Vitamin K, Cord Clamping, & ABO Incompatibility Jaundice

[Henry's_Mamma]

I'm hoping someone here has some information or leads to point me in the right direction. I'm O+, ds#1 is B+, and dh is B+ (as is every member of his family for generations), so it is highly likely that ds#2 will also be B+.

DS#1 had ABO incompatibility jaundice immediately from birth and was under the bililights within 30 hours of his birth and remained there for 2 days. He was very lethargic and very orange. He was born by coerced c/s, so his cord was clamped immediately. Dh did not waive the Vitamin K injection so he also had that fairly soon after birth.

As I prepare for my upcoming hopeful VBAC with ds#2, I'm wondering if either the vitamin K or early cord clamping contributed to the severity of ds#1's jaundice. I'm trying to write my baby care birth plan and want to include/disclude these items as necessary -- so for example, if vitamin K is actually a useful thing for potentially jaundiced babies, I'm ok with it; but if it makes it worse, I don't want it. In addition, I've heard conflicting information about cord clamping and ABO incompatibility jaundice -- that it might actually make it worse if you don't clamp early.

I'm birthing in a birth hostile state, in as VBAC friendly a hospital as possible (which isn't saying much), and have to pick my battles.

Thanks!

[maxmama]

I don't see how vitamin K would affect ABO jaundice either way. It basically is a factor in the clotting cascade, and clotting has nothing to do with the antibody response that is responsible for ABO jaundice.

Delayed cord clamping -- hm. Is the theory that with a slightly lower blood volume there will be less hemolysis and thus less bilirubin for a newborn liver to deal with? If so, that makes sense.

[eco_mama]

Originally Posted by Henry's_Mamma

I'm hoping someone here has some information or leads to point me in the right direction. I'm O+, ds#1 is B+, and dh is B+ (as is every member of his family for generations), so it is highly likely that ds#2 will also be B+.

DS#1 had ABO incompatibility jaundice immediately from birth and was under the bililights within 30 hours of his birth and remained there for 2 days. He was very lethargic and very orange. He was born by coerced c/s, so his cord was clamped immediately. Dh did not waive the Vitamin K injection so he also had that fairly soon after birth.

As I prepare for my upcoming hopeful VBAC with ds#2, I'm wondering if either the vitamin K or early cord clamping contributed to the severity of ds#1's jaundice. I'm trying to write my baby care birth plan and want to include/disclude these items as necessary -- so for example, if vitamin K is actually a useful thing for potentially jaundiced babies, I'm ok with it; but if it makes it worse, I don't want it. In addition, I've heard conflicting information about cord clamping and ABO incompatibility jaundice -- that it might actually make it worse if you don't clamp early.

I'm birthing in a birth hostile state, in as VBAC friendly a hospital as possible (which isn't saying much), and have to pick my battles.

Thanks!

My mw just told me the other day that clamping the cord while it's still pulsating is directly linked to Jaundice. She said if it's not clamped right away then the baby will not have jaundice. Tell them they need to wait until the cord is completely done pulsing BEFORE they clamp it.

Also, if you can refuse the vit. K you definitely should. I'm taking Alfalfa tabs this last month just to increase my level of Vit. K for the baby. The don't need the shot. Here's a great link you should check out. http://www.vaccination.inoz.com/VitaminK.html

[maxmama]

We routinely delay cord cutting until it stops pulsing, and we still have jaundiced babies. It's not a cure-all; there are too many other factors involved.

[savithny]

Eh, I *know* the cord cutting was delayed with DD and she was still pretty darn yellow for a pretty long time. I'm pretty sure cord cutting was also delayed with my DS (baby #1 - I wasn't paying as much attention) and he was yellow too. His cord was probably cut earlier and he was less yellow for less long. Someone - forget who - looked at pics of them both immediately after birth and saw how ruddy they were and told me "ruddy-faced babies get yellower." Something about fetal hemoglobin?

But ours wasn't ABO jaundice.

The pediatrician just said "Keep nursing. It's not dangerous. If it bothers you, you'll need to give formula for a day to clear it up faster - but it's better to just keep nursing."

[courtenay_e]

***DO NOT TAKE ALFALFA TABLETS IF YOU ARE GOING TO BE DEALING WITH ABO JAUNDICE!***

I took alfalfa tablets in preparation for a homebirth not knowing that we had a high probability of ABO jaundice...and not knowing that alfalfa tablets taken in high doses (as you would in prep for a homebirth to avoid vit. K) can CAUSE newborn jaundice. So, then, we were dealing with TWO types of jaundice!

ABO is bad enough, and frankly, if you're having a hospital birth, have them type him immediately from the cord blood and ask them (if he's B+) to just bring the bili blanket to you immediately to use while you're there. Hopefully that'll avoid having to come back to the hospital two days later to put him under the lights! This is my plan if I have another child, as both my kids had ABO jaundice. As I mentioned, though, I was taking alfalfa tabs for a homebirth with my second one, and it made his jaundice SO much worse!

As far as everything I've read about cord clamping as pertains to evidence based medicine, tell them that they must wait until the cord has stopped pulsing. I suggest to my clients that, if they have a vaginal birth, they may want to put it in their birth plan that the cord may not be cut until the placenta has been delivered and the cord has stopped pulsing...usually the cord is done pulsing by then, so you can tell that it's "safe" for them to cut the cord w/o feeling it.

Good luck with this...I suggest that you speak to your pediatrician (or the attending at the hospital) before you have your new little one, to try to set up for the bili blanket to be brought to your room (which would mean it'd have to be taken off of peds...gasp!)AHEAD of time. One less thing to deal with, you know?

Are homebirth VBACs allowed in your state? I'd consider one, if they are...which would take away the bili blanket option, unless you were able to get one from a home medical supply with a prescription, which might also be an option...just thinking aloud, as it were...

[bradleybirth2mom]

My midwife says

that she likes to leave the placenta on for at least 45 minutes without cutting the cord. She says it pumps all the blood into the baby that way and after around 30 minutes, baby pumps what he doesn't need back into the placenta. She claims that almost none of her babies show jaundice. Try to insist on this at the hospital and refuse the pitocin to get the placenta out---it has been shown to contribute to autism by blocking the effect that your natural oxytocin has on the baby's nervous system. Good luck!

[wannabe]

Don't they have to clamp the cord immediately in this sort of situation to use cord blood for typing and other tests?

Otherwise they'll have to take more from the baby to get enough to do the tests.

Granted, my baby needed blood tests to see her Rh type, as I'm -ve, and so is she. At the time we didn't know she'd have ABO incompatibility. But you already know you've got high titre levels, which potnetially means a very sick baby. I don't see a way around them doing blood tests straight up.

[wannabe]

Originally Posted by maxmama

Delayed cord clamping -- hm. Is the theory that with a slightly lower blood volume there will be less hemolysis and thus less bilirubin for a newborn liver to deal with? If so, that makes sense.

But you'd have higher blood volume, wouldn't you? And since she's already sensitised, the baby would have been exposed to antibodies in utero.

Very interesting question.