The pregnancy consult is an enjoyable appointment where soon to be parents come for the first time to meet and learn about the office. This is an important time to establish a good rapport with the parents and hopefully to forge what will be a long lasting relationship. I look forward to these appointments as the parents are excited about the new baby, and they radiate joyful anticipation.
Most come in with a list of questions. In a pre-emptive measure I ask them to hold the questions until I finish. I begin with the nursery experience; what will occur and what to expect. Next comes information about our office; the doctors in our group, the schedule of well-child care and how after hour calls and weekends are handled. Usually at this point they look at their list and say, “It looks like you have covered just about everything.”
When the Doe’s came in for a pregnancy consult I asked if they had any questions following my talk. Mr. Doe looked at his list and said, “There is just one thing. We don’t want our baby to get the vitamin K shot in the delivery room.” This caught me by surprise, as the usual topic of concern and angst is immunizations.
I asked him what his concerns about vitamin K were. He looked at his wife. After a long pause he said, ”We’re not sure, but a friend of ours just had a baby and they didn’t get vitamin K for their child. They said we shouldn’t either.” They went on to describe how they looked on the internet to research this. After much investigating they were more confused than ever. Mrs. Doe added, ”I haven’t been able to find a recent case of hemorrhagic disease of the newborn. Is this just one of those things that is done just because?” I then offered her this thought. “Isn’t it likely that you haven’t heard about hemorrhagic disease of the newborn BECAUSE it is standard of care to give vitamin K in the delivery room?”
I sensed their frustration and concerns and said, “Before you make a definitive decision, let me explain why we give vitamin K. Then you can think about it and hopefully this will guide you in your research so you can make an informed decision.” They almost seemed relieved by this statement as they were afraid about vitamin K, but weren’t sure what to be afraid of.
Vitamin K plays an essential role in the body’s ability to form blood clots and stop bleeding. It is synthesized by the normal bacteria that reside in our intestines. All newborns are born with low levels of vitamin K for the following reasons: a) they lack the normal gut flora to make the vitamin K, b) very small amounts of the vitamin cross the placenta from the mother, c) the newborn’s liver is not capable of storing significant amounts of vitamin K. As a result, the newborn is at risk for bleeding.
Before vitamin K was routinely given, physicians used to see a condition known as hemorrhagic disease of the newborn that Mrs. Doe alluded to. These babies would present with large bruises, bleeding from the gums or umbilicus, or having problematic bleeding after circumcision. They would have huge hematomas after routine injections. The worse manifestation would be an intra-cranial hemorrhage that could be devastating. Since the practice of giving an intramuscular dose of vitamin K in the delivery room became the standard of care, hemorrhagic disease of the newborn is a thing of the past. It is something that should NOT be seen anymore as it is entirely preventable.
Finishing my dissertation about vitamin K I asked them if they had any further questions. Mr. Doe looked down at his notebook, and took his pen to put a line through the words vitamin K that were near the top of his list. “I really don’t have a problem with our baby getting the vitamin K in the delivery room,” he said as his wife nodded in agreement.