Hepatitis B is a viral infection that attacks the liver, caused by the Hepatitis B virus (HBV). In Nigeria, the virus is hyperendemic, making it a critical public health concern for pregnant women. When a woman contracts the virus, her immune system reacts to destroy infected liver cells, which leads to inflammation and potential long-term damage.
Most pregnant women with chronic Hepatitis B are asymptomatic and feel completely well. Routine antenatal booking blood tests are therefore the primary way the condition is discovered. While acute infection during pregnancy carries a higher risk of fulminant hepatic failure, chronic carriers usually tolerate pregnancy well. However, the presence of the virus increases the risk of gestational diabetes, antepartum hemorrhage, and premature delivery. The primary goal of managing Hepatitis B in pregnancy is not just protecting the mother from cirrhosis or liver cancer, but crucially preventing the transmission of the virus to the unborn child.
Understanding how Hepatitis B spreads is vital for midwives providing safe maternity care. In regions with high endemicity like sub-Saharan Africa, the most common route of acquisition is vertical transmission—passing the virus from an infected mother to her baby during childbirth. Horizontal transmission can also occur through contact with infected blood, improperly sterilized surgical instruments, or sharing personal items.
During labour and delivery, exposure to maternal blood and genital secretions puts the newborn at high risk as they pass through the birth canal. Breast milk contains the virus, but standard infant prophylaxis effectively neutralizes this risk. Standard precautions must be maintained with every patient, treating all body fluids as potentially infectious. Midwives must practice strict aseptic techniques during vaginal examinations, episiotomy repairs, and managing the third stage of labour to protect both themselves and their patients.
Screening pregnant women for Hepatitis B relies primarily on detecting the Hepatitis B surface antigen (HBsAg). A positive HBsAg result indicates that the woman is actively infected and can transmit the virus. Midwives must ensure that every booking clinic includes this test alongside HIV and syphilis screening.
When a patient tests positive for HBsAg, additional markers help assess her infectiousness and liver status:
Managing a pregnant woman with Hepatitis B requires close collaboration between midwives, obstetricians, and physicians. Not every infected mother needs medication during pregnancy. For women with low viral loads and normal liver function tests, routine antenatal monitoring is sufficient.
Antiviral therapy is prescribed primarily for women with high viral loads (typically HBV DNA > 200,000 IU/mL) or those with markers of high infectivity like HBeAg positivity. Drugs such as tenofovir disoproxil fumarate are commonly used because they are safe during pregnancy and effectively lower the viral load. Starting antivirals around the 24th to 28th week of gestation reduces the amount of circulating virus, lowering the chance that the baby will contract the infection despite standard immunoprophylaxis after birth. Midwives must educate patients on the importance of adhering to these medications and attending all follow-up appointments.
Intrapartum care for a woman with Hepatitis B focuses on minimizing the infant's exposure to infectious maternal body fluids. Spontaneous vaginal delivery is generally safe and appropriate for most Hepatitis B positive women, provided there are no other obstetric complications. Cesarean section is reserved for standard obstetric indications rather than routine practice solely for Hepatitis B, as research shows it does not significantly lower vertical transmission rates when proper neonatal prophylaxis is given.
During labour, midwives should avoid invasive procedures that break the baby's skin, such as applying fetal scalp electrodes or taking fetal scalp blood samples. Routine artificial rupture of membranes should be minimized if possible to reduce prolonged contact with infected fluids. Immediately after delivery, prompt clamping of the umbilical cord and gently wiping the newborn clean of maternal blood and secretions before any routine handling helps protect the infant.
The cornerstone of preventing chronic Hepatitis B infection in newborns is immediate postnatal prophylaxis. Every infant born to an HBsAg-positive mother must receive a combination of active vaccination and passive immunization within the first 12 to 24 hours of life.
Timing is critical; these injections must be administered in separate limbs as soon as possible after delivery, ideally within 12 hours. Midwives working in delivery suites must ensure that HBIG and the first dose of the vaccine are readily available in the cold chain before the mother even goes into labour.
A common fear among newly delivered mothers with Hepatitis B is whether they can safely breastfeed their babies. Breastfeeding is safe and strongly encouraged for mothers with Hepatitis B, provided the newborn has received timely birth-dose vaccination and HBIG. Breast milk contains antibodies and nutrients essential for infant development, and normal feeding does not increase the risk of transmission once immunoprophylaxis has been successfully given.
Long-term follow-up is necessary to confirm that the infant is protected. Babies should complete the full three-dose national immunization schedule for Hepatitis B. Around 9 to 12 months of age, a blood test called anti-HBs is performed to check if the baby has successfully developed immunity or if revaccination is required. Midwives play a key educational role during postnatal visits, reassuring mothers about infant feeding and reminding them of immunization schedules.