here's my Vit K informed choice agreement:
Vitamin K Informed Choice Agreement
Newborn babies born in US hospitals are typically given routine Vitamin K injections - most of the time without parental knowledge of why this is done or their consent. As part of the midwifery standard of care, we believe that not only do parents deserve to know why this is done, but also to receive their consent or waiver regarding this choice.
What is Vitamin K?
Vitamin K is found in some food sources (dark, leafy greens, fruits, whole grains, safflower and polyunsaturated oils, dairy) and is assimilated through intestinal bacteria. This compound, Vitamin K, is necessary for proper blood clotting.
Adults do not usually develop a deficiency in Vitamin K unless they are on particular medications that affect their vitamin intake or if they have a disorder in which fat absorption is impaired (Vitamin K is fat-soluble). Babies are born with low reserves of vitamin K, and research has shown that they do not have enough vitamin K producing bacteria in their intestines until four to six months of age. 6 Unfortunately, human milk is low in Vitamin K (although colostrum contains slightly more than mature milk) and babies that are breastfed and / or fed soy infant formula are at higher risk for developing problems.
Because of this lack of Vitamin K, blood of newborns often takes an excessive amount of time to clot. Some babies can develop Hemorrhagic Disease of the Newborn or Vitamin K Deficiency Bleeding during the first few weeks, or even months, of life.
There are three kinds of Hemorrhagic Disease of the Newborn:
1.Early Onset: occurs in babies less than 24 hours old. Most often related to maternal drug intake (particularly seizure medications) during pregnancy. Life threatening intracranial bleeding is the most common sign. Vitamin K given at birth cannot prevent bleeding in all cases. The incidence of this problem is very low even in high risk groups.
2.Classical: occurs between 2 and 7 days of life, with most cases obvious on days 3-5. It is usually prompted by delayed onset of feeding or inadequate intake of breastmilk or marginal vitamin K content in the mother's milk. Bleeding may occur from the following sites: gastrointestinal tract, umbilicus (belly button), ear, nose, throat, needle pricks, circumcision, intracranial. Less likely to occur with full-term babies.1
3.Late Onset: appears between 2 weeks and six months of age, typically between 2 and 8 weeks. Often associated with hepatobiliary (liver) disease or cystic fibrosis, though is seen primarily in exclusively breastfed infants who have received no or inadequate Vitamin K after birth (including poor absorption of breastmilk or breastmilk low in vitamin K). Symptoms may include intracranial bleeding, or bleeding from the skin, ear/nose/throat region, needle prick sites, umbilicus, urogenital tract. Warning signs include jaundice, poor feeding, failure to thrive and any form of bleeding.1
What are the risks of my baby developing Hemorrhagic Disease of the Newborn (HDN)?
All three types of HDN have different predisposing factors. The most common form of HDN is Classical onset. Rates of incidence vary from study to study - most show the incidence to be 1 in 200 or 400. Other studies place 1 of every 2000 to 4000 babies who do not receive Vitamin K at birth at risk. 1 Babies that are at higher risk include: those that have some sort of birth injury (through the use of forceps or vacuum extraction, or from a quick delivery or shoulder dystocia), are born with a hematoma, will be circumcised within 8 days from birth, is born before 35 weeks, are born with a liver disease or some other illness requiring intravenous medications or antibiotics, and whose mother did not have adequate prenatal nutrition or was prescribed anti-seizure medications.
The risk of occurrence for Late onset HDN ranges from 4.4 to 7.2 per 100,00 births. After a single dose of oral Vitamin K is given after birth, the rate decreases to 1.4 to 4.6 per 100,000 births. Injectible Vitamin K prevents the development of late onset HDN, except for the rare cases of infants with severe malabsorption syndromes.
How is Vitamin K given?
There are questions about whether or not Vitamin K should be given orally or intramuscularly (through an injection into the muscle). A study was published in the British Medical Journal in 1992 that linked the injectible Vitamin K to childhood leukemia. These findings have never been able to be reproduced in subsequent studies. Some parents object to injectible Vitamin K because of obvious trauma for the baby. While oral Vitamin K has no links to childhood cancers, it is not nearly as effective as the injectible Vitamin K, and has to be given in larger doses and more frequently (2mg in three doses: at birth, at 2 weeks and at four weeks ) than the one-time injectible.
Can Vitamin K cross the placenta prenatally?
Some studies have documented the fact that Vitamin K does indeed cross the placenta, albeit in small amounts, but may not treat the newborn as effectively as Vitamin K given after birth. Women may choose to supplement their diet with Vitamin K to ensure that more will reach their babies (starting usually at about 34 weeks, but cord blood has shown elevations when women start as late as five days prior to birth). Alfalfa and nettles are both great sources of Vitamin K. Recommended dose is to drink 1-2 cups daily of each infused herb up until birth. Fresh alfalfa sprouts will also provide Vitamin K. After the birth, if the mother supplements her diet with vitamin K, levels in breast milk begin to rise almost immediately and are dramatically increased by 12 hours. ,
Please check one of the following:
[ ] I desire to have oral Vitamin K given to my baby at birth, at two weeks old and at four weeks old
[ ] I desire to have injectible Vitamin K given to my baby at birth
[ ] I wish to decline Vitamin K, injectible or oral, for my newborn baby
