DECISIONS: ROUTINE NEWBORN PROCEDURES

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?

21 responses to “DECISIONS: ROUTINE NEWBORN PROCEDURES

  1. Thankyou, thankyou, thankyou for this post. (again I’m not expecting – yet – but knew there were a few tests/ things given to the baby post-birth and was suspicious of them too) Just out of interest, did you get the amnio tests and things done at mid-pregnancy? Chris Kresser wrote an interesting post on that in the last few days…Best wishes….

    • We did not do an amnio. Instead we did a first trimester screen at 11 weeks (blood tests for hCG and PAPP-A levels plus an ultrasound) and had the regular mid-term ultrasound at 21 weeks. The FTS provides odds of various chromosomal abnormalities (1 in X), and then based on the risk level, you can choose to follow up with more detailed diagnostic procedures such as amnio or CVS. I believe that in BC all women 35 and over are entitled to amnio/CVS regardless of any screening results because that’s the age at which the rate of occurrence of chromosomal defects is approximately equal to the rate of complications resulting from the amnio/CVS.

  2. This is really useful, thank you! I’m not pregnant atm, but I’m going to remember it for the future!

  3. I found your blog looking for crossfit info. First of all congratulations on your impending birth! Such a wonderful time of life.

    Secondly, as a mom of four, I can tell you that you are wise to research everything and make your best informed decision. I truly believe that most doctors and nurses are well-meaning but often harmful in their practices. Sometimes because of ignorance, sometimes because of silly laws or administrative policies. Keep advocating for your baby!

    Hope you have an AMAZING birth– the most rewarding workout you’re ever going to have.

    • Thanks for the great post. I’m not sure how things differ in the US, but I am still keeping your post for reference for when the time comes.

      • I think the Vitamin K and erythromycin ointment are standard all over North America — at least that was the impression I garnered from the fact sheets, which often referred to American studies and statistics. I’m not sure about the newborn blood screening though, as it seems to be a relatively new thing here in BC (last 10 years or so). There may also be additional procedures performed in American hospitals that are not done here, so it’s definitely worth asking a whole bunch of questions when the time comes!

    • Jessica, thank you for the words of encouragement I agree that often times, so-called “best practices” may be best for the collective (or best for avoiding liabilities?), but not necessarily best for individuals. It is our job as parents to question and research everything!

    • Me too 🙂 I guess everybody has their panic moment at some point during the pregnancy… I have to say that it sure was nice to be able to call the midwife for advice instead of going to the ER to get checked out (and probably spending the whole night there).

      I’d be curious to hear about the procedures babies undergo in the US, and what you and Carl end up deciding to do when the time comes.

  4. I delivered a month ago in Minnesota. We get those three plus one more. The HepB shot. I skipped the Vitamin K shot and the HepB. As for the eye drops, I read somewhere that they can do more harm than theoretical good. Tho here we have three choices on eye drops, silver or two different drugs. I don’t remember the name of the other one. But the “Newborn Screening” is worth it and none of my kids noticed the little prick. I guess that’ why it’s done on the heal.

    • Hep B shots for newborns? Interesting. I wonder what the rationale is for that. Maybe it’s done just in case the mom is infected?

      They stopped using silver nitrate here quite a while back, mainly because it is quite irritating to mucous membranes and can actually cause damage. I assume the erythromycin ointment is “safe,” albeit (in my opinion) largely unnecessary.

  5. We opted out of the Vitamin K and erythromycin ointment when our first daughter was born, but did do the blood screening. She snoozed through the screening, half nursing and half snoozing. It didn’t seem traumatic for her in the slightest. The hearing test was a different story–she wasn’t keen on that at all, but it does give valuable feedback and aside from tacking little things all over the baby’s head, it’s not too invasive. We’re getting ready for baby number two in January (home birth) and are again likely to skip most of the standard procedures administered in a hospital.

    I continued exercising (not exactly cross fit style) up until about 8 months and then I just had to slow down. I think it’s our bodies trying to tell us to slow down, relax, and save energy for the birth at that point. I started needing to sleep a lot more during the day, which was good since I wasn’t too cozy to sleep all night. I don’t know how I’ll manage it with a 3.75 year old this time around. It’s not like I can just nap when I want anymore :-). During this pregnancy, I feel more tired an it seems a bit harder to keep up with my cross training routine. We’ll see how far I can go this time. I always seem to surprise myself!

    • I just looked up the hearing screening and it appears that it is usually done before hospital discharge, which is interesting since it was never mentioned to us in all of our prenatal appointments, nor in any of the literature we received (unless our particular hospital/midwives do this on a different timeline?). But it also looks like something that can be delayed for a few days and done at a clinic, which I think is what we’ll probably do. We’d like to (ideally) spend as little time as possible in the hospital, and to make the experience as free from trauma as possible.

      http://www.phsa.ca/AgenciesAndServices/Services/BCEarlyHearing/ForFamilies/NewbornHearingScreening/HowScreen.htm

      I’ve also been noticing the need for naps during the day; though only really in the past few weeks. It probably doesn’t help that I have to get up to use the bathroom three times a night now! 🙂 Best of luck with your current pregnancy! It sounds like you have your hands full with a pre-schooler and a growing belly, but you’re right: you’ll probably surprise yourself with the things you can do 🙂

  6. I think it’s great you’re looking into and researching all of this. I did all 3 (eye ointment, Vit. K shot and blood screening) with my son, but I didn’t really know at the time any could be refused. If you are wanting to be nursing when the baby gets the heel prick, I would strongly suggest letting the nursing staff know. The nurse came in our room at 6am when I, my husband and my son were all sleeping and did the heel prick. My son woke up screaming which woke up me and my husband. I don’t know how long it took to do the test, but at the time it seemed to go on forever. It was a traumatic way for all of us to wake up. If I had known they might come in and do the test so early in the morning, I would have requested it to be later when I could have been nursing or at least holding him.

    • Wow, that’s just terrible! 😦 I would hope that most nurses would at least have the courtesy to wake the baby’s parents so that they can be involved in the process and provide comfort to the baby. In our case, the procedure is (very fortunately) done by our midwives, and I trust that they will try to be as gentle and compassionate as possible about the whole experience.

  7. We did Vit K and heel pricks (they did them on a home visit, can’t remember the day). No eye goop.

    We didn’t do as much research on the Vit K shot as you did. Just talked it out with our midwife that we really trusted. The information you have presented is great and I will be referring back to it if we are expecting again.

    Very interested to hear your decisions on birth/labour routines for yourself. I decided against any oxytocin to speed up placenta delivery. I said if I was having excessive bleeding then, of course, shoot me up but otherwise just give it time.

    • I’ve also decided against the oxytocin — partly because I’d just prefer that everything happens on its own steam, and partly because the umbilical cord is inserted marginally into my placenta, which means that there is an increased risk of separation of the two when traction is applied (which is apparently what they do along with the oxytocin shot). Of course if bleeding is excessive, then the risks change entirely, and I would have no problem with receiving oxytocin in that case.

  8. I’ve heard that breast milk is supposed to be the best thing to fight any type of infection in a baby’s eyes.

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