Quick Answer: Hepatitis C can be passed from mother to baby during pregnancy or delivery. Yet many hospitals still don’t test at-risk newborns. New CDC guidance now recommends universal screening in pregnancy and infant follow-up if the parent is positive.
Why Hepatitis C Testing Isn’t Routine for Newborns
The short answer: there’s no national mandate requiring hospitals to test infants born to hepatitis C–positive parents. Pediatricians are expected to “flag” babies for follow-up testing at 2 to 6 months and again at 18 months, but that relies on accurate documentation, provider knowledge, and parental follow-through. In practice, many infants slip through the cracks.
Historically, this wasn’t seen as a public health emergency. Hepatitis C was viewed as a disease tied to older adults or people who inject drugs. But the rise of opioid-related infections in young adults, including pregnant women, has shifted the landscape dramatically. Still, many hospital systems haven’t caught up.
A 2021 study published in JAMA Pediatrics found that fewer than 30% of exposed infants in the U.S. were being tested appropriately. Even when mothers were known to be hepatitis C–positive, follow-up protocols failed more than two-thirds of the time. That’s not just a paperwork issue, it’s a health equity crisis.
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How Hepatitis C Can Pass From Mother to Baby
This isn’t just a theoretical concern. Vertical transmission, the passing of hepatitis C from pregnant person to child, happens in about 6% of births where the parent has chronic HCV. That number rises to around 10% if the parent is co-infected with HIV, and even higher if there’s high viral load at the time of delivery.
Transmission can occur:
- During pregnancy: Though rare, some evidence suggests that hepatitis C can cross the placenta.
- At delivery: Most cases are believed to happen during labor, especially with prolonged rupture of membranes or fetal scalp monitoring.
Importantly, breastfeeding does not typically transmit hepatitis C unless the parent has cracked or bleeding nipples. The CDC and WHO both support breastfeeding for hepatitis C–positive parents in most cases.
But even with these known pathways, routine infant testing still lags behind. Many hospitals simply don’t include it in newborn protocols unless it’s specifically requested, or unless the pediatrician is extremely up to date on HCV transmission risk.
Who’s Most at Risk, And Why It’s Not Always Who You Think
One major issue is how risk is defined. Universal hepatitis C screening in pregnancy only became official CDC guidance in 2020. Before that, it was based on “risk factors”, a murky and stigmatizing category that often excluded people who were infected through outdated medical care, unregulated tattoos, or early-life exposures they didn’t even know about.
This left many pregnant individuals without screening, and by extension, their babies without testing. Today, while more OB-GYNs are testing during prenatal visits, many still miss it if the parent appears “low risk.” Some states still don’t require HCV testing at all during pregnancy.
As a result, babies like Sofia’s son are born into uncertainty. Unless someone flags the chart, unless the pediatrician knows the mother’s status, unless the parent insists, it’s entirely possible that no one will check for a potentially life-long infection. The consequences can be profound: untreated hepatitis C in children can lead to liver inflammation, scarring, and eventual liver disease.
Why Testing Timing Matters, and How It Often Gets Missed
One of the most confusing parts of newborn hepatitis C testing is timing. Babies born to hepatitis C–positive mothers carry maternal antibodies in their blood for up to 18 months. That means an early antibody test might show a “false positive” even if the baby isn’t infected.
To avoid this, doctors can either:
- Use a viral RNA test at 2–6 months (to detect the virus directly), or
- Wait and test for antibodies again at 18 months (to see if the antibodies have cleared)
But here’s the catch: many families don’t return for 18-month testing, and few pediatricians consistently order viral load testing in infancy. This leads to huge gaps in diagnosis, with children being lost to follow-up, or only discovering their infection years later, during routine blood work or illness.
In one study, 78% of infants exposed to hepatitis C never received a complete set of follow-up tests. This isn’t just about awareness, it’s about broken systems, overwhelmed providers, and the silent nature of hepatitis C, which rarely shows symptoms in early childhood.
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What Most Hospitals Still Don’t Do (But Should)
Even with clear evidence that vertical transmission of hepatitis C happens and can lead to chronic infection, most hospitals still don’t have standardized newborn protocols. It’s not malicious, it's structural. Hospitals are overwhelmed, electronic records aren’t always synced with prenatal charts, and pediatric units often assume OB teams handled everything. But hepatitis C follow-up requires tight coordination, and right now, that coordination is the exception, not the rule.
Many hospitals still fail to automatically flag babies born to hepatitis C–positive parents. Some still rely on verbal disclosure from the parent, which is unreliable, especially in moments of exhaustion, fear, or when stigma makes disclosure feel risky. And some staff simply aren’t updated on the newest CDC recommendations, which now call for early RNA testing for exposed infants.
The result: a newborn may be labeled “healthy” and discharged without any testing plan at all. Parents may not learn about follow-up recommendations until months later, if ever. And because hepatitis C rarely causes symptoms in infancy, families often assume no news is good news. Unfortunately, that assumption can delay critical care.
The Emotional Toll of Not Knowing
When parents learn after the fact that their baby should have been tested, the emotional fallout can be heavy. Many describe a sense of betrayal, believing the hospital had handled everything. Others feel a crushing guilt, even when they did nothing wrong. One father, Malik, shared that he didn’t find out his daughter needed hepatitis C testing until she was two years old. “They didn’t tell us at the hospital,” he said. “When her new doctor asked about follow-up, I felt like I’d failed her somehow. But we didn’t even know.”
This emotional weight is real, and it’s often compounded by stigma. Parents may hesitate to ask clarifying questions if they fear judgment about past drug use, medical history, or sexual exposure. Some avoid discussing hepatitis C altogether with pediatricians out of fear of being reported or misunderstood. Trauma-informed care matters here, not just for the parent, but for the baby who needs timely evaluation.
That’s why this article exists: to give expecting parents clarity, not shame. To lay out exactly what should happen, so you don’t have to guess. And to remind you that testing is not an accusation, it’s protection.
The Science Behind Early Infant Testing
Why does early testing matter so much? Because hepatitis C is treatable, and for some children, early detection creates a pathway to cure long before liver damage happens. The current gold standard for infants exposed at birth is the HCV RNA test, which detects the virus itself instead of relying on maternal antibodies. This test can be used as early as two months of age, and when repeated, provides a reliable diagnosis.
By contrast, waiting until 18 months for an antibody test creates a long period of uncertainty. Some families never return for follow-up because life gets busy. Others move, change insurance, or experience postpartum upheaval. These gaps in care mean children who might have cleared the virus naturally, or who still need monitoring, are never fully evaluated.
For those who do test positive, ongoing monitoring is recommended, but treatments for children have become safer and more effective. Direct-acting antivirals (DAAs) approved for pediatric use now make cure possible for many children diagnosed early. But none of that is possible if testing never happens.
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Why Universal Screening During Pregnancy Is a Game Changer
Until recently, hepatitis C testing during pregnancy was based on “risk factors.” That approach left countless infected individuals undiagnosed because risk-based screening simply doesn’t work. Many people with hepatitis C don’t know how or when they were exposed. Others don’t feel safe disclosing past drug use or trauma. And plenty were infected through medical or cosmetic procedures years before.
In 2020, the CDC officially recommended universal hepatitis C screening during pregnancy. This shift acknowledges that anyone, regardless of history, stigma, or perceived risk, can have hepatitis C. When parents know their status before birth, infants can be flagged for proper follow-up and monitored appropriately.
This shift also helps clinicians move past assumptions and provide standardized, stigma-free care. But implementation is uneven. Some states adopted universal screening immediately. Others lagged. Many clinics still use outdated protocols, and overburdened medical teams often miss the new guidelines entirely. Until universal screening becomes universal practice, babies will continue to slip through the cracks.
How Documentation Failures Lead to Missed Cases
A surprising number of missed diagnoses happen because the mother’s hepatitis C status never makes it onto the baby’s chart. That documentation gap can occur for many reasons: electronic record mismatches, incomplete prenatal histories, or assumptions that “someone else handled it.” In busy labor-and-delivery units, communication errors are almost inevitable without strong protocols in place.
If the baby’s pediatrician doesn’t see hepatitis C flagged in the electronic record, it’s unlikely they’ll order the necessary follow-up tests. And unless the parent knows the exact timing and test type needed, the opportunity can quietly slip away. This is especially common in hospitals where pediatric teams rotate frequently or where postpartum discharge is rushed.
These documentation breaks aren’t rare, they’re systemic. Fixing them requires nationwide standardization, not individual vigilance. But until that happens, parents often carry the burden of ensuring their newborn gets the right follow-up tests.
One Parent’s Story: “I Didn’t Know What to Ask For”
Elena, 29, found out she had hepatitis C halfway through her pregnancy. She was shocked, but reassured when her OB-GYN told her it wouldn’t affect delivery. After her daughter was born, the hospital staff focused on feeding, jaundice checks, and routine newborn screenings. No one mentioned follow-up for hepatitis C.
“I thought it must not be a big deal,” she told us. “If something needed to happen, they would tell me, right?” It wasn’t until a friend in her support group asked about infant testing that Elena realized she had no discharge instructions about hepatitis C. Her pediatrician ordered an RNA test at four months, thankfully negative, but the anxiety she carried for weeks afterward was intense.
“I wish someone had just said, ‘Here’s what happens next,’” she said. “Instead, I felt like I was already failing as a mom because I didn’t know what I was supposed to do.” Her story echoes countless others: not a lack of love, but a lack of guidance from the healthcare system.
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Why So Many Pediatricians Still Miss It
Pediatricians are trained to monitor growth, development, feeding, sleep, and vaccinations, all time-consuming, high-stakes responsibilities. But without robust reminder systems, hepatitis C follow-up testing simply doesn’t appear on many clinicians’ radar. Many doctors assume the hospital already issued a plan. Others rely on outdated guidelines that downplay the risk of vertical transmission.
Compounding this is the lack of universally adopted electronic prompts. Some states have statewide health information exchanges that flag maternal infections to pediatric clinicians, but most do not. That means hepatitis C exposure often goes unnoticed unless a parent actively raises the issue.
The missed opportunities are not about negligence, they’re about overloaded systems that haven’t adapted to shifts in hepatitis C epidemiology. And while those systems catch up, parents and infants live in a painful limbo between risk and reassurance.
How Testing Works: What Parents Should Know
If you or your partner has tested positive for hepatitis C during pregnancy, or even if you suspect a past exposure, it’s critical to know how infant testing works. There are two main pathways for evaluating a baby:
| Test Type | When It's Done | What It Detects | Why It Matters |
|---|---|---|---|
| HCV RNA Test | 2–6 months | Viral RNA (the actual virus) | Early detection of infection; more accurate in infancy |
| HCV Antibody Test | After 18 months | Maternal or infant antibodies | Confirms if antibodies have cleared or indicate infection |
Figure 1. Comparison of hepatitis C testing methods for infants. Timing is key to avoid misinterpreting maternal antibodies as infant infection.
Most experts recommend an RNA test between 2 and 6 months of age. If that test is negative, and the baby remains healthy, follow-up may not be needed. If it’s positive, another RNA test is used to confirm. By 18 months, an antibody test can show whether the baby’s immune system has cleared the virus, or if chronic infection is present.
As a parent, you have every right to ask your baby’s pediatrician: “Was my baby tested for hepatitis C?” or “Can we schedule an RNA test?” Framing it as a routine follow-up can help normalize the request and sidestep any unnecessary discomfort.
Where Policy Meets Parenthood
Policy changes are underway, but until they become routine, gaps will persist. The CDC now recommends universal hepatitis C screening during every pregnancy. This helps flag at-risk newborns and prompts timely follow-up. But implementation is uneven, especially in underfunded or rural healthcare settings.
What this means for parents is clear: even when policies shift, vigilance is still required. If your OB-GYN hasn’t offered hepatitis C testing, ask. If your pediatrician hasn’t mentioned it, raise the question. And if you’re navigating this solo, without provider support, know that testing is available without stepping into a clinic.
The current system still relies on parents doing too much legwork. But the future of pediatric hepatitis C care could look very different. With universal screening, better documentation, and viral load testing in infancy, the days of “lost follow-ups” could end. Until then, knowledge is your best ally.
What We Can Learn from Missed Cases
Every missed case of vertical transmission is a story of assumptions. Assumptions that someone else documented it. That someone else would flag it. That someone else would remember to order the test months later. And sometimes, assumptions that hepatitis C simply isn’t a big deal in infancy.
But the research is clear. When infants with hepatitis C go undiagnosed, liver damage can silently progress. In rare but real cases, early childhood cirrhosis or liver transplant may result. Even for those who remain asymptomatic, the emotional toll of a late diagnosis can be immense.
We owe it to new parents, and their babies, to do better. To test when we know the risks. To document clearly. To normalize hepatitis C follow-up as part of routine newborn care. Because silence isn’t protection. Testing is.
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FAQs
1. Can a baby really get hepatitis C from their parent?
Yes, and it surprises a lot of people. Around 6% of babies born to hepatitis C–positive moms will get it during pregnancy or birth. That’s 6 out of every 100 babies. If the parent also has HIV, the odds go even higher. But here’s what most people miss: it’s not about something the parent “did wrong.” This is about a virus doing what viruses do. You deserve real facts, not guilt.
2. Why don’t hospitals automatically test newborns for hep C?
Short answer? The system still hasn’t caught up. Many hospitals rely on paperwork and handoffs between departments, and if no one flags the baby’s chart, the testing often never happens. It’s not that providers don’t care. It’s that protocols are broken, and hepatitis C isn’t always seen as urgent. That needs to change.
3. When should a baby be tested?
There are two windows. One: between 2 and 6 months using an HCV RNA test (that checks for the virus itself). Two: at 18 months using an antibody test (to see if the virus cleared). If this sounds confusing, that’s because it is, and parents are rarely walked through it clearly. Ask your pediatrician about the RNA test if your baby is under 6 months old. Don’t wait for them to bring it up.
4. What happens if my baby tests positive?
First, pause. Many babies who test positive at first actually clear the virus naturally in their first two or three years. If the virus sticks around, your doctor will likely refer you to a pediatric liver specialist. Treatments exist, even for young kids now, and outcomes are getting better every year. It’s scary, but it’s not the end of the road. Far from it.
5. Can a baby look totally fine and still have hepatitis C?
Absolutely. Hep C is sneaky like that. Many infected babies don’t show any signs at all. No fever. No rash. No yellowing of the eyes. That’s why testing matters, it’s the only way to know. Some parents only find out years later during routine labs, and by then, liver damage may have already started.
6. I wasn’t tested for hep C during pregnancy, should I get tested now?
Yes. And you’re not late, you’re just on time in a system that moves slow. The CDC recommends testing *every* pregnant person now, but not all clinics follow that rule. If your provider skipped it, you can still get tested with a quick fingerstick at a clinic, or even from home using an at-home hepatitis C test kit. One less “what if” to carry.
7. Is it safe to breastfeed if I have hepatitis C?
Yes, in almost all cases. Hepatitis C isn’t transmitted through breast milk. The only time there’s a concern is if your nipples are cracked or bleeding. If that happens, just switch sides or pump-and-dump until things heal. You’re not dangerous, you’re just human.
8. Should I have asked for a C-section to avoid transmission?
You didn’t miss anything. C-sections aren’t shown to lower the risk of transmitting hepatitis C. The infection typically passes through blood exposure during delivery, and right now, there's no strong data saying surgery changes that risk enough to justify it. The best thing you can do is focus on follow-up testing. That’s where real prevention happens.
9. My baby had an antibody test at birth and it was negative, are we in the clear?
Not necessarily. Antibody tests before 18 months can be misleading because babies carry their mom’s antibodies for a long time. That means a negative test early on doesn’t prove your baby’s clear. If you’re unsure what kind of test was done, or when, ask for an HCV RNA test just to be safe.
10. What if I don’t know how to bring this up to my pediatrician?
Try this: “I tested positive for hepatitis C during pregnancy, and I read that follow-up testing for my baby is recommended. Can we talk about that?” You don’t have to give a full backstory. You don’t need to be perfect. You just need one moment of clarity, and your voice. That’s enough.
You Know Your Baby Best, Trust That Instinct
If this article made your stomach sink, take a breath. It’s not too late. Whether you’re weeks postpartum or still preparing to give birth, hepatitis C screening can still make a difference. Ask your provider if you’ve been tested. Ask your pediatrician if your baby has. If something feels off, follow that instinct.
Testing for hepatitis C isn’t about assigning blame, it’s about giving babies the healthiest start possible. And if your hospital missed it, you’re not alone. Many parents have stepped into the gap the system left behind. You can, too.
Don’t wait and wonder. Order an at-home hepatitis C test and get clear answers. Your baby deserves them. So do you.
How We Sourced This Article: We combined current guidance from leading medical organizations with peer-reviewed research and lived-experience reporting to make this guide practical, compassionate, and accurate. In total, around fifteen references informed the writing; below, we’ve highlighted some of the most relevant and reader-friendly sources.
Sources
1. CDC – Recommendations for Hepatitis C Screening
2. WHO – Hepatitis C Fact Sheet
4. MotherToBaby: Hepatitis C Fact Sheet — Perinatal Transmission
5. Hepatitis C in Pregnancy — Review of Epidemiology and Perinatal Outcomes (PMC)
About the Author
Dr. F. David, MD is a board-certified infectious disease specialist focused on STI prevention, diagnosis, and treatment. He blends clinical precision with a no-nonsense, sex-positive approach and is committed to expanding access for readers in both urban and off-grid settings.
Reviewed by: J. Martinez, MPH | Last medically reviewed: November 2025
This article is for informational purposes and does not replace medical advice.
