By Michelle Chevernet, CCE (BWI)
An Uptick in Refusal
Not too long ago, somebody in a Facebook group I’m in posted a beautiful home birth picture (yay!), with a caption stating something along the lines of “Born at home, in water, lifted him out myself, no eye ointment, no vaccines, no Vitamin K! Proud natural warrior mama!” I experienced a moment of alarm. This may surprise you, being as I had out-of hospital births for all three of my children and am of course very supportive of this “warrior mama’s” water birth. The part of that post that got me was the “no Vitamin K” battle cry. I have experienced an uptick in clients asking about Vitamin K refusal. What is that about?
Throwing the Baby Out with the Bathwater
I believe that we have a couple of things happening here. One, some parents are so excited to give their child a gentle, “natural” birth, that they choose to refuse anything that comes from modern medicine. Two, care providers have perhaps done themselves a disservice by grouping eye ointment administration, Hepatitis B vaccination, and Vitamin K administration together in their “newborn procedures” discussions. The thing is, the science on eye ointment isn’t that great, Hepatitis B isn’t generally an immediate threat to a newborn . . . but Vitamin K administration DOES have very solid research supporting it, and it IS an immediate and severe (if rare) threat to a newborn.
As BirthWorks educators, I believe that we need to be clear when an issue is truly a matter of “preference” and when there is an actual scientific safety concern. Sometimes I feel that I don’t want to “alienate” parents by taking a research-based position that they may not like to hear, but I do think it is our responsibility. While I always encourage clients to consider their own wishes in the face of non-evidence-supported birth procedures, the science is clear here. So, I’ve started giving a more in-depth and explicit treatment of Vitamin K administration, and decided to highlight this concern in the BirthWorks context. That said, my job is to present the information and facilitate discussion, and not to judge. If a parent still chooses to decline Vitamin K administration, I would continue to support them.
The following information is based on Rebecca Dekker’s Evidence Based Birth signature article on Vitamin K, and on the Center for Disease Control and the American Academy of Pediatrics’ recommendations. Please see the hyperlinked sources for greater detail and actual research citations. This discussion is meant to raise awareness and introduce the topics to parents.
Are Babies “Deficient” in Vitamin K?
In a word, yes. Humans can’t make Vitamin K, or store it very well. We get it in our diets, but there’s not very much of it in breast milk. It does not cross the placenta very well, so even mothers who consume a lot of Vitamin K will have a baby born “deficient,” because all babies are born deficient. This is not “unnatural”, babies have many immature systems at birth. However, it is risky to them, just as their immature immune system puts them at risk for illness. “Natural” does not necessarily equate with “safe”.
What is the Danger?
Babies with Vitamin K deficiency (all of them, unless they get a shot of it within 6 hours after birth) are at risk for bleeding in the intestines, brain and other locations. Bleeding can be severe, and babies can sustain lifelong injuries or even die. There are three types of Vitamin K Deficiency Bleeding (VKDB)
- Early, within the first 24 hours of life. Usually occurs in skin, brain and abdomen.
- Classical, within days 2-7 of life, most often days 2-3 because that’s when levels have dropped to their lowest but baby isn’t eating enough to replace it. Often occurs in gastrointestinal system, umbilical cord site, skin, nose, and circumcision site.
- Late, usually during weeks 3-8 of life. Least common but statistically the most serious as far as fatality and severe injuries are concerned. Often occurs in brain, skin and gastrointestinal tract. Babies can experience a late bleed up to 6 months after birth.
Does a Baby Have to Experience Trauma to Trigger Bleeding?
I saw a blog post stating that Vitamin K was administered “in case the baby is in a car accident on the way home.” WRONG! First of all, even a gentle birth can cause minor bruising in a baby, and if their blood can’t clot, then “minor” can become “major”. Secondly, case studies of VKDB often find no known cause. It can be related to the cord stump or circumcision, but more often than not, they just start bleeding and can’t stop.
Does a Vitamin K Shot Work?
Yes, it does! Infants who receive Vitamin K at birth have almost no chance of getting VKDB. A study in England in 2013 showed that out of 64 million births in 18 years, only 2 babies who received a Vitamin K injection developed VKDB. Two. Out of 64 million. Comparatively, data from other European countries indicate that with no Vitamin K, VKDB occurs in 4.4-10.5 per 100,000 births. In Asia, the rate is higher, 1/6000 births, probably due to both dietary and genetic factors.
Are There Side Effects?
No, not any more than with any other injection – pain (which you can mitigate by nursing through the shot) and redness/swelling at the injection site. There have been NO reported cases of severe allergic reaction, severe injury or fatality from the modern fat-soluble injection form. (The form given in the 1950’s and 1960’s was less safe.) So, there are NO reported fatalities from getting the shot, but MANY reported severe injuries or fatalities from VKDB.
Are There Alternatives?
I will point you toward Evidence Based Birth for a more detailed discussion if you are interested, but 1) there is no FDA – approved oral version and 2) the three-dose oral version given sometimes in Europe is less effective.
This is a very brief overview, and I would invite you to read further from reputable scientific sources such as Evidence Based Birth, the Center for Disease Control, and HealthyChildren.org . . . and most importantly, talk to your care providers! Natural is great, but in this case, science is definitely better.