Lessons from the newborn vitamin K debacle

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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.

Natural childbirth advocates were dead wrong.

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.

  • Mariana

    I’m 100% pro vitamin k shot and vaccines, and both my babies received their shot right after birth (together with the tuberculosis vaccine). I just wish someone had told me about it. I knew babies got the tuberculosis shot on the arm, but I freaked out when I saw the tiny dot on my daughter’s thigh and didn’t know what other shot she had received! She was in the well baby nursery for a very long time, despite my pleas to have her back, and I had no idea if she had been in some kind of health crisis that needed a shot or what had happened. I would have consented to the shot if anyone had bothered to ask me or my husband. I had to ask 2 different nurses before the pediatrician gave me a full answer (the first said “it was a shot to help your baby grow”, the second said “vaccines”). Would it hurt anyone to tell me “it was a vitamin k shot”?

    I don’t agree with people who refuse vaccines or vitamin k shots, but if my experience is commom (and my friends tell me it happened to them too here in Brazil), I can understand that what happened to me it would rub people the wrong way, and could cause them to reject life-saving medical interventions. I don’t have any medical training, but I’m smart enough to understand something when it is explained to me.

    • Wasnomofear

      Wow! Yeah, that’s bad. In the U.S. we get info sheets for each vaccine.

      • Justanrph

        Except vitamin K isn’t a vaccine, it is a vitamin. Thus no vaccine information handout. My baby received it before being given to me for skin to skin, per my request.

    • lsn

      I signed the consent form for the vitamin K, the HepB and an open consent for blood transfusions when the NICU asked me to on the second day (had already given consent over the phone from the ward) despite having no idea what the vitamin K was for (hadn’t gotten that far in the book, hadn’t gotten to the antenatal classes which covered it yet due to son being premature). But then I trusted the neonatologists to know what they were doing and to act in the best interest of my child. The open consent was so they didn’t have to phone me every time he needed a transfusion – I was all in favour of 1. Them doing it ASAP without having to faff around and 2. Not being woken at 4.30am just to do a consent. Especially as I was still expressing at night at that point and needed the damn sleep!

      • Azuran

        I signed two treatment consent form as soon as I was admitted to the hospital, one for me and one for my not yet born baby.
        Despite having already signed a consent, they still asked me again before doing anything to me and I had to sign a second, different consent before they wheeled me in for emergency c-section.
        When my baby was born, they didn’t ask me again for consent to treat her, but that might have been because at that point I was just so far out of it with exhaustion from labour and fever from my prolonged ruptured membranes that I just wasn’t in a state to consent to anything anymore. So it’s a good thing they took care of this when I first came in.

    • lsn

      I do agree that they should have at least mentioned it at the time though – something like “baby’s had the TB shot here, and the vitamin K shot to prevent brain bleeding here, so s/he might be a bit tender there and a bit grizzly. Let us know if you’re worried about anything, otherwise have a nice cuddle.”

    • Madtowngirl

      I totally agree that they should have told you what they did and where. Two years ago, here in the U.S., they actually gave my baby the shots right in front of me, so I knew exactly what was happening.

  • Gene

    OT: for anyone following the news of Hurricane Harvey… NBC news just interviewed a midwife who refused to evacuate. In front of the birth tub at the Corpus Christi Birth Center. She has a mother who is overdue. She is a CPM, of course.

    • BeatriceC

      Oh ffs. I hope that mom and baby stay safe in spite of the idiot “caring” for them.

    • Empress of the Iguana People

      If any time called for a c-section of convenience. *eyeroll*

      • Roadstergal

        Or even *gasp* an induction.

        I mean, she’ll get an induction as long as it’s a midwife-approved one. That’s castor oil, nipple twiddling, and sweeps?

        • Empress of the Iguana People

          I am still touched out from kid 1 bf’ing. Nipple twiddling would probably have gotten someone bitten.

    • Azuran

      What are those people even thinking? They’ll have absolutely no way to transfer or get help if anything goes wrong.
      And even if everything goes right with the birth, what are they going to do after? It’s doubtful any of them will be able to drive back to their houses for days, are they just going to all live together in the birth center?

  • Box of Salt

    Both Dekker’s interview and her blog post that inspired it are from 2014, in response to the news stories Dr Amy mentions about the cluster of cases in Tennessee (Dr Amy covered one of the affected babies, Baby Olive, back then).

    Does anyone know what is Dekker’s stance on Vit K now, 3 years later? Did she follow through with promoting the actual evidence, and insisting on providing women with true informed consent about it instead of the fabricated nonsense that passed for advice before?

    • kfunk937

      It’s difficult to know what changed, but the blog post was updated in January 2015. It still reads as pretty shruggie, but the information is there.

  • MaineJen

    “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.”

    If only we could be sure that the people giving out this misinformation were capable of this level of remorse and self-examination. From what I’ve seen, that’s not likely. They’ll sweep these babies under the rug, just like those killed or injured due to other non-interventions. Or worse, they’ll blame the hospital and the doctors for the injuries. And then they’ll go teach their next childbirth class and give out the same bad information.

    • Ozlsn

      Yeah that for me was logic fail #8 – that the people who gave you the advice will have enough self-awareness to realise that their advice was terribly wrong and directly contributed to the outcome, and then be remorseful. From what I’ve seen that rarely happens – people dig in to their entrenched position and claim it couldn’t have been prevented.

  • OkayFine

    Ugh, I declined vit k shot with one of my children because I bought the it’s unnecessary bs. Nothing happened but I wish I could go back and slap the shit out of myself. Like an idiot, I listened to my doula. My doula with whom I am no longer on speaking terms because she tried to talk me into having a homebirth even though I am a bad candidate and she knew it and out of vaccinating among other things. I’ve had enough of the dangerous nut jobs. I’m grateful to no longer be buying the natural crowd party line.

    • Wasnomofear

      I delivered my first at a freestanding birth center (fortunately, we’re all ok), and found this site while pregnant with my second. I feel your pain.

      • OkayFine

        Yeah, it has been shockingly painful to realize the sorts of risks I took and what I could have lost. I’m processing a lot of recent life events and the cavalier attitude I took toward the health of my children is at the top of my mind. I’m so angry at myself and others who lead me towards decisions that had potential for real damage. Fortunately, nothing harmful came to pass and I’m incredibly fortunate for that to be the case.

    • You were NOT an idiot. You should be able to trust your doula, and the fact that you couldn’t doesn’t reflect badly on you. The whole reason we have medical professionals is because the rest of us can’t be expected to know this stuff.

      • OkayFine

        At the time I thought this person cared about me a my children and I considered her a knowledgeable friend. But truth be told, the warning signs were everywhere. A few things have happened since then to show me that she has more in common with the sociopath midwives than I initially thought. Fortunately, I ended up with no lasting damage from her advice other than deep and abiding anger and resentment toward her. Other clients of hers weren’t so lucky and followed her advice to the detriment of their or their baby’s health. So no, maybe not an idiot, but as someone who was seeking a mother figure, I allowed myself to be manipulated by someone who had zero skin in the game and wouldn’t have given two shits if me or my children would have gotten hurt.

        • Heidi_storage

          Not your fault.

        • Madtowngirl

          I have to echo the sentiments expressed that it wasn’t your fault. These people are very cult-like, and it is really easy to lure a pregnant woman into the woo. I almost fell for it, myself, and I even have a science background. Your anger and resentment is totally justified, but it was not your fault.

  • Mad Hatter

    OMG! People, have you not read the insert?! Its TOXINS! It’s SYNTHETIC! Its bad for the little baybees! (meant with all sarcasm)

    • Madtowngirl

      TOXINZZZZZZZZZ!

  • Sara

    The thing that kills me about this is that, on top of everything, vitamin k comes from plants, is about the most natural substance you could get. They urge all kinds of plant extracts for stopping, PPH, for breast milk increase, etc, and yet, this, which would totally fall into their philosophy, gets a no as a knee jerk reaction – doctors do it, therefore it must be bad. And yet, the substance is just like everything they love to promote.

    • MI Dawn

      Actually, sometimes it’s just “the SHOT is bad” and the parents are OK with oral vitamin K. Problem with that is, it’s poorly absorbed, needs to be given daily for some time, and tastes horrible so it’s a struggle getting the baby to swallow it.

      • Sullivan ThePoop

        Several times a day and even if given correctly it does little to prevent dangerous late bleeding.

      • Sarah

        Yes, I know someone who went for that with hers. Better than nothing I suppose, but that’s about it. Luckily she was formula feeding so at least that was one less risk factor.

      • Hannah

        In the UK they push either form of vitamin K. They prefer the shot, but actually seemed reluctant to push it; it was very ‘shot is better but if you don’t want to we will absolutely give you the oral’ but without actually going through why the shot is better. Or maybe they would if I was interested in oral… they looked relieved when I was very firm about preferring the shot. Wouldn’t even let them finish asking the last few times they asked right before his birth 🙂 But it made me wonder with the infiltration of woo into the NHS, if they had a spate of mums wanting to refuse it as well. Or if some of the NCT midwives were pushing against it, those classes are horrible with woo and bad information (needless to say, I was not popular with them when we had ours…)

    • MaineJen

      I wonder why they don’t just have the baby sniff some cinnamon candy.

  • BeatriceC

    Question: what year did the vitamin k shot become available. My Google search is telling me that the connection between vitamin k and hemorrhagic disease of the newborn was discovered in 1894 and that the AAP began recommending the shot in 1961. It’s a fair assumption that attempts were made to treat the issue and that the injectable version was around for a while before it was recommended across th board, but I’m having trouble finding any history between 1894 and 1961.

    • Who?

      My kids both had it in the UK in the early 90s.

  • TsuDhoNimh

    You know .. before you start telling people to STOP doing something, you should find out why that activity was started and what the consequences of stopping will be.

  • gyrfalcon

    From Dekker’s article: “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.”

    Hardly. The purveyors of bad information are probably blathering on about “variations of normal” and “it would have happened anyway”.

    • namaste863

      Or that it’s acceptable collateral damage when upholding their pet ideology.

    • TsuDhoNimh

      And “your angel baby was too fragile for the earthly plane” or “must not have been destined to survive”.

      Just meet it at the Rainbow Bridge.

    • Wasnomofear

      They have so much in common with anti-abortionists. Both sets of ideology kill women, but they shift blame.

  • KQ Not Signed In

    I just cannot understand the resistance to a vitamin supplement. It’s a vitamin! Aren’t vitamins one of those things they use to treat everything else??

    • BeatriceC

      It comes in a form that requires a doctor’s orders so it’s bad. If you can buy it at Whole Foods, it’s good.

    • Sullivan ThePoop

      Really people should be avoiding other vitamins they think are fine. A new study showed that excessive amounts of B vitamins found in popular supplements greatly increases your risk for lung cancer. There have been three news stories lately about people ODing their children on vitamin A and vitamin D. Plus a large study out of Denmark found no difference in illnesses between children taking supplements and those who don’t in preschool.

      • Heidi_storage

        My old boss said of vitamins, “If you don’t have oil in your car, it won’t work well. But putting too much oil in your car is a bad idea, too.” (He was an obgyn.)

        • Roadstergal

          I remember there was a commercial for… I think it was Lowe’s Home Improvement. A little ‘testimonial’ from a guy talking about how he over-watered a house plant, and it died, and he went to Lowe’s where the Expert Plant Person explained the phenomenon to him. At the end, he says something like, “I didn’t even know that could happen! But I’ve learned, and with my new plant – no more water for this baby!” And the Expert Plant Person looks pained.

          It was such a beautiful poke at that sort of thinking…

      • Helen

        This is a single dose of a vitamin, not a continuous megadosage. It’s medically indicated.

        In addition, the taking of a meg dose of a vitamin may be at doctor’s orders. I am ordered to take a large dose of calcium and vitamin D every day, because of my medical issue.

        • Heidi_storage

          Well, if your doctor ordered it, it must be bad, right? Unless your doctor is a naturopath or chiropractor or reiki master.

          • Helen

            It was my oncologist. I’m taking an estrogen blocker.

          • Heidi_storage

            Sorry, I was being sarcastic. Of course there can be indications for taking vitamins; I take iron on doctors’ orders, myself. I was just mocking the “natural” crowd’s odd belief that vitamins are magical unless prescribed by an actual medical professional, in which case they’re baaaad.

          • Petticoat Philosopher

            I think that’s what’s behind a lot of these ideas: pure contrarianism. Medical professionals are bad so therefore anything they recommend must be bad and you should do the opposite? They’re telling you your baby should have the K shot? The K shot is now deadly. They’re telling you that it’s not a good idea to drink unpasteurized milk when you’re pregnant or to to give it to babies? Unpasteurized milk is now a miracle food that you should consume regularly while pregnant and make the basis of the only acceptable (homemade) baby formulas in woo circles. The list goes on.

        • Sullivan ThePoop

          I know that. I was pointing out how stupid it is to refuse it but take other vitamins that are dangerous.

    • EmbraceYourInnerCrone

      It’s a shot and they somehow convince themselves it must have “toxins” and dangerous ingredients. And for some parents it seems a 2 second paint from a shot is worse than the possible consequences of not getting the shot.

      People sometimes just do not get the number of bad things that DON’T happen to kids any more because we test for/treat for them now as a matter of routine: heel stick for PKU and rhogam give to mothers with Rh negative blood type to name just 2 of many. I always wonder what happens to home birth babies and moms, do they just forgo all these preventative tests and treatments?

      • Mad Hatter

        Depends on how into the woo they are and what kind of midwife they have. I think a lot don’t get the tests. The midwife I know doesnlt really do anything but urine tests. Definitely believes ultrasounds are dangerous. I also know this midwife delivered a baby for a Rh negative mom, no rhogam, baby died. They knew she was Rh neg and this was her 3 or 4th baby.

        • swbarnes2

          There’s a post around here somewhere someone who transferred from working with a midwife to working with a doctor, or something like that, and realized all the stuff that her former employer was skipping out on.

        • Heidi_storage

          That makes me very angry. My mom was negative, and I was her fourth baby–but she was treated, so all I suffered was a little jaundice.

    • Merrie

      Could also be just being unaware of the benefits of it and figuring that it therefore wasn’t necessary. I’m ashamed to admit I declined Vit K with my first baby before I de-converted from the woo. I wasn’t worried about toxins, I just wrongly thought that it wasn’t necessary if doing delayed cord clamping, etc. Thankfully nothing adverse happened and I eventually wised up and got the shot for my other two.

    • Sue

      The anti-science movement practices blatant alphabetism.

      Vit C is the miracle cure-all, Vit K a nasty toxin. Not much sense going on here.

      • Charybdis

        Vitamin C is water soluble and Vitamin K is fat soluble. Water is good and fat is bad. Ergo, Vitamin C is good and healthy, because water. Vitamin K is bad and not needed, because FAT. QED.
        (Sarcasm, if you couldn’t tell).

        • Sue

          Oh – of course! It’s part of the Clean Food movement!

  • Zornorph

    Yes, but if you give your baby the Vitamin K shot, it will harsh their mellow. I mean, they just had this effortless glide out of their mum’s vagina and they are just chilling covered with their birthy smells waiting to gobble down some liquid gold colostrum and you are going to stab them with this knitting needle sized thing full of toxins? You monsters! That will prevent bonding forever.

    • Heidi_storage

      I already screwed over my kids by having AROM, an epidural, and pitocin; my boys were further messed up by my antibiotics during labor, and my girl wasn’t placed on my chest for, like, 15 minutes after birth because they were callously cleaning off meconium and doing things to her airway. I figured, oh well, they’re already ruined, might as well finish ’em off with the Vitamin K and the hepatitis shots, not to mention the totally unnecessary heel prick. (I mean, they didn’t even have any of those metabolic diseases!) My boys even got a bit of formula the first couple of days. Sorry I didn’t birth them in a natural pool and lick them, or whatever it is good mothers are supposed to do.

      • Mattie

        Random Q, they did the heel prick test at birth? Is that standard practice? In the UK it’s done on day 5 unless there’s a reason to do it sooner.

        • Heidi_storage

          We do it before the newborn leaves the hospital, at least in Virginia. I guess your pediatrician does it?

          • Dr Kitty

            In the UK midwives do the heelprick day five when they visit at home.

            Midwives usually visit new mums at least twice at home before handing over to the Health visitor, but can visit much more if there are problems. They weigh the baby, check mum’s stitches etc.

            The US does the heelprick in hospital because without universal healthcare you can’t ensure that every new baby is going to see a HCP in their first week of life.

          • Mattie

            Midwife, at home, babies/children here generally just see a GP, they’ll only see a specialist ped if they’re referred to a hospital for something, or if you go private. If baby is in hospital on day 5 then it’s done there

        • MaineJen

          Here it’s done before they leave the hospital, so before 2 days of age. You don’t hear back unless it’s positive, and I think they store the cards at the state lab for future testing if needed.

        • sapphiremind

          In the US, it needs to be done after 24 hours of life/feeds and before discharge or blood transfusion. If either of those things are not true, it will need repeated. Some states automatically do it twice. Galactosemia doesn’t show up well prior to feedings, but there are other things screened for that need to be known ASAP. And still sometimes don’t get found in time 🙁