Another Decision for Parents Who Already Have Too Many

This week, ACIP (the CDC’s vaccine advisory panel) voted 8–3 to change the long-standing guideline that all newborns receive the Hepatitis B vaccine at birth. If the baby's mother tests negative for Hep B, the shot is now categorized as “shared decision-making.” Translation: parents and providers will decide together whether to give it in the hospital or delay it.

My first reaction was immediate and visceral: If this decision had been handed to me in those first 24 hours postpartum, I would’ve spiraled. I remember lying in that hospital bed after my twins were born — exhausted, stitched, overwhelmed, trying to make sense of what had just happened to my body and my life. If someone had asked, “Do you want the Hep B vaccine now or wait?” I wouldn’t have had the capacity to process the question, let alone the risk. 

But here’s why the birth dose existed in the first place. Since the early ’90s, universal newborn vaccination has helped drive childhood Hep B infections down by roughly 99%. The vaccine is extremely effective when given within 24 hours, and infants who contract Hep B are far more likely to develop lifelong chronic infection, which can lead to liver disease and cancer. Screening helps, but it isn’t perfect — infections can be missed, acquired later in pregnancy, or come from household contacts.

The American Academy of Pediatrics responded almost immediately, reaffirming that the birth dose is still the safest, most effective way to protect infants, emphasizing that chronic infection is far more likely when the vaccine is delayed. In their words: timing matters.

That’s what made the birth dose a safety net. A simple, predictable layer of protection.

Now? Parents may get different answers depending on the hospital, the provider, or the philosophy of the moment. And that feels less like choice and more like pressure, especially for people who are already depleted, hormonal, and trying to keep a tiny human alive.

If you’re expecting, consider asking about Hep B before delivery, when your brain is still functioning. And ask directly: “What’s the actual risk of delaying this?” Their answer might tell you more than the policy does.