flourish, good men do nothing"  
I think that covers Sandra's stand.  MM

  
- Original Message - 
From: 
Sandra J. 
Eales 
To: [EMAIL PROTECTED] 

Sent: Sunday, March 09, 2003 6:30 
PM
Subject: [ozmidwifery] Hep B 
Vaccine at Birth

I have previously expressed concerns related to the 
administration of Hep B Vaccine (HBV) to all babes at birth ie that the 
midwives in my unit had become aware of marked increase in numbers of 
irritable babes and many more with breastfeeding difficulties in the 
first few days, since May 2000 when the new schedule was 
introduced.
Since then we have done some investigation and as 
we became convinced of the connection we have been much more 
conscientious about gaining "informed consent" prior to 
administration of birth dose of Hep B ie "full disclosure of 
risks/benefits without coercion or fraud".  As 
a result, parents are not consenting and the rate of uptake of the 
birth dose in our unit has dropped off dramatically.  (It is 
generally much nicer to come to work these days too with fewer screaming 
babies, distraught mothers and frantic fathers!)
We (the midwives) are now copping flak because we 
show up very large on the radar in the 'Early Warning System' of 
the authorities pushing the universal immunisation issue.  The 
pressure to conform has come from Public Health Unit, District Manager, 
Medical Superintendent as well as letters of complaint from a local GP 
(who may be fearful that he will lose his incentive payments if the 
children who return to hispractice have missedthe birth dose!).  We 
have been told that we must "actively encourage" our clients to accept 
the vaccination..that "it is frequently reported that the unit works 
well because of the high degree of trust and respect. Herein lies the 
opportunity to disseminate the positive effect of early Hepatitis 
vaccination"  We have been told that we must "act in line with the 
Code of Conduct" to actively promote this policy.
 
I do believe this is a terribly important ethical 
issue and will not persuade my clients to act against there best 
interests and instincts. 
We use the materials and information provided by Qld 
Health and "immunise Australia" when we discuss the issue with the 
parents.It is acknowledged in the "Understanding infant 
hepatitis B immunisation" pamphlet put out by the "immunise Australia 
Program" that among the common side effects are mild fever, joint pain, 
irritability and baby going "off its food for a short time". - discuss 
how this might affect their newborn in the first few days of life.
Whilst these common and perhaps transient side effects may be of 
little concern in an older child they are liable to be of much greater 
significance in a newborn child who is already facing many challenges at 
this deeply important point in its life.  Challenges to the newborn 
(physiological and iatrogenic pathology)

  adaptation to extrauterine life – profound physical changes in all 
  systems respiratory, circulatory, neurological, sensory, 
  digestive/alimentary 
  organisation of suck to enable feed 
  overcome effects of pharmacological substances used in labour, 
  birth an postnatally 
  recovery from the traumatic effect of birth eg head moulding and 
  other birth injury
We also give them the Qld

Re: [ozmidwifery] Hep B Vaccine at Birth

[Robin Moon]

Wow, at last someone has eloquently described 
something that has been bothering me for ages. Well Done, Sandra.
 
Does anyone have references to support this 
argument? Because, we're gonna need them if we can effect any 
change.
 
Robin

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: [EMAIL PROTECTED] 
  
  Sent: Tuesday, March 11, 2003 11:37 
  AM
  Subject: Re: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  Marilyn wrote: "Sandra you are so 
  brave." A long time agoe some ancient philosopher wrote something 
  like this:  "In order for evil to flourish, good men do nothing"  I 
  think that covers Sandra's stand.  MM
  

  - Original Message - 
  From: 
  Sandra J. 
  Eales 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, March 09, 2003 6:30 
  PM
  Subject: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  I have previously expressed concerns related to the 
  administration of Hep B Vaccine (HBV) to all babes at birth ie that the 
  midwives in my unit had become aware of marked increase in numbers of 
  irritable babes and many more with breastfeeding difficulties in the first 
  few days, since May 2000 when the new schedule was 
introduced.
  Since then we have done some investigation and as 
  we became convinced of the connection we have been much more conscientious 
  about gaining "informed consent" prior to administration of birth 
  dose of Hep B ie "full disclosure of risks/benefits without coercion or 
  fraud".  As a result, parents are not 
  consenting and the rate of uptake of the birth dose in our unit has 
  dropped off dramatically.  (It is generally much nicer to come 
  to work these days too with fewer screaming babies, distraught mothers and 
  frantic fathers!)
  We (the midwives) are now copping flak because we 
  show up very large on the radar in the 'Early Warning System' of 
  the authorities pushing the universal immunisation issue.  The 
  pressure to conform has come from Public Health Unit, District Manager, 
  Medical Superintendent as well as letters of complaint from a local GP 
  (who may be fearful that he will lose his incentive payments if the 
  children who return to hispractice have missedthe birth dose!).  We 
  have been told that we must "actively encourage" our clients to accept the 
  vaccination..that "it is frequently reported that the unit works well 
  because of the high degree of trust and respect. Herein lies the 
  opportunity to disseminate the positive effect of early Hepatitis 
  vaccination"  We have been told that we must "act in line with the 
  Code of Conduct" to actively promote this policy.
   
  I do believe this is a terribly important ethical issue 
  and will not persuade my clients to act against there best interests and 
  instincts. 
  We use the materials and information provided by Qld 
  Health and "immunise Australia" when we discuss the issue with the 
  parents.It is acknowledged in the "Understanding infant 
  hepatitis B immunisation" pamphlet put out by the "immunise Australia 
  Program" that among the common side effects are mild fever, joint pain, 
  irritability and baby going "off its food for a short time". - discuss how 
  this might affect their newborn in the first few days of life.
  Whilst these common and perhaps transient side effects may be of little 
  concern in an older child they are liable to be of much greater 
  significance in a newborn child who is already facing many challenges at 
  this deeply important point in its life.  Challenges to the newborn 
  (physiological and iatrogenic pathology)
  
adaptation to extrauterine life – profound physical changes in all 
systems respiratory, circulatory, neurological, sensory, 
digestive/alimentary 
organisation of suck to enable feed 
overcome effects of pharmacological substances used in labour, birth 
an postnatally 
recovery from the traumatic effect of birth eg head moulding and 
other birth injury
  We also give them the Qld Health Hep B Information which has this 
  advice "give extra fluids e.g more breast feeds or water"  - we 
  discuss the implication of this at initiation of breastfeeding.
  We also discuss the risk factors for contracting the disease both in 
  infancy and throught the lifespan.  
  All women are screened for HBsAg antenatally so that babes 
  of HB positive mothers can receive both Immunoglobulin and vaccination at 
  birth. This has been shown to be extremely effective in managing the risk 
  of vertical (mother to baby) transmission
  The risk 

Re: [ozmidwifery] Hep B Vaccine at Birth

[Ann green]

Dear Sandra,
I have been told that In Japan the immuisation program
does not start til the age of 2 years.Ann --- "Sandra
J. Eales" <[EMAIL PROTECTED]> wrote: > I have
previously expressed concerns related to the
> administration of Hep B Vaccine (HBV) to all babes
> at birth ie that the midwives in my unit had become
> aware of marked increase in numbers of irritable
> babes and many more with breastfeeding difficulties
> in the first few days, since May 2000 when the new
> schedule was introduced.
> Since then we have done some investigation and as we
> became convinced of the connection we have been much
> more conscientious about gaining "informed consent"
> prior to administration of birth dose of Hep B ie
> "full disclosure of risks/benefits without coercion
> or fraud".  As a result, parents are not consenting
> and the rate of uptake of the birth dose in our unit
> has dropped off dramatically.  (It is generally much
> nicer to come to work these days too with fewer
> screaming babies, distraught mothers and frantic
> fathers!)
> We (the midwives) are now copping flak because we
> show up very large on the radar in the 'Early
> Warning System' of the authorities pushing the
> universal immunisation issue.  The pressure to
> conform has come from Public Health Unit, District
> Manager, Medical Superintendent as well as letters
> of complaint from a local GP (who may be fearful
> that he will lose his incentive payments if the
> children who return to hispractice have missedthe
> birth dose!).  We have been told that we must
> "actively encourage" our clients to accept the
> vaccination..that "it is frequently reported that
> the unit works well because of the high degree of
> trust and respect. Herein lies the opportunity to
> disseminate the positive effect of early Hepatitis
> vaccination"  We have been told that we must "act in
> line with the Code of Conduct" to actively promote
> this policy.
> 
> I do believe this is a terribly important ethical
> issue and will not persuade my clients to act
> against there best interests and instincts. 
> We use the materials and information provided by Qld
> Health and "immunise Australia" when we discuss the
> issue with the parents.It is acknowledged in the
> "Understanding infant hepatitis B immunisation"
> pamphlet put out by the "immunise Australia Program"
> that among the common side effects are mild fever,
> joint pain, irritability and baby going "off its
> food for a short time". - discuss how this might
> affect their newborn in the first few days of life.
> Whilst these common and perhaps transient side
> effects may be of little concern in an older child
> they are liable to be of much greater significance
> in a newborn child who is already facing many
> challenges at this deeply important point in its
> life.  Challenges to the newborn (physiological and
> iatrogenic pathology)
> 
>   1.. adaptation to extrauterine life - profound
> physical changes in all systems respiratory,
> circulatory, neurological, sensory,
> digestive/alimentary
>   2.. organisation of suck to enable feed
>   3.. overcome effects of pharmacological substances
> used in labour, birth an postnatally
>   4.. recovery from the traumatic effect of birth eg
> head moulding and other birth injury
> We also give them the Qld Health Hep B Information
> which has this advice "give extra fluids e.g more
> breast feeds or water"  - we discuss the implication
> of this at initiation of breastfeeding.
> 
> We also discuss the risk factors for contracting the
> disease both in infancy and throught the lifespan.  
> 
> All women are screened for HBsAg antenatally so that
> babes of HB positive mothers can receive both
> Immunoglobulin and vaccination at birth. This has
> been shown to be extremely effective in managing the
> risk of vertical (mother to baby) transmission
> 
> The risk factors (for contracting the disease) are
> IV drug use, unsafe sexual practices and certain
> ethnic groups have high endemnicity so may have a
> slightly elevated risk of transmission (e.g
> aboriginal, TSI, particular asian groups for whom we
> have had an effectective 3 dose targetted program
> for many years). Certain occupational groups, eg
> health workers, have a higher than average risk and
> are generally vaccinated witha 3 dose progam.
> 
> World Health Organisation classifies Australia as a
> "low" risk for Hep B with low endemnicity of <2%,
> transmission rates in infancy are "rare" and
> "infrequent" in childhood. Qld Health Notifiable
> Diseases Annual Report 1997 -2001 did not count any
> in the age group of < 13 years. The majority of
> notifications in the 15 -39 yr age range.
> 
> WHO recommendation is for universal Hep B
> immunisation in childhood for those countries with
> "high" endemnicity and the recommended program is
> for 3 doses.
> 
> Immunisation success (90% sero-conversion which is
> as high as it gets) occurs after the 2nd dose, so a
> child will become immunised at 4.5 

Re: [ozmidwifery] Hep B Vaccine at Birth

[Sandra J. Eales]

You are right Mary.  I don't think it is 
question of bravery.  I don't believe I am putting myself at 
risk by my actions.  I do think it is a little intimidating if I 
consider that my goal must be to get the immunisation schedule changed. The 
opposing forces are too great for me.  However we need only 
concentrate on "informing parents" as we encounter them and we are obliged to do 
this.  They are entitled to the information "free of 
coercion".
It is frightening to consider that these powerful 
profit-driven organisations have tentacles of their network covering the globe, 
influencing the most reputable and powerful policy makers e.g WHO and government 

They are very good at controlling information in 
the media and the health systems and have immense experience at presenting 
research which they fund and control results of. (not unlike the cigarette 
company operations in years past)
Sandra

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: [EMAIL PROTECTED] 
  Sent: Tuesday, March 11, 2003 10:37 
  AM
  Subject: Re: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  Marilyn wrote: "Sandra you are so 
  brave." A long time agoe some ancient philosopher wrote something 
  like this:  "In order for evil to flourish, good men do nothing"  I 
  think that covers Sandra's stand.  MM
  

  - Original Message - 
  From: 
  Sandra J. 
  Eales 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, March 09, 2003 6:30 
  PM
  Subject: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  I have previously expressed concerns related to the 
  administration of Hep B Vaccine (HBV) to all babes at birth ie that the 
  midwives in my unit had become aware of marked increase in numbers of 
  irritable babes and many more with breastfeeding difficulties in the first 
  few days, since May 2000 when the new schedule was 
introduced.
  Since then we have done some investigation and as 
  we became convinced of the connection we have been much more conscientious 
  about gaining "informed consent" prior to administration of birth 
  dose of Hep B ie "full disclosure of risks/benefits without coercion or 
  fraud".  As a result, parents are not 
  consenting and the rate of uptake of the birth dose in our unit has 
  dropped off dramatically.  (It is generally much nicer to come 
  to work these days too with fewer screaming babies, distraught mothers and 
  frantic fathers!)
  We (the midwives) are now copping flak because we 
  show up very large on the radar in the 'Early Warning System' of 
  the authorities pushing the universal immunisation issue.  The 
  pressure to conform has come from Public Health Unit, District Manager, 
  Medical Superintendent as well as letters of complaint from a local GP 
  (who may be fearful that he will lose his incentive payments if the 
  children who return to hispractice have missedthe birth dose!).  We 
  have been told that we must "actively encourage" our clients to accept the 
  vaccination..that "it is frequently reported that the unit works well 
  because of the high degree of trust and respect. Herein lies the 
  opportunity to disseminate the positive effect of early Hepatitis 
  vaccination"  We have been told that we must "act in line with the 
  Code of Conduct" to actively promote this policy.
   
  I do believe this is a terribly important ethical issue 
  and will not persuade my clients to act against there best interests and 
  instincts. 
  We use the materials and information provided by Qld 
  Health and "immunise Australia" when we discuss the issue with the 
  parents.It is acknowledged in the "Understanding infant 
  hepatitis B immunisation" pamphlet put out by the "immunise Australia 
  Program" that among the common side effects are mild fever, joint pain, 
  irritability and baby going "off its food for a short time". - discuss how 
  this might affect their newborn in the first few days of life.
  Whilst these common and perhaps transient side effects may be of little 
  concern in an older child they are liable to be of much greater 
  significance in a newborn child who is already facing many challenges at 
  this deeply important point in its life.  Challenges to the newborn 
  (physiological and iatrogenic pathology)
  
adaptation to extrauterine life – profound physical changes in all 
systems respiratory, circulatory, neurological, sensory, 
digestive/alimentary 
organisation of suck to enable feed 
overcome effects of pharmacological substances used in labour, birth 
an postnatally 
recovery from the traumatic e

Re: [ozmidwifery] Hep B Vaccine at Birth

[Marilyn Kleidon]

I had never administered Hep B to a baby in 
the USA at birth or in the postpartum period. Of course I was dealing with 
babies who were primarily born out of hospital, to parents who had no intention 
of having them immunised in the neonatal period, but even for babies born after 
hospital transfer there was never an issue in the state of Washington.  I 
thought i learnt that the birth/close to birth dose of Hep B was halted in the 
USA about 1999/2000(at least on the west coast). I will follow up on this as it 
may have recommenced. I think it was the mercury based preservative that was the 
problem (as far as the powers that be were concerned). 
 
marilyn 

  - Original Message - 
  From: 
  Sandra J. 
  Eales 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, March 10, 2003 4:31 
PM
  Subject: Re: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  Tina
  Making us feel like "bad parents" if we refuse 
  this vaccination is the blatant and stated strategy to ensure 
  conformity.  It is written up the the summary of recommendations from the 
  meeting of "chiefs" from the Antwerp conference that I included in my first 
  posting.
  Most women in Australia (and the US where they 
  have had this in place for many more years than us) with Early Discharge 
  Programs or the HB being given on discharge, probably go home and have to cope 
  with stressed babe with no support.  We do not keep rates of "new mothers 
  who fall in a heap" when they go home.  We don't know how when or why 
  they stop breastfeeding.  Adverse reactions are hugely underreported 
  because they go to their GP and are sloughed off with the same sort of tender 
  care and understanding that your sister experienced.
  We need to start a revolution!
  Sandra
  
- Original Message - 
From: 
Marty & Tina 
To: [EMAIL PROTECTED] 

Sent: Monday, March 10, 2003 9:59 
    PM
    Subject: Re: [ozmidwifery] Hep B 
Vaccine at Birth

Dear Sandra,
 
My sister had her baby at a large public 
hospital in QLD just 4 months ago.  I discussed many things with her 
prior to birth & Hep B vaccine was one of them.  As a result she 
chose not to have her baby vaccinated at birth.  She was made to feel 
like a "bad" mother at every turn & this coupled with poor breastfeeding 
management, poor communication & compassion by staff, & traumatic 
birth experience she ended up with postnatal depression. (sorry off the 
topic there for a minute).  Anyway, when she went for her 6 week 
check-up with her GP she asked when the best time to start Hep B 
immunisation would be (from now on).  Her GP rudely told her that it 
was too late because she hadn't had it at birth... this distressed her even 
more in her depressed state.  Just another way of belittling her as a 
mother.
 
Also, on the point of some of the effects such 
as irritability & going of food etc. I wonder how some parents cope 
when going home after having this injection... I say this with regards to 
one hospital that I can think of that gives the Hep B at same time as NNST 
which is usually day of discharge.    
 
Hope I'm making sence with my tired pregnant 
brain (BABY NO. 4 DUE TOMORROW - BUT HAPPY TO GO OVER A WEEK OR 
THREE).
 
Tina 
H.

Re: [ozmidwifery] Hep B Vaccine at Birth

[Marilyn Kleidon]

I totally agree Mary, which is why I wanted to 
achnowledge her doing something.
 
marilyn
 
 

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, March 10, 2003 4:37 
PM
  Subject: Re: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  Marilyn wrote: "Sandra you are so 
  brave." A long time agoe some ancient philosopher wrote something 
  like this:  "In order for evil to flourish, good men do nothing"  I 
  think that covers Sandra's stand.  MM
  

  - Original Message - 
  From: 
  Sandra J. 
  Eales 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, March 09, 2003 6:30 
  PM
  Subject: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  I have previously expressed concerns related to the 
  administration of Hep B Vaccine (HBV) to all babes at birth ie that the 
  midwives in my unit had become aware of marked increase in numbers of 
  irritable babes and many more with breastfeeding difficulties in the first 
  few days, since May 2000 when the new schedule was 
introduced.
  Since then we have done some investigation and as 
  we became convinced of the connection we have been much more conscientious 
  about gaining "informed consent" prior to administration of birth 
  dose of Hep B ie "full disclosure of risks/benefits without coercion or 
  fraud".  As a result, parents are not 
  consenting and the rate of uptake of the birth dose in our unit has 
  dropped off dramatically.  (It is generally much nicer to come 
  to work these days too with fewer screaming babies, distraught mothers and 
  frantic fathers!)
  We (the midwives) are now copping flak because we 
  show up very large on the radar in the 'Early Warning System' of 
  the authorities pushing the universal immunisation issue.  The 
  pressure to conform has come from Public Health Unit, District Manager, 
  Medical Superintendent as well as letters of complaint from a local GP 
  (who may be fearful that he will lose his incentive payments if the 
  children who return to hispractice have missedthe birth dose!).  We 
  have been told that we must "actively encourage" our clients to accept the 
  vaccination..that "it is frequently reported that the unit works well 
  because of the high degree of trust and respect. Herein lies the 
  opportunity to disseminate the positive effect of early Hepatitis 
  vaccination"  We have been told that we must "act in line with the 
  Code of Conduct" to actively promote this policy.
   
  I do believe this is a terribly important ethical issue 
  and will not persuade my clients to act against there best interests and 
  instincts. 
  We use the materials and information provided by Qld 
  Health and "immunise Australia" when we discuss the issue with the 
  parents.It is acknowledged in the "Understanding infant 
  hepatitis B immunisation" pamphlet put out by the "immunise Australia 
  Program" that among the common side effects are mild fever, joint pain, 
  irritability and baby going "off its food for a short time". - discuss how 
  this might affect their newborn in the first few days of life.
  Whilst these common and perhaps transient side effects may be of little 
  concern in an older child they are liable to be of much greater 
  significance in a newborn child who is already facing many challenges at 
  this deeply important point in its life.  Challenges to the newborn 
  (physiological and iatrogenic pathology)
  
adaptation to extrauterine life – profound physical changes in all 
systems respiratory, circulatory, neurological, sensory, 
digestive/alimentary 
organisation of suck to enable feed 
overcome effects of pharmacological substances used in labour, birth 
an postnatally 
recovery from the traumatic effect of birth eg head moulding and 
other birth injury
  We also give them the Qld Health Hep B Information which has this 
  advice "give extra fluids e.g more breast feeds or water"  - we 
  discuss the implication of this at initiation of breastfeeding.
  We also discuss the risk factors for contracting the disease both in 
  infancy and throught the lifespan.  
  All women are screened for HBsAg antenatally so that babes 
  of HB positive mothers can receive both Immunoglobulin and vaccination at 
  birth. This has been shown to be extremely effective in managing the risk 
  of vertical (mother to baby) transmission
  The risk factors (for contracting the disease) are IV drug use, unsafe 
  sexual practices and certain ethnic groups have high endemnicity so may 
  ha

Re: [ozmidwifery] Hep B Vaccine at Birth

[Sandra J. Eales]

Megan
Go for it. Spread it far and wide.  I want to 
see lots of little blips showing up on the "Early Warning System".
Thanks
Sandra

  - Original Message - 
  From: 
  Larry & 
  Megan 
  To: [EMAIL PROTECTED] 
  Sent: Tuesday, March 11, 2003 10:59 
  AM
  Subject: RE: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  Dear 
  Sandra,
  I 
  remembered when you first raised this, congratulations and a big thankyou for 
  following it through. 
  With 
  your permission I would like to pass on your inspiring e-mail to Adelaides 
  vaccination support group, let me know if you agree, [EMAIL PROTECTED]
   
  best 
  of luck with it
  Megan
  
-Original Message-From: [EMAIL PROTECTED] 
[mailto:[EMAIL PROTECTED]On Behalf Of Sandra J. 
EalesSent: Monday, 10 March 2003 1:01To: 
[EMAIL PROTECTED]Subject: [ozmidwifery] Hep B 
Vaccine at Birth
I have previously expressed concerns related to 
the administration of Hep B Vaccine (HBV) to all babes at birth ie that the 
midwives in my unit had become aware of marked increase in numbers of 
irritable babes and many more with breastfeeding difficulties in the first 
few days, since May 2000 when the new schedule was introduced.
Since then we have done some investigation 
and as we became convinced of the connection we have been much more 
conscientious about gaining "informed consent" prior to administration 
of birth dose of Hep B ie "full disclosure of risks/benefits without 
coercion or fraud".  As a result, 
parents are not consenting and the rate of uptake of the birth dose in 
our unit has dropped off dramatically.  (It is generally much 
nicer to come to work these days too with fewer screaming babies, distraught 
mothers and frantic fathers!)
We (the midwives) are now copping flak 
because we show up very large on the radar in the 'Early Warning System' of 
the authorities pushing the universal immunisation issue.  The 
pressure to conform has come from Public Health Unit, District Manager, 
Medical Superintendent as well as letters of complaint from a local GP (who 
may be fearful that he will lose his incentive payments if the children who 
return to hispractice have missedthe birth dose!).  We have been told 
that we must "actively encourage" our clients to accept the 
vaccination..that "it is frequently reported that the unit works well 
because of the high degree of trust and respect. Herein lies the opportunity 
to disseminate the positive effect of early Hepatitis vaccination"  We 
have been told that we must "act in line with the Code of Conduct" to 
actively promote this policy.
 
I do believe this is a terribly important 
ethical issue and will not persuade my clients to act against there best 
interests and instincts. 
We use the materials and information provided 
by Qld Health and "immunise Australia" when we discuss the issue with 
the parents.It is acknowledged in the "Understanding infant 
hepatitis B immunisation" pamphlet put out by the "immunise Australia 
Program" that among the common side effects are mild fever, joint pain, 
irritability and baby going "off its food for a short time". - discuss how 
this might affect their newborn in the first few days of life.
Whilst these common and perhaps transient side effects may be of little 
concern in an older child they are liable to be of much greater significance 
in a newborn child who is already facing many challenges at this deeply 
important point in its life.  Challenges to the newborn (physiological 
and iatrogenic pathology)

  adaptation to extrauterine life – profound physical changes in all 
  systems respiratory, circulatory, neurological, sensory, 
  digestive/alimentary 
  organisation of suck to enable feed 
  overcome effects of pharmacological substances used in labour, birth 
  an postnatally 
  recovery from the traumatic effect of birth eg head moulding and other 
  birth injury
We also give them the Qld Health Hep B Information which has this 
advice "give extra fluids e.g more breast feeds or water"  - we discuss 
the implication of this at initiation of breastfeeding.
We also discuss the risk factors for contracting the disease both in 
infancy and throught the lifespan.  
All women are screened for HBsAg antenatally so that babes 
of HB positive mothers can receive both Immunoglobulin and vaccination at 
birth. This has been shown to be extremely effective in managing the risk of 
vertical (mother to baby) transmission
The risk factors (for contracting the disease) are IV drug use, unsafe 
sexual practices and certain ethnic groups have high endemnicity so may h

RE: [ozmidwifery] Hep B Vaccine at Birth

[Larry & Megan]

Dear 
Sandra,
I 
remembered when you first raised this, congratulations and a big thankyou for 
following it through. 
With 
your permission I would like to pass on your inspiring e-mail to Adelaides 
vaccination support group, let me know if you agree, [EMAIL PROTECTED]
 
best 
of luck with it
Megan

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of Sandra J. 
  EalesSent: Monday, 10 March 2003 1:01To: 
  [EMAIL PROTECTED]Subject: [ozmidwifery] Hep B Vaccine 
  at Birth
  I have previously expressed concerns related to 
  the administration of Hep B Vaccine (HBV) to all babes at birth ie that the 
  midwives in my unit had become aware of marked increase in numbers of 
  irritable babes and many more with breastfeeding difficulties in the first few 
  days, since May 2000 when the new schedule was introduced.
  Since then we have done some investigation 
  and as we became convinced of the connection we have been much more 
  conscientious about gaining "informed consent" prior to administration of 
  birth dose of Hep B ie "full disclosure of risks/benefits without coercion or 
  fraud".  As a result, parents are not 
  consenting and the rate of uptake of the birth dose in our unit has 
  dropped off dramatically.  (It is generally much nicer to come to 
  work these days too with fewer screaming babies, distraught mothers and 
  frantic fathers!)
  We (the midwives) are now copping flak 
  because we show up very large on the radar in the 'Early Warning System' of 
  the authorities pushing the universal immunisation issue.  The 
  pressure to conform has come from Public Health Unit, District Manager, 
  Medical Superintendent as well as letters of complaint from a local GP (who 
  may be fearful that he will lose his incentive payments if the children who 
  return to hispractice have missedthe birth dose!).  We have been told 
  that we must "actively encourage" our clients to accept the vaccination..that 
  "it is frequently reported that the unit works well because of the high degree 
  of trust and respect. Herein lies the opportunity to disseminate the positive 
  effect of early Hepatitis vaccination"  We have been told that we must 
  "act in line with the Code of Conduct" to actively promote this 
  policy.
   
  I do believe this is a terribly important ethical 
  issue and will not persuade my clients to act against there best interests and 
  instincts. 
  We use the materials and information provided by 
  Qld Health and "immunise Australia" when we discuss the issue with the 
  parents.It is acknowledged in the "Understanding infant hepatitis 
  B immunisation" pamphlet put out by the "immunise Australia Program" that 
  among the common side effects are mild fever, joint pain, irritability and 
  baby going "off its food for a short time". - discuss how this might affect 
  their newborn in the first few days of life.
  Whilst these common and perhaps transient side effects may be of little 
  concern in an older child they are liable to be of much greater significance 
  in a newborn child who is already facing many challenges at this deeply 
  important point in its life.  Challenges to the newborn (physiological 
  and iatrogenic pathology)
  
adaptation to extrauterine life – profound physical changes in all 
systems respiratory, circulatory, neurological, sensory, 
digestive/alimentary 
organisation of suck to enable feed 
overcome effects of pharmacological substances used in labour, birth an 
postnatally 
recovery from the traumatic effect of birth eg head moulding and other 
birth injury
  We also give them the Qld Health Hep B Information which has this 
  advice "give extra fluids e.g more breast feeds or water"  - we discuss 
  the implication of this at initiation of breastfeeding.
  We also discuss the risk factors for contracting the disease both in 
  infancy and throught the lifespan.  
  All women are screened for HBsAg antenatally so that babes of 
  HB positive mothers can receive both Immunoglobulin and vaccination at birth. 
  This has been shown to be extremely effective in managing the risk of vertical 
  (mother to baby) transmission
  The risk factors (for contracting the disease) are IV drug use, unsafe 
  sexual practices and certain ethnic groups have high endemnicity so may have a 
  slightly elevated risk of transmission (e.g aboriginal, TSI, particular asian 
  groups for whom we have had an effectective 3 dose targetted program for many 
  years). Certain occupational groups, eg health workers, have a higher than 
  average risk and are generally vaccinated witha 3 dose progam.
  World Health Organisation classifies Australia as a "low" risk for Hep B 
  with low endemnicity of <2%, transmission rates in infancy are "rare" and 
  "infrequent" in childhood. Qld Health Notifiable Diseases Annual Report 1997 
  -2001 did not count any in the age group of < 13 years. The majority

Re: [ozmidwifery] Hep B Vaccine at Birth

[Sandra J. Eales]

Thanks for your feedback Mary and Lois.  You 
are somewhat advantaged in that the clientele who are assertive enough to choose 
homebirth are less fearful of "bucking the system" and are often clear, well 
informed and strong enough to risist the subtle and not so subtle pressures that 
might be applied to make them conform.  We have a small assertive element 
amongst our clientele as well ( around 15% of mothers in our unit resisted the 
HB push from the start).  The letters from "above" started arriving with 
the last compilation of rates when there was only 25% who refused the birth 
dose.  There is bound to be some squawking and feathers flying when they 
compile the next lot and discover that it is up to about 75%!!
Sandra

  - Original Message - 
  From: 
  Lois 
  Wattis 
  To: [EMAIL PROTECTED] 
  Sent: Monday, March 10, 2003 9:29 
PM
  Subject: Re: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  Congratulations, Sandra  on a 
  comprehensive and GUTSY account of the Hep.B at 
  birth situation.  This information needs to be disseminated all over 
  Australia.  I work with Mary M. and have a similar approach to the Hep.B 
  question when asked by clients etc.  Keep up the great efforts 
  towards enlightenment.  I look forward to your published 
  work!   Kind regards, Lois
    
  
- Original Message - 
From: 
Sandra J. 
Eales 
To: [EMAIL PROTECTED] 

Sent: Monday, March 10, 2003 10:30 
AM
Subject: [ozmidwifery] Hep B Vaccine at 
Birth

I have previously expressed concerns related to 
the administration of Hep B Vaccine (HBV) to all babes at birth ie that the 
midwives in my unit had become aware of marked increase in numbers of 
irritable babes and many more with breastfeeding difficulties in the first 
few days, since May 2000 when the new schedule was introduced.
Since then we have done some investigation 
and as we became convinced of the connection we have been much more 
conscientious about gaining "informed consent" prior to administration 
of birth dose of Hep B ie "full disclosure of risks/benefits without 
coercion or fraud".  As a result, 
parents are not consenting and the rate of uptake of the birth dose in 
our unit has dropped off dramatically.  (It is generally much 
nicer to come to work these days too with fewer screaming babies, distraught 
mothers and frantic fathers!)
We (the midwives) are now copping flak 
because we show up very large on the radar in the 'Early Warning System' of 
the authorities pushing the universal immunisation issue.  The 
pressure to conform has come from Public Health Unit, District Manager, 
Medical Superintendent as well as letters of complaint from a local GP (who 
may be fearful that he will lose his incentive payments if the children who 
return to hispractice have missedthe birth dose!).  We have been told 
that we must "actively encourage" our clients to accept the 
vaccination..that "it is frequently reported that the unit works well 
because of the high degree of trust and respect. Herein lies the opportunity 
to disseminate the positive effect of early Hepatitis vaccination"  We 
have been told that we must "act in line with the Code of Conduct" to 
actively promote this policy.
 
I do believe this is a terribly important 
ethical issue and will not persuade my clients to act against there best 
interests and instincts. 
We use the materials and information provided 
by Qld Health and "immunise Australia" when we discuss the issue with 
the parents.It is acknowledged in the "Understanding infant 
hepatitis B immunisation" pamphlet put out by the "immunise Australia 
Program" that among the common side effects are mild fever, joint pain, 
irritability and baby going "off its food for a short time". - discuss how 
this might affect their newborn in the first few days of life.
Whilst these common and perhaps transient side effects may be of little 
concern in an older child they are liable to be of much greater significance 
in a newborn child who is already facing many challenges at this deeply 
important point in its life.  Challenges to the newborn (physiological 
and iatrogenic pathology)

  adaptation to extrauterine life – profound physical changes in all 
  systems respiratory, circulatory, neurological, sensory, 
  digestive/alimentary 
  organisation of suck to enable feed 
  overcome effects of pharmacological substances used in labour, birth 
  an postnatally 
  recovery from the traumatic effect of birth eg head moulding and other 
  birth injury
We also give them the Qld Health Hep B Information which has this 
advice "give extra fluids e

Re: [ozmidwifery] Hep B Vaccine at Birth

[Sandra J. Eales]

Tina
Making us feel like "bad parents" if we refuse this 
vaccination is the blatant and stated strategy to ensure conformity.  It is 
written up the the summary of recommendations from the meeting of "chiefs" from 
the Antwerp conference that I included in my first posting.
Most women in Australia (and the US where they have 
had this in place for many more years than us) with Early Discharge Programs or 
the HB being given on discharge, probably go home and have to cope with stressed 
babe with no support.  We do not keep rates of "new mothers who fall in a 
heap" when they go home.  We don't know how when or why they stop 
breastfeeding.  Adverse reactions are hugely underreported because they go 
to their GP and are sloughed off with the same sort of tender care and 
understanding that your sister experienced.
We need to start a revolution!
Sandra

  - Original Message - 
  From: 
  Marty & Tina 
  To: [EMAIL PROTECTED] 
  Sent: Monday, March 10, 2003 9:59 
PM
  Subject: Re: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  Dear Sandra,
   
  My sister had her baby at a large public 
  hospital in QLD just 4 months ago.  I discussed many things with her 
  prior to birth & Hep B vaccine was one of them.  As a result she 
  chose not to have her baby vaccinated at birth.  She was made to feel 
  like a "bad" mother at every turn & this coupled with poor breastfeeding 
  management, poor communication & compassion by staff, & traumatic 
  birth experience she ended up with postnatal depression. (sorry off the topic 
  there for a minute).  Anyway, when she went for her 6 week check-up with 
  her GP she asked when the best time to start Hep B immunisation would be (from 
  now on).  Her GP rudely told her that it was too late because she hadn't 
  had it at birth... this distressed her even more in her depressed state.  
  Just another way of belittling her as a mother.
   
  Also, on the point of some of the effects such as 
  irritability & going of food etc. I wonder how some parents cope when 
  going home after having this injection... I say this with regards to one 
  hospital that I can think of that gives the Hep B at same time as NNST which 
  is usually day of discharge.    
   
  Hope I'm making sence with my tired pregnant 
  brain (BABY NO. 4 DUE TOMORROW - BUT HAPPY TO GO OVER A WEEK OR 
  THREE).
   
  Tina H.

Re: [ozmidwifery] Hep B Vaccine at Birth

[Mary Murphy]

Marilyn wrote: "Sandra you are so 
brave." A long time agoe some ancient philosopher wrote something like 
this:  "In order for evil to flourish, good men do nothing"  I think 
that covers Sandra's stand.  MM

  
- Original Message - 
From: 
Sandra J. 
Eales 
To: [EMAIL PROTECTED] 

Sent: Sunday, March 09, 2003 6:30 
PM
Subject: [ozmidwifery] Hep B Vaccine at 
Birth

I have previously expressed concerns related to the 
administration of Hep B Vaccine (HBV) to all babes at birth ie that the 
midwives in my unit had become aware of marked increase in numbers of 
irritable babes and many more with breastfeeding difficulties in the first 
few days, since May 2000 when the new schedule was introduced.
Since then we have done some investigation and as we 
became convinced of the connection we have been much more conscientious 
about gaining "informed consent" prior to administration of birth dose 
of Hep B ie "full disclosure of risks/benefits without coercion or 
fraud".  As a result, parents are not 
consenting and the rate of uptake of the birth dose in our unit has 
dropped off dramatically.  (It is generally much nicer to come to 
work these days too with fewer screaming babies, distraught mothers and 
frantic fathers!)
We (the midwives) are now copping flak because we 
show up very large on the radar in the 'Early Warning System' of 
the authorities pushing the universal immunisation issue.  The 
pressure to conform has come from Public Health Unit, District Manager, 
Medical Superintendent as well as letters of complaint from a local GP (who 
may be fearful that he will lose his incentive payments if the children who 
return to hispractice have missedthe birth dose!).  We have been told 
that we must "actively encourage" our clients to accept the 
vaccination..that "it is frequently reported that the unit works well 
because of the high degree of trust and respect. Herein lies the opportunity 
to disseminate the positive effect of early Hepatitis vaccination"  We 
have been told that we must "act in line with the Code of Conduct" to 
actively promote this policy.
 
I do believe this is a terribly important ethical issue 
and will not persuade my clients to act against there best interests and 
instincts. 
We use the materials and information provided by Qld 
Health and "immunise Australia" when we discuss the issue with the 
parents.It is acknowledged in the "Understanding infant 
hepatitis B immunisation" pamphlet put out by the "immunise Australia 
Program" that among the common side effects are mild fever, joint pain, 
irritability and baby going "off its food for a short time". - discuss how 
this might affect their newborn in the first few days of life.
Whilst these common and perhaps transient side effects may be of little 
concern in an older child they are liable to be of much greater significance 
in a newborn child who is already facing many challenges at this deeply 
important point in its life.  Challenges to the newborn (physiological 
and iatrogenic pathology)

  adaptation to extrauterine life – profound physical changes in all 
  systems respiratory, circulatory, neurological, sensory, 
  digestive/alimentary 
  organisation of suck to enable feed 
  overcome effects of pharmacological substances used in labour, birth 
  an postnatally 
  recovery from the traumatic effect of birth eg head moulding and other 
  birth injury
We also give them the Qld Health Hep B Information which has this 
advice "give extra fluids e.g more breast feeds or water"  - we discuss 
the implication of this at initiation of breastfeeding.
We also discuss the risk factors for contracting the disease both in 
infancy and throught the lifespan.  
All women are screened for HBsAg antenatally so that babes 
of HB positive mothers can receive both Immunoglobulin and vaccination at 
birth. This has been shown to be extremely effective in managing the risk of 
vertical (mother to baby) transmission
The risk factors (for contracting the disease) are IV drug use, unsafe 
sexual practices and certain ethnic groups have high endemnicity so may have 
a slightly elevated risk of transmission (e.g aboriginal, TSI, particular 
asian groups for whom we have had an effectective 3 dose targetted program 
for many years). Certain occupational groups, eg health workers, have a 
higher than average risk and are generally vaccinated witha 3 dose 
progam.
World Health Organisation classifies Australia as a "low" risk for Hep B 
with low endemnicity of <2%, transmission rates in infancy are "rare" and 
"infrequent" in childhood. Qld Health Notifiable Diseases Annual Report 1997 
-2001 did not count a

Re: [ozmidwifery] Hep B Vaccine at Birth

[Marty & Tina]

Dear Sandra,
 
My sister had her baby at a large public 
hospital in QLD just 4 months ago.  I discussed many things with her prior 
to birth & Hep B vaccine was one of them.  As a result she chose not to 
have her baby vaccinated at birth.  She was made to feel like a "bad" 
mother at every turn & this coupled with poor breastfeeding management, poor 
communication & compassion by staff, & traumatic birth experience she 
ended up with postnatal depression. (sorry off the topic there for a 
minute).  Anyway, when she went for her 6 week check-up with her GP she 
asked when the best time to start Hep B immunisation would be (from now 
on).  Her GP rudely told her that it was too late because she hadn't had it 
at birth... this distressed her even more in her depressed state.  Just 
another way of belittling her as a mother.
 
Also, on the point of some of the effects such as 
irritability & going of food etc. I wonder how some parents cope when 
going home after having this injection... I say this with regards to one 
hospital that I can think of that gives the Hep B at same time as NNST which is 
usually day of discharge.    
 
Hope I'm making sence with my tired pregnant brain 
(BABY NO. 4 DUE TOMORROW - BUT HAPPY TO GO OVER A WEEK OR THREE).
 
Tina H.

Re: [ozmidwifery] Hep B Vaccine at Birth

[Lois Wattis]

Congratulations, Sandra  on a 
comprehensive and GUTSY account of the Hep.B at birth 
situation.  This information needs to be disseminated all over 
Australia.  I work with Mary M. and have a similar approach to the Hep.B 
question when asked by clients etc.  Keep up the great efforts towards 
enlightenment.  I look forward to your published work!   Kind 
regards, Lois
  

  - Original Message - 
  From: 
  Sandra J. 
  Eales 
  To: [EMAIL PROTECTED] 
  
  Sent: Monday, March 10, 2003 10:30 
  AM
  Subject: [ozmidwifery] Hep B Vaccine at 
  Birth
  
  I have previously expressed concerns related to 
  the administration of Hep B Vaccine (HBV) to all babes at birth ie that the 
  midwives in my unit had become aware of marked increase in numbers of 
  irritable babes and many more with breastfeeding difficulties in the first few 
  days, since May 2000 when the new schedule was introduced.
  Since then we have done some investigation 
  and as we became convinced of the connection we have been much more 
  conscientious about gaining "informed consent" prior to administration of 
  birth dose of Hep B ie "full disclosure of risks/benefits without coercion or 
  fraud".  As a result, parents are not 
  consenting and the rate of uptake of the birth dose in our unit has 
  dropped off dramatically.  (It is generally much nicer to come to 
  work these days too with fewer screaming babies, distraught mothers and 
  frantic fathers!)
  We (the midwives) are now copping flak 
  because we show up very large on the radar in the 'Early Warning System' of 
  the authorities pushing the universal immunisation issue.  The 
  pressure to conform has come from Public Health Unit, District Manager, 
  Medical Superintendent as well as letters of complaint from a local GP (who 
  may be fearful that he will lose his incentive payments if the children who 
  return to hispractice have missedthe birth dose!).  We have been told 
  that we must "actively encourage" our clients to accept the vaccination..that 
  "it is frequently reported that the unit works well because of the high degree 
  of trust and respect. Herein lies the opportunity to disseminate the positive 
  effect of early Hepatitis vaccination"  We have been told that we must 
  "act in line with the Code of Conduct" to actively promote this 
  policy.
   
  I do believe this is a terribly important ethical 
  issue and will not persuade my clients to act against there best interests and 
  instincts. 
  We use the materials and information provided by 
  Qld Health and "immunise Australia" when we discuss the issue with the 
  parents.It is acknowledged in the "Understanding infant hepatitis 
  B immunisation" pamphlet put out by the "immunise Australia Program" that 
  among the common side effects are mild fever, joint pain, irritability and 
  baby going "off its food for a short time". - discuss how this might affect 
  their newborn in the first few days of life.
  Whilst these common and perhaps transient side effects may be of little 
  concern in an older child they are liable to be of much greater significance 
  in a newborn child who is already facing many challenges at this deeply 
  important point in its life.  Challenges to the newborn (physiological 
  and iatrogenic pathology)
  
adaptation to extrauterine life – profound physical changes in all 
systems respiratory, circulatory, neurological, sensory, 
digestive/alimentary 
organisation of suck to enable feed 
overcome effects of pharmacological substances used in labour, birth an 
postnatally 
recovery from the traumatic effect of birth eg head moulding and other 
birth injury
  We also give them the Qld Health Hep B Information which has this 
  advice "give extra fluids e.g more breast feeds or water"  - we discuss 
  the implication of this at initiation of breastfeeding.
  We also discuss the risk factors for contracting the disease both in 
  infancy and throught the lifespan.  
  All women are screened for HBsAg antenatally so that babes of 
  HB positive mothers can receive both Immunoglobulin and vaccination at birth. 
  This has been shown to be extremely effective in managing the risk of vertical 
  (mother to baby) transmission
  The risk factors (for contracting the disease) are IV drug use, unsafe 
  sexual practices and certain ethnic groups have high endemnicity so may have a 
  slightly elevated risk of transmission (e.g aboriginal, TSI, particular asian 
  groups for whom we have had an effectective 3 dose targetted program for many 
  years). Certain occupational groups, eg health workers, have a higher than 
  average risk and are generally vaccinated witha 3 dose progam.
  World Health Organisation classifies Australia as a "low" risk for Hep B 
  with low endemnicity of <2%, transmission rates in infancy are "rare" and 
  "infrequent" in childhood. Qld Health Notifiable Diseases Annual Report 1997 
  -2001 did not count any i

Re: [ozmidwifery] Hep B Vaccine at Birth

[jireland]

ditto Mary jan

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: [EMAIL PROTECTED] 
  Sent: Monday, March 10, 2003 3:29 
PM
  Subject: Re: [ozmidwifery] Hep B Vaccine 
  at Birth
  
  Sandra, thank you for your frank discussion of hep B vacc at birth on 
  this list and the "birth talk" list.  I am definitely not supportive of 
  this agenda and thankfully as I practice in homebirth, I do not have to give 
  this vaccination..actually I would refuse and refer parents to a GP if they 
  did want it.  MM

Re: [ozmidwifery] Hep B Vaccine at Birth

[Marilyn Kleidon]

Sandra you ar so brave.
 
marilyn

  - Original Message - 
  From: 
  Sandra J. 
  Eales 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, March 09, 2003 6:30 
PM
  Subject: [ozmidwifery] Hep B Vaccine at 
  Birth
  
  I have previously expressed concerns related to 
  the administration of Hep B Vaccine (HBV) to all babes at birth ie that the 
  midwives in my unit had become aware of marked increase in numbers of 
  irritable babes and many more with breastfeeding difficulties in the first few 
  days, since May 2000 when the new schedule was introduced.
  Since then we have done some investigation 
  and as we became convinced of the connection we have been much more 
  conscientious about gaining "informed consent" prior to administration of 
  birth dose of Hep B ie "full disclosure of risks/benefits without coercion or 
  fraud".  As a result, parents are not 
  consenting and the rate of uptake of the birth dose in our unit has 
  dropped off dramatically.  (It is generally much nicer to come to 
  work these days too with fewer screaming babies, distraught mothers and 
  frantic fathers!)
  We (the midwives) are now copping flak 
  because we show up very large on the radar in the 'Early Warning System' of 
  the authorities pushing the universal immunisation issue.  The 
  pressure to conform has come from Public Health Unit, District Manager, 
  Medical Superintendent as well as letters of complaint from a local GP (who 
  may be fearful that he will lose his incentive payments if the children who 
  return to hispractice have missedthe birth dose!).  We have been told 
  that we must "actively encourage" our clients to accept the vaccination..that 
  "it is frequently reported that the unit works well because of the high degree 
  of trust and respect. Herein lies the opportunity to disseminate the positive 
  effect of early Hepatitis vaccination"  We have been told that we must 
  "act in line with the Code of Conduct" to actively promote this 
  policy.
   
  I do believe this is a terribly important ethical 
  issue and will not persuade my clients to act against there best interests and 
  instincts. 
  We use the materials and information provided by 
  Qld Health and "immunise Australia" when we discuss the issue with the 
  parents.It is acknowledged in the "Understanding infant hepatitis 
  B immunisation" pamphlet put out by the "immunise Australia Program" that 
  among the common side effects are mild fever, joint pain, irritability and 
  baby going "off its food for a short time". - discuss how this might affect 
  their newborn in the first few days of life.
  Whilst these common and perhaps transient side effects may be of little 
  concern in an older child they are liable to be of much greater significance 
  in a newborn child who is already facing many challenges at this deeply 
  important point in its life.  Challenges to the newborn (physiological 
  and iatrogenic pathology)
  
adaptation to extrauterine life – profound physical changes in all 
systems respiratory, circulatory, neurological, sensory, 
digestive/alimentary 
organisation of suck to enable feed 
overcome effects of pharmacological substances used in labour, birth an 
postnatally 
recovery from the traumatic effect of birth eg head moulding and other 
birth injury
  We also give them the Qld Health Hep B Information which has this 
  advice "give extra fluids e.g more breast feeds or water"  - we discuss 
  the implication of this at initiation of breastfeeding.
  We also discuss the risk factors for contracting the disease both in 
  infancy and throught the lifespan.  
  All women are screened for HBsAg antenatally so that babes of 
  HB positive mothers can receive both Immunoglobulin and vaccination at birth. 
  This has been shown to be extremely effective in managing the risk of vertical 
  (mother to baby) transmission
  The risk factors (for contracting the disease) are IV drug use, unsafe 
  sexual practices and certain ethnic groups have high endemnicity so may have a 
  slightly elevated risk of transmission (e.g aboriginal, TSI, particular asian 
  groups for whom we have had an effectective 3 dose targetted program for many 
  years). Certain occupational groups, eg health workers, have a higher than 
  average risk and are generally vaccinated witha 3 dose progam.
  World Health Organisation classifies Australia as a "low" risk for Hep B 
  with low endemnicity of <2%, transmission rates in infancy are "rare" and 
  "infrequent" in childhood. Qld Health Notifiable Diseases Annual Report 1997 
  -2001 did not count any in the age group of < 13 years. The majority of 
  notifications in the 15 -39 yr age range.
  WHO recommendation is for universal Hep B immunisation in childhood for 
  those countries with "high" endemnicity and the recommended program is for 3 
  doses.
  Immunisation success (90% sero-conversion which is as high as it gets) 
  occurs after 

Re: [ozmidwifery] Hep B Vaccine at Birth

[Cheryl LHK]

Sandra

Thanks for the info on HB inj.  there was a discussion on it some months 
ago, so when we had this baby in hospital, I definitely did NOT have the HB 
given.  She will have it later.  My second son had the inj at birth, 
although he started well with the breast-feeding, had a lot of probs later 
and ended up suppressing close to 5 months.  Have been determined to BF 
longer with this baby (last one) so chose not to have the injection, so far 
all is going well...  might be the luck of the draw, but ? at least it seems 
to work for me.

HB is covered in our antenatal classes, so the women tend to turn up in 
labour ward with consent signed and expecting the injection.  Whoever are 
the PR people for vaccination, they work well!!  I have personally met 1-2 
women who refused immunisation in my (less than 5 yrs) mid career.

Cheryl

Cheryl







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Re: [ozmidwifery] Hep B Vaccine at Birth

[Mary Murphy]

Sandra, thank you for your frank discussion of hep B vacc at birth on this 
list and the "birth talk" list.  I am definitely not supportive of this 
agenda and thankfully as I practice in homebirth, I do not have to give this 
vaccination..actually I would refuse and refer parents to a GP if they did want 
it.  MM