Lessons from the newborn vitamin K debacle


In the last few years a deadly disorder that we thought was vanquished has begun to reappear.

The disorder is hemorrhagic disease of the newborn, also known as vitamin K deficiency bleeding. It can lead to life hemorrhage into the infant gut, and neurologically threatening hemorrhage into the infant brain.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural childbirth advocates were dead wrong.[/pullquote]

Why did it make a comeback? Because natural childbirth advocates declared that newborn vitamin K injections were both unnecessary and dangerous.

They were dead wrong.

From The Tennesean in 2014:

A bleeding disorder in babies so rare that it typically affects fewer than one in 100,000 is becoming more common in Tennessee because parents are refusing vitamin K injections at birth, according to pediatric specialists.

Since February, four babies with no signs of injury or abuse have been sent to Monroe Carell Jr. Children’s Hospital at Vanderbilt with either brain hemorrhages or bleeding in the gastrointestinal tract…

What happened to the babies?

All four children survived, but the three who suffered brain bleeds face challenges.

“These are kids that end up having surgery to remove the large amount of blood out of their head or they would have died,” he said. “It’s early. It’s only since February, but some of the kids have issues with seizure disorders and will have long-term neurological symptoms related to seizures and developmental delays.”

Vitamin K deficiency bleeding is remarkably easy to prevent with just simple injection of vitamin K shortly after birth. Yet on the advice of natural childbirth advocates, including some midwives and doulas, mothers began refusing the lifesaving injections.

It’s hardly surprising that natural childbirth were wrong since there was never any scientific evidence to dispute the vital role of vitamin K injection and no scientific evidence that it caused harm. Nonetheless natural childbirth advocates labeled it an intervention and with typical natural childbirth “logic” concluded that it must be unnecessary.

In an interview, Rebecca Dekker, of Evidence Based Birth, acknowledges that these injuries and deaths were both entirely preventable and caused by irresponsible claims. Dekker unwittingly gives a primer on the classic logic fails that lead to deadly advice irresponsibly offered by natural childbirth providers and irresponsibly followed by parents.

Logic fail #1: I haven’t seen it so it must not be a problem.

I knew that Vitamin K deficiency bleeding (VKDB) was rare, but I didn’t realize—until I started reading the research—how effective the shot is at basically eliminating this life-threatening problem.

Like most natural childbirth advocates, Dekker had no clue that a particular complication is rare because of interventions, not rare in nature.

Logic fail #2: I pride myself on being “educated,” although in reality I am ignorant.

…[T]here is this misconception that “Vitamin K doesn’t have any evidence supporting its use,” and I found that belief is totally untrue. There is a lot of evidence out there. People have just forgotten about it or not realized it was there.

Logic fail #3: If I am practicing natural parenting, my baby won’t need interventions.

That the two main risk factors for late Vitamin K deficiency bleeding (the most dangerous kind of VKDB that usually involves brain bleeding) are exclusive breastfeeding and not giving the Vitamin K shot.

Parents who have been declining the shot are the ones who are probably exclusively breastfeeding. So their infants are at highest risk for VKDB.

Logic fail #4: Inteventions by definition are always unnecessary.

There are so many misconceptions and myths. I’ve heard them all. The scary thing is, I’ve heard these misconceptions from doulas and childbirth educators—the very people that parents are often getting their information from. I’ve heard: “You don’t need Vitamin K if you aren’t going to circumcise.” “Getting the shot isn’t necessary.” “Getting the shot causes childhood cancer.” “Getting the shot is unnatural and it’s full of toxins that will harm your baby.” “You don’t need the shot as long as you have delayed cord clamping.” “You don’t need the shot if you had a gentle birth.”

Logic fail #5: Ignore doctors and do your own “research.”

… It is truly alarming the things that parents are reading. “Vitamin K leads to a 1 in 500 chance of leukemia.” “Vitamin K is full of toxins.” Most of the articles on the front page of results are written by people who have no healthcare or research background and did not do any reference checking to see if what they were saying was accurate. It’s appalling to me that some bloggers are putting such bad information out there.

If parents don’t trust the evidence, it may be because they have read so many of these bad articles that it’s hard to overcome the bias against Vitamin K. All I can say is, given the number of bad articles on the internet about Vitamin K, I can totally understand the confusion people have.

Logic fail #6: Believing natural childbirth advocates are knowledgeable, unbiased sources of information.

I mean, even I was confused before I started diving into the research! I truly went into this experience with no pre-existing biases. I just wanted to figure out the truth. If even I—the founder of Evidence Based Birth—didn’t know all the facts about Vitamin K, then I think that’s a pretty good sign that most other people don’t know the facts, either!

Dekker flatters herself. She started with a preexisting bias: reflexive distrust of doctors, scientists and government health agencies; she assumed they could not be trusted to determine that vitamin K is the best way to prevent bleeding from vitamin K deficiency.

Logic fail #7: My doula told me, so it must be true.

I don’t think we are doing a very good job with the parents who decline the shot, either. If you read the part of my article where I wrote about the epidemic in Nashville, all of the parents refused the shot, but none of the parents gave informed refusal. All of them had been given inaccurate information about the shot, so they couldn’t make a truly informed decision. Can you imagine what it must be like for the people who gave them the inaccurate information? That would be so terrible to know that your misinformation may have led to the parents making the choice that they did.

No shit, Sherlock!

Sadly, Dekker does not acknowledge that it is the logic fails so beloved of natural childbirth advocates that led to these preventable injuries and deaths. The reflexive distrust of physicians and scientists, the basic ignorance of science and the bias against interventions all combined to convince parents that refusing the vitamin K shot was “educated” when it was in fact deadly.

Which brings us to the biggest take home lesson of all: If natural childbirth advocates (including some midwives, doulas and childbirth educators) could be so wrong about something so simple — that vitamin K injections safely and reliably prevent vitamin K deficiency bleeding — should their advice ever be trusted?

Of course not.