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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
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It is unfortunate that the current standard of care regarding Hemorrhagic Disease of the Newborn and vitamin K is still experimental; early results were put into practice without adequate research to determine best practices.
Therefore, practitioners are in a difficult place regarding what to recommend.
If you just want to protect yourself legally with the least
amount of trouble, then you'll probably want to recommend the
standard vitamin K injection at birth.
If you want to provide the best care, you'll work to ensure that
baby has a trauma-free birth and gets all the blood nature
intended through Optimal Cord Clamping.
Then you'll encourage parents to agree to either injected or oral
vitamin K shortly after the birth and then empower them to
continue giving at least weekly doses of oral vitamin K for three
Midwife Informed Consent for Vitamin K
Falcao, LM MS
High Risks to Your Baby From Vitamin K Shot They Don’t Warn You About
According to Dr. Cees Vermeer, PhD, Associate Professor of
Biochemistry at the University of Maastricht (in The Netherlands),
the world’s leading specialist in vitamin K, "Vitamin K shots
are completely unnecessary for your newborn."
The forces of nature are so focused on a successful birth that it just seems unlikely that all babies are deficient in vitamin K. Instead of simply accepting that nature goofed about clotting factors in newborns, I thought about all the ways that interventions at birth interfere with the normal physiological birth process regarding clotting. The most obvious intervention is premature cutting of the umbilical cord; this deprives a newborn of 25% to 40% of the physiological blood volume, and thus 25% to 40% of the physiological clotting factors that nature intended to be present in the newborn's blood. As someone who does Newborn Screening heelsticks on newborns whose umbilical cords were not cut prematurely (and some of whom did not receive supplemental vitamin K), I can tell you that they have no trouble clotting normally. This solves the problem of early-onset or classical HDN.
Although vitamin K doesn't pass easily from the mother's bloodstream to the newborn through the placenta, it DOES pass easily through breastmilk. (Doesn't this seem like a strong clue that nature is actually protecting the baby somehow by managing the clotting factors in a very specific way?) Women who eat lots of fresh, leafy green vegetables will pass the vitamin K through to their babies, and this will protect them from late-onset HDN.
So, maybe nature got it right, after all, and all we have to do is support physiological health by waiting at least 5 minutes after the birth to cut the cord and by encouraging nursing mothers to eat lots of fresh, leafy green vegetables (or take a vitamin K supplement).
Some exceptions are:
Some maternal medications interfere with vitamin K, such as anticonvulsants, anticoagulants, and antibiotics. [Maternal vitamin K supplementation that is administered prenatally may prevent this form of HDN.
Vitamin K generation is also inhibited in babies who have received antibiotics.
A very few babies will have a liver disorder that prevents the normal production of vitamin K in the newborn's gut; symptoms tend to appear slowly.
Other risk factors include diarrhea, hepatitis, cystic fibrosis
(CF), celiac disease, and alpha1-antitrypin deficiency.
- Excellent Patient Education from Kent Midwifery Practice in the
UK (Kay Hardie and Virginia Howes)
K for vitamin K deficiency bleeding in neonates (Cochrane
Vitamin K at Birth: To Inject or Not By Linda Folden Palmer, DC, author of Baby Matters
This is an excellent discussion of why a dosage of 20,000 times
the normal newborn level of vitamin K is inappropriate for a
normal, physiological birth where the baby's umbilical cord is
left intact. She also discusses how vitamin K could disrupt
the regulation of cell growth, which might lead to leukemia or
other childhood cancers.
"Policies for giving babies vitamin K prophylactically at birth have been dictated, over the last 60 years, more by what manufacturers decided on commercial grounds to put on the market, than by any informed understanding of what babies actually need, or how it can most easily be given. By a pure fluke a 1 mg IM dose, designed to prevent early vitamin deficiency bleeding ("haemorrhagic disease of the newborn") has been found to protect against late deficiency bleeding-a condition unrecognised at the time this policy took hold. Alternative strategies for oral prophylaxis are now opening up (see pp 109 and 113), but these are also, at the moment, dictated more by what the manufacturers choose to provide than by what would make for ease of delivery either in poor countries, or in the developed world."
From the full-text paper:
CONCLUSION - So what have we learnt in the last 64 years? That
babies have very limited reserves of vitamin K at birth, and that
some will soon bleed if a continuing intake is not guaranteed. We
also know that a few "supplements" of cows milk50 or formula
milk14 can suffice to restock those reserves, and that there is
really no case for giving the healthy, artificially fed, baby
further supplementation, either by injection or by mouth, other
than administrative convenience. Babies who are not fed, and a
very small number of fully breast fed babies, will develop
symptomatic deficiency. Without prophylaxis the risk of early
(easily recognised) bleeding in a healthy non-traumatised term
baby in the first two weeks of life is probably only 1–2 in a
thousand. The risk of a later (potentially more dangerous) bleed
is perhaps a third of that. Both these risks can be virtually
eliminated by giving a single 1 mg intramuscular "depot"
injection of phytomenadione, or by giving the baby 1 mg by mouth
once a week for the first three months of life. Indeed the
only babies not protected by four 1 mg (or three 2 mg) oral doses,
if well spaced out, are those with some as yet unrecognised liver
K - An Alternative Perspective
Midwife Sara Wickham provides a much-needed update on vitamin K prophylaxis.
AIMS Journal, Summer 2001, Vol 13 No 2
From a WHO (World Health Organization) publication--Maternal and newborn health / Postpartum care of the mother and newborn: a practical guide / 10. Care and service provision in the postpartum period
Care in the first hours includes: . . . administering vitamin K to the baby if country policy prescribes it, either by injection or orally. However, the evidence for routine administration of vitamin K to all newborns to prevent the relatively rare haemorrhagic disease of the newborn is still lacking.
It occurs to me that WHO has much more exposure to physiological birth practices than other evidence-based recommendations bodies, such as the Cochrane Collaboration. And given that WHO works on health issues for those who often have very poor nutrition, you'd think they would have noticed problems with HDN or vitamin K deficiency if it were seen in cases where the cord is left intact for a few minutes after the birth.
Sara Wickham's writing points out that HDN or vitamin K
deficiency was not reported in the literature before the modern
practice of premature cutting of the umbilical cord at birth.
for the Vitamin K - National standard mandates newborn
vitamin K injection. Ignorance becomes tacit consent for the
questionable neonatal procedure by Don Harkins [Ed: It may be that
healthcare providers are required to offer the vitamin K
injection, and many don't actually wait for parental consent, but
I don't think the injection is technically mandated.]
The purpose of vitamin K is to increase the clotting factors for a newborn. But is that always a good idea?
This web page on Polycythemia of the Newborn reminds us that increased clottng factors can cause blood clots and decreased tissue oxygenation. This is especially true with a higher blood plasma volume, as occurs when the cord is left intact for a few minutes after birth and the baby naturally plumps up its circulatory system.
Some very recent studies in The Lancet have associated increased clotting with twice the likelihood of death from bacterial meningitis. These higher clotting factors may increase the risk from all bacterial infections. Since the purpose of administration of vitamin K is to increase clotting factors, is it possible that this is also inadvertently increasing a newborn's susceptibility to infection? [Although no mechanism is proposed for this increased infection rate, it is possible that the decreased tissue oxygenation leaves tissues more susceptible to infection and that this is the cause, rather than the genetic tendency towards clotting? This would mean that increased clotting from vitamin K would increase susceptibility from this same effect.]
LONDON (AP) _ Children with a genetic predisposition to produce high concentrations of a blood-clotting enzyme linked to meningitis are twice as likely to die from the severe form of that disease as other children, new research says.
The findings do not indicate that genetics influence the chances of contracting meningococcal disease, but rather that those who get it are more likely to progress to deadly septic shock.
Genetic basis for meningococcal septic shock - Summary
polymorphism in the plasminogen-activator-inhibitor-1 gene and
outcome of meningococcal disease. Meningococcal Research Group.
Hermans PW, Hibberd ML, Booy R, Daramola O, Hazelzet JA, de Groot R, Levin M
Lancet 1999 Aug 14;354(9178):556-60
plasminogen-activator-inhibitor-1 gene and risk of meningococcal
Westendorp RG, Hottenga JJ, Slagboom PE
Lancet 1999 Aug 14;354(9178):561-3
Vitamin K for
newborns - why & what risks? - from Danny Tucker's pages
However, an injection creates an avenue of infection for a newborn with an immature immune system in an environment that contains the most dangerous germs. In addition, the possible trauma from the injection can jeopardize the establishment of breastfeeding, which does much more to protect the baby's health than vitamin K injections have ever been alleged to do. At the very least, the injection should be delayed until after the baby has learned to nurse.
I've sometimes wondered whether there's a connection between vitamin K administration and SIDS. Some studies have shown a lower incidence of SIDS among breastfed babies, and we know that breastmilk is lower in vitamin K. Who knows? Nobody, really. Why are we messing with delicate systems we don't understand?
There is likely a very complex relationship between baby's blood volume (which is reduced by as much as 40% with immediate cutting of the umbilical cord), and the baby's vitamin K and iron levels. It may be that when a baby is allowed to receive all its blood from the placenta, the coagulation factors are more than adequate to prevent hemorrhage.
Given the study that claims that vitamin K levels are not associated with clotting factors, it might be that the best thing parents can do to prevent hemorrhage in newborns is to insist that their babies be allowed to get all their blood back from the placenta after birth. Those would seem to be the clotting factors of greatest use to the baby.
Maybe the association between traumatic birth and newborn hemorrhagic disease is really an association between traumatic birth and early cutting of the cord, which is more likely with a traumatic birth where the baby is rushed across the room for resuscitation. Maybe someday hospitals will develop the sophistication to be able to perform any needed resuscitation without cutting off the baby's oxygen and blood supply.
Until we have the definitive answers to these questions, parents
have to choose between a system that's been in place for less than
a hundred years and one that's been in place for thousands of
Here are a bunch of links on vit K:
Alternatives to the Vitamin K Shot by Lauren Feder, M.D.
Vitamin K from whale.to
Vitamin K By Karin Rothville DipCBEd.
To Inject or Not by Linda Folden Palmer, DC [Reprinted from International Chiropractic Pediatric Association Newsletter, September/October 2002 Issue]
Vitamin K Status of Breastfeeding Infants With Maternal Vitamin
Frank R. Greer*, Dagger , Sharon P. Marshall§, Andrea L. Foleyparallel , and John W. SuttieDagger , parallel
PEDIATRICS Vol. 99 No. 1 January 1997, pp. 88-92
of vitamin K to newborns
A joint position statement of the Fetus and Newborn Committee, Canadian Paediatric Society (CPS),
and the Committee on Child and Adolescent Health, College of Family Physicians of Canada
Paediatr Child Health 1997;2(6):429-31
Here is an excerpt from it that gives oral dosing instructions (for the baby):
"For newborn infants whose parents refuse an intramuscular
injection, the physician should recommend an oral dose of 2.0 mg
vitamin K1 at the time of the first feeding. (A minority of
committee members believe that physicians should have the option
to recommend oral administration of vitamin K for newborns under
their care.) Use of the parenteral form of vitamin K for oral
administration is all that is currently available. This should be
repeated at two to four weeks and six to eight weeks of age.
Parents should be advised of the importance of the baby receiving
follow-up doses and be cautioned that their infants remain at an
increased risk of late HDNB (including the potential for
intracranial hemorrhage) using this regimen."
Treatise on Vitamin K
Another Treatise on Vitamin K
Another Long Vitamin K Treatise
General Discussion of Oral Vitamin K
instead of Injected Vitamin K
General Discussion about Controversy over
Administration of Vitamin K to Newborns
CONTROVERSY? WHAT CONTROVERSY?
It has been suggested that if the mother takes oral Vit K, during
the last trimester, that there would not be a need for the newborn
shot. Anyone know of a study related to this? I have seen a number
of clients in this area that choose to take the prenatal Vit K in
order to avoid the shot for their newborn.
There really is little known about the physiologic process of vitamin k absorption and blood factor response. Supplementation was started before the norms were known -- and the dosage was set almost at random (with little research first).
there are a lot of questions being asked now -- especially
since it's been found that the IM levels are much higher than
needed, and might be harmful.
Vitamin K Abstracts
after oral or intramuscular vitamin K1 in neonates.
McNinch AW, Upton C, Samuels M, Shearer MJ, McCarthy P, Tripp JH, L'E Orme R.
Arch Dis Child. 1985 Sep;60(9):814-8.
"One hundred and seven healthy, breast fed infants received 1 mg
vitamin K1 either at birth (orally or intramuscularly) or with the
first feed (orally). Venous blood samples collected in the next 24
hours were assayed for plasma vitamin K1. In babies given the
vitamin orally at birth, the peak median concentration (73 ng/ml)
occurred at four hours. By 24 hours median plasma
concentrations had fallen to 23 ng/ml and 35 ng/ml in the groups
fed vitamin K1 at birth or with the first feed,
respectively; this difference was not, however, significant.
Plasma concentrations after intramuscular injection exceeded those
in the oral groups at all comparable times, with a peak median
concentration of 1781 ng/ml at 12 hours falling to 444 ng/ml at 24
hours. Since median plasma vitamin K1 concentrations 24 hours
after oral administration were some 100 times and 1000 times
greater than previously estimated adult and newborn values
respectively, this study supports giving vitamin K1 orally at
birth to well, mature babies to protect against early haemorrhagic
disease of the newborn. Further studies are needed to determine
the optimum dose for protection over subsequent weeks."
oral and intramuscular vitamin K on the factors II, VII, IX, X,
and PIVKA II in the infant newborn under 60 days of age]
[Article in Spanish]
Arteaga-Vizcaino M, Espinoza Holguin M, Torres Guerra E, Diez-Ewald M, Quintero J, Vizcaino G, Estevez J, Fernandez N.
Rev Med Chil. 2001 Oct;129(10):1121-9.
BACKGROUND: Neonates on exclusive breast feeding that do not
receive vitamin K at birth are at higher risk hemorrhagic disease
of the newborn. AIM: To compare the effect of oral or
intramuscular administration of vitamin K1 (VK1), on clotting
factors II, VII, IX, X and PIVKA II, in children until the 60 days
of age with exclusive breast feeding or mixed feeding. PATIENTS
AND METHODS: Forty healthy full term infants, distributed in two
groups, A: 20 with mixed feeding (formula-feeding and
breast-feeding) and B: 20 with exclusive breast feeding, were
studied. Nine infants of each group received 1 mg of VK1
intramuscularly and eleven 2 mg VK orally 5 ml of cord blood was
collected initially from each infant. Venous blood samples were
taken on 15, 30 and 60 days of age. RESULTS: All factors
increased in a progressive form reaching levels over 50% at 60
days of age, in both groups. PIVKA II decreased
significantly during the study period (p < 0.01). Factor II
increased more in children with mixed feeding that received
intramuscular vitamin K, than in the rest of study groups. No
other differences between groups were observed. No infant had an
abnormal bleeding during the study period. CONCLUSIONS: Oral
administration of vitamin K is as effective as the intramuscular
route in the prevention of the hemorrhagic disease of the newborn.
[Vitamin K 1 concentration and vitamin K-dependent
clotting factors in newborn infants after intramuscular and oral
administration of vitamin K 1] [Article in Hungarian]
Goldschmidt B, Kisrakoi C, Teglas E, Verbenyi M, Kovacs I.
Orv Hetil. 1990 Jun 17;131(24):1297-300.
Serum concentration of vitamin K1 and activity of
vitamin-K-dependent factors II, VII, IX and X were determined
before and after vitamin K1 administration in infants. The babies
received vitamin K1 intramuscularly or orally. 12 hours after
vitamin K1 treatment the mean concentration was increased in the
groups receiving vitamin K1 intramusculary or orally,
respectively. Serum level of vitamin K1 fell exponentially, the
mean half life was about 30 hours in both groups. Activity
of vitamin K-dependent clotting factors did not change
significantly after intramuscular or oral vitamin K1
administration during the first four-five days of life. It was no
direct correlation between the concentration of vitamin K1 and the
activity of vitamin-K-dependent clotting factors. This study
suggest that oral administration of vitamin K1 is as effective as
the intramuscular route. [Remember that prevention
effectiveness continues even after the supplemented K levels
From Nursing Times, October 14, 1998:
Researchers have found that plasma vitamin K concentrations were
at least equal to or significantly higher in babies who are given
the new oral form compared to those who are given the vitamin via
injection. The oral form is given in doses of 2 mg soon
after birth and again four to seven days later. It has been
recommended that if the baby is being breastfed, an additional
dose be given when it is one month old.
Prophylaxis from British
Columbia Reproductive Care Program
I have mom take oral Vit. K for two weeks prior to EDD. I find
this helps bleeding pp as well. Then I give baby 2 drops at birth
(before I leave) and then again on day five.
I'm curious why you give 2 drops of vitamin K. I was thinking
that I would need to give them the same amount of mgs as I would
of the synthetic. Do you know more about this, any study on this,
or suggested amount. When I worked at a birth center they gave the
injectable orally, and it was 50mg. Just wondering what you think
about giving the natural vit. K in the same dose.
I give the same dose PO as is suggested for IM. Some, I have
heard, do double the dose when giving it PO.
we give three doses, following one of the european protocols (birth, one week, three weeks). Not certain whether this is needed or not, but what the heck... perhaps is does extend protection and lessen the low incidence of late onset hemorrhagic disease. The dose is two drops.
How does it taste? I've tasted it! One brand (aquamephytin) tasted rather fishy -- not gawdawful, just not my favorite flavor! babies seem to get down the two drops without flinching.
the brand we've been using for a while is alphalpha-derived (I hear) and doesn't have much taste at all.
Law - 333-021-0800 - Search for Administration of
Vitamin K to Newborns
Although this article is about very low-birth weight babies, it's interesting because of the relationship between delayed cord clamping and protection from IVH (Intraventricular Hemorrhage) and LOS (Late-Onset Sepsis). This is the closest information we have about the protective effect of delayed cord clamping against HDN for term babies.
clamping in very preterm infants reduces the incidence of
intraventricular hemorrhage and late-onset sepsis: a randomized,
Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W.
Pediatrics. 2006 Apr;117(4):1235-42.
RESULTS: Seventy-two mother/infant pairs were randomized. Infants in the ICC and DCC groups weighed 1151 and 1175 g, and mean gestational ages were 28.2 and 28.3 weeks, respectively. Analyses revealed no difference in maternal and infant demographic, clinical, and safety variables. There were no differences in the incidence of our primary outcomes (BPD and suspected NEC). However, significant differences were found between the ICC and DCC groups in the rates of IVH and LOS. Two of the 23 male infants in the DCC group had IVH versus 8 of the 19 in the ICC group. No cases of sepsis occurred in the 23 boys in the DCC group, whereas 6 of the 19 boys in the ICC group had confirmed sepsis. There was a trend toward higher initial hematocrit in the infants in the DCC group. CONCLUSIONS: Delayed cord clamping seems to protect VLBW infants from IVH and LOS, especially for male infants.
Here's the Reuter's version:
Thursday, April 6, 2006
By Clementine Wallace
NEW YORK (Reuters Health) - Waiting 30 to 45 seconds before clamping the umbilical cord of very low birth weight infants -- those weighing less than 1500 grams -- seems to protect them against bleeding in the brain and the development of blood infections later on, researchers report.
The strategy seems to benefit boys especially.
"While countries in Europe tend to wait before clamping these children's umbilical cord, the current practice in the United States is to clamp it immediately after delivery," Judith Mercer told Reuters Health. "There hasn't been a lot of research done in this country on delayed cord clamping, and most studies were limited by small samples."
Evidence is accumulating to suggest that, for very low birth weight infants, delaying cord clamping and lowering the newborn below the mother's level significantly increase the amount of blood flowing from the placenta to the newborn, according to Mercer, from the University of Rhode Island in Kingston.
In their article in the medical journal Pediatrics, she and her colleagues note that waiting 30 to 45 seconds results in an 8 percent to 24 percent increase in the baby's blood volume.
"Immediate cord clamping may deprive these infants of essential blood volume, which might result in hypotension (low blood pressure) and in a poor perfusion of the tissues," Mercer explained.
Her group's study involved 72 pregnant women who gave birth to infants before the 32nd week of gestation. The women underwent either immediate cord clamping at 5 to 10 seconds after the birth, or delayed cord clamping 30 to 45 seconds after delivery.
The researchers saw differences between the two groups in rates of brain bleeds in the babies, and in their risk of late-onset sepsis.
These differences were significant from a statistical standpoint in male infants, but not in females. Specifically, 2 of the 23 male infants in the delayed-clamping group had intraventricular hemorrhage compared to 8 of the 19 in the immediate-clamping group. No case of sepsis occurred among the first group, whereas 6 cases occurred among the others.
The researchers say the strategy is a simple way to improve outcomes of very preterm infants.
SOURCE: Pediatrics, April 2006.
Oral vitamin K is listed at birthwithlove.com
The Vitamin K forms suitable for newborns are forms of Vitamin K1
(Phytonadione), available in injectable or oral forms: as Mephyton
for oral use, or as aquamephyton or konakion for injectable use.
Menadione (Vitamin K3) is not recommended for prophylaxis and
treatment of hemorrhagic disease of the newborn.
Cascade HealthCare Products
Vitamin K) in the Professional
> Supplies > Pharmaceuticals section.
The oral vit K is just 2x the normal injectable but given orally.
It is AquaMephyton (Phytonadione, MSD) Aqueous colloidal solution
1 mg per 0.5 ml neonatal concentration.
Scientific Botanicals, Inc.
8003 Roosevelt Wy Ne
Seattle, Washington 98115-4225
$18.00 for 1 fl. oz. (500 drops)
Standard dose ... 2 drops (2mg./drop) sublingual at birth
I repeat the dose X 2
Konakion is available over the counter in many European
countries; my friend gets it for me in Germany. I don't
think there are any customs issues.
Here in Canada we can order Serax directly thru the pharmacy
. Costs me 80 cents per 1 ml glass vile. I draw up
0.1ml to get
the 10 mg. doseage (oral or I.M.) and then toss the rest as they are notmulti-use viles. What a waste.... Oh well.
Or you might be able to order it through the mail from Weston's in the
The pharmacy I called indicated: -there are no oral sources of Vit.K manufactured for sale in Canada; -some take the IM product orally; and -Serax is the trade name for octazipam, a sleeping drug.
I am not a pharmacist, and have not checked this with others.
It's the bacteria present in fecal matter that colonise the
baby's gut and allow it to start producing it's own Vit K, and yes
the theory is that if midwives weren't so "clean" it would be
easier for babies to become colonised with these bacteria.
I'd also argue that using antibiotics in labour would mean that
the baby wouldn't get exposure to the necessary bugs. By virtue of
route of delivery c/s babies would also not be exposed to these
bacteria and so would be higher risk for bleeding disorders.
Lars Hanson, Immunology of Breast Milk is an excellent
book for explaining the importance of avoiding anal wiping and
babies needing to be exposed to the maternal gut flora. Babies
need this to help colonise their uncolonised gut at birth. This
indeed helps them to produce their own vitamin K. Babies just need
to be near it an exposed at birth. I heard him speak a few weeks
ago and he said that babies are born next to the anus for a
reason! Ina May Gaskin talks about avoiding wiping for the other
reason. To avoid tensing muscles.
Signs Suggesting Need for Vitamin K:
I have encountered several home birth families whose babies were born completely gently, and who were pressured to have their babies receive Vitamin K as much as one to two months PP.
In the 1986 NAPSAC Summit video Doris Haire gives an excellent
explanation of how and why obstetric anesthesia/analgesia causes
newborn hemorrhagic conditions. Knowing the historical and current
heavy uses of narcotics and forceful delivery techniques (mighty
vac, forceps, head pulling etc.) it is my belief that the routine
administration of Vitamin K has evolved out of the need to protect
newborns from iatrogenic conditions rather than inherent problems
of gently born babies. In this sense it is a simple, effective and
needed technology, however its risks (jaundice and some types of
childhood leukemia--injectable) may not be worthwhile when babies
have been born without trauma or drug exposure.
Doris Haire has a wonderful speech recorded on the NAPSAC Summit
video of 1986 where she describes infant hemorrhagic conditions
being caused by the drugs which are commonly injected in epidurals
and spinal anesthesia. In the speech, she actually reads off
of a package insert for bupivicaine, which states that a known
risk of giving this drug to pregnant, laboring women is to have
brain hemorrhage in the infant. that is what the package
I recently transported a primip with prolonged ROM. Baby was ultimately delivered by section (serious decels) after 4 attempts at vacuum extraction. This couple opted not to have a vitamin K shot for the baby because they feel that the baby's vitamin K levels will be rapidly increasing in the coming week and would not need the shot. The pediatrician "harassed" them and threatened to call child protective services on them if they did not get one because they thought it was a form of child abuse (endangerment of a child). The ped frightened them beyond belief concerning infant hemorrhage which can occur at 4-6 weeks of age.
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