Help me decide on newborn procedures and write a birth plan! Should we get the vitamin K shot?

[ILoveMyBabyBird]

Okay, I am a terrible procrastinator, so if some of you could give advice, tips and links on writing a birth plan i would appreciate it! Here is the basics, I am having hospital birth with a CNM, I plan to have an unmedicated birth, I have agreed to do intermittant fetal monitoring, have a heplock put in, but not necessarily hooked up, and I also agreed to IV antiobiotics if I come up group b positive, (haven't been tested yet).

I am having a DD, so circumcision is out of the equation. Midwife is already onboard for skin to skin, avoiding pain meds, delayed cord clamping, and no IV fluids unless necessary.

My biggest area is trying to decide on the vitamin k shot and the silver nitrate, I am pretty sure we will do the silver nitrate at dh's request. I will not do the hep B vax, and will do the mandatory newborn screening, so I just have to decide on the vitamin K, anyone getting it, and reasons why or not getting it and reasons why?

Thanks!

[Tumble Bumbles]

Have you been exposed to Chlamydia, syphilis, or gonorrhea? (you obviously don't have to answer that here) because that's the main reason the eye drops are used. We decline them, as I have no STDs and am in a monogamous marriage.

We also decline vitamin K, as in my opinion and research, there is no justifiable reason to use it unless there is birth trauma and severe bruising/moulding that may cause bleeding issues. Vitamin K does get passed through breastmilk, and all babies are 'deficient' until they begin producing it in larger quantities around the first week mark of life.

The only newborn screening we do is the PKU, which I don't even believe is necessary but I do feel more comfortable knowing baby doesn't have any of the conditions it screens for.

As far as the birth plan, keep it short and to the point,  fitting all on one page. Keep to the facts, no need to interject opinions or reasons why you've chosen something unless it's to clarify exercise of religious freedom or exemption.

 Mine is tailored to 'in case of transfer' as I won't be going to a hospital unless I feel it's a medical situation requiring treatment/equipment only a hospital can provide so it's probably a bit different than yours.

I use statements such as "I do/do not consent" rather than "please remember" or "we would like" or "I would prefer". Those statements are not ones of consent or refusal of consent and can be quickly manipulated or wrongly interpreted.

Remember, a birth plan in and of itself is not a legal document, however, it serves as written documentation that supports your verbal consent and serves as a guide while advocating for yourself. It also serves to document your 'informed' consent/refusal. That's why it's important to circulate copies and have copies posted. In the event of a situation where something was done without your consent, your birth plan can serve as support documentation that your consent/refusal was not honored. However, Your verbal consent or refusal is legal and binding and overrides your birth plan so you have to be careful what you say. For example, a woman yelling in labor "give me the epidural now" no matter how much you may not 'mean it' overrides any prior verbal refusal. You have the right to insist upon signing documentation that details any procedure you consent/refuse consent to. You have a right to refuse any recommended or suggested interventions or treatment.

Knowing one's rights is so important!

[Marissamom]

I agree that unless you have one of those STDs, there's no reason for the eye drops (and as a side note, it's usuallly not silver nitrate anymore, but an antibiotic eye drop.) if you are negative for those STDs, and your care provider can test you if they havn't already, there's no reason to do it, and it can affect baby's eyesight and bonding (and if they do use silver nitrate, it's really irratating and painful for their eyes). why does your DH think you need to do them?

[MegBoz]

ITA with PPs on the eye drops. Of course, if my DH told me we should do it, I would take that to mean he is "telling me something" -if you know what I mean- so I would do it if he said so. (Of course, I'd probably want him to come right out & tell me he cheated, but that's another story.)

We're also declining vit K except in case of bruising. There's a good thread on it now & the birth & beyond forum. What sold me not to do it was reading info my MW provided stating that there's some research the vit k hemmorahgic (sp?) disease goes up as a result of premature cord-clamping & administration of antibiotics.

Aaah-HA! I figured there HAD TO BE SOMETHING... I just couldn't accept that nature got it so wrong that it's really better to inject every single healthy newborn... so once again, it may partially be a case of Western medicine causing problems & then using more meds to 'fix' them again. So no vit K at all for us. Although I"m going to make an effort to eat lots of vit K foods to increase amount in my breast milk.

I also think the risk-based protocol for GBS they do in the UK makes a lot more sense than the current US protocol. I wrote "current" protocol because I have a suspicion it'll change within another decade or 2. Hibiclens wash is another option to consider if you're +. My MW also says eating both fermented foods & natural probiotics helps her clients test -.

Don't forget to include stuff in the plan on CS just-in-case, like maybe skin-to-skin, have both your 2 support people in OR, no Versed or sedative drugs (so you don't forget the first hour or 2 of baby's birth), close uterus with 2-stitch method, etc.

I also had a section on 'medication & monitoring' which included that I want to keep vag exams to a minimum & would rather not know how far dilated I am anyway. Didn't want to do "labor math" in my head & let it get me discouraged... thinking how many more hours were ahead of me - because it doesn't work like that anyway.

[ILoveMyBabyBird]

dh is just being overly cautious, he said since he's a had a couple other partners in the past, it is better to be safe than sorry...I am not worried about it, but then again i started discussing the hep b shot and he was all saying well i come from a third world country and i could have been injected with dirty needles, i am like what? You said you weren't even vaxed as a kid, so I think he is just being paranoid imo. I told him no go on the hep b, okay for the eye just because it is not injected and i would do more research on the vitamin k shot and then decide. He has supported that we no longer vax ds, but he really has done zero research in the matter so it is pretty much all on me to decide.

[Marissamom]

The STDs aren't ones that can "hide" from the tests. so if you have tested negative, there is absolutely no reason to do the eye gunk (it was implemented as standard before we had reliable tests). usually they test you or at least offer to test you at the beginning of pregnancy, but if they didn't. well, you getting an extra swab would make a lot more sense as a way of putting him at ease then giving a newborn a procedure there's absolutely no need for. ditto if your DH is worried about HepB, he can go get tested for it instead of treating your kid on the off-chance he was exposed (though if he was exposed as a kid, he would have symptoms by now).

[lexapurple]

Those decisions are only yours and your claim to be doing research but it sounds to me like you need to make more research and educate your DH since he is influencing your decisions. Ether his worries are unfound and come from lack of understanding how those things work or he is trying to tell you something. In that case you need to seriously look into getting tested and treated. If you live with Hep B and STD possitive partner you need to know to protect yourself.

Draw back of having eye goop it done is that it interfeers with bonding and can irritate babies eyes. Having it done benefits you child only if you have untreated STD when you go in labor. STD testing is part of first prenatal testing and unless you refused STD testing specifically, your care provider knows your status and you would have been treated for it if you had it at the time. If you are infection clear eye goop has only cons and no benefit for your child.

If you your husband if concerned that he might have been exposed to it during your pregnancy and passed it to you, you both need to be tested and treated ASAP. STDs can damage unborn child in utero!

Plus if you have it you can reinfect your DH and vise versa. Same thing is for Hep B. Unless you (mother) have Hep b it would not pass to the child. It is part of prenatal work up. If it was not done, both you and DH need to get tested ASAP. You would not want to unknowingly exposes others to it.

Vit K is more debatable. From one standpoint having an injection done prevents extremely rare bleeding disorder that results from liver disorder. for normal baby supplementing with VitK though breastmilk or with oral VitK prevents the bleeding but in very rare cases of undiagnosed liver disease only shot provides adecvate ammount.

[MegBoz]

Great posts from Marissamom & Lexapurple. I was going to post exactly what Marissamom did.

Yes, I too see zero logic in the eye goop. If you've tested negative for STDs at the beginning of pregnancy (& it's pretty standard for them to do those tests), as long as you & DH have been faithful, it's impossible for you to have STDs now and therefore totally, absolutely pointless to give baby eye goop ("only cons and no benefit" as Lexapurple wrote.)

If, on the other hand, there has been some exposure (i.e. DH is 'trying to tell you something' that he has been unfaithful) then you need to act & get tested. 

[starbyfar7]

we're not doing the vitamin K shot or oral. our midwives are very much in favor of vitamin k, but also very open to whatever we decide to do. my whole things is that there's a reason baby's are born without high levels of vitamin k.. i dont think its some flaw that nature messed up with. and besides, by the time they're 8 days old,  vitamin K levels go up dramatically on its own. also, from what ive read, the amount of vitamin k they give a newborn in that shot is a ridiculously unnecessary amount. none of it sits well with me..

now in the event that i had to be transferred to a hospital and some emergency procedures were done.. obviously i wouldn't have a choice.. but right now.. in my lovely homebirth we aren't shooting my kid up with anything!

oh, and no erythomycin (sp?) for us either..

i guess we're rebels lol

[HRJ]

Does anyone know of a good oral vitamin K?  My ped was looking for one but hasn't found one yet.

[tzs]

Originally Posted by HRJ 

Does anyone know of a good oral vitamin K?  My ped was looking for one but hasn't found one yet.

we got ours with a prescription from the pharmacy at the hospital. i think any compounding pharmacy would be an option, although i'm not sure what the definition of "good" is, it sure was easy and cheap (aka free through insurance) to just get it there.

[starbyfar7]

i think the website "frombirthwithlove.com" has a oral vitamin K.. its the one my midwives recommend

[Mayfly]

Originally Posted by starbyfar7 

i think the website "frombirthwithlove.com" has a oral vitamin K.. its the one my midwives recommend

Yes, I just ordered and received mine from them although it's actually just birthwithlove.com :).

[mama_mich]

I did the oral vit k for m son.  I thought it was crazy that I would give the same amount of vit k to my son over a period of a few months that he would get in a shot right at birth!!

[Asheya]

Here's some information you might find helpful in making your decision. It is excerpted from Having a Baby, Naturally by Peggy O'Mara

·         Newborns with increased risk of hemorrhagic disease include:

o   If mother has been treated with anticoagulants, antiseizure medications, or antibiotics during her pregnancy

o   Women who have used extremely excessive amounts of Vitamin E, aspirin, mineral oil, alcohol, or have been exposed to rat poison.

·         Vitamin K promotes coagulation of the blood, although we are not sure how it works as it is not a clotting agent.

·         Babies, and most mammals, are born with extremely low levels of Vitamin K.

·         1 in 17, 000 babies will get hemorrhagic disease between two and twelve weeks.

·         Speculation the Vitamin K supplements may increase risk for leukemia and other cancers in children.

·         High percentages of newborn jaundice in infants who have received Vitamin K.

·         We don’t know why we are born with low levels of Vitamin K—there may be a very good reason we just haven’t figured out yet

·         Colostrum, the first fluid a breastfeeding infant receives from her mother for three to four days, is quite rich in Vitamin K.

Alternatives

·         Avoid the substances that create increased risk, and eat a nutritious diet with plenty of Vitamin K rich foods: green vegetables, alfalfa, kelp, green tea, and dairy products.

You may also want to consider delayed cord clamping (waiting at least 120 seconds, with baby on your chest, until cord stops pulsing), which can ensure that your baby receives all of her blood at birth (instead of losing up to 50% of her blood because it is still in the placenta). This will help your baby to have the most amount of of nutrients possible (including Vit K) in her body.

[snguyen]

Asheya--  Thanks, that is very helpful, especially the specific alternative sources!

[Asheya]

Glad you found it helpful! I also wanted to point you to this birth plan--it's quite tongue-in-cheek, but Rixa makes a number of good points! As you read it keep in mind that she has only had home births, so bringing this to the hospital may get a laugh but it also might have a negative effect. I personally like some of the points she makes, though, and the fact that she states what she plans to do in general, rather than a list of this or that.

[Maisea]

Vit K isn't really primarily used to prevent  bleeding in weeks 2-12, the much bigger concern is bleeding in the first week or two of life. As Asheya pointed out, the later bleeding is much more rare.

In the United States, routine intramuscular administration of vitamin K immediately after birth has made vitamin K deficiency bleeding an uncommon occurrence. The frequency of vitamin K deficiency bleeding varies from 0.25-1.7% in the first week of life in infants not receiving vitamin K prophylaxis.  (from emedicine.com)

So, that is more like 1 in 400 or 1 in 70 -- not 1 in 17,000.

Originally Posted by Asheya 

Here's some information you might find helpful in making your decision. It is excerpted from Having a Baby, Naturally by Peggy O'Mara

·         Newborns with increased risk of hemorrhagic disease include:

o   If mother has been treated with anticoagulants, antiseizure medications, or antibiotics during her pregnancy

o   Women who have used extremely excessive amounts of Vitamin E, aspirin, mineral oil, alcohol, or have been exposed to rat poison.

·         Vitamin K promotes coagulation of the blood, although we are not sure how it works as it is not a clotting agent.

·         Babies, and most mammals, are born with extremely low levels of Vitamin K.

·         1 in 17, 000 babies will get hemorrhagic disease between two and twelve weeks.

·         Speculation the Vitamin K supplements may increase risk for leukemia and other cancers in children.

·         High percentages of newborn jaundice in infants who have received Vitamin K.

·         We don’t know why we are born with low levels of Vitamin K—there may be a very good reason we just haven’t figured out yet

·         Colostrum, the first fluid a breastfeeding infant receives from her mother for three to four days, is quite rich in Vitamin K.

Alternatives

·         Avoid the substances that create increased risk, and eat a nutritious diet with plenty of Vitamin K rich foods: green vegetables, alfalfa, kelp, green tea, and dairy products.

You may also want to consider delayed cord clamping (waiting at least 120 seconds, with baby on your chest, until cord stops pulsing), which can ensure that your baby receives all of her blood at birth (instead of losing up to 50% of her blood because it is still in the placenta). This will help your baby to have the most amount of of nutrients possible (including Vit K) in her body.

[Smokering]

Doesn't the vitamin K shot give the baby a HUGE dose? I read it puts the baby's vitamin K level several hundred times above normal; which just seems scary to me. We opted out of the short, with the proviso that we might consider a low dose of oral vitamin K if DD showed excessive bruising. She didn't.

[yummus]

I would normally decline the Vitamin K shot but I had two rounds of antibiotics while pregnant so we did do it.