I have literally been working on this post ALL WEEK. These days, by the time evening rolls around and I finally sit down to blog, my brain is fried and I just can’t seem to concentrate on anything more than mindless Internet surfing. I really need to start napping in the afternoons!
Last night, I had my first pregnancy panic moment. We’d been lying in bed for a good couple of hours when I realized that I’d barely felt the baby move. It wasn’t that he hadn’t moved at all — he’d definitely moved more than the requisite six times in two hours — but the movements were merely a few light, fast twitches, compared with his usual late-night routine of squirming and rolling about, making my stomach bulge out Alien style (much to both J’s and my great amusement). I tried all of the usual poking, prodding and shaking, and he barely responded. Normally, I get at least a few good, solid kicks or pushes out of him when I put pressure on certain parts of my stomach. From what I’ve read, a change in the quality of movements — not just the quantity — can be a sign of a problem, and last night I let my worry get the best of me.
Next thing I knew, we were on the phone with the on-call midwife at almost 1:00 A.M. She suggested that prior to going to the hospital to get checked out, I try drinking a glass of juice to see if that perked him up. When I told her we didn’t have any juice (Paleo household — we only drink water and tea), she suggested going for a walk instead. So we got dressed and walked over to 7Eleven, where we bought a bottle of orange juice. After chugging 500 millilitres of liquid fructose and taking a brief but lovely walk through our West End neighbourhood, we returned home and the baby commenced his usual rocking and rolling. Obviously, this was merely a case of him objecting to our low-glycemic dinner of fajita steak and vegetables, with no fruit for dessert 😉 Crisis averted, but the blog post was deferred for yet another night.
So, without further ado, here is the post that has taken an entire week to compose. I know: it had better be worth the wait 🙂
(Please note: All statistics and information that follow are taken from fact sheets provided by our local public health department.)
In British Columbia there are three routine procedures administered to newborns within the first 48 hours after birth, namely: a Vitamin K injection, antibiotic ointment (erythromycin) on the eyes and a newborn blood screening. As parents, we have the option of refusing the administration of any or all of them. The default is for the procedures to be conducted; signed paperwork is required in order to opt out.
When we were first advised by our midwife about these standard protocols, they made sense to us, but upon closer examination, we started to question the necessity of “routine” medical procedures following a normal, healthy birth.
Vitamin K Prophylaxis
Vitamin K injections are given in order to prevent Vitamin K Deficiency Bleeding (VKDB), a rare but potentially fatal condition that can result from the fact that Vitamin K2 (an essential factor in blood coagulation) is synthesized by gut bacteria, yet newborns are born with sterile guts. VKDB can range in severity from nosebleeds or a lack of clotting at needle prick sites to severe and often fatal intracranial or gastrointestinal bleeding. The total prevalence of VKDB (all forms and levels of severity) in untreated newborns is thought to be anywhere from five to 25 per 100,000. The prevalence in infants who receive the Vitamin K injection is approximately one in one million.
Among other risk factors, VKDB is more common in babies born to mothers who have taken certain drugs during pregnancy (e.g. anticonvulsants and anticoagulants), in premature babies, in babies who undergo instrument-assisted births (vacuum and forceps) and in babies who are born with liver or bowel disease.
Our first major concern with Vitamin K prophylaxis is whether there is some evolutionary reason not yet understood by science or medicine as to why human infants are born with a lack of Vitamin K in their blood. How is it possible that half a million years of evolution would have left humanity with such a glaring deficiency? Our second major concern is for the size of the dose, which from what we can tell, might be overkill for such a small person. Our third concern is that the Vitamin K injection is given intramuscularly, while Vitamin K is normally produced in the gut and absorbed through the digestive system; thus, an intramuscular injection completely bypasses the body’s preferred way of receiving the vitamin. We also have concerns about the preservative ingredients (propylene glycol and polyethylene glycol) that are injected alongside the vitamin, and about subjecting him to the potential pain and trauma of a muscular injection within six hours of birth, during a time that he should be bonding with us and feeling safe and comfortable.
One important note: If you search the Internet for information on this procedure, you will come across references to a study that concluded newborn Vitamin K injections were linked with as many as 85 percent of childhood leukemia cases. This study has since been thoroughly debunked, though like most internet zombies, the myth refuses to die.
Our decision: We have decided to forego the Vitamin K injection unless the birth itself presents physiologically traumatic circumstances that might increase the risk of VKDB. We will instead rely on colostrum feedings and (possibly) oral supplementation in the days and weeks following birth. I have recently had my Vitamin K levels tested as normal, and we are confident that between dietary intake (grass-fed beef and butter) and my regular probiotic supplementation, I will have sufficient levels of Vitamin K in my colostrum and breast milk to provide the baby with exactly what he requires.
Newborn Eye Prophylaxis (Erythromycin Ointment)
Mothers who are infected with Chlamydia or Gonorrhea and do not receive treatment are at risk of transmitting these infections to their babies during childbirth. This can result in an inflammatory eye condition called opthalmia neonatorum (ON), which may result in corneal damage or blindness. All mothers are routinely tested for these communicable diseases early in pregnancy (unless they decline testing), though there is always a small chance of the test yielding falsely negative results.
The incidence of ON in North America is three cases per 100,000 births, where 20 percent of those (6 in 1,000,000) babies suffer corneal damage and three percent (9 in 10,000,000) suffer blindness. To protect against this condition, babies are routinely administered topical erythromycin antibiotic ointment along the lower eyelid within one hour of birth.
Our biggest concern with this procedure is the fact that the ointment is known to disrupt visual interaction between the baby and its parents (a critical component of early bonding) during the immediate post-birth period, due to the fact that it blurs vision, decreases eye openness and may even cause inflammation of the ocular area. Secondly, even in cases where a mother is known to be infected with Chlamydia or Gonorrhea, the odds of the baby suffering traumatic eye damage are positively minute. For a mother who has tested negative on all accounts, the risk to the baby is almost nil. And even if the baby were to develop ON, it is a highly treatable condition when diagnosed early.
Our decision: We have decided to forego newborn eye prophylaxis. We believe that our baby’s risk of developing ON is minimal (in hospital, there is always still a chance of the baby contracting pathogens through other means). In the unlikely event he were to develop any sort of early onset conjunctival inflammation, we would seek immediate treatment.
Newborn Blood Screening
Between 24 and 48 hours after birth (and again at approximately two weeks of age if the baby’s screening is done before 24 hours), newborns in BC are screened via blood test for 19 different conditions, including several metabolic disorders, endocrine disorders, blood disorders and cystic fibrosis. The test involves extracting a small blood sample (a few drops) via heel prick. The screen is just that — a screen — and is not a diagnostic test; however, a negative screen means it is highly unlikely that the baby has any of these disorders, and a positive screen provides sound basis for further testing.
As far as we could ascertain, there were no compelling reasons to decline this testing. It is minimally invasive (the baby can be held sleeping or breast feeding while the sample is drawn), and allows for diagnosis of disorders that may be treatable if detected sufficiently early. Of course, a false positive screen could cause unnecessary stress, but this is a small risk to take in exchange for the overall reassurance that a negative screen would provide.
Our decision: We will allow our baby to undergo the newborn blood screening. We believe that the value of the information that can be gleaned from this test far outweighs the small amount of discomfort the baby may experience during the collection procedure.
For those who have had babies, did you decline or consider declining any “routine” post-natal procedures? Why or why not? If you are currently pregnant, what are your thoughts on the benefits and risks of these procedures? How do you think you will proceed?