Sample Post-Natal Care Letter of Refusal

For mothers preferring a natural birth, there is much research to be done, not only regarding the birth but also natural post-natal care of the new little life that emerges. Standard post-natal care of newborns in most hospitals includes immunizations and routine procedures such as eye ointment and Vitamin K shots. If you’re like me, you question each medical procedure and intervention with an eye toward where such interventions are merited and where they may be, in my personal opinion, the product of excessive medicalization in a profit-oriented medical establishment.

In order to decline such services, you may need to provide a signed letter accepting responsibility for your decision. I provide such a sample post-natal preferences letter for declining procedures for your newborn below.

Though your opinion may differ from mine, the fact is that if you were to survey the post-natal care given by industrialized nations — many of which have higher records of neonatal health than our own — you would find much variance in standard birth procedures. There is no international standard of care and certain procedures that may be routine in the U.S. are rarely practiced in countries such as The Netherlands, Finland, Sweden, or Japan. Unless you believe that such countries are irresponsible in their care of infants, you must consider that these decisions often enter a gray area, and that many factors contribute to the recommendations made by medical establishments across nations and cultures. That being the case, it’s certainly possible to do the research yourself, and demand the kind of care you prefer for your baby.

The following letter includes paragraphs covering the following issues of infant care after birth:

• Vitamin K Injection
• Antibiotic Eye Ointment
• Hepatitis Vaccination

Like many mothers, I put in hours of reading and research on the topics of Vitamin K, antibiotic eye ointment, and vaccinations. A fellow mom of mine requested samples of the letters I wrote to refuse certain treatments, so I provide them here as a sample for those considering these decisions.

As I was planning a home birth, I prepared this letter for use by the hospital in case I was transferred from the home. However, I wrote these letters after considering my medical history and pre-natal care with my health provider thoroughly, as well as the risks involved and the options for reducing those risks to protect the safety of myself and my child.

Some home birth midwives may also request such a letter in writing. The important point to note here is that you are stating that you accept all responsibility for such decisions, therefore you would not have the option of suing for malpractice as a result of a doctor or hospital following your wishes.

Although I’ll be posting some of the research information I located on these topics in future posts, I highly recommend doing your own research and considering carefully before you follow a path like my own. Especially consider your own risk and medical history, and don’t refuse a treatment until you are quite certain that you have no chance of passing a related medical condition to your child during vaginal birth.

Don’t forget! This content is no substitute for professional advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition or decision.

Sample Letter for Refusal of Standard Post-Natal Procedures

Here is the text of the intro of my letter. I am splitting the letter below into sections which you may add or remove from your letter per your choices.

Date

Your Medical Center
Address Line 1
City, State Zip

Re: Post-Natal Care Preferences for Baby Doe, Due 1/1/2009
Decline Administration of IM Vitamin K
Decline Administration of Eye Ointment/Prophylaxis
Decline Administration of Hepatitis B Immunization

To whom it may concern:

(Add the appropriate lines for the Re: section as appropriate.)

Refusal of Administration of IM (Intramuscular) Vitamin K

Vitamin K has encountered certain controversy as studies have implicated it in higher rates of leukemia among children. Like every study, until further research is done it is uncertain whether this risk is real. In addition, some fear that the extreme and unusually high dosage of Vitamin K given to infants through IM injection may present unknown hazards. Yet it is risks associated with internal bleeding that present the reasons for Vitamin K supplementation. Oral Vitamin K is available, which we chose to administer as an alternative to injection. Certainly do your research before making this decision, and consider difficult births, especially those involving forceps or suction, as possible exceptions should you choose to decline Vitamin K or substitute oral supplementation. Every situation is different!

Here is the sample text from my letter declining Vitamin K injection:

We would like to decline intramuscular dosing of Vitamin K for our baby, due 1/1/2009. Instead we would prefer administration of oral Vitamin K at the time of birth, which we will supplement with weekly doses for the following 3 months. Our decision is based upon both avoidance of physical pain early after delivery as well as avoidance of any potential complications due to unnaturally high levels of Vitamin K following IM dosage. We are aware of the risks of HDN and the benefits of Vitamin K treatment. We understand that the use of oral Vitamin K has not been approved by the FDA, and that it must be repeated to be fully effective. We are also aware of the warning signs for HDN, which we plan to watch for, and we take full responsibility for any problems that may occur as a result of our decision.

Refusal of Administration of Eye Ointment/Prophylaxis

Eye infection in the infant is a real risk for mothers with a history or a current infection of Gonorrhea or Chlamydia. On the other hand, most mothers are tested for these infections during pre-natal treatment. Should you choose, due to zero risk, to decline eye ointment, be sure you’re aware of the symptoms of eye infection in infants. Certain eye infections can cause blindness if undetected and untreated.

Here is the sample text from my letter declining eye ointment:

We would also like to decline administration of eye ointment/prophylaxis for our baby, including silver nitrate and antibiotic ointments. Our decision is based upon limited risk to our baby from Gonorrhea and Chlamydial eye infections, promotion of early postnatal bonding, and avoidance of potential complications due to early administration of antibiotics. Neither [father] nor [mother] are at risk for Gonorrhea, and [mother]’s medical records show negative prenatal testing for both Gonorrhea and Chlamydia. We are aware of the risks, signs, symptoms of newborn eye infection, which we plan to watch for, and we take full responsibility for any problems that may occur as a result of our decision.

Refusal of Hepatitis B Immunization

Immunization is a hot topic these days and one that I do not take lightly. Suffice it to say that immunization, by its very nature, directly interacts with the healthy infant’s immune system forcing it to behave in ways unnatural to the existing situation. There are risks inherent to both sides of this controversy, and a parent must make their personal decision as to which risks suit their family both practically, philosophically, and spiritually. There is no lack of risk on either side of the vaccination decision!

Here is the sample text from my letter declining Hepatitis B Immunization following birth:

We would also like to decline administration of Hepatitis B Immunization for our baby. Our decision is based upon limited risk to our baby from Hepatitis, as well as avoidance of potential complications caused by vaccination and preservative ingredients. Neither [father] nor [mother] are at risk for Hepatitis, and [mother]’s medical records show negative prenatal testing for Hepatitis. We take full responsibility for any problems that may occur as a result of our decision.

Close of Letter

We closed our letter with a simple “Sincerely” and the signature of both myself “Mother” and my husband “Father.” By contacting your health provider in advance, you could also determine whether any other specific language would be required.

Declining Hospital Newborn Care Procedures

I’ve not researched the legal requirements for care myself, but when I have spoken with other health providers I was told the following: “Legally, hospitals are required to treat you, and legally you may refuse any treatment you wish.” It stands to follow in this free nation that this would be true. There may be other legal ramifications at issue here, in terms of responsible parental care and interest in the well being of your child. But keep in mind that, especially if your concerns are both practical and spiritual in nature, you have a right to observe your beliefs and preferences in the care of your children. I say, be thankful for that, and exercise that right, using thorough knowledge, informed consultation, genuine effort, prudence, and love.

Best of health to you and yours,

Mama Hope

Disclaimer: The above content is for informational purposes only and is not intended to give medical advice. This content not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional advice or delay in seeking it because of content found on this site.

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