[Fwd: Administration of Vitamin K to Newborns - Full info with links]

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The gentlebirth.org website is provided courtesy

of

Ronnie Falcao, LM

MS,

a homebirth midwife in Mountain View, CA

Administration of Vitamin K to Newborns

Support Choices

in Childbirth - Rally

in New York City on March 18, 2009

Or sign

their petition!

Subsections on this page:

Updated

Observations

The

Vitamin K Controversy

Research

Vitamin

K Protocols

Sources

of Vitamin K

Supporting

Normal Vitamin K Production

Signs

Suggesting Need for Vitamin K

Vitamin

K Administration Without Parental Consent

Updated Observations

It is unfortunate that the current standard of care regarding

Hemorrhagic

Disease of the Newborn and vitamin K is still experimental; early

results

were put into practice without adequate research to determine best

practices.

Therefore, practitioners are in a difficult place regarding what to

recommend.

If you just want to protect yourself legally with the least amount

of

trouble, then you'll probably want to recommend the standard vitamin K

injection at birth.

The Vitamin K

Controversy

Summary of Key Points:

Early or "Classic" HDN (also called Vitamin K Deficiency Bleeding)

occurs

in the first week of life. It is an iatrogenic condition, meaning that

it is caused by medical care:

premature clamping/cutting of the umbilical cord deprives babies

of up

to 40% of their natural blood volume, including platelets and other

clotting

factors

the use of vacuum extractor or forceps often causes bruising or

internal

bleeding, which uses up the baby's available clotting factors

the use of antibiotics inhibits the baby's generation of clotting

factors

Late-onset HDN

For breastfed infants, an oral vitamin K preparation (Konakion

MM) given

in 3 doses of 2 mg at birth, 7 days, and 30 days of life results in

higher

plasma vitamin K concentrations than a single injected dose at birth.

[The

preparation must be Konakion MM, which contains lecithin and

glycocholic

acid; vitamin K requires emulsification and the presence of bile salts

for its absorption.] (Greer

et al, Arch Dis Child. 1998 Oct;79(4):300-5.) [Konakion

MM Paediatric from the manufacturer, Roche, including

administration

instructions.]

Midwife

Informed Consent for Vitamin K by

Ronnie Falcao, LM MS

The forces of nature are so focused on a successful birth that it

just

seems unlikely that all babies are deficient in vitamin K. Instead

of simply accepting that nature goofed about clotting factors in

newborns,

I thought about all the ways that interventions at birth interfere with

the normal physiological birth process regarding clotting. The most

obvious intervention is premature cutting of the umbilical cord; this

deprives

a newborn of 25% to 40% of the physiological blood volume, and thus 25%

to 40% of the physiological clotting factors that nature intended to be

present in the newborn's blood. As someone who does Newborn Screening

heelsticks on newborns whose umbilical cords were not cut prematurely

(and

some of whom did not receive supplemental vitamin K), I can tell you

that

they have no trouble clotting normally. This solves the problem of

early-onset or classical HDN.

Although vitamin K doesn't pass easily from the mother's bloodstream

to the newborn through the placenta, it DOES pass easily through

breastmilk.

(Doesn't this seem like a strong clue that nature is actually

protecting

the baby somehow by managing the clotting factors in a very specific

way?)

Women who eat lots of fresh, leafy green vegetables will pass the

vitamin

K through to their babies, and this will protect them from late-onset

HDN.

So, maybe nature got it right, after all, and all we have to do is

support

physiological health by waiting at least 5 minutes after the birth to

cut

the cord and by encouraging nursing mothers to eat lots of fresh, leafy

green vegetables (or take a vitamin K supplement).

Some exceptions are:

Some maternal medications interfere with vitamin K, such as

anticonvulsants,

anticoagulants, and antibiotics. [Maternal vitamin K supplementation

that

is administered prenatally may prevent this form of HDN.

Vitamin K generation is also inhibited in babies who have received

antibiotics.

A very few babies will have a liver disorder that prevents the

normal

production of vitamin K in the newborn's gut; symptoms tend to appear

slowly.

Other risk factors include diarrhea, hepatitis, cystic fibrosis

(CF),

celiac disease, and alpha1-antitrypin deficiency.

Prophylactic

vitamin K for vitamin K deficiency bleeding in neonates (Cochrane

Review)

Vitamin

K at Birth: To Inject or Not By

Folden Palmer, DC, author of Baby

Matters

This is an excellent discussion of why a dosage of 20,000 times the

normal newborn level of vitamin K is inappropriate for a normal,

physiological

birth where the baby's umbilical cord is left intact. She also

discusses

how vitamin K could disrupt the regulation of cell growth, which might

lead to leukemia or other childhood cancers.

An excellent history of the haphazard nature of decisions regarding

vitamin

K administration and the lack of adequate research.

Vitamin

K--what, why, and when. [Full

text]

Hey E.

Arch Dis Child Fetal Neonatal Ed. 2003 Mar;88(2):F80-3.

"Policies for giving babies vitamin K prophylactically at birth

have

been dictated, over the last 60 years, more by what manufacturers

decided

on commercial grounds to put on the market, than by any informed

understanding

of what babies actually need, or how it can most easily be given.

By

a pure fluke a 1 mg IM dose, designed to prevent early vitamin

deficiency

bleeding ("haemorrhagic disease of the newborn") has been found to

protect

against late deficiency bleeding-a condition unrecognised at the time

this

policy took hold. Alternative strategies for oral prophylaxis are now

opening

up (see pp 109 and 113), but these are also, at the moment, dictated

more

by what the manufacturers choose to provide than by what would make for

ease of delivery either in poor countries, or in the developed world."

From the

full-text paper:

CONCLUSION - So what have we learnt in the last 64 years? That

babies

have very limited reserves of vitamin K at birth, and that some will

soon

bleed if a continuing intake is not guaranteed. We also know that a few

"supplements" of cows milk50 or formula milk14 can suffice to restock

those

reserves, and that there is really no case for giving the healthy,

artificially

fed, baby further supplementation, either by injection or by mouth,

other

than administrative convenience. Babies who are not fed, and a very

small

number of fully breast fed babies, will develop symptomatic deficiency.

Without prophylaxis the risk of early (easily recognised) bleeding in a

healthy non-traumatised term baby in the first two weeks of life is

probably

only 1–2 in a thousand. The risk of a later (potentially more

dangerous)

bleed is perhaps a third of that. Both these risks can be virtually

eliminated by giving a single 1 mg intramuscular "depot" injection of

phytomenadione,

or by giving the baby 1 mg by mouth once a week for the first three

months

of life. Indeed the only babies not protected by four 1 mg (or

three

2 mg) oral doses, if well spaced out, are those with some as yet

unrecognised

liver disease.36,48

Vitamin K

- An Alternative Perspective

Midwife Sara Wickham provides a much-needed update on vitamin K

prophylaxis.

AIMS Journal, Summer 2001, Vol 13 No 2

From a WHO (World Health Organization) publication - "

Care

in the first hours includes: . . .

* administering vitamin K

to the baby if country policy prescribes it, either by injection or

orally.

However,

the evidence for routine administration of vitamin K to all newborns to

prevent the relatively rare haemorrhagic disease of the newborn is

still

lacking.

It

occurs to me that WHO has much more exposure to physiological birth

practices than other evidence-based recommendations bodies, such as the

Cochrane Collaboration. And given that WHO works on health issues

for those who often have very poor nutrition, you'd think they would

have

noticed problems with HDN or vitamin K deficiency if it were seen in

cases

where the cord is left intact for a few minutes after the birth.

Sara

Wickham's writing points out that HDN or vitamin K deficiency was

not reported in the literature before the modern practice of premature

cutting of the umbilical cord at birth.

The purpose of vitamin K is to increase the clotting factors

for a newborn.

But is that always a good idea?

This web page on Polycythemia

of the Newborn reminds us that increased clottng factors can cause

blood clots and decreased tissue oxygenation. This is especially

true with a higher blood plasma volume, as occurs when the cord is left

intact for a few minutes after birth and the baby naturally plumps up

its

circulatory system.

Some very recent studies in The Lancet have associated increased

clotting

with twice the likelihood of death from bacterial meningitis. These

higher clotting factors may increase the risk from all bacterial

infections.

Since the purpose of administration of vitamin K is to increase

clotting

factors, is it possible that this is also inadvertently increasing a

newborn's

susceptibility to infection? [Although no mechanism is proposed for

this increased infection rate, it is possible that the decreased tissue

oxygenation leaves tissues more susceptible to infection and that this

is the cause, rather than the genetic tendency towards clotting?

This would mean that increased clotting from vitamin K would increase

susceptibility

from this same effect.]

LONDON (AP) _

Children with a genetic predisposition to produce high concentrations

of a blood-clotting enzyme linked to meningitis are twice as likely

to die from the severe form of that disease as other children, new

research says.

The findings

do not indicate that genetics influence the chances of contracting

meningococcal

disease, but rather that those who get it are more likely to progress

to

deadly septic shock.

Genetic basis for meningococcal septic shock - Summary

4G/5G

promoter polymorphism in the plasminogen-activator-inhibitor-1 gene and

outcome of meningococcal disease. Meningococcal Research Group.

Hermans PW, Hibberd ML, Booy R, Daramola O, Hazelzet JA, de Groot R,

Levin M

Lancet 1999 Aug 14;354(9178):556-60

Variation

in plasminogen-activator-inhibitor-1 gene and risk of meningococcal

septic

shock.

Westendorp RG, Hottenga JJ, Slagboom PE

Lancet 1999 Aug 14;354(9178):561-3

Vitamin K for

newborns

- why & what risks? - from Danny Tucker's pages

How do Parents Decide about Vitamin K?

If there were absolutely no risks or costs associated with vitamin K

administration

or the shot, nobody would argue against it.

However, an injection creates an avenue of infection for a newborn

with

an immature immune system in an environment that contains the most

dangerous

germs. In addition, the possible trauma from the injection can

jeopardize

the establishment of breastfeeding, which does much more to protect the

baby's health than vitamin K injections have ever been alleged to do.

At the very least, the injection should be delayed until after the baby

has learned to nurse.

I've sometimes wondered whether there's a connection between vitamin

K administration and SIDS. Some studies have shown a lower incidence

of SIDS among breastfed babies, and we know that breastmilk is lower in

vitamin K. Who knows? Nobody, really. Why are we messing with

delicate systems we don't understand?

There is likely a very complex relationship between baby's blood

volume

(which is reduced by as much as 40% with immediate cutting of the

umbilical

cord), and the baby's vitamin K and iron levels. It may be that when a

baby is allowed to receive all its blood from the placenta, the

coagulation

factors are more than adequate to prevent hemorrhage.

Given the study that claims that vitamin K levels are not associated

with clotting factors, it might be that the best thing parents can do

to

prevent hemorrhage in newborns is to insist that their babies be

allowed

to get all their blood back from the placenta after birth. Those would

seem to be the clotting factors of greatest use to the baby.

Maybe the association between traumatic birth and newborn

hemorrhagic

disease is really an association between traumatic birth and early

cutting

of the cord, which is more likely with a traumatic birth where the baby

is rushed across the room for resuscitation. Maybe someday hospitals

will

develop the sophistication to be able to perform any needed

resuscitation

without cutting off the baby's oxygen and blood supply.

Until we have the definitive answers to these questions, parents

have

to choose between a system that's been in place for less than a hundred

years and one that's been in place for thousands of years.

Here are a bunch of links on vit K:

http:

http:

http:

http:

http:

(click on vit K link)

http:

Here

is a new one I just found:

http:

Here

is an excerpt from it that gives oral dosing instructions (for

the baby):

"For

newborn infants whose parents refuse an intramuscular injection,

the physician should recommend an oral dose of 2.0 mg vitamin K1 at the

time of the first feeding. (A minority of committee members believe

that

physicians should have the option to recommend oral administration of

vitamin

K for newborns under their care.) Use of the parenteral form of vitamin

K for oral administration is all that is currently available. This

should

be repeated at two to four weeks and six to eight weeks of age. Parents

should be advised of the importance of the baby receiving follow-up

doses

and be cautioned that their infants remain at an increased risk of late

HDNB (including the potential for intracranial hemorrhage) using this

regimen."

Treatise

on Vitamin K

Another

Treatise on Vitamin K

Another

Long Vitamin K Treatise

General

Discussion of Oral Vitamin K instead

of Injected Vitamin K

General

Discussion about Controversy over Administration

of Vitamin K to Newborns

VITAMIN K:

CONTROVERSY?

WHAT CONTROVERSY?

It has been suggested that if the mother takes oral Vit K, during

the

last trimester, that there would not be a need for the newborn shot.

Anyone

know of a study related to this? I have seen a number of clients in

this

area that choose to take the prenatal Vit K in order to avoid the shot

for their newborn.

There really is little known about the physiologic process of

vitamin

k absorption and blood factor response. Supplementation was started

before

the norms were known -- and the dosage was set almost at random (with

little

research first).

there are a lot of questions being asked now -- especially since

it's been found that the IM levels are much higher than needed, and

might

be harmful.

Hemorrhagic Disease of the Newborn Really Low Blood Volume from

Early Cord

Cutting?

Maybe the association between traumatic birth and newborn hemorrhagic

disease

is really an association between traumatic birth and early cutting of

the

cord, which is more likely with a traumatic birth where the baby is

rushed

across the room for resuscitation.

Research

Vitamin K

Abstracts

Study Supports Maternal Vitamin K Supplementation for Breastfeeding

Mothers

as Alternative to Newborn Administration

Vitamin

K prophylaxis to prevent neonatal vitamin K deficient intracranial

haemorrhage

in Shizuoka prefecture.

Nishiguchi T, Saga K, Sumimoto K, Okada K, Terao T

Br J Obstet Gynaecol 1996 Nov;103(11):1078-1084

Coagulation Factors Not Related to Vitamin K Levels

Vitamin

K1 levels and coagulation factors in healthy term newborns till 4 weeks

after birth.

Pietersma-de Bruyn AL, van Haard PM, Beunis MH, Hamulyak K, Kuijpers

JC

Haemostasis 1990;20(1):8-14

Plasma

concentrations after oral or intramuscular vitamin K1 in neonates.

McNinch AW, Upton C, s M, Shearer MJ, McCarthy P, Tripp JH, L'E

Orme R.

Arch Dis Child. 1985 Sep;60(9):814-8.

"One hundred and seven healthy, breast fed infants received 1 mg

vitamin

K1 either at birth (orally or intramuscularly) or with the first feed

(orally).

Venous blood samples collected in the next 24 hours were assayed for

plasma

vitamin K1. In babies given the vitamin orally at birth, the peak

median

concentration (73 ng/ml) occurred at four hours. By 24 hours median

plasma concentrations had fallen to 23 ng/ml and 35 ng/ml in the groups

fed vitamin K1 at birth or with the first feed, respectively; this

difference was not, however, significant. Plasma concentrations after

intramuscular

injection exceeded those in the oral groups at all comparable times,

with

a peak median concentration of 1781 ng/ml at 12 hours falling to 444

ng/ml

at 24 hours. Since median plasma vitamin K1 concentrations 24 hours

after

oral administration were some 100 times and 1000 times greater than

previously

estimated adult and newborn values respectively, this study supports

giving

vitamin K1 orally at birth to well, mature babies to protect against

early

haemorrhagic disease of the newborn. Further studies are needed to

determine

the optimum dose for protection over subsequent weeks."

[Effect

of oral and intramuscular vitamin K on the factors II, VII, IX, X, and

PIVKA II in the infant newborn under 60 days of age] [Article in

Spanish]

Arteaga-Vizcaino M, Espinoza Holguin M, Guerra E, Diez-Ewald

M, Quintero J, Vizcaino G, Estevez J, Fernandez N.

Rev Med Chil. 2001 Oct;129(10):1121-9.

BACKGROUND: Neonates on exclusive breast feeding that do not receive

vitamin K at birth are at higher risk hemorrhagic disease of the

newborn.

AIM: To compare the effect of oral or intramuscular administration of

vitamin

K1 (VK1), on clotting factors II, VII, IX, X and PIVKA II, in children

until the 60 days of age with exclusive breast feeding or mixed

feeding.

PATIENTS AND METHODS: Forty healthy full term infants, distributed in

two

groups, A: 20 with mixed feeding (formula-feeding and breast-feeding)

and

B: 20 with exclusive breast feeding, were studied. Nine infants of each

group received 1 mg of VK1 intramuscularly and eleven 2 mg VK orally 5

ml of cord blood was collected initially from each infant. Venous blood

samples were taken on 15, 30 and 60 days of age. RESULTS: All

factors

increased in a progressive form reaching levels over 50% at 60 days of

age, in both groups. PIVKA II decreased significantly during the

study

period (p < 0.01). Factor II increased more in children with mixed

feeding

that received intramuscular vitamin K, than in the rest of study

groups.

No other differences between groups were observed. No infant had an

abnormal

bleeding during the study period. CONCLUSIONS: Oral administration of

vitamin

K is as effective as the intramuscular route in the prevention of the

hemorrhagic

disease of the newborn.

[Vitamin K 1

concentration and vitamin K-dependent clotting

factors in newborn infants after intramuscular and oral administration

of vitamin K 1] [Article in Hungarian]

Goldschmidt B, Kisrakoi C, Teglas E, Verbenyi M, Kovacs I.

Orv Hetil. 1990 Jun 17;131(24):1297-300.

Serum concentration of vitamin K1 and activity of

vitamin-K-dependent

factors II, VII, IX and X were determined before and after vitamin K1

administration

in infants. The babies received vitamin K1 intramuscularly or orally. 12

hours after vitamin K1 treatment the mean concentration was increased

in

the groups receiving vitamin K1 intramusculary or orally, respectively.

Serum level of vitamin K1 fell exponentially, the mean half life was

about

30 hours in both groups. Activity of vitamin K-dependent clotting

factors

did not change significantly after intramuscular or oral vitamin K1

administration

during the first four-five days of life. It was no direct correlation

between

the concentration of vitamin K1 and the activity of vitamin-K-dependent

clotting factors. This study suggest that oral administration of

vitamin

K1 is as effective as the intramuscular route. [Remember that

prevention

effectiveness continues even after the supplemented K levels drop.]

Vitamin K Protocols

From Nursing

Times,

October

14, 1998:

Researchers have found that plasma vitamin K concentrations were at

least equal to or significantly higher in babies who are given the new

oral form compared to those who are given the vitamin via injection.

The oral form is given in doses of 2 mg soon after birth and again four

to seven days later. It has been recommended that if the baby is

being breastfed, an additional dose be given when it is one month old.

Vitamin

K1 Prophylaxis from British

Columbia

Reproductive Care Program

I have mom take oral Vit. K for two weeks prior to EDD. I find this

helps bleeding pp as well. Then I give baby 2 drops at birth (before I

leave) and then again on day five.

I'm curious why you give 2 drops of vitamin K. I was thinking that I

would need to give them the same amount of mgs as I would of the

synthetic.

Do you know more about this, any study on this, or suggested amount.

When

I worked at a birth center they gave the injectable orally, and it was

50mg. Just wondering what you think about giving the natural vit. K in

the same dose.

I give the same dose PO as is suggested for IM. Some, I have heard,

do double the dose when giving it PO.

we give three doses, following one of the european protocols (birth,

one week, three weeks). Not certain whether this is needed or not, but

what the heck... perhaps is does extend protection and lessen the low

incidence

of late onset hemorrhagic disease. The dose is two drops.

How does it taste? I've tasted it! One brand (aquamephytin) tasted

rather

fishy -- not gawdawful, just not my favorite flavor! babies seem to get

down the two drops without flinching.

the brand we've been using for a while is alphalpha-derived (I hear)

and doesn't have much taste at all.

How to Administer Vitamin K Orally

I've seen Vitamin K administered orally as follows: The Vitamin K

is drawn up as if for the injection, although you draw up a double dose

for oral administration. Once the fluid is in the syringe, you remove

the needle. Then you help the baby to be as comfortable as possible,

insert the syringe into the side of the baby's mouth so the tip is kind

of in the back corner behind the taste buds. Then you slowly push

the plunger to push the fluids into the baby's mouth. If done slowly

and gently, this doesn't seem to bother them.

Oregon

State Law - 333-021-0800 - Search for Administration of Vitamin

K to Newborns

Although this article is about very low-birth weight babies, it's

interesting

because of the relationship between delayed cord clamping and

protection

from IVH (Intraventricular Hemorrhage) and LOS (Late-Onset Sepsis).

This is the closest information we have about the protective effect of

delayed cord clamping against HDN for term babies.

Delayed

cord clamping in very preterm infants reduces the incidence of

intraventricular

hemorrhage and late-onset sepsis: a randomized, controlled trial.

Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W.

Pediatrics. 2006 Apr;117(4):1235-42.

RESULTS: Seventy-two mother/infant pairs were randomized. Infants in

the ICC and DCC groups weighed 1151 and 1175 g, and mean gestational

ages

were 28.2 and 28.3 weeks, respectively. Analyses revealed no difference

in maternal and infant demographic, clinical, and safety variables.

There

were no differences in the incidence of our primary outcomes (BPD and

suspected

NEC). However, significant differences were found between the ICC and

DCC

groups in the rates of IVH and LOS. Two of the 23 male infants in the

DCC

group had IVH versus 8 of the 19 in the ICC group. No cases of sepsis

occurred

in the 23 boys in the DCC group, whereas 6 of the 19 boys in the ICC

group

had confirmed sepsis. There was a trend toward higher initial

hematocrit

in the infants in the DCC group. CONCLUSIONS: Delayed cord clamping

seems

to protect VLBW infants from IVH and LOS, especially for male infants.

Here's the

Reuter's version:

Thursday, April 6, 2006

By Clementine Wallace

NEW YORK (Reuters Health) - Waiting 30 to 45 seconds before clamping

the umbilical cord of very low birth weight infants -- those weighing

less

than 1500 grams -- seems to protect them against bleeding in the brain

and the development of blood infections later on, researchers report.

The strategy seems to benefit boys especially.

"While countries in Europe tend to wait before clamping these

children's

umbilical cord, the current practice in the United States is to clamp

it

immediately after delivery," Judith Mercer told Reuters Health. "There

hasn't been a lot of research done in this country on delayed cord

clamping,

and most studies were limited by small samples."

Evidence is accumulating to suggest that, for very low birth weight

infants, delaying cord clamping and lowering the newborn below the

mother's

level significantly increase the amount of blood flowing from the

placenta

to the newborn, according to Mercer, from the University of Rhode

Island

in Kingston.

In their article in the medical journal Pediatrics, she and her

colleagues

note that waiting 30 to 45 seconds results in an 8 percent to 24

percent

increase in the baby's blood volume.

"Immediate cord clamping may deprive these infants of essential

blood

volume, which might result in hypotension (low blood pressure) and in a

poor perfusion of the tissues," Mercer explained.

Her group's study involved 72 pregnant women who gave birth to

infants

before the 32nd week of gestation. The women underwent either immediate

cord clamping at 5 to 10 seconds after the birth, or delayed cord

clamping

30 to 45 seconds after delivery.

The researchers saw differences between the two groups in rates of

brain

bleeds in the babies, and in their risk of late-onset sepsis.

These differences were significant from a statistical standpoint in

male infants, but not in females. Specifically, 2 of the 23 male

infants

in the delayed-clamping group had intraventricular hemorrhage compared

to 8 of the 19 in the immediate-clamping group. No case of sepsis

occurred

among the first group, whereas 6 cases occurred among the others.

The researchers say the strategy is a simple way to improve outcomes

of very preterm infants.

SOURCE: Pediatrics, April 2006.

Sources of Vitamin K

Oral vitamin K is listed at birthwithlove.com

The Vitamin K forms suitable for newborns are forms of Vitamin K1

(Phytonadione),

available in injectable or oral forms: as Mephyton for oral use, or as

aquamephyton or konakion for injectable use. Menadione (Vitamin K3) is

not recommended for prophylaxis and treatment of hemorrhagic disease of

the newborn.

Cascade

HealthCare Products

carries

Mephyton

(Oral Vitamin K) in the

Professional

Products > Supplies > Pharmaceuticals section.

The oral vit K is just 2x the normal injectable but given orally. It

is AquaMephyton (Phytonadione, MSD) Aqueous colloidal solution 1 mg per

0.5 ml neonatal concentration. The one I have is made by Merck, Sharp

and

Dohme.

Phytonadione .... Vitamin K-1

Scientific Botanicals, Inc.

8003 Roosevelt Wy Ne

Seattle, Washington 98115-4225

(206) 527-5521

$18.00 for 1 fl. oz. (500 drops)

Standard dose ... 2 drops (2mg./drop) sublingual at birth

I repeat the dose X 2

Konakion is available over the counter in many European countries;

my

friend gets it for me in Germany. I don't think there are any customs

issues.

Here in Canada we can order Serax directly thru the pharmacy .

Costs me 80 cents per 1 ml glass vile. I draw up 0.1ml to get

the 10 mg. doseage (oral or I.M.) and then toss the rest as they are

notmulti-use viles. What a waste.... Oh well.

Or you might be able to order it through the mail from Weston's

in the UK

The pharmacy I called indicated: -there are no oral sources of Vit.K

manufactured for sale in Canada; -some take the IM product orally; and

-Serax is the trade name for octazipam, a sleeping drug.

I am not a pharmacist, and have not checked this with others.

Supporting Normal

Vitamin K Production

It's the bacteria present in fecal matter that colonise the baby's

gut

and allow it to start producing it's own Vit K, and yes the theory is

that

if midwives weren't so "clean" it would be easier for babies to become

colonised with these bacteria. I'd also argue that using antibiotics

in labour would mean that the baby wouldn't get exposure to the

necessary

bugs. By virtue of route of delivery c/s babies would also not be

exposed

to these bacteria and so would be higher risk for bleeding disorders.

Lars Hanson, Immunology of Breast Milk is an excellent book

for

explaining the importance of avoiding anal wiping and babies needing to

be exposed to the maternal gut flora. Babies need this to help colonise

their uncolonised gut at birth. This indeed helps them to produce their

own vitamin K. Babies just need to be near it an exposed at birth. I

heard

him speak a few weeks ago and he said that babies are born next to the

anus for a reason! Ina May Gaskin talks about avoiding wiping for the

other

reason. To avoid tensing muscles.

Signs Suggesting Need for

Vitamin K

Signs Suggesting Need for Vitamin K:

bleeding from the umbilicus, nose, mouth, ears, urinary tract or

rectum

any bruise not related to a known trauma

pinpoint bruises called petechiae

black tarry stools after meconium has already been expelled

black vomit

bleeding longer than 6 minutes from a blood sampling site even

after there

has been pressure on the wound

symptoms of intracranial bleeding including paleness, glassy eyed

look,

irritability or high pitched crying, loss of appetite, vomiting, fever,

prolonged jaundice.

This list is written by Enoch. Midwifery Today. Issue 40.

Vitamin K

Administration Without Parental

Consent

I have encountered several home birth families whose babies were

born

completely gently, and who were pressured to have their babies receive

Vitamin K as much as one to two months PP.

In the 1986 NAPSAC Summit video Doris Haire gives an excellent

explanation

of how and why obstetric anesthesia/analgesia causes newborn

hemorrhagic

conditions. Knowing the historical and current heavy uses of narcotics

and forceful delivery techniques (mighty vac, forceps, head pulling

etc.)

it is my belief that the routine administration of Vitamin K has

evolved

out of the need to protect newborns from iatrogenic conditions rather

than

inherent problems of gently born babies. In this sense it is a simple,

effective and needed technology, however its risks (jaundice and some

types

of childhood leukemia--injectable) may not be worthwhile when babies

have

been born without trauma or drug exposure.

Doris Haire has a wonderful speech recorded on the NAPSAC Summit

video

of 1986 where she describes infant hemorrhagic conditions being caused

by the drugs which are commonly injected in epidurals and spinal

anesthesia.

In the speech, she actually reads off of a package insert for

bupivicaine,

which states that a known risk of giving this drug to pregnant,

laboring

women is to have brain hemorrhage in the infant. that is what the

package insert stated.

I recently transported a primip with prolonged ROM. Baby was

ultimately

delivered by section (serious decels) after 4 attempts at vacuum

extraction.

This couple opted not to have a vitamin K shot for the baby because

they

feel that the baby's vitamin K levels will be rapidly increasing in the

coming week and would not need the shot. The pediatrician "harassed"

them

and threatened to call child protective services on them if they did

not

get one because they thought it was a form of child abuse (endangerment

of a child). The ped frightened them beyond belief concerning infant

hemorrhage

which can occur at 4-6 weeks of age.

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