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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

General Discussion about Controversy over Administration of Vitamin K to Newborns

I am trying to help a lady from the Netherlands with a question about vitamin K. Doctors in her country are saying the breastmilk is lacking in vit K and that breastfed babies need to be supplemented. I found it interesting that in her country that babies are not given vit. K at birth but mothers are being told to give it to the babies on a regular basis after birth.

It's true! Breastmilk and colostrum have LOW levels of vitamin K. Breastfed babies who do not receive supplemental vit. K have low levels of both vitamin K and certain important blood clotting factors. In rare cases, this can lead to newborn hemorrhagic disease. This disorder is life-threatening and can cause permanent brain damage in some babies who survive. It's so easy to prevent--either with one intramuscular dose of vitamin K on the day of birth or with a series of oral doses. Human milk is the best food for human babies. But it IS low in vitamin K.

Found my source for this statement. First of all, just to clarify, breastmilk *is* low in vitamin K, but this is not a deficiency, nor is it a hazard for the newborn. We were taught that the gut utilizes bacteria in the synthesis of vitamin K. Because formula is extremely processed and sterilized, etc. in its manufacture, it takes the formula-fed infant longer to build up enough of these friendly bacteria than it does in the breastfed infant. The substance lactoferrin in breastmilk helps the "digestive system [to be] colonized with non-pathogenic bacteria" which are necessary for the infant to synthesize her own vitamin K. My source for this is the "Resource Notebook for the Breastfeeding Educator Program", 1995 edition, by Debbie Bocar, RN, BSN, BSS, MEd, MSN, IBCLC (and probably Doctor of Education by now; she was working on it last year at the time of the course). She gives her source as "Edwards 1994" but I can't find the complete reference for this; still looking!

I won't quote the entire last piece of good information on Vitamin K, but I wanted to add Anne Frye's comments to the discussion: From UNDERSTANDING DIAGNOSTIC TESTS DURING THE CHILDBEARING YEAR, 5th Ed. pages 648, 649... The emphasis, is my own (don't know how to do italics in e-mail)

"Other studies have shown that cord blood lacks detectable vitamin K (Shearer, 1982). In addition, breast-milk from the UNSUPPLEMENTED mother contains a small amount. Administration of 1 mg. IV vitamin K to laboring women produces very low plasma cord blood levels. IS NATURE INSULATING THE NEWBORN FROM HIGH LEVELS OF VITAMIN K FOR REASONS YET TO BE DISCOVERED? JUST BECAUSE WE HAVEN'T FIGURED OUT WHY DOES NOT MAKE THIS A PATHOLOGICAL EVENT. We must always beware of science's attempts to improve upon nature. Remember, that's how they sold us on bottlefeeding and hospital birth in the first place!

Science has yet to answer why the newborn does not have adult levels of clotting factors, why s/he receives low levels of maternal vitamin K both before and after birth, and why the normal newborn may produce a CLOTTING INHIBITOR. (Some symptomatic babies, no doubt, suffer from high levels of the heparin-like inhibitor. Unfortunately, no differential diagnosis is done to determine if a baby is having clotting difficulties since all babies are treated prophylactically.) What does vitamin K do to the vast majority of newborns who do not have a hemorrhagic problem? The fact that too much vitamin K may cause hemolysis evokes questions regarding vitamin K's stress on the liver, and whether the production of certain clotting factors are low at birth to facilitate the immature liver's metabolism of bilirubin. (Perhaps vitamin K overrides the heparin-like inhibitor commonly present, promoting what amounts to abnormal clotting for a newborn?)"

Anyway, folks, I definitely don't think Anne is against giving vitamin K and neither am I; however, I think the jury is still out on this one and we may not have enough information for a while for a "final say"..... What do y'all think?

You really made a light bulb go on! Do you think it could have anything to do with the fetal circulation transition to newborn circulation. Keeping the sticky platelets etc of normal clotting away from all of those shunts, etc? Maybe I'm just grasping at straws, but it may be God's little fix to strokes and DVT's in his early trials (tee,hee)

By definition, midwives are supposed to trust a woman's body to birth and nurture her child without intervention.

To some extent I have to agree with you. It seems bizarre that the almighty ( or Darwinian selection ) has produced an off-spring who has a tendency to experience adverse effects of a vitamin despite a normal diet. Unfortunately this is how it is. Breastmilk is particularly deficient in vitamin K.

Haemolytic disease of the newborn is not common. When it does occur it is very seriously life-threatening. As vitamin K is so cheap and now shown to be safe I can see no argument for not using it.

Failing to offer vit K is a similar form of nihilism to not advocating

• folic acid supplements to low risk women
• routine fluoridation of tap-water
• fortification of margarine
• supplementation with Iodine of cooking salt in Iodine deficient areas

Could it be because the liver of a newborn is not yet ready to handle the increased production of prothrombin? I definitely see an increase in jaundice in the babies we give vit k.

Since I have stopped;
1/ cutting or clamping the cord until birth of the placenta or at least cord has ceased pulsating
2/ Giving routine Vitamin 'K' or konakion whether im or oral I have not had a case of neonatal jaundice Maybe a tinge yellow day 3 but that is normal physiological.