Evidence Based Birth: Vitamin K

Here at Annapolis Area Doulas we see a lot of clients who question best birth practices, and we think that’s awesome.  You should absolutely be an informed patient and parent; knowledgeable about current research on pregnancy, birth, newborns, and the maternal post partum period.  But there is so much information out there!  That’s where we come in.  We are passionate about staying informed, and passing that information onto you, our clients.  Today we are spotlighting Vitamin K.

Vitamin K is a fat-soluble vitamin needed for blood clotting.  We are not able to make Vitamin K ourselves, and we do not store it well in our bodies.  Healthy babies (beginning around 6 months of age), children, and adults get most of their vitamin K in the form of K1 from plant sources such as leafy greens, broccoli, and avocado.  The remainder of our Vitamin K, in the form of K2, is absorbed from bacteria in our intestinal tract.  Vitamin K is necessary to activate blood-clotting factors, which are present in normal numbers at birth, but they are not fully activated due to low levels of Vitamin K.  A Vitamin K deficiency makes our blood less able to clot.  Normally our bodies adapt to low levels of Viatmin K, but in rare cases, especially with infants, the levels of Vitamin K continue to drop until spontaneous bleeding occurs.  In infants, this bleeding can occur at the umbilical site, circumcision site, skin, nose, gastrointestinal tract, and brain, depending on the age of the infant at onset.  Although rare, this condition is life threatening, and can take time to diagnose.  Thankfully, Vitamin K deficiency in infants is almost 100% preventable.

In 1961, after two decades of published research and over 150 years since the first recognition of bleeding in newborns, the American Academy of Pediatrics recommended administering a Vitamin K shot to infants just after birth, and it has been the standard of care in the Unites States ever since. 

Babies are born with very low levels of Vitamin K, even if their mothers have normal levels.  This is thought to be because babies’ blood lacks enough fatty lipids to pick up the Vitamin K that adults and even babies over six months old can get from foods.  Babies born to mothers who were administered Vitamin K right before delivery also had low Vitamin K levels, possibly because Vitamin K does not easily cross the placenta.

Babies who are exclusively breast fed are more likely to have low levels of Vitamin K if they do not receive the shot at birth.  In fact, virtually all cases of Vitamin K deficiency occur in infants who are exclusively breast fed.  The reasons for this are unknown, but it is thought that some babies cannot properly absorb Vitamin K from their mothers’ breast milk.  Formula contains high levels of Vitamin K and the fatty lipids that help babies absorb it.

A few very small studies have shown that breast feeding mothers who consume more than the recommended daily dose of Vitamin K, through diet and supplements, were able to boost the levels in their breast milk, in turn increasing the levels of their babies’ Vitamin K.  It is important to note that all the infants in these studies were given the Vitamin K shot.  No research has been done on maternal supplementation alone.

Although some other countries routinely use a heavily monitored 3-part oral dose of Vitamin K, the Unites States preferred method of administration is an intramuscular (IM) injection.  The reasons for this include easier absorption, delayed release effect that protects babies from Vitamin K deficiency long-term, and a near-perfect success rate at preventing Vitamin K deficiency in newborns without underlying liver or gallbladder disorders.  If parents are concerned about the ingredients in a Vitamin K injection, they can see the list HERE.  You also have the option to ask your hospital or birth center for the preservative-free version of the shot.  The side effects of the Vitamin K shot are bruising, bleeding, and pain at the injection site; many pediatricians recommend feeding baby while the shot is administered for comfort.  In recent history, only one allergic reaction to the Vitamin K shot has been reported.  

We believe you are your own best advocate when it comes to the many choices surrounding pregnancy and birth.  We offer supportive, non-judgmental care for you and our goal is to help you find your strength and voice as a parent.  There can be so much misleading information on the internet, especially about birth choices.  When it comes to medical decisions, we encourage you to foster open communication with your care provider. 

Source: https://evidencebasedbirth.com/evidence-for-the-vitamin-k-shot-in-newborns/