Below is a link to a recent USA Today article on a situation at Children’s Hospital at Vanderbilt University in Nashville. Since February, four babies have been admitted for brain hemorrhages or bleeding in the intestinal tract. All babies survived. The article states that all of the parents in the cases had declined routine Vitamin K shots. This is a scary article that causes me to revisit and ponder more the issue of Hemorrhagic Disease of the Newborn (HDN) and rationale for administering Vitamin K.
Although this story is in Tennessee, a licensed Vermont midwife is licensed to carry and administer Vitamin K shots for newborns. I imagine that most states with regulated and legalized midwifery and home birth are similar. The stark contrast in the midwifery profession related to the hospital/medical profession, is that midwives provide Informed Consent – meaning midwives offer education and information on the risks/benefits to diagnostics, interventions or prophylaxis before cookie-cutter administration of care. Parents make their informed decision, perhaps further discussion is had, the chart noted on the clinical course taken and everyone moves on. Parental rights trump all. I really hate to see parents and midwives attacked in the national media by the medical community for not forcing drugs upon a newborn two hours old – who is still regulating his fragile temperature, glucose regulation and respiration systems. Some studies examining the risks of Vitamin K are inconclusive, meaning that no health care professional can guarantee a parent that no risk will come to their newborn by flooding their system with adult levels of Vitamin K within 2 hours of birth. Read this article – how do you feel? If you are like me, you may feel like a terrible parent or midwife for not accepting this injection or coercing clients into it. Approximately 50% of my clients to date elect intramuscular injection of Vitamin K at birth. I’d say that sounds like I am doing my most important job of Informed Consent.
I really hate feeling scared and coerced. So before blaming devastated and traumatized parents for a simple decline, questions everyone should be asking are:
1. Why are all of these deaths reported in the same community hospital? Shouldn’t we be seeing even more deaths in states and hospitals where midwives and home births constitute up to 25% of babies born such as New Mexico?
2. Did these children have any trauma during the births or weeks following delivery causing the internal bleeds? What else besides Vitamin K injection declines do these four children have in common?
One of my favorite lines in this USA Today article is:
“Anna Morad, a pediatrician at Vanderbilt, said years ago no one questioned the protocol of giving the vitamin injection the day a baby is born. These parents also typically refuse a hepatitis B vaccine, which is given to the babies to protect them from possible exposure from the mother.”
3. Are doctors and hospitals uncomfortable when parents “question” their practice? Are doctors uncomfortable when a parent declines their recommendations? Why?
4. We are testing every mother for Hepatitis B prenatally, so short of being in one of the known high-risk ethnic groups, why are we forcing/coercing parents to inject newborns fragile immune system with a Hepatitis B vaccine that is aimed at preventing a disease that is transmissible by semen, body fluids or blood products?
5. Should there be ethical considerations when a doctor or hospital attaches their personal desires, beliefs and need to control onto parents who respectfully decline?
6. Why ARE some physicians so attached to coercion control and scare tactics with parents who get themselves off the conveyor belt of the U.S. hospital delivery system?
7. Perhaps most importantly, why are babies born naturally low in Vitamin K? Common thought is a lack of intestinal bacteria immediately after birth. Other considerations have to do with the placenta filtering it from the mother’s system. Wouldn’t these low levels be considered the “norm” rather than adult levels considered the norm for newborns? Are we effectively questioning God’s and nature’s perfect design for ALL babies and ALL womens’ ability to create and grow the perfect baby?
8. Are there inherent risks to injecting all 1 or 2 hour newborns with adult levels of Vitamin K?
Since the article was published by USA Today, midwife internet boards around the country have been lighting up on the issue and healthy debate/discussion rampant. I found another article that offers another perspective on the Vitamin K issue for newborns.
I personally found the second article better cited and more balanced than the USA Today scary article. The author did not interview one midwife or cite any opposing research. It could almost be considered not real credible news.
Although I struggle to form a solid opinion or position on the issue, I’m discovering that’s not really my job. My job as a midwife is to promote evidence-based care and informed consent. I’m doing that regardless of my personal opinion on the subject matter.
Here is a link to a Stanford University protocol.