What do you think about Jaundice??

[MarineMommy]

Hello,
My sister had a homebirth on Tue. He was crowning for a long time, about 30 min and then had a mild shoulder dystocia. The midwife recommended vit K which they had previously declined. He is now jaundice. I can't help but feel like the Vit K is what is causing the jaundice. And I feel guilty for also recommending the shot. What do you think??

Thanks
Katie

[kate3]

Jaundice isn't caused by vit K, it's caused by the lysis of RBC. I would imagine with the dystocia and prolonged crowning, he probably had a fair amount of bruising. With more bruising, there are more RBCs to break down, and hense, more jaundice.

It could also be a mild ABO incompatibility that would have occured regardless of the type of delivery. Either way, you're off the hook for recommending the vit K. It didn't cause the jaundice.

[pampered_mom]

I have actually read some observations (obviously these are anecdotal) that Vit K can lead to jaundice in babes. I'm thinking I probably read that in a discussion over in the archives at www.gentlebirth.org. That being said, in spite of that given that the birth likely resulted in some trauma to the babe I can't say as I wouldn't have gone for the Vit K either.

[MarineMommy]

Thanks, I too read online that a side affect of the vit K is jaundice. I am not feeling too guilty anymore. I too opted for vit k when I had a rough birth with #3. I was just wondering more because I don't want my sister to worry too much. And I also worry that her ped will tell her something crazy like start feeding him formula!!
So what would be the absolute worst outcome from the jaundice??

[mwherbs]

100% of babies have jaundice -- 100% of newborn babies have jaundice- it is all a matter of degree.
bilirubin is the breakdown of red blood cells- the liver manages them and the bowels excrete the excess- but it is a fat soluable substance so water will not flush bilirubin out it takes something like colostrum to bind it for bowel removal a small amount will come through urine- and sunlight will bind it in the skin-- true sunlight has a greater aray of binding ability but can burn as well so careful exposure to indirect sunlight will help
now to say something positive about bilirubin- it is a very very strong anti-oxidant so there are some possible protective effects (benefits) of having some excess ---
the concern is that in some babies that have died they have found brain staining by bilirubin -- the numbers depend on the gestational age at birth and if there have been any other problems like Rh sentization or something else that may be pathologic, some researchers even think that maybe the bilirubin is not the cause but the result/response to a problem-- full term babies where the bili # reaches a peak on the 3rd day and then starts to drop are fine -- depending on the baby and age and the ped I have seen treatment on 15 and I have seen babies sent home with a bili of 20... in reading the more worrisome # for full term is 28 -- last year I read a CDC report on cases of untreated jaundice in California and it seems that there were several babies that did not recieve treatment who had bili levels in the 30-35 range.

as far as vitamin K-- possible that some minor increase because of liver function on the other hand a baby who has had a "traumatic" birth uses up their vitamin K rapidly and could actually have worse jaundice if they were to continue to bleed because bleeding =destruction of red blood cells.. vitamin K is complex in action and is anti-inflammatory,antioxidant as well as stopping bleeding - a bruise is bleeding , sometimes trauma results in internal bleeding that we don't see as bruises but it still uses vitamin K
how jaundiced is the baby? is the baby nursing well 11-18 times a day and eliminating ? what does the baby look like sick or well?

[lorijds]

I can see where Vit K may cause a slight increase in jaundice--ANY medication given to the baby that is processed by the liver is going to take a bit of time away from the liver and may make a slight difference in bilirubin processing.

However, I can tell you that in my several years of working in an out of hospital birthing environment where many, many people declined the vit K, I saw no evidence that vit K babies had more problems with jaundice than vit K-free babies. My thoughts are totally anecdotal and not scientific. They're just my personal observations.

I would think that the prolonged crowning and shoulder dystocia can cause jaundice, particularly with bruising. And sometimes, babies are just jaundiced. What is the gestational age of this infant? Any other medications given to mother or baby during labor or immediately afterwards? How long did it take her milk to come in? Is baby a good nurser? How long did she push? Was her water intact during pushing? Did baby have a lot of molding/a big ol' conehead? What are the parents' blood types and is there a possibility of incompatibility?

All of these factors can contribute to jaundice. If her mw is a typically non-interventive or at least a thoughtfully interventive type, and she recommended vit K, I'd be inclined to trust her. Not that you should never question or evaluate your mw's performance--I'm just saying that none of us were there and therefore cannot understand the thought process behind the mw recommending the vit K even in the event they were planning on declining; none of us are there to evaluate the infant and the mother to determine if any of these other factors are an issue.