Newborns can receive breastfeeding from hepatitis B surface antigen (AoA) positive mothers after receiving hepatitis B immune globulin and hepatitis B vaccine within 12 hours of birth. Author：Zhang Yu Source：《Only the Doctor Knows!3》 After I became an attending physician, I started to manage the wards under the supervision of professors, which was a more advanced rotation after the residents and chief residents. Obstetricians and gynecologists at Concordia have to rotate back and forth through the wards of various specialty groups, each time in a different professional role, with their butts sitting in a different position, and their heads naturally using a different channel of thought. After experiencing different levels of each segment of the experience, the disease is still the same disease, you have been different you, more than ten years down, really grew into a stand up a stall work, put down a face, really unique backbone of the doctor. As usual, the morning shift, the night shift admitted a hepatitis B triple positive pregnant women, to the emergency room when the water has broken, the mouth of the uterus opened 8 fingers, the doctor while asking for a diagnosis, while busy blood sampling to send for the necessary laboratory tests, in the blink of an eye, pregnant women’s uterus has been opened all the way to the midwifery table of all sorts of guys and gals have just been placed in place, and then in a twinkling of an eye, the child croaked out. This was a patient who came into the emergency room at night with no prenatal checkups, for unknown motives and reasons, and we didn’t ask, and we didn’t have time to ask, because no matter whose shift it was on, we had to manage it. Whether it is a street wandering completely unable to say who the father of the child’s mentally handicapped pregnant women, or covered with a flower quilt ambulance across the province to come to the critically ill pregnant women, even if they have not done any obstetrics, but also can not take any reference to the laboratory, so bam a big a small two living people put you in front of the doctor does not have any choice but to meet the head on the top. Doctors are most afraid of making mistakes in the middle of their work, no mistakes of course, but more or less some fear. This pregnant woman was almost in emergency labor, causing the doctors and nurses to be in a mess. The doctor on shift had a sulky look on his face, and the pediatrician who was on shift with me tapped me on the shoulder and said, “Buddy, we need to do a better job of educating the public and educating mothers with Hepatitis B to go to state-designated infectious hospitals to give birth, and all of them are like this nighttime emergency, sooner or later, there will be a problem.” The pediatrician had a point, a good hospital is good because it is comprehensive and integrated, not every aspect is outstanding and perfect, if the hospital does not admit and treat pregnant women with hepatitis as its main business and strength, naturally, it does not have the processes and routines in this area, and even the emergency pharmacy does not list Hepatitis B Immune Globulin, which is urgently needed by newborns to be injected within 24 hours, as a regular medication. The pediatrician had been in contact with the pharmacy to urgently mix the medication and administer the life-saving shot to the child in a timely manner. Doctors treat patients and save lives, knowledge comes from the classroom, experience comes from the clinic, what kind of patients are admitted, what kind of diseases will be treated. Concordia is best at pathological obstetrics. In addition to the strength of obstetrics itself, there is a strong support of internal medicine consultation before the birth, a strong maternity ward, operating room and anesthesiology available at the time of the birth, and a strong ICU after the birth to back it up. At the same time, as a top general hospital in China, critically ill patients keep coming to our door, and there is no higher hospital to refer them to, so we can only work together and treat the dead horse as a living horse. Patients live, we accumulate experience; patients die, we keep in mind the lessons learned, so many years as one day to meet head on, discuss and try and summarize, and then repeated practice and verification, to have today’s strong. And for those patients who cannot be seen in outpatient clinics, emergency clinics and wards, even if they are concordant, they can only be treated on paper, and they do not even have the ability to be treated on paper. Such is the case now, and in my head, the key points of perinatal management for pregnant women with hepatitis B are empty, except for the doomed and outdated knowledge in the textbooks when I was in college. What are the do’s and don’ts of giving birth to a pregnant woman with hepatitis B? In addition to the obstetrician’s attention to uterine contractions, perineal wounds, and reducing the use of medications that may cause liver damage, the looming question of whether or not a mother with hepatitis B can breastfeed her nursing child is one that will inevitably be encountered during the upcoming rounds. My clients, the mothers, may consult me; my mentors, the interns, residents, and fellows, may ask me for advice; in short, I am being quizzed, and I am lost in a series of self-interrogations and ramblings, without a clue. The International Medical Department is the only one in the Concordia compound with a private room, and when we knocked on the door, the woman who had gone through an agonizing labor last night was already freshened up and quietly holding her baby and feeding it a bottle. Upon further inspection, the mobile table provided by the hospital was filled with cans of formula, bottles of milk, sterilized pans, and rubberized silicone nipples of all sizes, with no breastfeeding in sight. The Hepatitis B mother gave us two tasks: first, the medical staff kept her condition a secret, and her family and even her loved ones did not know that she was a Hepatitis B patient; second, she wanted the doctor to help her withdraw her milk. Protecting patients’ privacy is the responsibility of healthcare professionals, especially in obstetrics and gynecology, too many things need to be kept confidential, the patient has had what STDs, how many sexual partners, how many abortions before marriage and even induced abortion in large months, etc., too many women do not want to be known by the current pillows of the past, they have to tell the doctor. When patients reveal their bodies to us and tell us their worst pains, doctors must make the office a safe place for them to feel, to heal their pain, to help them regain their self-confidence, and to keep their mouths shut. But why did she have to withdraw her milk? Was she afraid of transmitting hepatitis B to her child? The textbook of obstetrics and gynecology in the chapter of Combined Medical Diseases in Pregnancy probably states the following: breastfeeding is contraindicated for women who are triple positive, breastfeeding is contraindicated for those whose breast milk is HBV-DNA positive, and breastfeeding for newborns is only allowed if the newborns are immunized and the mothers are just simple hepatitis B carriers. What I do know is that as long as the newborn is immunized with hepatitis B vaccine and immune globulin as soon as possible after birth, hepatitis B carriers with stable liver function and mothers with minor triple positive should be able to breastfeed, not so sure about major triple positive. “We see a very limited number of pregnant women with hepatitis B here, and this is a special case today, so let’s split up and look up the information, and if there is evidence to support that mothers with triple III can breastfeed, we will definitely mobilize the mothers to breastfeed.” I left everyone with their homework and continued to check the room. Concordia, the reason why it is one of the top general hospitals in the country, is not because all the doctors here are so gifted that they were born knowing everything, but there is a rare academic atmosphere that drives doctors of all sizes, and when they encounter a not-so-common patient or a tricky case, the doctors know exactly what they don’t know, and they also know where to look for the answer. Clinicians do not know how outdated they are just by reading textbooks; they do not know how limited they are just by reading Chinese literature; and they will fall into the strange circle of having a high opinion, not being grounded, and not being able to link theory to practice just by reading English literature. In fact, as early as 1997, the World Health Organization clearly stated that there is no evidence to prove that breastfeeding for mothers of hepatitis B will increase the risk of their children being infected with hepatitis B. It is recommended that all mothers of hepatitis B breastfeed, and that mothers of hepatitis B should prefer breastfeeding even if there is no way to provide every newborn with the hepatitis B vaccine and immunoglobulin in some poor and backward countries and regions. Then look at the professional medical literature at home and abroad. in 2002, the world’s leading journal Obstetrics and Gynecology reported 365 cases of newborn babies of pregnant women with hepatitis B. All of these children were promptly vaccinated with hepatitis B vaccine and injected with hepatitis B immune globulin after delivery. 101 mothers were breastfeeding, with an average feeding time of 4.9 months, and 268 mothers were not breastfeeding. the physical examination of the children at the age of 15 months showed that the 9 children who were not breastfed were infected with hepatitis B, and the 9 children who were exclusively breastfed were not breastfed. The physical examination of the children at 15 months of age showed that 9 children who were not breastfed were infected with hepatitis B, while 101 children who were exclusively breastfed were safe and sound. In 2011, a team of epidemiologists in the field of public health at Fudan University in Shanghai summarized and analyzed 32 large clinical studies from around the world. All 5,650 children delivered by mothers with hepatitis B were routinely immunized with the hepatitis B vaccine, and 244 cases (4.32%) were infected with hepatitis B. Of these, 2,717 children were breastfed, with an incidence of 4.2%, and 2,933 children were artificially fed, with an incidence of 4.4%. This shows that there is almost no difference in the percentage of children infected with Hepatitis B whether they are breastfed or not, and after vaccination, the percentage is roughly 4% to 5%. Breastfeeding itself does not increase the risk of hepatitis B infection in the child, most of the real hepatitis B infection occurs in the womb and during labor and delivery, which are two processes that no one can escape, and mothers with hepatitis B may have already been infected with hepatitis B no matter which way they intend to feed their children. The results of this study were published in the 2011 London-based journal “Can Hepatitis B Mothers Breastfeed? This result was published in 2011 in the prestigious London public health journal, Biomedical Center for Public Health, under the title “Can mothers with hepatitis B breastfeed? In December 2010, the latest edition of the Chronic Hepatitis B Prevention and Control Guidelines was released in Beijing, which clearly states that newborns can be breastfed by mothers who are positive for Hepatitis B Surface Antigen (SAB) after receiving Hepatitis B Immunoglobulin (HBIG) and Hepatitis B Vaccine (HBV) within 12 hours of birth. I was sweating as I recorded and organized the information I had gathered. Ignorance on the part of a doctor is a sin, and a doctor’s outdated knowledge can be a poison to a happy family, not to mention being some kind of messenger of God. Avoiding love, kindness and compassion, a doctor’s failure to keep his knowledge up-to-date is enough to be a hindrance to human progress.