Oral vitamin K - just doesn't make sense

[Haselnuss]

Planning my 4th homebirth in a few months, and I had a midwife appointment today where we discussed the typical newborn procedures (heel stick, vit K, etc.) I never really asked about the vitamin K with my previous babies, but this time I did, and the explanation - that breastmilk doesn't have "enough" of it - just doesn't make sense to me. My philosophy would usually be that if something is true across the board, naturally (like breastmilk being low in Vit K, or boys having foreskins, or whatever), it probably is supposed to be that way and doesn't need "correction". I mean, if breastmilk doesn't have a particular vitamin, that suggests to me that a) babies don't need it, and b) it might even be bad for them. I don't particularly want to argue with the midwife without a good reason, but the main thing she seems to be concerned about is the baby having breastfeeding problems and therefore, not enough K, and I've breastfed three babies already with no problems whatsoever. It just seems odd for a homebirth midwife, who normally tends to trust the body and nature and have an "if it ain't broke, don't fix it" attitude to take the stance that breastmilk is, universally, not good enough! Any information or advice on this?

[Jojo F.]

I'm interested in learning more about this too. I thought colostrum was naturally sufficient in vit K, but then again I'm no expert on the issue.

Did a quick search and found a really good discussion about vit K. I haven't read the whole thing, maybe a 1/4th so far- http://www.radmid.demon.co.uk/vitk.htm

[nashvillemidwife]

There are 2 issues here. One is the idea that breastmilk is "deficient" in vitamin K when we are all born that way. I think it is more accurate to say breast milk has low levels of vitamin K as opposed to being "deficient", but unfortunately that's the terminology that is used.

The second issue is the significance of breastmilk having low levels. Is there a reason? We have never been able to identify a positive reason for breast milk being low in vitamin K, while we have been able to identify benefit of supplementing babies to prevent bleeding disorders.

[sevenkids]

Normally, breastmilk being naturally low in Vit K is not an issue. By the 8th day of life, the gut of a breastfed baby is producing enough vit K to meet the baby's needs. If the baby has had a rough start with risks for hemorrhages, then no, breastmilk does not have sufficient Vit K to prevent bleeding disorders and I will strongly recommend Vit K.

[*MamaJen*]

My midwife didn't recommend for or against the "routine" newborn interventions. She's all about the informed consent. I wound up doing the eye ointment, but not until about four hours after the birth. We declined the Vit. K and Heb B shots.
The metabolic screening (heel stick) is important though. It's not putting anything into your baby, just testing for some very serious diseases that are manageable if caught early. I can't remember if we did that at the 3 day or 7 day postpartum visit.

[dziwozony]

i completely agree with your initial thoughts about vit K & those are the conclusions we came to. if a baby really needed more amounts of vit K, then breastmilk would supply it.

apparently if the birth is a traumatic one for the baby (i.e. lots of bruising...a long, difficult trip down the birthing canal, etc), vit K is helpful in preventing further trouble. so that might be a good time to consider using it.

but we chose not to use it at all & our babe was just fine =)

[nashvillemidwife]

Originally Posted by sevenkids

By the 8th day of life, the gut of a breastfed baby is producing enough vit K to meet the baby's needs. If the baby has had a rough start with risks for hemorrhages, then no, breastmilk does not have sufficient Vit K to prevent bleeding disorders and I will strongly recommend Vit K.

But there are some babies who develop bleeding disorders who did not have a "rough start", and while there are some risk factors for "deficiency bleeding" they can't all be predicted. Supplementation will prevent it and potentially save their lives. It is very rare and we have to supplement thousands? of babies to save just one, but that's little consolation when that one baby is your own. There are no real known risks to vitamin K, especially oral (severe jaundice is only caused by IV administration and correlations with cancer have been discredited), which is why it is given to every baby.

A lot of moms choose not to give their babies vitamin K and that is understandable to me. However, they need to understand the truth about why it is given and the facts about deficiency bleeding: that deficiency bleeding is a rare but real disease that can't always be predicted, that there are risk factors in which vitamin K is especially important (certain medications including antibiotics, family history of liver problems or bleeding disorders, prematurity, traumatic birth), vitamin K supplementation can easily prevent it, that enriching mom's diet will not raise vitamin K to protective levels, that vitamin K levels have nothing to do with the timing of cord clamping, and that breastmilk babies are at higher risk than formula fed babies because formula has vitamin K while breast milk doesn't, that IM or oral administration of vitamin K1 does not cause severe jaundice, and that the suggested link between vitamin K and childhood cancer has been discredited.

[Jojo F.]

Lots to think about here.

Which is better, IM or oral? Intramuscular means that vit K is going into the baby's muscle but it is a higher dosage, right? With the oral dose it's lower but more dosages AND the vit K goes into the gut where it can be metabolized or stored since it is a fat soluble vit.

So is it safe to say that oral is better then IM?

[flapjack]

That depends on how many doses of oral are given and at what intervals. If we were in a situation where a risk for bleeding had been identified, we would not be farting around with oral vitamin K- we'd go straight to intramuscular. Oral vitamin K is NOT suitable for veg*ns, btw- I haven't checked the ingredient listings on the IM package. I don't routinely supplement, I figure that the levels of vitamin K at birth are low for a reason.

[sevenkids]

But there are some babies who develop bleeding disorders who did not have a "rough start", and while there are some risk factors for "deficiency bleeding" they can't all be predicted.

Oh, believe me, I know! I've had two babies in my practice suffer brain bleeds and seizures, and both babies were sweet butter births. I am definately a lot more conservative about administering Vit K than I was, and always tell moms the risks, while low, are real and scary. Of course, having seen 2 gorgeous babies go on to suffer life long consequences of brain bleeds (and we really don't know if the bleeds came first, or the seizures) colours my perspective of routine Vit K. Let's just say more babies get Vit K than not in my practice!

[MsBlack]

To give some numbers on this Vit K issue, firstly:

It is understood that btwn 6-8 babies of every 100,000 will suffer newborn hemorrhagic disease, WITHOUT vit K supplementing.

Vit K supplementing at birth can cut that down to 3-4 babies having newborn hemorrhagic disease (out of 100,000).

To me this says 2 things:

1. vit k apparently does help 1/2 of the babies that apparently either were low in vit k to begin with, or who, for OTHER reasons, were too greatly challenged for their available vit k to be 'enough' for their situation.

2. Vit K deficiency is NOT the cause of 1/2 of the cases of hemorrhagic disease.

As for the average amount of available vit k in breastmilk being 'low' or 'deficient'--on the face of it, this does not make sense to me. I trust birth and breastfeeding! However: vit k must be created in the gut with the help of beneficial bacteria--food sources only contain vit k precursors. So, in this age of antibiotic overuse, and of eating fewer fermented foods (generally speaking) than ever before in human history, it DOES make sense to me that for some women, there is a true 'deficiency' of vit k.

Antibiotics kill beneficial gut flora, as we know. So it is very possible that many women are not making as much vit k as they need for their own health *and* to put into their milk, even if they are eating plenty of foods that contain vit k precursors. You don't need much vit k (rda measured in MICROgrams), and many meat and veg foods contain plenty of it, btw...it's really not hard to get plenty of vit k precursors in one's diet. But of course, that won't help if your body does not have the other components needed to process the precursors into the actual vitamin.

Fermented foods replace beneficial flora--so if you're not eating any (or enough) of those foods, you will not have sufficient appropriate gut flora to aid plentiful vit k production.

You might not have used antibiotics anytime recently, but if you ever used them (especially if you used them much during any period of your life), then it does make sense to me that your gut flora is insufficient and/or out of balance. And if you don't eat fermented foods regularly, then chances are you have not recovered full integrity and balance of gut flora.

Anyway--at least 1/2 of all cases of HDN have 'no known cause'--vit k is not the problem, and will not help prevent it from occurring.

As for the other half--my understanding of vit k's production in our bodies, along with the fact that we have spent more than a generation now in screwing up our normal operations via antibiotics and dead food, tells me that there really IS some sense in vit k supplementation for at least some newborns.

My own recommendations to clients are that they work during pregnancy to establish healthy gut flora, first, because this will serve their health in so very many ways anyway (not just in vit k production). Then, that they consider giving oral vit k at birth IF mom or baby got antibiotics during pregnancy or at birth, or, IF birth was rough on the baby (e.g., bruising), or IF they otherwise feel safest in giving it!

[pamamidwife]

Ms Black, you are so eloquent and as always, right on. xo

[chic2chic]

Originally Posted by MsBlack

So, in this age of antibiotic overuse, and of eating fewer fermented foods (generally speaking) than ever before in human history, it DOES make sense to me that for some women, there is a true 'deficiency' of vit k.

thanks so much for this explanation. it makes a lot of sense.

i'm wrestling with the vitamin K issue myself. i haven't used antibiotics in many years (i had a single round 5 years ago, first time in 20 years), and i make sure to consume sauerkraut/kimchi/kefir every day throughout my pregnancy... so is it safe to skip the vit. K for this baby?

[Haselnuss]

MsBlack, thanks for a very informative answer! Mind if I pick your brain a little more? I do eat fermented foods regularly, but I would still get the Vit K, I suppose, if I knew it was safe, and didn't amount to an overdose. Are there any side effects linked with it? How does the dose compare to what the baby would produce naturally (assuming there were no antibiotics, etc.)?

[Unconventional1]

I don't remember where the info is from, but when I was researching before and during my first pregnancy, I found that the cord blood was a rich source of vit K, and if you waited until the cord was done pulsing, your infant got a large dose.

[nashvillemidwife]

No, that's not true. A baby's natural vitamin K levels have nothing to do with the timing of cord clamping, and everything to do with when their intestines become colonized with the bacteria needed to synthesize it on their own.

But I think we're missing the point. The reason we give babies vitamin K is not because they're born "deficient" - by about a week their bodies will begin making what they need for normal functioning. We give them vitamin K to prevent them from succumbing to a rare bleeding disorder that their normal levels of vitamin K cannot prevent.

[~Ryleigh's Mommy~]

right, it's not about breastmilk being "deficient". Breastmilk contains enough vitamin K for normal infants who do not develop the disease.
Breastmilk is only deficient for those babies who go on to develop the disease.
The problem is that we don't know which babies are "normal" and which ones will go on to get the disease. So we give it to all of them, because you won't know that they have the disease until something catastrophic happens and it's too late. For those babies, a simple vitamin injection is a simple and easy fix to their disease and prevents it from happening in the first place.

[Jojo F.]

Originally Posted by Jojo F.

Lots to think about here.

Which is better, IM or oral? Intramuscular means that vit K is going into the baby's muscle but it is a higher dosage, right? With the oral dose it's lower but more dosages AND the vit K goes into the gut where it can be metabolized or stored since it is a fat soluble vit.

So is it safe to say that oral is better then IM?

I'm still not understanding HOW IM is better then oral. Vit K is needs to be metabolized in the GUT. Getting shot up in the arm just doesn't make sense to me, it's going into the muscle and not the gut.

I'm glad a like my sauerkraut, kefir, yogurt and other fermented foods and drinks and I have been working on my gut health since before I was pregnant.

[nashvillemidwife]

Originally Posted by Jojo F.

I'm still not understanding HOW IM is better then oral. Vit K is needs to be metabolized in the GUT. Getting shot up in the arm just doesn't make sense to me, it's going into the muscle and not the gut.

We don't metabolize vitamin K in the gut, it's just made there. It then enters the blood stream where it is metabolized. Neither route of supplementation (IM or oral) is designed to facilitate the baby's own creation of vitamin K. It is introduced to the body where it is metabolized directly without having to be made first in the gut.

It's kind of like the difference between taking a vitamin D supplement and increasing your vitamin D naturally through exposure to sunlight. Taking the supplement doesn't increase your exposure to sunlight, it bypasses the need for it.

[Jojo F.]

Originally Posted by nashvillemidwife

We don't metabolize vitamin K in the gut, it's just made there. It then enters the blood stream where it is metabolized. Neither route of supplementation (IM or oral) is designed to facilitate the baby's own creation of vitamin K. It is introduced to the body where it is metabolized directly without having to be made first in the gut.

It's kind of like the difference between taking a vitamin D supplement and increasing your vitamin D naturally through exposure to sunlight. Taking the supplement doesn't increase your exposure to sunlight, it bypasses the need for it.

Oooooo K, now I get it, thanks