Tuesday, October 20, 2009

Ask Busca: Vitamin K?

Ali asked:
My first question is about Vitamin K injection given at birth. I had two [nursing] teachers tell me they are necessary to jump start the blood coagulation. They also said the dose given in 20,000 times the amount you need. This seems way out of control to me, and also unnecessary. so I was just wondering what you thought about it.
Busca's babble:

I should start off by saying that all three of my children have received a vitamin K injection at birth. I should also admit that except for the brief handout/consent form I received on from my midwives during my last pregnancy, I did zero research on the subject before my children were born. Sad, I know. I guess my only excuse is that I was so busy educating myself about other things that I just never got around to it. So I'm really glad you asked this question because it gave me a chance to do some digging.

The medical establishment's explanation for routine administration of vitamin K is that all babies are born with "low levels" of vitamin K. This begs the question: If all babies are born with "low levels," then aren't their levels of vitamin K "normal" for newborns?

Midwife Sara Wickham explains:
"The risk of a baby who is not given vitamin K developing HDN [Hemorrhagic Disease of the Newborn] is between 1 in 10,000 and 1 in 25,000 (Von Kries and Hanawa 1993). We also know that the babies most at risk from HDN are those who have traumatic births (clinically, this might include babies who are delivered by forceps, ventouse or emergency caesarean section, or babies who show bruising)" (from "Vitamin K - An Alternative Perspective," AIMS Journal, Summer 2001, Vol 13 No 2)
It doesn't surprise me that birth trauma would be highly associated with newborn bleeding disorders. Midwife Ronnie Falcao's gentlebirth.org has a wealth of helpful information. She starts her vitamin K discussion with these points:
Early or "Classic" HDN (also called Vitamin K Deficiency Bleeding) occurs in the first week of life. It is an iatrogenic condition, meaning that it is caused by medical care:

* premature clamping/cutting of the umbilical cord deprives babies of up to 40% of their natural blood volume, including platelets and other clotting factors
* the use of vacuum extractor or forceps often causes bruising or internal bleeding, which uses up the baby's available clotting factors
* the use of antibiotics inhibits the baby's generation of clotting factors
I'm always quick to believe that God/nature got things right, and it's us fallible humans who got things wrong, so this information just felt right to me.

She also shares fascinating bits of articles and research on vitamin K for newborns. Among the details I found most interesting and pertinent were...

* Colonization of the newborn gut with the mother's fecal matter and microflora is essential to jumpstarting vitamin K production in the newborn. Antibiotics and efforts to make the mother's perineum "sterile" will interfere with this important transfer of beneficial bacteria. "Babies are born next to the anus for a reason!" Yet another reason to avoid a cesarean whenever possible! (More info on how the newborn gut produces vitamin K here.)

* There is little clear-cut evidence that vitamin K injections are themselves harmful, but we can't ignore the fact that an injection will always be a potential avenue of infection. When administered in a hospital, the potential for serious infection is a cause for concern.

* There are situations where a vitamin K injection would be necessary. Some medications taken by the mother may interfere with vitamin K, babies who receive antibiotics have disrupted clotting mechanisms, and an extremely rare liver disorder can inhibit vitamin K production.

* Formula-fed babies receive sufficient vitamin K through feedings to supply their bodies' reserves, so it appears there is little need for these infants to receive vitamin K injections.

* Oral doses of vitamin K are sometimes even more effective at boosting newborn vitamin K levels than injections.

* Eating lots of fresh, leafy green vegetables will boost the vitamin K content of breastmilk and further protect newborns from late-onset HDN.

When/If I have more babies, I hope to do what I can to prevent HDN by giving birth in an environment where my baby will be exposed to beneficial bacteria to jumpstart vitamin K production, avoid birth trauma, delay cord clamping/cutting, and boost my own vitamin K levels through nutrition to increase my breastmilk's vitamin K content. As long as all of these preventative measures are achieved, I think it's unlikely that my future babies' "low" vitamin K levels will be problematic, but I plan to consider oral vitamin K as opposed to an injection if I feel it is necessary.

If all babies could be born under such natural/normal circumstances, I'd wager there would only very rarely be a need for vitamin K administration. As Sara Wickham argues, perhaps newborns and breastmilk are "low" in vitamin K for a reason? Should we really be messing with nature? Ronnie Falcao aptly concludes, "Until we have the definitive answers to these questions, parents have to choose between a system that's been in place for less than a hundred years and one that's been in place for thousands of years."

Any other research, facts, tips, and/or experiences from my readers?


Liz Johnson said...

This is really interesting, actually. Both of my kids have had it, but it makes me glad that my first (a forceps delivery) did, and less so with my second. It's interesting... in a way, I'm kind of glad that it's standard procedure given how the "standard" birth goes these days, but I wish we could get the standard birth a lot more gentle and thus eliminate the need for routine Vitamin K injections.

Interesting stuff. Thanks, Busca.

Fig said...

Yet another thing I've never even heard of. For the love.

Anonymous said...

I had 2 girls and my midwife said they're really only necessary for traumatic births or baby boys who will be circumsized so I opted out. My first had to be extracted with a vacuum so I wonder if they just gave the injection anyway, I don't remember.

Sherry said...

I have a little rant on this subject here!:


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