Archive | March 2013

Belly shots at 37 weeks!

37weeks_front

37weeks_side

37 weeks pregnant and the countdown is really on! My bellybutton is popped out a lot and the spot where my belly piercing was looks like a little slit that is about an inch above my bellybutton now. I have a small stretch-mark that runs up along that area and I wonder if it’s there because I took my piercing out too late in my last pregnancy or if I would have gotten a stretch-mark there regardless. Either way I am not too concerned, I don’t have any new stretch-marks, but I did get some bad varicose veins in my right leg again! They went away after my last pregnancy, so hopefully they will disappear again after this pregnancy!.

At my doctor’s visit I was “a fingertip dilated and 80% effaced”, not that this information tells me much about when I will give birth seeing as a woman could have a closed cervix in the morning and have her baby later that night! Or a mom could be dilated to four centimeters for three weeks or longer without any other signs of birth! So I am not concerned with this info, nor do I care to have any more pelvic exams. The OBs have not been particularly gentle, and I don’t want anything getting messed with in there! The OB said Vera’s head was very low, she has been head down for a while now which I am happy about. If she decides to come early or even around my due date than I have about 20 days or less till I go into labor!

When I asked the office staff if I could opt out of pelvic exams they actually had to go back and ask if it was ok. It turns out it is ok, but they were really hush hush and acting like it was a big secret or something. Is it that big of a deal to refuse a pelvic exam? They can tell how my baby is doing from measurements of my belly and by the baby’s heartbeat, so I don’t see a problem with it now. I also hope they weren’t too surprised when I asked for a female doctor for my appointment next week, the reason is because I don’t really like the male OB that my appointment was scheduled with, it is so not so much the fact that he is a man. He was just to distracting, asking a bunch of questions about my tattoo instead of giving me information about the baby. I love the last OB I saw, she took a lot of time with me this last visit and she listened to the heartbeat for a good while, so that totally made up for the last appointment. And she was really excited for me! So that was a nice feeling and affirmation that Vera is getting closer to entering the world!

I have still been nesting like crazy, cleaning, organizing and preparing as much as I can. It’s so fun and feels great when I accomplish a “nesting goal” now, and I am so thankful that I am not dead tired like I was in the beginning and middle of pregnancy. Not that I don’t have some dead tired days right now, but it is much better than it was, I am able to function! Time for more nesting today and some more precious quality time with Elena!

Advertisements

Our Birth Plan, Edited Edition

I have slightly edited our birth plan because when I transferred it from my original post to Word, it came to a little over two pages, and I didn’t want to print out that much paper or have too many pages for nurses and delivery staff to keep track of. So here is a slightly edited version which comes to about a page and a half on a Word document.

Hello to the staff at Sutter Memorial Birthing Center!

We are the S family expecting our second baby girl who we are naming Vera. We are very excited that you will be helping and sharing her birth with us. Please let us help you to get to know us better by reading our wishes for this birth. We are planning an un-medicated vaginal birth, our second one! We know that, with your help and the absence of complications, that this will be an amazing natural birth. We believe that flexibility and having an open mind for all our parts is key. We would like to ask to be attended by staff who the most enthusiastic about helping with an un-medicated birth. We look forward to getting your support and your advice throughout our experience. Our birth team consists of myself, my husband, our doula Teresa and my grandma Betty.

Labor

  • I am happy to move around and change positions for more comfort and to speed up labor.
  • I would like the room to remain dim with no bright lights during labor and after delivery.
  • I would like to sip water or coconut water throughout labor to prevent dehydration.
  • In the absence of complications I would like minimal interventions such as pain medication, vaginal exams, internal monitoring and IV.
  • Please help me by not asking if I want pain medications since myself or one of my birth team members will let you know if I change my mind.
  •  If interventions become necessary, please allow us time to review all the risks and benefits with you.
  • I would like to forgo continuous monitoring unless it becomes necessary.

Delivery

  • Please help me to try a variety of positions including the squatting bar.
  • I would like to push only when I feel the urge and would like direction in my low grunting and vocal noises.
  • I would prefer not to have an episiotomy unless it is absolutely necessary to hasten Vera’s delivery
  • If possible my husband would like to help deliver or catch Vera.

After Delivery

  • I want my daughter placed on my stomach/chest immediately after delivery to allow us to bond.
  • We do not want the umbilical cord to be cut until it has stopped pulsating and until Vera has received all of the blood from the placenta. My husband would like to cut the cord when the time comes.
  • We do not want Vera to receive the Vitamin K Shot/injection
  • We do not want Vera to receive Erythromycin eye ointment
  • Please delay all noncritical measures: We would like all non-emergency routines to be postponed from being administered to Vera until at least 1 to 2 hours after her birth so we can immediately bond with her and begin breastfeeding.
  • If my daughter must be taken from me to receive medical treatment, my husband will accompany her at all times.
  • We want to request a private room whenever one is available.
  • Please do not announce our daughter’s birth to family members who may be waiting outside, we will let them know after Vera has breastfed.

Placenta

  • We want to keep the placenta, please do not discard it
  • We prefer to allow the placenta to be delivered without assistance, pulling, or medication.
  • We plan on encapsulating the placenta and have brought a cooler filled with ice for the placenta to remain in until transfer by us.

Breastfeeding

  • I would like to avoid all artificial nipples including pacifiers and bottles.
  • If Vera and I have any trouble with breastfeeding I welcome your guidance and support to help us along with our latching and with any other problems we may have.
  • This will be my second time breastfeeding a newborn and I plan to nurse on demand and exclusively.

In case of Cesarean: I would like my husband present at all times, as well as my doula if the anesthesiologist allows it. As long as we are both stable, please facilitate a minimal separation between Vera and I so I can breastfeed and bond as soon as possible.

Thank You!

We would like to thank you ahead of time for your help and participation in our un-medicated birth of our baby girl Vera! We understand that in the event of an emergency flexibility is required, and we will discuss necessary changes to our birth plan with the hospital staff and medical team. Thank you for helping us make the birth of baby Vera unique and special.

Packing Our Hospital Bag!

Open

I am 35 weeks pregnant, so it is time to prepare our hospital bags! By researching online and from what I remember about my first birth I have prepared this packing list.

Labor/Delivery Bag

  • Photo ID
  • My birth plan and copies of it
  • A prepackaged snack for the labor and delivery staff like a box of muffins or granola bars
  • Glasses and contact lenses
  • Delivery outfit: Sports or nursing bra, my new pink delivery dress
  • Socks and slippers in case I don’t want bare feet
  • Picture of me with my oldest daughter at her birth
  • Lip gloss and/or chap stick
  • Coconut water for hydration
  • Favorite snacks such as luna bars
  • Picture of birthing statue from Ina May’s book
  • My pillow
  • Money in cash or change
  • Camera and video camera
  • Gum or mints
  • Placenta bags and cooler
  • Headband and rubber bands

For Recovery/Postpartum Room

  • Cell Phones and chargers
  • Toiletries, toothbrush, toothpaste, deodorant, body wash, shampoo
  • Change of clothes
  • Nightgown or sweat pants and nursing tank top
  • Clothes to go home in, probably a sweat suit or maternity dress
  • Nursing bras
  • Gift for big sister
  • Picture of big sister
  • List of people to call
  • Nipple shields and nipple cream
  • Motrin or tylenol

For Baby

  • A going-home outfit
  • socks, under shirts, sleep gown
  • Burp cloths
  • Favorite receiving blanket that smells like home
  • Car Seat
  • Diaper bag with a few diapers and gentle wipes

Is Erythromycin Eye Ointment Always Necessary for Newborns? « Evidence Based Birth

Newborn child, seconds after birth. The umbili...

Newborn child, seconds after birth. The umbilical cord has not yet been cut. (Photo credit: Wikipedia)

 

By Rebecca Dekker, PhD, RN, APRN © 2012

 

What is the history of using eye ointment in newborns?

 

The use of erythromycin eye ointment in newborns has its roots in the late 1800s. During that time period, approximately 10% of newborns born in maternity hospitals across Europe developed ophthalmia neonatorum (ON). This is a type of pink eye that caused blindness in 3% of infants who were affected (Schaller and Klauss 2001). This means that during the late 1800s, before antibiotics were discovered, 0.3% of infants (3 out of 1,000) were blinded from ON.

 

In 1881, a physician named Carl Crede realized that infants were catching ON during vaginal delivery, and that the infections were caused by gonorrhea—a sexually transmitted infection. Dr. Crede found that by putting silver nitrate in the eyes of newborn babies, he could prevent ON. In fact, the number of newborn ON infections in Dr. Crede’s hospital went from 30-35 cases per year to 1 case in the first six months he started using silver nitrate.

 

Today, more than 130 years after Dr. Crede made his discovery, quite a few things have changed. First, the development of antibiotics has made it possible to treat an infant who contracts ON—thus making blindness highly unlikely. Also, silver nitrate is no longer used in most developed countries, because it is highly irritating to the eye and can cause severe pain, chemical pink eye, and temporary vision impairment. Silver nitrate is also not effective with infections caused by chlamydia, the most common cause of ON today. Furthermore, silver nitrate and tetracycline eye ointment (another antibiotic that has been used in the past to prevent ON) are no longer available in the U.S. For these reasons, 0.5% erythromycin ophthalmic ointment is used in the U.S. and Canada to prevent ON infection.

 

What causes ophthalmia neonatorum?

 

Pink eye, or conjunctivitis, can be caused by viruses (ex. Herpes), bacteria, chemicals, and blocked tear ducts. One type of pink eye called ophthalmia neonatorum (ON). ON is a conjunctivitis or pink eye that occurs during the first month of life and is contracted during birth. The two main causes of ON are chlamydia or gonorrhea, both of which are sexually transmitted infections (Ali, Khadije et al. 2007). For the rest of this article, whenever I say “ON,” I am referring to chlamydial or gonorrheal ON. Without treatment, ON can potentially lead to permanent eye damage or blindness. However, this is a treatable disease, and blindness can be avoided if oral or intravenous antibiotics are administered promptly after an infant develops ON (Darling and McDonald 2010).

 

The only way for a newborn to contract ON is if the mother is infected with chlamydia or gonorrhea. If the mother does not have chlamydia or gonorrhea, then the newborn cannot catch it. Also, if a baby is born by C-section and if the mom’s water never broke before surgery, then it is extremely unlikely that the baby could catch ON (Medves 2002).

 

How do you know if a mother is at risk for chlamydia or gonorrhea?

 

Anyone who is sexually active can contract chlamydia or gonorrhea. You can avoid both chlamydia and gonorrhea if you are in a long-term, mutually faithful relationship in which both partners have been tested and are uninfected. Your risk of contracting chlamydia or gonorrhea is higher if you are young (under the age of 25), if you have multiple sexual partners, or if you live in an area where there are high rates of infection. In the U.S., gonorrhea rates are lower now than they have been in the past, while chlamydia rates are rising (CDC, 2010). In Africa and in some developing countries rates of these infections are much higher.

 

Most people who have chlamydia or gonorrhea do not have any symptoms, so you can have an infection and not know it. Chlamydia and gonorrhea can cause serious health consequences, such as infertility, ectopic pregnancy, pelvic inflammatory disease and preterm birth. For these reasons, most women in developed countries are screened for chlamydia and gonorrhea (CDC, 2012).

 

Why is erythromycin used to prevent ON?

 

One way to prevent ON is to give all newborns an eye treatment (such as erythromycin) that would prevent the infection. This is called prophylaxis (“Pro- fuh- LAX-is”). Prophylaxis means taking action ahead of time to prevent something bad from happening. Automatic newborn prophylaxis with eye ointment is currently recommended by multiple health organizations in the United States, including the U.S. Preventive Services Task Force, the American Association of Family Physicians, and the American Academy of Pediatrics.

 

Newborn eye prophylaxis is also mandated by state law in most U.S. states. In 2006, a search of state law databases found that at least 32 U.S. states had laws requiring newborn prophylaxis against ON (Standler 2006). In these states, health care providers are required to administer the eye ointment in every newborn, regardless of the mother’s chlamydia or gonorrhea status, and regardless of whether or not the baby was born vaginally or by C-section. Some states, such as New York, do not allow parents to exercise their right to informed refusal, and hospital employees in New York will go so far as to call Child Protective Services if the parents do not want the erythromycin ointment.

 

On the other hand, automatic erythromycin prophylaxis is no longer used in the United Kingdom, Australia, Norway, or Sweden (Darling and McDonald, 2010).

 

What is the evidence for erythromycin prophylaxis to prevent newborn pink eye?

 

In a 2010 meta-analysis, researchers combined results from 8 semi-randomized trials that looked at the effectiveness of various eye ointments to prevent ON (Darling and McDonald 2010). The use of erythromycin was evaluated in 4 of those studies. As you can see from looking at the table below, erythromycin was more effective than silver nitrate at preventing chlamydial ON, but it is not any better than silver nitrate at preventing gonorrheal ON. Only one study compared erythromycin to no prevention, and it found no differences in ON rates between newborns who received erythromycin and those who did not receive any.

 

Study author (year) Participants Findings
Isenberg (1995) 3,117 newborns in a hospital setting in Kenya

When compared to silver nitrate, erythromycin resulted in a 30% reduced risk of chlamydia ON. Erythromycin resulted in no reduction in the risk of gonorrhea ON when it was compared to silver nitrate.  

Chen (1992) 4,544 newborns in a hospital in Taiwan Erythromycin did not make any difference in the rates of chlamydia ON when compared to no prophylaxis at all.
Hammerschlag (1989) 230 newborns born to mothers with chlamydia in New York, as well as the overall 12,431 newborns born during the study period When compared to silver nitrate, erythromycin led to a 28% reduction in the risk of chlamydia ON. Erythromycin did not reduce the risk of gonorrhea ON (when compared to silver nitrate).
Hammerschlag (1980) 60 newborns born to mothers who all had chlamydia at the time of birth in Seattle, Washington There were no cases of chlamydia ON, so researchers could not tell if erythromycin was more effective than silver nitrate.

 

The overall quality of these clinical trials was low, and so it is necessary to look at other types of studies to determine the effects of ON prophylaxis. In a large observational study in South Africa, no eye prophylaxis was used for a certain amount of time, and then 3 hospitals started using silver nitrate and erythromycin. When they compared no prophylaxis to prophylaxis among 30,530 newborns, the number of gonorrheal ON infections dropped from 273 cases per 100,000 births to 34 cases per 100,000 births. However, there was a 20% failure rate, meaning that the prophylaxis was not perfect—it failed to work 20% of the time (Lund et al., 1987).

 

It may be helpful to summarize the risks and benefits of erythromycin like this:

 

Benefits:

 

  • Erythromycin can reduce the risk of chlamydial and gonorrheal ON (Darling and McDonald 2010)
  • Erythromycin prophylaxis may be helpful if the mother was not screened for chlamydia/gonorrhea, screening results were not correct, or if there is a sexual partner who may be re-infecting her (Medves 2002)
  • Erythromycin prophylaxis may be especially helpful in geographic regions where rates of chlamydia and gonorrhea are very high (Medves 2002)
  • Erythromycin ointment is inexpensive (Darling and McDonald 2010)

 

Risks:

 

 

Are there any other options beside the erythromycin?

 

One option is for the mother to be screened for sexually transmitted infections during pregnancy and receive antibiotic treatment if needed. If the mother is treated, then she would need follow-up testing to make sure the treatment was effective. If a mother is not infected with chlamydia or gonorrhea and is in a mutually faithful relationship with an uninfected partner, then newborn eye ointment may be reasonably declined (Medves, 2002).

 

The benefits of this option are that a potentially harmful sexually transmitted infection can be detected and treated. This improves the health of both the mother and the newborn. The disadvantages are that if this is done on a large scale, it requires a well-organized maternity care system in which all pregnant women are screened for sexually transmitted infections. Although this is do-able in some countries, it may not be feasible in others. Another disadvantage is that a woman may test negative for chlamydia or gonorrhea, but then be infected by a partner before giving birth.

 

The U.S. Centers for Disease Control recommends that all pregnant women be screened for chlamydia at the first prenatal visit, and that women at high risk for gonorrhea be screened as well. In a recent study of 1.29 million pregnant women, researchers found that 57-59% of U.S. women were screened at least once during pregnancy for chlamydia or gonorrhea. Of these women who were screened, 3.5% tested positive for chlamydia and 0.6% tested positive for gonorrhea. The majority of the women who tested positive (76-68%) were re-tested again. A small number of these women were still positive for chlamydia (6%) or gonorrhea (3.8%) at the last test before giving birth (Blatt et al. 2012)

 

Another option is to wait and see if a newborn develops ON. If the newborn baby shows signs of ON, treatment can be started with systemic antibiotics.This method is currently used in the United Kingdom. In 1998, there were 31 cases per 100,000 newborns born in the United Kingdom. In the year 1999 in Canada—where they use erythromycin eye ointment—the rate of ON was 49.5 per 100,000 newborns (Medves 2002). 

 

Another option is Povidone-iodine, a disinfectant drop that can be placed into the newborn’s eyes. Povidone-iodine is becoming popular in developing countries because it is less expensive than erythromycin. This disinfectant does NOT increase the risk of antibiotic resistance and it is just as effective as erythromycin and silver nitrate at preventing gonorrheal ON. Povidone iodone is also more effective than silver nitrate and equally effective as erythromycin at preventing chlamydial ON. However, newborn eye drops made out of povidone-iodine are not yet available in the United States (Darling and McDonald 2010).

 

In summary

 

  • ON is a preventable and treatable newborn eye infection caused by chlamydia and gonorrhea
  • Options include screening for chlamydia and gonorrhea, using erythromycin eye ointment after birth, a “wait and see” approach in which antibiotics are used only when necessary, or using povidone-iodine eye drops after birth
  • Erythromycin eye ointment can be reasonably declined if the mother is not infected with chlamydia or gonorrhea and if she is in a mutually faithful relationship with an uninfected partner
  • It is highly unlikely that a baby that is born by C-section could catch ON as long as the mother’s membranes were intact at the time of surgery
  • Laws in most U.S. states mandate the use of erythromycin with all newborns even though the erythromycin is not always necessary and even though other options are available
  • Given the fact that other options can be used to safely prevent and treat newborn eye infections, the mandatory nature of these erythromycin state laws should be re-evaluated

 

If you liked this article, you will probably like:

 

 

For more information about erythromycin:

 

 

What are the laws about newborn erythromycin ointment in your country or state? Do you agree with my conclusion that erythromycin is not always necessary? 

 

References

 

  1.  Ali, Z., D. Khadije, et al. (2007). “Prophylaxis of ophthalmia neonatorum comparison of betadine, erythromycin and no prophylaxis.” J Trop Pediatr 53(6): 388-392.
  2. Blatt, A. J., J. M. Lieberman, et al. (2012). “Chlamydial and gonococcal testing during pregnancy in the United States.” Am J Obstet Gynecol 207(1): 55 e51-58.
  3. Centers for Disease Control (2012). Chlamydia – CDC Fact Sheet.
  4. Centers for Disease Control (2010). STD trends in the United States: 2010 national data for gonorrhea, chlamydia, and syphilis.
  5. Chen, J. Y. (1992). “Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis.” Pediatr Infect Dis J 11(12): 1026-1030.
  6. Darling, E. K. and H. McDonald (2010). “A meta-analysis of the efficacy of ocular prophylactic agents used for the prevention of gonococcal and chlamydial ophthalmia neonatorum.” J Midwifery Womens Health 55(4): 319-327.
  7. Hammerschlag, M. R., J. W. Chandler, et al. (1980). “Erythromycin ointment for ocular prophylaxis of neonatal chlamydial infection.” Journal of the American Medical Association 224(20): 2291-2293.
  8. Hammerschlag, M. R., C. Cummings, et al. (1989). “Efficacy of neonatal ocular prophylaxis for the prevention of chlamydial and gonococcal conjunctivitis.” N Engl J Med 320(12): 769-772
  9. Hedberg, K., Ristinen, T. L., Soler, J. T., et al. (1990). “Outbreak of erythromycin-resistant staphylococcal conjunctivitis in a newborn nursery.” Pediatr Infcect Dis J 9(4): 268-273.
  10. Isenberg, S. J., L. Apt, et al. (1995). “A controlled trial of povidone-iodine as prophylaxis against ophthalmia neonatorum.” N Engl J Med 332(9): 562-566.
  11. Lund, R. J., M. A. Kibel, et al. (1987). “Prophylaxis against gonococcal ophthalmia neonatorum. A prospective study.” S Afr Med J 72(9): 620-622.
  12. Medves, J. M. (2002). “Three infant care interventions: reconsidering the evidence.” J Obstet Gynecol Neonatal Nurs 31(5): 563-569.
  13. Schaller, U. C. and V. Klauss (2001). “Is Crede’s prophylaxis for ophthalmia neonatorum still valid?” Bulletins of the World Health Organization 79(3): 262-263.
  14. Standler, R. B. (2006). Statutory law in the USA: requiring silver nitrate in eyes of newborns. Published online at http://www.rbs2.com/SilvNitr.pdf

 

via Is Erythromycin Eye Ointment Always Necessary for Newborns? « Evidence Based Birth.

 

Vitamin K at Birth: To Inject or Not

A baby having milk from a bottle.

A baby having milk from a bottle. (Photo credit: Wikipedia)

Vitamin K at Birth: To Inject or Not

Posted By Dr. Ben Kim

Before my wife gave birth to our first child, our primary midwife asked us to think about whether we wanted our child to receive a vitamin K shot after he was born or not.

Vitamin K shots are routinely administered to newborn babies because 1.8 out of every 100,000 babies who do not receive vitamin K injections suffer permanent injury or death due to uncontrolled bleeding in the brain that may be the result of having extremely low levels of vitamin K in their systems.

Our instinct was to decline the shot for our baby, but after our midwife gave the vitamin K shot a strong endorsement due to an experience she had of seeing an non-injected baby die from intracranial bleeding, we felt enough uncertainty to go with her recommendation.

Most fortunately, our son had no problems with his injection and is thriving as he approaches 22 months of age.

In preparing to welcome our second child this coming summer, we recently decided to do some more research into the pros and cons of giving vitamin K shots to newborns. After reading through several papers and discussing the matter over many days, we decided that for our second child, we will decline the vitamin K shot.

After reading about some of the potential problems that can result from administering vitamin K shots to newborns, we decided that we feel more comfortable having my wife each plenty of vitamin K-rich foods late in her pregnancy and while she nurses our baby.

What follows is the most balanced and informative article on this topic that we encountered during our research. If this topic is of interest to you, please be sure to read the entire article that follows. Do not be alarmed when you first encounter the references to vitamin K shots being linked with an increased risk of developing cancer. When you get to the section that is subtitled “The Numbers,” you will see that the statistics do not clearly favor giving or not giving a vitamin K shot to newborns.

If you are expecting to have a baby, we hope that you find this information to be useful as you make a decision that feels right for your unique circumstances.

***

Reprinted from the International Chiropractic Pediatric Association Newsletter, September/October 2002 Issue

UPDATED May 19, 2004

by Linda Folden Palmer, DC (http://babyreference.com)

Newborn infants routinely receive a vitamin K shot after birth in order to prevent (or slow) a rare problem of bleeding into the brain weeks after birth. Vitamin K promotes blood clotting. The fetus has low levels of vitamin K as well as other factors needed in clotting. The body maintains these levels very precisely.(1) Supplementation of vitamin K to the pregnant mother does not change the K status of the fetus, confirming the importance of its specific levels.

Toward the end of gestation, the fetus begins developing some of the other clotting factors, developing two key factors just before term birth.(2) It has recently been shown that this tight regulation of vitamin K levels helps control the rate of rapid cell division during fetal development. Apparently, high levels of vitamin K can allow cell division to get out of hand, leading to cancer.

What’s the Concern?

The problem of bleeding into the brain occurs mainly from 3 to 7 weeks after birth in just over 5 out of 100,000 births (without vitamin K injections); 90% of those cases are breastfed infants (3) because formulas are supplemented with unnaturally high levels of vitamin K. Forty percent of these infants suffer permanent brain damage or death.

The cause of this bleeding trauma is generally liver disease that has not been detected until the bleeding occurs. Several liver problems can reduce the liver’s ability to make blood-clotting factors out of vitamin K; therefore extra K helps this situation. Infants exposed to drugs or alcohol through any means are especially at risk, and those from mothers on anti-epileptic medications are at very high risk and need special attention.

Such complications reduce the effectiveness of vitamin K, and in these cases, a higher level of available K could prevent the tragic intracranial bleeding. This rare bleeding disorder has been found to be highly preventable by a large-dose injection of vitamin K at birth.

The downside of this practice however is a possibly 80% increased risk of developing childhood leukemia. While a few studies have refuted this suggestion, several tightly controlled studies have shown this correlation to be most likely.(4,5) The most current analysis of six different studies suggests it is a 10 or 20% increased risk. This is still a significant number of avoidable cancers.(6)

Apparently the cell division that continues to be quite rapid after birth continues to depend on precise amounts of vitamin K to proceed at the proper rate. Introduction of levels that are 20,000 times the newborn level, the amount usually injected, can have devastating consequences.

The Newborn’s Diet

Nursing raises the infant’s vitamin K levels very gradually after birth so that no de-regulation occurs that would encourage leukemia development. Additionally, the clotting system of the healthy newborn is well planned, and healthy breastfed infants do not suffer bleeding complications, even without any supplementation.(7)

While breastfed infants demonstrate lower blood levels of vitamin K than the “recommended” amount, they show no signs of vitamin K deficiency (leading one to wonder where the “recommended” level for infants came from). But with vitamin K injections at birth, harmful consequences of some rare disorders can be averted.

Infant formulas are supplemented with high levels of vitamin K, generally sufficient to prevent intracranial bleeding in the case of a liver disorder and in some other rare bleeding disorders. Although formula feeding is seen to increase overall childhood cancer rates by 80%, this is likely not related to the added vitamin K.

The Numbers

Extracting data from available literature reveals that there are 1.5 extra cases of leukemia per 100,000 children due to vitamin K injections, and 1.8 more permanent injuries or deaths per 100,000 due to brain bleeding without injections. Adding the risk of infection or damage from the injections, including a local skin disease called “scleroderma” that is seen rarely with K injections (8), and even adding the possibility of healthy survival from leukemia, the scales remain tipped toward breastfed infants receiving a prophylactic vitamin K supplementation. However, there are better options than the .5 or 1 milligram injections typically given to newborns.

A Better Solution

The breastfed infant can be supplemented with several low oral doses of liquid vitamin K9 (possibly 200 micrograms per week for 5 weeks, totaling 1 milligram, even more gradual introduction may be better). Alternatively, the nursing mother can take vitamin K supplements daily or twice weekly for 10 weeks. (Supplementation of the pregnant mother does not alter fetal levels but supplementation of the nursing mother does increase breast milk and infant levels.)

Either of these provides a much safer rate of vitamin K supplementation. Maternal supplementation of 2.5 mg per day, recommended by one author, provides a higher level of vitamin K through breast milk than does formula (10), and may be much more than necessary.

Formula provides 10 times the U.S. recommended daily allowance,” and this RDA is about 2 times the level in unsupplemented human milk. One milligram per day for 10 weeks for mother provides a cumulative extra 1 milligram to her infant over the important period and seems reasonable. Neither mother nor infant require supplementation if the infant is injected at birth. (11)

The Bottom Line

There is no overwhelming reason to discontinue this routine prophylactic injection for breastfed infants. Providing information about alternatives to allow informed parents to refuse would be reasonable. These parents may then decide to provide some gradual supplementation, or, for an entirely healthy term infant, they may simply provide diligent watchfulness for any signs of jaundice (yellowing of eyes or skin) or easy bleeding.

There appears to be no harm in supplementing this vitamin in a gradual manner however. Currently, injections are provided to infants intended for formula feeding as well, although there appears to be no need as formula provides good gradual supplementation. Discontinuing routine injections for this group alone could reduce cases of leukemia.

One more curious look at childhood leukemia is the finding that when any nation lowers its rate of infant deaths, their rate of childhood leukemia increases.(12) Vitamin K injections may be responsible for some part of this number, but other factors are surely involved, about which we can only speculate.

Note from Ben Kim: To learn more about Dr. Linda Folden Palmer and her work, please visit: BabyReference.com.

Notes

1. L.G. Israels et al., “The riddle of vitamin K1 deficit in the newborn,” Semin Perinatol 21, no. 1 (Feb 1997): 90-6.

2. P. Reverdiau-Moalic et al., “Evolution of blood coagulation activators and inhibitors in the healthy human fetus,” Blood (France) 88, no. 3 (Aug 1996): 900-6.

3. A.H. Sutor et al., “Late form of vitamin K deficiency bleeding in Germany,” Klin Padiatr (Germany) 207, no. 3 (May-Jun 1995): 89-97.

4. L. Parker et al., “Neonatal vitamin K administration and childhood cancer in the north of England: retrospective case-control study,” BMJ (England) 316, no. 7126 (Jan 1998): 189-93.

5. S.J. Passmore et al., “Case-control studies of relation between childhood cancer and neonatal vitamin K administration,” BMJ (England) 316, no. 7126 (Jan 1998): 178-84.

6. E. Roman et al., “Vitamin K and childhood cancer: analysis of individual patient data from six case-control studies,” Br J Cancer (England) 86, no. 1 (Jan 2002): 63-9.

7. M. Andrew, “The relevance of developmental hemostasis to hemorrhagic disorders of newborns,” Semin Perinatol 21, no. 1 (Feb 1997): 70-85.

8. E. Bourrat et al., “[Scleroderma-like patch on the thigh in infants after vitamin K injection at birth: six observations],” Ann Dermatol Venereol (France) 123, no. 10 (1996): 634-8.

9. A.H. Sutor, “Vitamin K deficiency bleeding in infants and children,” Semin Thromb Hemost (Germany) 21, no. 3 (1995): 317-29.

10. S. Bolisetty, “Vitamin K in preterm breast milk with maternal supplementation,” Acta Paediatr (Australia) 87, no. 9 (Sep 1998): 960-2.

11. K. Hogenbirk et al., “The effect of formula versus breast feeding and exogenous vitamin K1 supplementation on circulating levels of vitamin K1 and vitamin K-dependent clotting factors in newborns,” Eur J Pediatr 152, no. 1 (Jan 1993): 72-4.

12. A. Stewart, “Etiology of childhood leukemia: a possible alternative to the Greaves hypothesis,” Leuk Res (England) 14, nos. 11-12 (1990): 937-9.

Pregnancy is Sexy?

Hot Milk cinderella Hot Milk mimi lingerie Screen-Shot- beautifulBy Caring Doula

Pregnancy is sexy…this is a reality that is so hard for many women and men to grasp, not only because of what society teaches us about what is or should be sexy, but because of all the changes our bodies go through that we see as “ugly” or even “disgusting”. Throughout my Anieline feeding lingerietwo pregnancies and from what I have learned from my first birth and from my relationship with my husband, I discovered that I have lost most of my sexy. I used to be vibrantly sexy, meaning I felt passion, desire and sexiness when it came to myself, my life, and my relationship with my husband. But somewhere between taking care of our new baby girl and having my mother-in-law living with us at that crucial time in our lives, we started struggling emotionally, and of course a physical relationship is hard to keep up as first time parents (or second, or third time parents…), which didn’t help up in our attempts at reconnecting.

I am certainly not alone when it comes to facing stresses like these. These are struggles that many first time mothers go through, and if we don’t remember to bring our sexy back, I believe it creates a real imbalance in our lives. Especially if we choose to have more children! Thankfully, my husband and I have adjusted and regained our intimacy, but I haven’t been feeling “vibrantly sexy” for a while, and now I am trying to get it back! Changes in our bodies that we see in a negative light, because they are ugly or uncomfortable, are far too easy to focus on. We have to remember to find our positives and flaunt those! Positives may include that pregnancy “glow”, that adorable baby bump, that thick shinning head of hair, the increase of breast voluptuousness (bigger boobies!), the increased sex drive, or just the radiant joy of knowing that you are carrying a miracle.

Through all of my reading and research on pregnancy and birth I finally discovered how important my intimate relationship between myself and my husband and my feelings about myself and my body will be during my labor and birth, as well as my postpartum experience. Our baby was created in a dark, safe, and intimate space of love, trust, and pleasurable emotions free from fear and pain, and this is the same environment that I want our baby to be born in. It is not the same as making love obviously! But the love and intimacy and the trust you create with your partner is vital for a woman in labor. It will not only create an easier labor for the mother, but can make labor and birth an even more profound and strengthening experience for our relationship and for ourselves as individuals.

In his book Husband Coached Childbirth, Dr. Robert A Bradley writes, “…your wife must be…supported, loved, guided, directed and encouraged”, and of course if the woman does not have a person with her such as a husband or partner, then a friend, family member, doula or nurse can be the labor coach. As I have mentioned before, our nurse, Heather, was so incredibly important to our first daughter’s birth, she showed my husband how to coach me and he took over from there, becoming my rock.

Dr. Bradley’s book helped me realize the importance of a labor support person and the importance of my husband’s role when I read his book during my first pregnancy. My new realizations about myself and my life have stemmed from reading the book Orgasmic Birth: Your Guide to a Safe, Satisfying, and Pleasurable Birth Experience by Elizabeth Davis and Debra Pascali-Bonaro. Trust me, it’s not what you think! At least, not all of it! This book is about how to achieve something more than lovemaking, it is about discovering birth as a spiritual and unforgettable moment that is beyond words, about the passion of the gift of life, and experiencing birth  as the miracle that it truly is: the “welcoming” into our world and celebration of the greatest gift and the greatest love that we can or will ever experience in our lives.

So, back to the sexiness of pregnancy, or in other words, back to myself and my passions for life. How will I get it back? The Orgasmic Birth has some great steps, but I am still in the middle of this book, so I will have to come back to that. Steps I can make for myself include listening to more music that ignites joy and vibrancy from within, taking up belly dancing again, being as healthy as I can, meditating in the present moment, and looking at gorgeous and inspiring photos of other pregnant women or families with newborns such as the ones I have included in this post, and maybe taking some of our own pictures like these. Oh, I also bought a sexy nursing bra by Hot Milk and I plan on buying more sexy maternity and postpartum wear that make me not only feel like I am still a woman, but a sexy and beautiful woman.